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Sample records for postoperative chylothorax successfully

  1. Localization of chyle leakage site in postoperative chylothorax by oral administration of I-123 BMIPP.

    PubMed

    Sugiura, Kimihiko; Tanabe, Yoshio; Ogawa, Toshihide; Tokushima, Takeshi

    2005-10-01

    The authors present a 71-year-old woman who had a right chylothorax after right upper lobectomy for lung cancer. As the chylothorax was considered to be due to thoracic duct injury at the time of operation, lymphoscintigraphy was performed by oral administration of I-123 beta-methyl-iodophenyl pentadecanoic acid (BMIPP). After visualization of the stomach and intestine, abnormal accumulation of the radiotracer was found initially around the right pulmonary hilum and then spread laterally in the upper pleural cavity, indicating chyle leakage in the region of the right pulmonary hilum. Scintigraphic finding was well correlated with the subsequent thoracoscopic observation, showing chyle leakage from a lymphatic tributary near its confluence to the thoracic duct at the level of the azygos continuation. The disruption site was ligated by video-assisted-thoracoscopic-surgery procedure with successful termination of the chyle leakage. Lymphoscintigraphy by oral administration of I-123 BMIPP is thought to be a useful method for localization of chyle leakage in patients with chylothorax induced by thoracic surgery. PMID:16363625

  2. Successful management of bilateral refractory chylothorax after double lung transplantation for lymphangioleiomyomatosis

    PubMed Central

    Hussein, Mohammed; Aljehani, Yasser M.; Nizami, Imran; Saleh, Waleed

    2014-01-01

    Lymphangioleiomyomatosis (LAM) is a rare disease that leads to airways and lymphatic channels obstruction due to abnormal smooth muscle proliferation. It presents with dyspnea, pneumothorax or chylothorax. Lung transplantation (LT) has emerged as a valuable therapeutic option with limited reports. We report a case of LAM that underwent double LT and complicated by refractory bilateral chylothorax which was managed successfully by povidone-iodine pleurodesis and the addition of sirolimus to the post-transplantation immunosuppressive therapy. The patient has no recurrence with 24 months follow-up. PMID:24791177

  3. Computed Tomography-Guided Access to the Cisterna Chyli: Introduction of a Technique for Direct Lymphangiography to Evaluate and Treat Chylothorax

    SciTech Connect

    Schoellnast, Helmut; Maybody, Majid; Getrajdman, George I.; Bains, Manjit S.; Finley, David J.; Solomon, Stephen B.

    2011-02-15

    The purpose of this report is to introduce a technique of direct lymphangiography to enable chylothorax treatment. Using a hybrid computed tomography (CT) and fluoroscopy imaging system, a 21-gauge needle was placed under CT guidance into the cisterna chyli to allow contrast lymphangiography and CT lymphangiography in two patients with presumed postoperative chylothorax. Water-soluble contrast media injection demonstrated the thoracic duct anatomy in both patients. Further successful needle disruption of the cisterna chyli was performed in one patient to interrupt lymph flow and stop the chylous leak, with subsequent resolution of the chylothorax.

  4. Sarcoidosis presenting with chylothorax.

    PubMed Central

    Jarman, P. R.; Whyte, M. K.; Sabroe, I.; Hughes, J. M.

    1995-01-01

    A patient in whom chylothorax was the presenting feature of sarcoidosis is reported. Mediastinal lymphadenopathy was shown by computed tomographic scanning. Obstruction of the thoracic duct by enlarged lymph nodes or fibrosis is the probable cause of chylothorax in this case. The association of chylothorax and sarcoidosis is extremely rare. Images PMID:8553312

  5. Incidence and Etiology of Chylothorax after Congenital Heart Surgery in Children

    PubMed Central

    Akbari Asbagh, Parvin; Navabi Shirazi, Mohammad Ali; Soleimani, Aliakbar; Razzaz, Maryam; Akbari Asbagh, Naseradine; Rayatzadeh, Hussein; Shariat, Mamak

    2014-01-01

    Abstract Background: Chylothorax is a rare but serious postoperative condition with a high rate of morbidity and may lead to the mortality of children undergoing congenital heart disease (CHD) surgery. This study evaluated the specific surgical procedures associated with the higher risk of postoperative chylothorax. Methods: We assessed 435 cases undergoing CHD surgery between April 2003 and May 2006. We detected postoperative chylothorax in 6 patients. The diagnosis of chylothorax was established based on the presence of an odorless fluid with the characteristic milky appearance of the fluid (except when the patients were fasting in the immediate postoperative period), a triglyceride level greater than 110 mg/dL or between 50 and 110 mg/dL with a pleural fluid white cell count greater than 1000, and more than 80% lymphocytes on differential when the pleural fluid was not chylous. Results: Over a 37-month period, 435 (mean age = 51.6 months; 232 males) patients underwent various types of surgical procedures for CHD; 6 patients developed chylothorax after the Fontan operation; one patient died due to severe chylothorax; 3 patients were managed by nutritional modifications, diuretics, and thoracocentesis; and 2 patients required thoracic duct ligation. The Fisher exact test analysis showed a significant association between the Fontan operation and postoperative chylothorax (p value < 0.0001). Conclusion: Our study showed a significant association between the Fontan surgery and chylothorax. PMID:25861320

  6. Laparoscopic ligation of the thoracic duct in management of chylothorax.

    PubMed

    Icaza, Orlando J; Andrews, Kris; Kuhnke, Mark

    2002-04-01

    Laparoscopic ligation of the cisterna chyli at the level of the aortic hiatus was performed in a 69-year-old woman with post-lobectomy chylothorax refractory to 3 weeks of conservative therapy and one repeat thoracotomy with attempted ligation of a leaking lymphatic channel. This laparoscopic procedure was successful, and resolution of the chylothorax was achieved. We feel that this technique offers surgeons a valid, minimally invasive treatment option for a persistent chylothorax in which conservative management or more direct thoracic procedures have failed to control the chyle leak. PMID:12019574

  7. Dasatinib-Related Chylothorax

    PubMed Central

    Huang, Yen-Min; Wang, Cheng-Hsu; Huang, Jen-Seng; Yeh, Kun-Yun; Lai, Chien-Hong; Wu, Tsung-Han; Chang, Pei-Hung; Chang, Yueh-Shih; Lan, Yii-Jenq

    2015-01-01

    Dasatinib is a potent second-generation tyrosine kinase inhibitor for the treatment of chronic myeloid leukemia. The most common adverse event associated with dasatinib therapy is fluid retention, including pleural effusion. Dasatinib-related chylothorax has rarely been reported. The clinical manifestations, pathophysiology, management, and prognosis are not fully understood. Here we report a 40-year-old woman presenting with chylothorax following dasatinib use. We propose the hypothesis of its mechanism as well as offering a review of the relevant literature. PMID:25805678

  8. [Idiopathic chylothorax in an infant: management and progression].

    PubMed

    Chemaou, A; Ayachi, M; Ailal, F; Najib, J

    2012-07-01

    Chylothorax is a rare disease (1-2 % of pleural effusions), with a prevalence between 1/8600 and 1/15,000 births. It is characterized by the presence of chyle in the pleural cavity. Three categories of chylothorax are known: congenital chylothorax, which can be either idiopathic or the result of a malformation, and traumatic chylothorax (mostly postoperative). We report the observation of a 9-month-old infant with idiopathic chylothorax revealed by respiratory symptoms, with pleural effusion and collapse of the ipsilateral lung on chest X-ray and ultrasound examination. Cytology and chemical analysis of the pleural fluid showed an exudative liquid with a chylous aspect, a high concentration of albumin (52 g/dL), triglycerides (11.42 g/L), and a high number of cells (6600 cells/mL), with lymphocyte predominance (96 %). The culture was sterile. Chylothorax is usually revealed by dyspnea, but also by nausea, vomiting, anorexia and/or malnutrition. The diagnosis is suspected when milky white fluid is obtained from thoracocentesis and is confirmed by the presence of a triglyceride level greater than 1.2 mmol/L and more than 1000 cells/mL, with lymphocyte predominance. The treatment of chylothorax can be either conservative or surgical. Conservative treatment (medical) has four goals: ensure pleural emptiness, decrease production of chyle, restore and/or maintain proper nutritional status, and treatment of the cause when identified. Surgical intervention is indicated when conservative management fails and aims to stop a radical and permanent leakage of chyle. PMID:22682519

  9. The combination of breast necrosis and chylothorax following the OPCAB

    PubMed Central

    Sabzi, Feridoun; Yaghoubi, Alireza

    2016-01-01

    Due to long term patency, the internal mammary artery is considered as a conduit of choice for revascularization of the left anterior descending coronary artery. The internal mammary artery and its accessory branches in addition to perfusing the chest wall structures also contributes to supplying, part of the female breast arteries. In addition, due to the accompaniment of thoracic duct branches with the left internal mammary artery, harvesting may be associated with injury to these branches and contribute to chylothorax. We report a rare case of chylothorax and the breast necrosis following the coronary artery bypass grafting. The chylothorax was started in the second postoperative day and ceased gradually in the 12th day of operation. The breast necrosis appeared in the 3th weeks of operation with pain, and tenderness and black skin color change. The patient underwent total mastectomy in the 4th weeks of operation. PMID:27493707

  10. CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS.

    PubMed

    Fernandes, Flávia Fonseca; Alves, Victor Oliveira; Sánchez, Tarquino Erastides Gavilanes; Paula, Wagner Diniz de; Santana, Alfredo Nicodemos Cruz

    2016-07-11

    A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells). Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer), especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions. PMID:27410917

  11. CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS

    PubMed Central

    FERNANDES, Flávia Fonseca; ALVES, Victor Oliveira; SÁNCHEZ, Tarquino Erastides Gavilanes; de PAULA, Wagner Diniz; SANTANA, Alfredo Nicodemos Cruz

    2016-01-01

    SUMMARY A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells). Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer), especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions. PMID:27410917

  12. Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax

    PubMed Central

    Das, Jayanta; Thambudorai, Robin; Ray, Soumendranath

    2015-01-01

    Post operative chylothorax is a known complication of various thoracic surgeries. It needs identification of precise site of leak in the thoracic duct. Lymphosicintigraphy can identify chyle leak but cannot delineate exact site of leak. SPECT-CT is precise in anatomic localisation and hence SPECT-CT should be combined with every lymphoscintigraphy in evaluation of clinically suspected case of post operative chylothorax. We report such a case. PMID:25829744

  13. Successful treatment of postoperative pyoderma gangrenosum with cyclosporin.

    PubMed

    Schöfer, H; Baur, S

    2002-03-01

    Postoperative pyoderma gangrenosum (PPG), also known as postoperative progressive gangrene of Cullen, is a rare and rapidly evolving complication of surgical procedures. Since the first description by Cullen in 1924 (Surg Gynecol Obstet 1924; 38: 579-582) various case reports have been published. Even in typical cases PPG is often misdiagnosed and therefore wrongly treated; the unknown aetiology makes treatment difficult. The therapies used for pyoderma gangrenosum include systemic corticosteroids, azathioprine, dapsone, mercaptopurine, sulphasalazine, sulphapyridine, thalidomide, cyclophosphamide, clofazimine, isotretinoin, immunoglobulins and cyclosporin. We report on two patients with PPG following breast surgery who were successfully treated with low-dose cyclosporin (2.5-5 mg/kg per day). PMID:12046819

  14. VATS therapy of chylothorax caused by leiomyomatosis complicated with tuberous sclerosis complex

    PubMed Central

    Csiszkó, Adrienn; Herr, György; Sz. Kiss, Sándor; Hallay, Judit; Gyöngyösi, Zoltán; Szentkereszty, Zsolt

    2013-01-01

    Lymphangioleiomyomatosis with tuberous sclerosis complex is a rare disease. One of the most frequent complications of lymphangioleiomyomatosis is pleural effusion (chylothorax) wich can be treated with the use of VATS. Authors report a case of pulmonary lymphangioleiomyomatosis in a 56-year-old female patient with tuberous sclerosis complex with an 8-week history of recurrent chylothorax, dyspnea and debilitating weakness. By CT scan a flat tissue proliferation was seen in the site of the thoracic duct and it was supposed to be the reason for the pleural effusion. A VATS resection of this laesion and ligation of the thoracic duct was performed successfully. Chylothorax is often associated with pulmonary lymphangioleiomyomatosis. Lymphangioleiomyomatosis combined with tuberous sclerosis complex is extremely rare. In case of chylothorax VATS treatment is successful and may be the first choice. PMID:23741116

  15. Transjugular intrahepatic portosystemic shunt creation as treatment for refractory chylous ascites and chylothorax in a patient with cirrhosis.

    PubMed

    Kinney, Thomas B; Ferrara, Stephen L; Miller, Franklin J; Roberts, Anne C; Hassanein, Tarek

    2004-01-01

    The etiology of chylothorax is usually considered to consist of four major categories: tumors, trauma, idiopathic conditions, and miscellaneous conditions. It appears that chylothorax is a rare and underreported manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. This condition can be debilitating as a result of respiratory compromise from a large volume of pleural fluid, as well as metabolic derangements, malnutrition, and immunologic impairment from loss of vital lymphatic constituents. Herein the authors present a case of a 46-year-old male patient with cirrhosis and complications of high-volume chylous ascites and chylothorax who was successfully treated with creation of a transjugular intrahepatic portosystemic shunt. PMID:14709693

  16. Role of Interventional Radiology in the Management of Chylothorax: A Review of the Current Management of High Output Chylothorax

    SciTech Connect

    Lyon, Stuart Mott, Nigel Koukounaras, Jim; Shoobridge, Jen; Hudson, Patricio Vargas

    2013-06-15

    Chylothorax is an uncommon type of pleural effusion whose etiology may be classified as traumatic or nontraumatic. Low-output chylothoraces usually respond well to conservative management, whereas high-output chylothoraces are more likely to require surgical or interventional treatment. Conservative management focuses on alleviation of symptoms, replacement of fluid and nutrient losses, and reduction of chyle output to facilitate spontaneous healing. Surgical management can be technically difficult due to the high incidence of variant anatomy and the high-risk patient population. Percutaneous treatments have rapidly developed and evolved during the past 14 years to represent a minimally invasive treatment compared with the more invasive nature of surgery. Percutaneous therapies provide a range of treatment options despite difficult or variant anatomy, with a reported high success rate coupled with low morbidity and mortality. This article is a review of etiology, diagnosis, and treatment of chylothorax, with a focus on interventional management techniques.

  17. Tension chylothorax complicating acute malignant airway obstruction.

    PubMed

    Piastra, Marco; Pietrini, Domenico; Ruggiero, Antonio; Rizzo, Daniela; Marzano, Laura; Attinà, Giorgio; De Luca, Daniele; De Rosa, Gabriella; Conti, Giorgio

    2011-05-01

    Acute upper airway obstruction represents one of the most challenging emergencies in pediatric practice. In particular, a tension chylothorax complicating a malignant airway obstruction is a rare and life-threatening complication. We report a rapidly progressing tension chylothorax associated with a cervical mass in a 10-month-old male infant. To our knowledge, the extension of a cervical mass to the supraclavear region resulting in a compressive chylothorax represents an exceptional event in pediatrics. Early recognition and prompt treatment resulted to be essential to relieve the compression and to avoid end-stage hemodynamic and respiratory function derangement. PMID:21546802

  18. Chyloperitoneum and chylothorax: a combined rare occurrence after retroperitoneal lymphadenectomy and radiotherapy for testis tumor.

    PubMed

    Dharman, K; Temes, S P; Wetherell, F E; Kendrick, M J

    1984-02-01

    We report a case of chyloperitoneum and chylothorax 5 weeks after retroperitoneal lymphadenectomy and radiotherapy for embryonal cell carcinoma of the testis. To our knowledge, this is the second reported case of this rare combined complication. The patient was treated successfully with an alimental dietary regimen (medium chain triglycerides and Vivonex), coupled with thoracenteses and paracenteses. PMID:6699970

  19. [Chylothorax of cirrhotic origin: a case report].

    PubMed

    Vandenbos, F; Rakotoarisoa, C; Zeanandin, G; Mourani, A

    2005-12-01

    Chylothorax and chylous ascites are an accumulation of fluid containing a large proportion of triglycerides. The presence of these two effusions simultaneously is rare. A case of a patient with a known history of cirrhosis, hospitalized for an ascetic decompensation with left pleural effusion is herein presented. The woman was diagnosed as presenting both chylous ascites and chylothorax. Both fluids are transudate type fluids. After evacuation of the fluids and implementation of an adapted treatment neither effusion reappeared. The patient has been followed for the past year and has not shown any signs of relapse. Chylothorax, in cirrhotic patients is due to trans-diaphragmatic passage of fluid originating from the chylous ascites. Both extravasations have the same biological characteristics. PMID:16449926

  20. New Combined Medical Treatment With Etilefrine and Octreotide for Chylothorax After Esophagectomy: A Case Report and Review of the Literature.

    PubMed

    Ohkura, Yu; Ueno, Masaki; Iizuka, Toshiro; Haruta, Shusuke; Tanaka, Tsuyoshi; Udagawa, Harushi

    2015-12-01

    Postoperative chylothorax is a rare but well-known complication of general thoracic surgery. Medical treatment of chylothorax was reported in the past, but there is still considerable controversy on the appropriate management strategies.Two patients with esophageal cancer underwent esophagectomy, 2-field lymph node dissection, and resection of thoracic duct together with ileocolic reconstruction via the retrosternal route at our hospital. Chylothorax developed on the 32nd postoperative day (POD) in 1 patient and the 12th POD in the other, manifesting as a change in the character of thoracic drainage to turbid white. Both were immediately started on octreotide (300 μg/ day) and etilefrine (120 mg/day). When the amount of pleural effusion decreased to <50 mL/day, we performed pleurodesis with Picibanil (OK432). Thereafter, the patients gradually made satisfactory progress and resumed oral food intake, and the thoracotomy tubes were eventually removed. They have remained recurrence-free at the time of writing.In this report, we demonstrated the clinical efficacy of etilefrine for the management of postesophagectomy chylothorax. New medical treatment options for this condition are now broad and the usefulness of combined therapy consisting of a sclerosing agent, etilefrine, and octreotide is underscored, regardless of the status of the thoracic duct. PMID:26656358

  1. Congenital neonatal chylothorax with hydrops fetalis treated with octreotide

    PubMed Central

    Ibrahim, Abdelakarim; Dammas, Ali Saed

    2013-01-01

    Congenital idiopathic chylothorax is the most common form of pleural effusion in neonates. It results from collection of lymphatic fluid in the pleural space secondary to leakage from the thoracic duct or one of its main tributaries. Chylothorax complicated by hydrops fetalis in a premature or term infant is an uncommon, serious clinical problem. We report on two cases with congenital chylothorax both treated with octreotide. One of the cases responded well to octreotide treatment, while the other did not. We conclude that octreotide should be considered in the treatment of neonatal chylothorax.

  2. Metastatic prostate cancer initially presenting as chylothorax: A case report

    PubMed Central

    YANG, YU-JIN; SEO, MINJUNG; JEON, HEE-JEONG; NOH, JIN-HEE; PARK, SEOL HOON; CHOI, YUNSUK; JO, JAE-CHEOL; BAEK, JIN HO; KOH, SU-JIN; KIM, HAWK; MIN, YOUNG JOO

    2016-01-01

    Chylothorax is caused by disruption or obstruction of the thoracic duct, which results in leakage of chyle in the pleural space. The most common etiologies are malignancy and trauma. Among the causative malignancies, lymphoma is the most common, followed by primary lung cancer, mediastinal tumors, and other metastatic malignancies. Conversely, prostate cancer has rarely been reported as the cause of chylothorax. We herein report a case of metastatic prostate cancer initially presenting as chylothorax, with disappearance of the pleural effusion after the initiation of androgen deprivation therapy. Moreover, we also discuss the various rare manifestations of metastatic prostate cancer, including chylothorax. PMID:27313861

  3. Is bilateral chylothorax possible after simple cough? Yes.

    PubMed

    Candas, Fatih; Yildizhan, Akin; Gorur, Rauf; Isitmangil, Turgut

    2015-05-01

    Chylothorax is accumulation of chylous fluid in the pleural space due to impaired integrity of the thoracic duct or its branches. In childhood, the causes differ from those in adults because children less frequently develop malignancies and are more resistant to trauma. Commonly, chylothorax occurs as a complication of tumoral invasion or cardiopulmonary surgery. Treatment of chylothorax is essentially medical. In the event of medical treatment failure or a massive effusion, surgery is needed. We describe the case of a 65-year-old woman who developed bilateral chylothorax after a simple cough. She was treated with a medium-chain triglyceride diet and thoracentesis. PMID:24928644

  4. Octreotide in malignant chylothorax: a case report.

    PubMed

    Gupta, Ajay; Singh, Taranjit

    2016-03-01

    The treatment of malignancy-associated chylous pleural effusion and ascites, especially in the palliative setting, represents a major therapeutic challenge. Our patient, a case of metastatic lung cancer, was suffering from high-output, non-resolving, malignancy-related chylothorax. We found that subcutaneous octreotide in combination with fasting and total parenteral nutrition, followed later by institution of low-fat diet, resulted in its resolution. We suggest that it is a reasonable approach associated with minimal morbidity in what is otherwise a challenging clinical condition. PMID:26644224

  5. Successful radiotherapy in postoperative recurrence of a primary mediastinal yolk sac tumor: A case report.

    PubMed

    Sakaguchi, Masakuni; Maebayashi, Toshiya; Aizawa, Takuya; Ishibashi, Naoya; Fukushima, Shoko; Saito, Tsutomu

    2016-04-26

    A woman in her 60s was evaluated for anterior chest pain. Computed tomography (CT) revealed a 50 mm mass with irregular contrast enhancement in the anterior mediastinum. α-fetoprotein (AFP) level was elevated to 1188 ng/mL. A germ cell tumor was diagnosed, mostly comprising of a yolk sac tumor (YST). Two courses of chemotherapy with cisplatin (CDDP) and etoposide (VP16) were administered and surgical tumor resection was then performed. The final diagnosis was YST. CDDP and VP16 were continued postoperatively; however, because the AFP level increased about six months after surgery, the chemotherapy regimen was altered to bleomycin and CPT-11. As the AFP again increased and a CT scan revealed tumor re-enlargement, recurrent YST was diagnosed and radiotherapy was administered. The patient received a total of 60 Gy (2 Gy per fraction). The tumor started to shrink during radiotherapy and AFP levels decreased. By one month post-radiotherapy, AFP levels had normalized and the tumor had disappeared. As of six years after radiotherapy, the patient remains alive without recurrence. Mediastinal YSTs are rare, and treatment usually includes surgery and preoperative and postoperative chemotherapy with cisplatin-based regimens. Successful treatment with radiotherapy has occasionally been reported. Our patient showed recurrence of a YST after surgery and chemotherapy, but achieved long-term survival after radiotherapy. Few patients with YST have undergone radiotherapy, but this approach was successful in our patient. In cases of postoperative recurrent YST resistant to chemotherapy, radiotherapy, together with salvage surgery, may offer a valuable option. PMID:27148423

  6. [Nursing experience with an lymphangioleiomyomatosis patient with chylothorax].

    PubMed

    Sung, Rung-Ping; Jong, Shwu-Yuan; Lu, Pi-Chen

    2006-08-01

    This article discusses experience providing nursing care to a patient suffering from Lymphangioleiomyomatosis who was re-hospitalized for recurrence of chylothorax complications, which caused dyspnea, sterility and mental instability. Based on parameters provided by Roy's adaptation model, the patient was identified as suffering from respiratory impairment, acute pain, sleep pattern disturbance and low self-esteem. Data was collected through interviews, observation and physical assessments. During the course of providing nursing care, the author established a good relationship with the patient through devoted attention to the patient's needs and by actively caring, listening and accompanying. Increased family member visits and interaction, resulting from the author's urgings, gave the patient added support and consolation. Eventually, the author gained the trust of the patient, who, in turn, regained self-control as well as physical and sociopsychological adaptabilities. Clinical nursing must attend to the physical care needs of patients as well as patient mental wellness, the latter of which extends beyond the disease itself, in order to achieve a truly comprehensive quality of nursing care. We are glad to share this successful experience with others in the nursing profession. PMID:16874609

  7. [A case of X-linked myotubular myopathy with chylothorax].

    PubMed

    Oishi, Taku; Sato, Tetsuya; Matsushita, Kenshi; Takechi, Tomoki; Murakami, Nobuyuki; Fujieda, Mikiya

    2016-01-01

    We report a case of X-linked myotubular myopathy with chylothorax. A male infant weighing 2,114 g was born to a mother whose pregnancy was complicated with polyhydramnios from gestational week 32. At gestational week 37, emergent caesarian section was performed due to membrane rupture followed by fetal bradycardia. Ventilatory support was necessary because the neonate showed severe birth asphyxia accompanied by hypotonia and dyspnea. He also showed a respiratory complication of chylothorax at 10 days old; therefore, thoracic drainage was performed. Congenital chylothorax associated with congenital myotonic dystrophy (CMD) has been described in a number of past reports. Specific findings of congenital myotubular myopathy and partial CMD, such as peripheral halo of muscle fibers, were demonstrated in biopsied muscle, and mutation of the myotubularin (MTM1) gene was identified. Tracheostomy was performed at 5 months old because of prolonged ventilatory support and severe dysphagia. The infant was able to be discharged at 17 months old. Congenital chylothorax might be associated with congenital myotubular myopathies such as CMD. PMID:27012108

  8. Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: a case report

    PubMed Central

    2013-01-01

    Introduction Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult. Case presentation We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well. Conclusion Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn. PMID:23302289

  9. A case of postoperative recurrent cholangitis after pancreaticoduodenectomy successfully treated by tract conversion surgery

    PubMed Central

    Shiihara, Masahiro; Miura, Osamu; Konishi, Kozo; Takeo, Sachiko; Kakimoto, Tadatoshi; Hidaka, Gen; Shibui, Yuichi; Minamisono, Yoshikazu; Toda, Tomohiro; Uemura, Shuichiro; Yamamoto, Masakazu

    2016-01-01

    A 69-year-old man, who had undergone pylorus-preserving pancreaticoduodenectomy (PD) (Imanaga procedure) for duodenum papilla cancer 13 years prior, had a history of repeated hospitalization due to cholangitis since the third year after surgery and liver abscess at the 10th year after surgery. Gastrointestinal series indicated no stenosis after the cholangiojejunostomy. However, reflux of contrast media into the bile duct and persistence of food residues were observed. We considered the cholangitis to be caused by reflux and persistence of food residues into the bile duct. So, we performed the tract conversion surgery, Imanaga procedure to Child method. The postoperative course was good even after re-initiating dietary intake. He was discharged on the 19th day after surgery. He has not experienced recurrent cholangitis for 18 months. For patients with post-PD recurrent cholangitis caused by reflux of food residues like ours, surgical treatment should be considered because tract conversion may be an effective solution. PMID:27402542

  10. Empyema Caused by Prevotella bivia Complicating an Unusual Case of Spontaneous Chylothorax

    PubMed Central

    Di Marco Berardino, Alessandro; Smargiassi, Andrea; Re, Antonina; Torelli, Riccardo; Fiori, Barbara; d'Inzeo, Tiziana; Corbo, Giuseppe Maria; Valente, Salvatore; Sanguinetti, Maurizio; Spanu, Teresa

    2014-01-01

    Spontaneous chylothorax is rare in adults. We present an unusual case that was complicated by Prevotella bivia empyema. Full recovery was achieved with chest tube drainage and prompt treatment with intravenous clindamycin. PMID:24452170

  11. Chylothorax following anterior thoraco-lumbar spine exposure. A case report and review of literature.

    PubMed

    Mora de Sambricio, A; Garrido Stratenwerth, E

    2015-01-01

    Pleural effusion is a possible complication of the thoraco-abdominal approach to the spine. It is more commonly a reactive effusion, but it also may be caused by hemothorax, empyema or, less commonly, a chylothorax. The case of a chylothorax is reported as a late onset complication of a double anterior and posterior instrumented fusion of the lumbar spine. Its management and clinical outcome, and a review of the literature is presented. PMID:24794096

  12. Efficacy of octreotide against chylothorax following lateral neck dissection for thyroid cancer: A case report

    PubMed Central

    Hayashibara, Noriaki; Ogawa, Toshihisa; Tsuji, Eiichi; Ishizuna, Kazuo

    2016-01-01

    Introduction Postsurgical chylothorax is a rare complication of cervical dissection for thyroid cancer. We report that octreotide, a synthetic analog of somatostatin, is effective in treating chylothorax after thyroid carcinoma surgery. Presentation of case The patient was a 48-year-old woman who presented to our institution complaining of a left anterior cervical mass. We diagnosed this as thyroid papillary carcinoma and performed a subtotal excision of the thyroid gland with left cervical lymph node dissection. The patient developed dyspnea, and a chest X-ray revealed bilateral chylothorax on Day 4 post-surgery. Octreotide was administered since bilateral chylothorax was noted. A marked decrease in chyle effusion was noted just 3 days after starting octreotide, and after a total of 9 days of treatment, there were no further signs of chylous effusion. Discussion Octreotide is effective against postsurgical chylothorax; however, if there are no signs of improvement, we believe surgical treatment should be considered. Conclusion Octreotide should be administered first to treat postsurgical chylothorax before surgical treatment is considered. PMID:26963261

  13. Successful management of a refractory case of postoperative herniorrhaphy pain with extended duration pulsed radiofrequency

    PubMed Central

    Thapa, D; Ahuja, V; Verma, P; Das, C

    2016-01-01

    Chronic postsurgical pain (CPSP) is a distressful condition following hernia surgery. A 25-year-old, 55 kg male patient presented with severe pain on the right side of the lower abdomen that radiated to the testicle and the inner side of the thigh. Patient was symptomatic since 5 months following inguinal herniorrhaphy surgery. The pain was not relieved with pharmacological and interventional nerve blocks. An ultrasound-guided ilioinguinal-iliohypogastric (II-IH) block with extended duration (42°C, four cycles of 120 s each) pulsed radiofrequency (PRF) and a diagnostic genital branch of genitofemoral nerve (GGFN) block provided pain relief. After 1-month, an extended duration PRF in GGFN resulted in complete resolution of symptoms. During a regular follow-up of 9 months, patient reported an improved quality-of-life. We believe the successful management of CPSP following hernia repair with single extended duration PRF of II-IH and GGFN has not been described in the literature. PMID:26955321

  14. Boerhaave Syndrome, Pneumothorax, and Chylothorax in a Critically Ill Patient with Tuberous Sclerosis Complex

    PubMed Central

    Ijaz, Mohsin; Rafiq, Arsalan; Venkatram, Sindhaghatta; Diaz-Fuentes, Gilda

    2015-01-01

    Tuberous sclerosis complex (TSC) is an autosomal dominant, variably expressed multisystem disease. The predominant pulmonary features of TSC are identical to those of lymphangioleiomyomatosis (LAM). Pneumothorax, multifocal micronodular pneumocyte hyperplasia, and chylothorax are rare complications of TSC. We report a young male with pneumothorax, lung nodules, and chylous effusion who developed empyema thoracis after esophageal rupture. Hospital course was complicated by respiratory failure. Family opted to transfer to hospice care. Chylothorax is a rare complication of TSC with few scattered reports mostly in female patients. Patients with TSC are usually managed by multispecialists and it is important to be aware of the rare pulmonary manifestations of this disease. A male patient with TSC having lung nodules presenting with chylothorax and empyema thoracis from Boerhaave syndrome makes our case unique. PMID:26550497

  15. Chylothorax bilatéral au cours de la maladie de Behçet

    PubMed Central

    Zemed, Naaima; Amangar, Nadia; Herrak, Laila; Elftouh, Mustapha

    2015-01-01

    L'atteinte médiastino-pulmonaire de la maladie de Behçet est représentée essentiellement par la thrombose de la veine cave supérieure et l'angéite pulmonaire. L'association de la maladie et du chylothorax est rare, sa prise en charge n'est pas codifiée. Nous rapportant un cas clinique concernant la survenue d'un chylothorax bilatéral secondaire à une thrombose cave supérieure dans un contexte de maladie de Behçet. PMID:26185561

  16. Chylothorax and lymphedema as the initial manifestations of gastric carcinoma: A case report and review of the literature

    PubMed Central

    WU, JIE; LV, LIANG; ZHOU, KUNYAN; HUO, JIRONG

    2016-01-01

    Chylothorax is the accumulation of lymph fluid in the pleura. Gastric carcinoma with chylothorax and lymphedema as the initial manifestations has rarely been reported, with only 14 cases reported to date. The mechanisms of gastric carcinoma generating chylothorax have not yet been determined. The current study reports the case of a 63-year-old woman presenting with chylothorax and lower extremity lymphedema, and reviews the existing literature. A chest radiograph performed on the present patient revealed large pleural effusion and chylothorax was diagnosed. Upper gastrointestinal endoscopy identified an irregular apophysis lesion and a biopsy confirmed poorly differentiated gastric adenocarcinoma. The patient was discharged at her request, and subsequently succumbed to the disease 4.5 months later. Based on the findings of the present study, as well as those of the literature, we proposed a novel form of gastric carcinoma infiltrating the body. Chylothorax and lymphedema may be a consequence of gastric carcinoma cells infiltrating the lymphatic circulatory system; therefore, the differential diagnosis of chylothorax and lymphedema of unknown cause should consider gastric carcinoma, regardless of gastrointestinal symptoms. PMID:27073560

  17. Chylous Ascites: A Rare Complication of Thoracic Duct Embolization for Chylothorax

    SciTech Connect

    Gaba, Ron C. Owens, Charles A.; Bui, James T.; Carrillo, Tami C.; Knuttinen, M. Grace

    2011-02-15

    Thoracic duct embolization represents a safe and effective method to treat postsurgical chylothorax. Complications of this procedure are rare despite transabdominal puncture of lymphatic channels for thoracic duct access, and chylous ascites is unreported. Herein, we describe a case of chylous ascites formation after lymphatic puncture and attempted cannulation. Our management approach is also discussed.

  18. Chylothorax and Recurrent Laryngeal Nerve Injury Associated with Robotic Video-Assisted Mediastinal Lymph Node Dissection

    PubMed Central

    Sarkaria, Inderpal S.; Finley, David J.; Bains, Manjit S.; Adusumilli, Prasad S.; Rizk, Nabil P.; Huang, James; Downey, Robert J.; Rusch, Valerie W.; Jones, David R.

    2016-01-01

    Summary Objective Although the technical aspects of robotic video-assisted thoracic surgery (RVATS) for lung resections may be advantageous, compared with standard thoracoscopy, complications of chylothorax and recurrent laryngeal nerve injury (RLNI) associated with mediastinal lymph node dissection (MLND) may be significant. Methods Consecutive patients who underwent RVATS anatomic lung resection for suspected or confirmed cancer and experienced RLNI or chylothorax were identified and reviewed from a prospectively maintained database. Complications were graded according to the Common Terminology Criteria for Adverse Events version 3.0. Results From July 28, 2010, to December 20, 2013, 251 patients underwent RVATS segmentectomy, lobectomy, or bilobectomy with mediastinal lymph node dissection (MLND). Eleven patients (4.4%) experienced MLND-related complications and composed the study group; 81.8% were right-sided resections, and median lymph node counts in right station IV and station VII were 9 (range, 1–23) and 5.5 (range, 1–10); 72.7% of cases were performed for early-stage I and II lung cancers. Chylothorax (6/251 [2.4%]) and RLNI (6/251 [2.4%]) were significantly more common in the RVATS group than in the open thoracotomy and standard VATS groups. Complications requiring procedural intervention (Grade 3) are as follows: 4 cases of RLNI in patients undergoing percutaneous vocal cord medialization and 3 cases of chylothorax in patients undergoing image-guided thoracic duct embolization or maceration. No operative interventions were required. Conclusions RVATS MLND may be associated with increased rates of chylothorax and RLNI. Attention must be paid to identifying potential technical pitfalls with RVATS lung resections, adjusting surgical techniques accordingly, and minimizing patient morbidity. PMID:26165562

  19. Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants.

    PubMed

    Fogg, Kristi L; DellaValle, Diane M; Buckley, Jason R; Graham, Eric M; Zyblewski, Sinai C

    2016-08-01

    Chylothorax is a well-described complication after cardiothoracic surgery in children. Medical nutritional therapy for chylothorax includes medium-chain triglyceride (MCT) formulas and reduction in enteral long-chain triglyceride intake to reduce chyle production. Human milk is usually eliminated from the diet of infants with chylothorax because of its high long-chain triglyceride content. However, given the immunologic properties of human milk, young infants with chylothorax may benefit from using human milk over human milk substitutes. We performed a retrospective cohort study to describe the feasibility and efficacy of defatted human milk (DHM) for the treatment for chylothorax in infants after cardiac surgery and to compare growth outcomes between infants treated with DHM (n = 14) versus MCT formula (n = 21). There were no differences in mortality or length of hospital stay between the DHM and MCT formula treatment groups. The DHM treatment group had a significantly higher weight-for-age z-score at hospital discharge compared to the MCT formula group with median z-scores of -1 (-2 to 0.5) and -1.5 (-2 to 0), respectively (p = 0.02). In infants with chylothorax after cardiac surgery, DHM is a safe and feasible medical nutritional treatment and may have potential benefits for improved nutrition and growth. PMID:27090650

  20. Using extracorporeal membrane oxygenation support preoperatively and postoperatively as a successful bridge to recovery in a patient with a large infarct-induced ventricular septal defect

    PubMed Central

    Jacob, Samuel; Patel, Mitesh J.; Lima, Brian; Felius, Joost; Malyala, Rajasekhar S.; Chamogeorgakis, Themistokles; MacHannaford, Juan C.; Gonzalez-Stawinski, Gonzalo V.

    2016-01-01

    Rupture of the ventricular septum during acute myocardial infarction usually occurs within the first week. The event is usually followed by low cardiac output, heart failure, and multiorgan failure. Despite the many advances in the nonoperative treatment of heart failure and cardiogenic shock, including the intra-aortic balloon pump and a multitude of new inotropic agents and vasodilators, these do not supplant the need for operative intervention in these critically ill patients. This article describes the successful use of extracorporeal membrane oxygenation support as a bridge to recovery postoperatively in a patient with a large infarct-produced ventricular septal defect. PMID:27365878

  1. Bilateral chylothorax in a renal transplant recipient: case report and literature review.

    PubMed

    Gheith, Osama; Al Otaibi, Torki; Nampoory, M R N; Attia, Hosam; Halim, Medhat; Said, Tarek; Nair, Prasad; Balaha, Mohamed; Awadein, Waleed; Zakariya, Zakaria; Aboatteya, Hasanein; Moideenkutty, Nawas

    2014-04-01

    Chylothorax is the accumulation of chyle in the pleural cavity as a result of damage to the lymphatic ducts. We treated a young man who was a kidney transplant recipient who had a prior internal jugular vein permanent catheter for hemodialysis, who developed dyspnea and hypoxemia. Chest radiography showed bilateral pleural effusion. Analysis of the white, milky, cloudy, odorless effusion fluid showed cell count > 500/μL; lymphocytes, 60%; total protein, 3.6 mg/dL; urea nitrogen, 45 mg/dL; creatinine, 90 μmol/L; triglycerides, above 2.2 mmol/L (repeatedly high); lactate dehydrogenase, 450 U/L (normal); and cultures, no growth. Magnetic resonance imaging showed thrombosis of the major neck veins, superior vena cava, and azygos vein. Treatment included pleural drains, gut rest, and dietary modification, octreotide, and warfarin. The chylothorax resolved with no relapse. In summary, chylothorax may occur in patients associated with thrombosis of major veins associated with a permanent dialysis catheter. PMID:24702147

  2. Transjugular Intrahepatic Portosystemic Shunt for Treatment of Cirrhosis-related Chylothorax and Chylous Ascites: Single-institution Retrospective Experience

    SciTech Connect

    Kikolski, Steven G. Aryafar, Hamed Rose, Steven C.; Roberts, Anne C.; Kinney, Thomas B.

    2013-08-01

    PurposeTo investigate the efficacy and safety of the use of transjugular intrahepatic portosystemic shunt (TIPS) creation to treat cirrhosis-related chylous collections (chylothorax and chylous ascites).MethodsWe retrospectively reviewed data from four patients treated for refractory cirrhosis-related chylous collections with TIPS at our institution over an 8 year period.ResultsOne patient had chylothorax, and three patients had concomitant chylothorax and chylous ascites. There were no major complications, and the only procedure-related complications occurred in two patients who had mild, treatable hepatic encephalopathy. All patients had improvement as defined by decreased need for thoracentesis or paracentesis, with postprocedure follow-up ranging from 19 to 491 days.ConclusionTIPS is a safe procedure that is effective in the treatment of cirrhosis-related chylous collections.

  3. Management of Postoperative Respiratory Failure.

    PubMed

    Mulligan, Michael S; Berfield, Kathleen S; Abbaszadeh, Ryan V

    2015-11-01

    Despite best efforts, postoperative complications such as postoperative respiratory failure may occur and prompt recognition of the process and management is required. Postoperative respiratory failure, such as postoperative pneumonia, postpneumonectomy pulmonary edema, acute respiratory distress-like syndromes, and pulmonary embolism, are associated with high morbidity and mortality. The causes of these complications are multifactorial and depend on preoperative, intraoperative, and postoperative factors, some of which are modifiable. The article identifies some of the risk factors, causes, and treatment strategies for successful management of the patient with postoperative respiratory failure. PMID:26515943

  4. [Thoracic duct collaterals of lymphatic and pulmonary origin. Anatomy and chylothorax after pulmonary surgery].

    PubMed

    Riquet, M; Hidden, G; Debesse, B

    1989-01-01

    Dye injection of lung segments reveals the existence of lymphatic drainage of the lungs generally into cervical venous confluents and more rarely into the arch of the thoracic duct in the neck and also occasionally into the thoracic duct in the mediastinum. Direct drainage of the lymph into the thoracic duct was observed in 10 cases out of a series of 589 injections of lung segments in adult cadavers. In one half of cases, the thoracic duct was injected from the left suprabronchial lymph node chain, the origin of the left recurrent chain, and in one quarter of cases from the lateral anteroposterior right major azygos and left azygo-aortic lymph node chains, not recognised by the classical authors. More rarely, direct lymphatic collaterals drained certain segments of the lower lobes into the thoracic duct via the triangular ligament. Analysis of cases of chylothorax occurring after lung resection and observed in the authors' department or in the literature reveals that most of them can be attributed to a chyle leak from one of these pulmonary lymph collaterals. These pathways are probably also involved in the development of medical or idiopathic chylothorax. PMID:2686514

  5. POSTOPERATIVE DELIRIUM

    PubMed Central

    Whitlock, Elizabeth L.; Vannucci, Andrea; Avidan, Michael S.

    2013-01-01

    Delirium is an unfortunately common complication seen during the postoperative course. Because of its significant association with physical and cognitive morbidity, clinicians should be aware of evidence-based practices relating to the diagnosis, treatment, and prevention of postoperative delirium. Here, we review selected recent literature pertaining to the epidemiology and impact of the condition, perioperative risk factors for its development and/or exacerbation, and strategies for management of delirium, with additional attention to the intensive care unit population. PMID:21483389

  6. Treatment of idiopathic chylothorax in 14 dogs by ligation of the thoracic duct and partial pericardiectomy.

    PubMed

    Carobbi, B; White, R A S; Romanelli, G

    The outcome and complications associated with thoracic duct ligation combined with partial pericardiectomy in 14 dogs with idiopathic chylothorax were investigated retrospectively. Nine of the dogs were treated in the uk and five in Italy. All of them were reassessed clinically four weeks after surgery and the respiratory function and any pleural fluid accumulation were evaluated; they were followed up by telephone contact for at least six months. Eleven of the dogs were clinically normal and had no radiographic signs of pleural effusion when reassessed after four weeks. Two showed radiographic signs of a minor accumulation of pleural fluid but were clinically normal; when reassessed after three months they showed similar radiographic signs and clinical findings; but after four months there was no evidence of pleural effusion. One dog had a major complication that required a second surgical intervention. PMID:19103616

  7. Postoperative hyperkalemia.

    PubMed

    Ayach, Taha; Nappo, Robert W; Paugh-Miller, Jennifer L; Ross, Edward A

    2015-03-01

    Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided. PMID:25698564

  8. Lymphangiography: Forgotten Tool or Rising Star in the Diagnosis and Therapy of Postoperative Lymphatic Vessel Leakage

    SciTech Connect

    Kos, Sebastian Haueisen, Harald; Lachmund, Ulrich; Roeren, Thomas

    2007-09-15

    Since the advent of computed tomography, numbers and expertise in Lymphangiography (LAG) have markedly dropped. The intention of our study was to demonstrate the persisting diagnostic and therapeutic impact of LAG on the postoperative patient with known or suspected lymphatic vessel leakage. Between May 1, 1999, and April 30, 2006, we investigated pedal lipiodol-LAGs (18 monopedal, 2 bipedal) on 22 patients (16 male, 6 female) with known or suspected postoperative chylothorax, chylaskos, lymphocele, or lymphatic fistula. Ages varied from 26 to 81 years. The spectrum of operative procedures was broad: 6 thoracic, 5 abdominal, and 11 peripheral operations were performed. In 20 patients who underwent mono- or bipedal LAG for lymphatic vessel injury, we were able to demonstrate the specific site of leakage in 15 cases (75%) and found signs of extravasation in 5 patients (25%). Furthermore, in 11 patients (55%) we were able to avoid surgery because of closure of the leak after LAG. As the conservative therapeutic approach usually takes 2-3 weeks to reveal its therapeutic effects, 73.3% (11/15) of the patients who were not reoperated before this hallmark was passed did not need any further operation. Our study clearly demonstrates that even in the decades of modern cross-sectional imaging, classic LAG is a powerful and highly reliable tool to visualize and even assist occlusion of the postoperatively damaged lymphatic vessel and may thereby avoid the need for reoperation.

  9. Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage

    PubMed Central

    Yan, Shi; Wang, Xing; Lv, Chao; Phan, Kevin; Wang, Yuzhao; Wang, Jia; Yang, Yue

    2016-01-01

    Background Postoperative pleural drainage markedly influences the length of postoperative stay and financial costs of medical care. The aim of this study is to retrospectively investigate potentially predisposing factors related to pleural drainage after curative thoracic surgery and to explore the impact of mediastinal micro-vessels clipping on pleural drainage control after lymph node dissection. Methods From February 2012 to November 2013, 322 consecutive cases of operable non-small cell lung cancers (NSCLC) undergoing lobectomy and mediastinal lymph node dissection with or without application of clipping were collected. Total and daily postoperative pleural drainage were recorded. Propensity score matching (1:2) was applied to balance variables potentially impacting pleural drainage between group clip and group control. Analyses were performed to compare drainage volume, duration of chest tube and postoperative hospital stay between the two groups. Variables linked with pleural drainage in whole cohort were assessed using multivariable logistic regression analysis. Results Propensity score matching resulted in 197 patients (matched cohort). Baseline patient characteristics were matched between two groups. Group clip showed less cumulative drainage volume (P=0.020), shorter duration of chest tube (P=0.031) and postoperative hospital stay (P=0.022) compared with group control. Risk factors significantly associated with high-output drainage in multivariable logistic regression analysis were being male, age >60 years, bilobectomy/sleeve lobectomy, pleural adhesion, the application of clip applier, duration of operation ≥220 minutes and chylothorax (P<0.05). Conclusions This study suggests that mediastinal micro-vessels clipping during lymph node dissection may reduce postoperative pleural drainage and thus shorten hospital stay. PMID:27076936

  10. Thoracoscopic Ligation of the Thoracic Duct

    PubMed Central

    Teixeira, Julio A.

    2000-01-01

    Objective: When nonoperative treatment of chylothorax fails, thoracic duct ligation is usually performed through a thoracotomy. We describe two cases of persistent chylothorax, in a child and an adult, successfully treated with thoracoscopic ligation of the thoracic duct. Methods: A 4-year-old girl developed a right chylothorax following a Fontan procedure. Aggressive nonoperative management failed to eliminate the persistent chyle loss. A 72-year-old insulin-dependent diabetic man was involved in a motor vehicle accident, in which he sustained multiple fractured ribs, a right hemopneumothorax, a right femoral shaft fracture, and a T-11 thoracic vertebral fracture. Subsequently, he developed a right chylothorax, which did not respond to nonoperative management. Both patients were successfully treated with thoracoscopic ligation of the thoracic duct. Results: The child had significant decrease of chyle drainage following surgery. Increased drainage that appeared after the introduction of full feedings five days postoperatively was controlled with the somatostatin analog octreotide. The chest tube was removed two weeks after surgery. After two years' follow-up, she has had no recurrence of chylothorax. The adult had no chyle drainage following surgery. He was maintained on a medium-chain triglyceride diet postoperatively for two weeks. The chest tube was removed four days after surgery. After six months' follow-up, he has had no recurrence of chylothorax. Conclusions: Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity. PMID:10987402

  11. Postoperative Spine Infections.

    PubMed

    Pawar, Abhijit Yuvaraj; Biswas, Samar Kumar

    2016-02-01

    Postoperative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and postoperative care, wound infection continues to compromise patient outcome after spinal surgery. Spinal instrumentation also has an important role in the development of postoperative infections. This review analyses the risk factors that influence the development of postoperative infection. Classification and diagnosis of postoperative spinal infection is also discussed to facilitate the choice of treatment on the basis of infection severity. Preventive measures to avoid surgical site (SS) infection in spine surgery and methods for reduction of all the changeable risk factors are discussed in brief. Management protocols to manage SS infections in spine surgery are also reviewed. PMID:26949475

  12. Postoperative Spine Infections

    PubMed Central

    Biswas, Samar Kumar

    2016-01-01

    Postoperative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and postoperative care, wound infection continues to compromise patient outcome after spinal surgery. Spinal instrumentation also has an important role in the development of postoperative infections. This review analyses the risk factors that influence the development of postoperative infection. Classification and diagnosis of postoperative spinal infection is also discussed to facilitate the choice of treatment on the basis of infection severity. Preventive measures to avoid surgical site (SS) infection in spine surgery and methods for reduction of all the changeable risk factors are discussed in brief. Management protocols to manage SS infections in spine surgery are also reviewed. PMID:26949475

  13. [Management of postoperative hemorrhage following thyroid surgery].

    PubMed

    Lorenz, K; Sekulla, C; Kern, J; Dralle, H

    2015-01-01

    The incidence of postoperative hemorrhage following thyroid surgery stands at 1%-2 %. This low incidence contrasts with the significant potential complications of postoperative hemorrhage. Influencing factors and measures mentioned in the literature and own studies are discussed. Although an improvement in the postoperative hemorrhage rate was to be expected indirectly due to the increasing use of coagulation-relevant medication, there has been neither an increase in incidence nor a reduction in resultant complications, including primarily recurrent vocal cord paresis, tracheotomy and mortality. Factors that influence surgical success include a meticulous technique and caution, as well as ensuring intensive and qualified postoperative monitoring for a minimum of 4-6 h, thereby permitting immediate revision surgery at any time. PMID:25532753

  14. Surgical Method, Postoperative Complications, and Gastrointestinal Motility of Thoraco-Laparoscopy 3-Field Esophagectomy in Treatment of Esophageal Cancer

    PubMed Central

    Wan, Jun; Che, Yun; Kang, Ningning; Zhang, Renquan

    2016-01-01

    Background The aim of this study was to investigate the surgical method, postoperative complications, and gastrointestinal motility of thoraco-laparoscopic esophagectomy in the treatment of esophageal cancer. Material/Methods Using random sampling method, we selected 132 esophageal cancer patients who were treated in our hospital from January 2012 to December 2014; these patients were regarded as the study group and underwent thoraco-laparoscopy 3-field surgery treatment. Another 108 esophageal cancer patients admitted to our hospital over the same period were regarded as the control group and underwent traditional open McKeown esophagectomy. Results The amount of blood loss and postoperative drainage of pleural fluid in the study group were significantly lower (P<0.05) and the time to removal of the chest tube and hospital stay were significantly shorter (P<0.05). The incidence of anastomotic fistula, vocal cord paralysis, chylothorax, and arrhythmia were significantly lower in the study group than in the control group (P<0.05). However, no significant differences in the incidence of pneumonia, atelectasis, or acute respiratory distress were detected (P>0.05). For postoperative gastrointestinal motility, first flatus time, first defecation time, and bowel tone recovery time after the operation, as well as the total amount of gastric juice draining, were reduced in the thoraco-laparoscopic esophagectomy group (P<0.05). The postoperative MTL and NO levels were higher but VIP level was lower in the thoraco-laparoscopic group (P<0.05). Conclusions Thoraco-laparoscopic esophagectomy was technically feasible and safe; it was associated with lower incidence of certain postoperative complications and had less effect on postoperative gastrointestinal motility. Skilled technique and cooperation could further shorten the operation time and might lead to better patient outcomes. PMID:27310399

  15. Surgical Method, Postoperative Complications, and Gastrointestinal Motility of Thoraco-Laparoscopy 3-Field Esophagectomy in Treatment of Esophageal Cancer.

    PubMed

    Wan, Jun; Che, Yun; Kang, Ningning; Zhang, Renquan

    2016-01-01

    BACKGROUND The aim of this study was to investigate the surgical method, postoperative complications, and gastrointestinal motility of thoraco-laparoscopic esophagectomy in the treatment of esophageal cancer. MATERIAL AND METHODS Using random sampling method, we selected 132 esophageal cancer patients who were treated in our hospital from January 2012 to December 2014; these patients were regarded as the study group and underwent thoraco-laparoscopy 3-field surgery treatment. Another 108 esophageal cancer patients admitted to our hospital over the same period were regarded as the control group and underwent traditional open McKeown esophagectomy. RESULTS The amount of blood loss and postoperative drainage of pleural fluid in the study group were significantly lower (P<0.05) and the time to removal of the chest tube and hospital stay were significantly shorter (P<0.05). The incidence of anastomotic fistula, vocal cord paralysis, chylothorax, and arrhythmia were significantly lower in the study group than in the control group (P<0.05). However, no significant differences in the incidence of pneumonia, atelectasis, or acute respiratory distress were detected (P>0.05). For postoperative gastrointestinal motility, first flatus time, first defecation time, and bowel tone recovery time after the operation, as well as the total amount of gastric juice draining, were reduced in the thoraco-laparoscopic esophagectomy group (P<0.05). The postoperative MTL and NO levels were higher but VIP level was lower in the thoraco-laparoscopic group (P<0.05). CONCLUSIONS Thoraco-laparoscopic esophagectomy was technically feasible and safe; it was associated with lower incidence of certain postoperative complications and had less effect on postoperative gastrointestinal motility. Skilled technique and cooperation could further shorten the operation time and might lead to better patient outcomes. PMID:27310399

  16. [Influence of prolonged treatment with octreotide on GH, IGF I, insulin, ACTH, cortisol, T3, T4 and TSH secretion in a case of congenital chylothorax].

    PubMed

    Bagnoli, F; Badii, S; Conte, M L; Toti, M S; De Felice, C; Bellieni, C V; Borlini, G; Tomasini, B; Zani, S

    2010-08-01

    Congenital chylothorax is a rare condition characterized by the accumulation of lymph fluid in the pleural space that causes respiratory and circulatory dysfunctions, immune deficiencies, hypoalbuminemia, electrolyte imbalance and alterations of the coagulation. Mortality rates are elevated and can rise to 50%. Therapy consists in conservative treatment based on thoracic drainage combined with total parenteral nutrition or use of low-fat high-protein diet supplemented with medium chain triglycerides. In case of failure surgical intervention may be considered. During the last years some authors have experienced the use of octreotide with doubtful results. In no case the drug impact on insulin, GH and cortisol secretion in neonatal age has been investigated and only in one case the effect on thyroid hormones has been assessed. We report the case of a 36-week baby with congenital chylothorax treated with octreotide for 42 days. The drug was well tolerated but hormonal level measurements showed a deep depression of insulin secretion unaccompanied by alterations of glucose levels. Levels of GH and TSH showed only a transitory decrease. ACTH and cortisol remained normal. At 5 months, the measurements of hormonal levels did not show significant alterations. It is not possible to determine if such a drug played an essential role in the solution of the pleural effusion, but it is important to emphasize that a prolonged treatment with octreotide has not caused, in our case, persistent hormonal alterations. PMID:20940674

  17. Postoperative pain management.

    PubMed

    Nett, Michael P

    2010-09-01

    Although the long-term results following traditional total joint arthroplasty are excellent, postoperative pain management has been suboptimal. Under-treatment of pain is a focus of growing concern to the orthopedic community. Poorly controlled postoperative pain leads to undesirable outcomes, including immobility, stiffness, myocardial ischemia, atelectasis, pneumonia, deep venous thrombosis, anxiety, depression, and chronic pain. Over the past decade, the attempt to minimize postoperative complications, combined with the move toward minimally invasive surgery and early postoperative mobilization, has made pain management a critical aspect of joint replacement surgery. Effective protocols are currently available; all include a multimodal approach. Debate continues regarding the ideal approach; however, reliance on narcotic analgesia alone is suboptimal. PMID:20839719

  18. Acute postoperative endophthalmitis by Gemella haemolysans

    PubMed Central

    Nalamada, Suma; Jalali, Subhadra; Reddy, Ashok Kumar

    2010-01-01

    Endophthalmitis is a rare and serious post-surgical complication. We report a case of acute postoperative endophthalmitis after an uneventful cataract surgery caused by a commensal organism, Gemella haemolysans. The patient was successfully treated with vitrectomy and intravitreal antibiotics like vancomycin, along with topical cefazolin. PMID:20413936

  19. Postoperative Spine Infections

    PubMed Central

    Evangelisti, Gisberto; Andreani, Lorenzo; Girardi, Federico; Darren, Lebl; Sama, Andrew; Lisanti, Michele

    2015-01-01

    Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of postoperative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication. PMID:26605028

  20. Postoperative pyoderma gangrenosum: A rare complication after appendectomy

    PubMed Central

    Faghihi, G; Abtahi-Naeini, B; Nikyar, Z; Jamshidi, K; Bahrami, A

    2015-01-01

    Pyoderma gangrenosum (PG) is an uncommon inflammatory ulcerative skin disease. It is characterized by painful progressive necrosis of the wound margins. Rarely, postoperative pyoderma gangrenosum (PPG) manifests as a severe disturbance of wound healing following surgical interventions. Only rare cases of this complication have been reported after appendectomy. We report a case of PPG in a 29-year-old female after appendectomy. She was successfully treated with oral prednisolone. Postoperative pyoderma gangrenosum should be kept in mind in the differential diagnosis of any postoperative delayed wound healing, because this disease is simply distinguished from a postoperative wound. PMID:25511218

  1. Pre- and post-operative management of dental implant placement. Part 1: management of post-operative pain.

    PubMed

    Bryce, G; Bomfim, D I; Bassi, G S

    2014-08-01

    Although dental implant placements have high success rates and a low incidence of morbidity, post-operative pain and complications with the healing process have been reported. There is little guidance available regarding optimal pre- and post-operative management of dental implant placement. This first paper discusses the mechanisms of pain associated with dental implant placement and offers guidance to clinicians on optimal pre- and post-operative pain management regimes. The second paper aims to discuss pre- and post-operative means of reducing the risk of early healing complications. PMID:25104691

  2. Postoperative pain management

    PubMed Central

    Kolettas, Alexandros; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Lampaki, Sofia; Karavergou, Anastasia; Pataka, Athanasia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Fassiadis, Nikolaos; Zarogoulidis, Konstantinos

    2015-01-01

    Postoperative pain is a very important issue for several patients. Indifferent of the surgery type or method, pain management is very necessary. The relief from suffering leads to early mobilization, less hospital stay, reduced hospital costs, and increased patient satisfaction. An individual approach should be applied for pain control, rather than a fix dose or drugs. Additionally, medical, psychological, and physical condition, age, level of fear or anxiety, surgical procedure, personal preference, and response to agents given should be taken into account. The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia. Again a multidisciplinary team approach should be pursued planning and formulating a plan for pain relief, particularly in complicated patients, such as those who have medical comorbidities. These patients might appear increase for analgesia-related complications or side effects. PMID:25774311

  3. Face lift postoperative recovery.

    PubMed

    Mottura, A Aldo

    2002-01-01

    The purpose of this paper is to describe what I have studied and experienced, mainly regarding the control and prediction of the postoperative edema; how to achieve an agreeable recovery and give positive support to the patient, who in turn will receive pleasant sensations that neutralize the negative consequences of the surgery.After the skin is lifted, the drainage flow to the flaps is reversed abruptly toward the medial part of the face, where the flap bases are located. The thickness and extension of the flap determines the magnitude of the post-op edema, which is also augmented by medial surgeries (blepharo, rhino) whose trauma obstruct their natural drainage, increasing the congestion and edema. To study the lymphatic drainage, the day before an extended face lift (FL) a woman was infiltrated in the cheek skin with lynfofast (solution of tecmesio) and the absorption was observed by gamma camera. Seven days after the FL she underwent the same study; we observed no absorption by the lymphatic, concluding that a week after surgery, the lymphatic network was still damaged. To study the venous return during surgery, a fine catheter was introduced into the external jugular vein up to the mandibular border to measure the peripheral pressure. Following platysma plication the pressure rose, and again after a simple bandage, but with an elastic bandage it increased even further, diminishing considerably when it was released. Hence, platysma plication and the elastic bandage on the neck augment the venous congestion of the face. There are diseases that produce and can prolong the surgical edema: cardiac, hepatic, and renal insufficiencies, hypothyroidism, malnutrition, etc. According to these factors, the post-op edema can be predicted, the surgeon can choose between a wide dissection or a medial surgery, depending on the social or employment compromises the patient has, or the patient must accept a prolonged recovery if a complex surgery is necessary. Operative

  4. Postoperative circadian disturbances.

    PubMed

    Gögenur, Ismail

    2010-12-01

    An increasing number of studies have shown that circadian variation in the excretion of hormones, the sleep wake circle, the core body temperature rhythm, the tone of the autonomic nervous system and the activity rhythm are important both in health and in disease processes. An increasing attention has also been directed towards the circadian variation in endogenous rhythms in relation to surgery. The attention has been directed to the question whether the circadian variation in endogenous rhythms can affect postoperative recovery, morbidity and mortality. Based on the lack of studies where these endogenous rhythms have been investigated in relation to surgery we performed a series of studies exploring different endogenous rhythms and factors affecting these rhythms. We also wanted to examine whether the disturbances in the postoperative circadian rhythms could be correlated to postoperative recovery parameters, and if pharmacological administration of chronobiotics could improve postoperative recovery. Circadian rhythm disturbances were found in all the examined endogenous rhythms. A delay was found in the endogenous rhythm of plasma melatonin and excretion of the metabolite of melatonin (AMT6s) in urine the first night after both minor and major surgery. This delay after major surgery was correlated to the duration of surgery. The amplitude in the melatonin rhythm was unchanged the first night but increased in the second night after major surgery. The amplitude in AMT6s was reduced the first night after minimally invasive surgery. The core body temperature rhythm was disturbed after both major and minor surgery. There was a change in the sleep wake cycle with a significantly increased duration of REM-sleep in the day and evening time after major surgery compared with preoperatively. There was also a shift in the autonomic nervous balance after major surgery with a significantly increased number of myocardial ischaemic episodes during the nighttime period. The

  5. Postoperative conversion disorder.

    PubMed

    Afolabi, Kola; Ali, Sameer; Gahtan, Vivian; Gorji, Reza; Li, Fenghua; Nussmeier, Nancy A

    2016-05-01

    Conversion disorder is a psychiatric disorder in which psychological stress causes neurologic deficits. A 28-year-old female surgical patient had uneventful general anesthesia and emergence but developed conversion disorder 1 hour postoperatively. She reported difficulty speaking, right-hand numbness and weakness, and right-leg paralysis. Neurologic examination and imaging revealed no neuronal damage, herniation, hemorrhage, or stroke. The patient mentioned failing examinations the day before surgery and discontinuing her prescribed antidepressant medication, leading us to diagnose conversion disorder, with eventual confirmation by neuroimaging and follow-up examinations. PMID:27041258

  6. Postoperative pain in children.

    PubMed

    Goddard, J M; Pickup, S E

    1996-06-01

    An audit project was designed to assess and improve the provision of postoperative analgesia in a children's hospital. Pain assessment for all children and analgesia standards for our institution were introduced prior to data collection. Data were collected on consecutive samples of 316 and 325 children undergoing surgery as inpatients during 10-week periods. Change was initiated between the two periods in response to our findings; our action plan involved education, changes to documentation, the widespread use of diclofenac in children over 2 years of age and recommendations for the prescription of analgesia. The initial prescription of analgesia increased from 95% to 98% (p = 0.019), administration of analgesia to children experiencing bad or severe pain increased from 57% to 71% (p = 0.032) and the number of children experiencing severe pain reduced from 17% to 11% (p = 0.050). Application of audit, by a clinical nurse specialist, enabled us to achieve and demonstrate improvements in the prescription, administration and effectiveness of postoperative analgesia. PMID:8694218

  7. [Retroperitoneal postoperative necrotizing fasciitis].

    PubMed

    Fichev, G; Poromanski, I; Marina, M

    2000-01-01

    This is a report on clinical experience had with 17 patients presenting necrotizing fasciitis--a complication ever more frequently encountered. The case material is distributed in two group differing by origin and clinical course of the complication. In group one (n = 11) it is a matter of postoperative development of postoperative complication, consistent with the classical "per continuitatem" and "per contiguitatem" mechanisms, while in group two (n = 6) the process originates, evolves and speads within the retroperitoneal space proper. Comprehensive microbiological examinations performed in 13 cases show that in either group different microorganisms are identified. In group one aerobic-anaerobic mixed infection is documented in all patients, with predominance of Enterobacteroidaceae among aerobic ones. In group two, anaerobic bacterial species, mainly Clostridium sp, prevail in all the isolates. The clinical study points to a substantial difference in the time of septic complication occurrence, as well as between the clinical picture of the two species. Accordingly, the final results are radically different--in group one survivorship amounts to 62.6%, whereas in group two--to 16.6% only. PMID:11692928

  8. Management of Postoperative Spondylodiscitis with and without Internal Fixation.

    PubMed

    Wang, Xiang; Tao, Hairong; Zhu, Yanhui; Lu, Xiongwei; Hu, Xiaopeng

    2015-01-01

    Postoperative spondylodiscitis is relatively uncommon. This complication is associated with increased cost, and long-term of inability to work, and even morbidity. Although the majority of postoperative spondylodiscitis cases can be well managed by conservative treatment, postoperative spondylodiscitis after internal fixation and those cases that are unresponsive to the conservative treatment present challenges to the surgeon. Here, a review was done to analyze the treatment of postoperative spondylodiscitis with/without internal fixation. This review article suggested that majority of postoperative spondylodiscitis without internal fixation could be cured by conservative treatment. Either posterior or anterior debridement can be used to treat postoperative spondylodiscitis without internal fixation when conservative treatment fails. In addition, minimally invasive debridement and drainage may also be an alternative treatment. In case of postoperative spondylodiscitis after internal fixation, surgical treatment was required. In the cervical spine, it can be well managed by anterior debridement, removal of internal fixation, and reconstruction of the spinal stability by using bone grafting/cage/anterior plate. Postoperative spondylodiscitis after internal fixation is successfully managed by combined anterior debridement, fusion with posterior approach and removal of pedicle screw or extension of pedicle screw beyond the lesion site, in the thoracic and lumbar spine. PMID:26242325

  9. Keratoplasty postoperative treatment update.

    PubMed

    Shimmura-Tomita, Machiko; Shimmura, Shigeto; Satake, Yoshiyuki; Shimazaki-Den, Seika; Omoto, Masahiro; Tsubota, Kazuo; Shimazaki, Jun

    2013-11-01

    Immunosuppressive therapy is the main postoperative treatment for keratoplasty, but there are considerable differences in protocols for the use of steroids and other immunosuppressants. Therefore, we conducted 2 prospective randomized clinical trials and 1 prospective nonrandomized clinical trial on keratoplasty postoperative treatment. One study evaluated the efficacy and safety of long-term topical corticosteroids after a penetrating keratoplasty was performed. Patients who underwent keratoplasty and maintained graft clarity for >1 year were randomly assigned to either a steroid or a no-steroid group. At the 12-month follow-up, the no-steroid group developed significantly more endothelial rejection than did the steroid group. A second study elucidated the effectiveness and safety of systemic cyclosporine in high-risk corneal transplantation. The patients were assigned to a systemic cyclosporine or control group. At a mean follow-up of 42.7 months, no difference was observed in the endothelial rejection rates and graft clarity loss between the 2 groups. A third study elucidated the effectiveness and the safety of systemic tacrolimus in high-risk corneal transplantation. Of 11 consecutive eyes decompensated despite systemic cyclosporine treatment, there was no irreversible rejection in eyes treated with tacrolimus, which was significantly better than in previous penetrating keratoplasty with systemic cyclosporine treatment. Prognosis after keratoplasty in patients with keratoconus is relatively good, but special attention is required for patients with atopic dermatitis. Postkeratoplasty atopic sclerokeratitis (PKAS) is a severe form of sclerokeratitis after keratoplasty in atopic patients. Our retrospective study showed that 35 eyes of 29 patients from a total of 247 keratoconus eyes undergoing keratoplasty were associated with atopic dermatitis, of which 6 eyes of 5 patients developed PKAS. Eyes with PKAS had a significantly higher incidence of atopic blepharitis

  10. Cardiac Transplant Postoperative Management and Care.

    PubMed

    Freeman, Regi; Koerner, Erika; Clark, Courtney; Halabicky, Kathy

    2016-01-01

    Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted. PMID:27254638

  11. Postoperative Peritoneal Adhesions

    PubMed Central

    Ryan, Graeme B.; Grobéty, Jocelyne; Majno, Guido

    1971-01-01

    This paper describes an experimental model of peritoneal adhesions, in the rat, based on two relatively minor accidents that may occur during abdominal surgery in man: drying of the serosa, and bleeding. Drying alone had little effect; drying plus bleeding consistently produced adhesions to the dried area. Fresh blood alone produced adhesions between the three membranous structures [omentum and pelvic fat bodies (PFBs)]. The formation of persistent adhesions required whole blood. Preformed clots above a critical size induced adhesions even without previous serosal injury; they were usually captured by the omentum and PFBs. If all three membranous structures were excised, the clots caused visceral adhesions. The protective role of the omentum, its structure, and the mechanism of omental adhesions, are discussed. These findings are relevant to the pathogenesis of post-operative adhesions in man. ImagesFig 3Fig 4Fig 5Fig 6Fig 7Fig 12Fig 13Fig 1Fig 2Fig 14Fig 15Fig 8Fig 9Fig 10Fig 11 PMID:5315369

  12. Lymphangiography to Treat Postoperative Lymphatic Leakage: A Technical Review

    PubMed Central

    Lee, Edward Wolfgang; Ko, Heung Kyu; Park, Jihong; Kim, Soo Hwan; Sung, Kyu-Bo

    2014-01-01

    In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. In this pictorial review, we present the detailed technique, clinical applications, and complications of lymphangiography and thoracic duct embolization. PMID:25469083

  13. [Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

    PubMed

    Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki

    2016-04-01

    We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium. PMID:27188116

  14. Noninvasive ventilation in large postoperative flail chest.

    PubMed

    Piastra, Marco; De Luca, Daniele; Zorzi, Giulia; Ruggiero, Antonio; Antonelli, Massimo; Conti, Giorgio; Pietrini, Domenico

    2008-12-01

    An 11-year-old male developed a severe respiratory failure due to a iatrogenic flail chest following a surgery for removing a large chest wall area. A rare Ewing sarcoma was histologically diagnosed and intensive chemotherapy was administered. Postoperatively, because of the failure in ventilation weaning, the patient was electively extubated and noninvasive positive pressure ventilation through face-mask was provided. Respiratory support avoided asynchronous paradoxical movements and achieved pneumatic stabilization. Clinical and respiratory improvement allowed a successful weaning from ventilator. PMID:18798557

  15. Postoperative psychosis after heart surgery.

    PubMed

    Sveinsson, I S

    1975-10-01

    One hundred heart surgery patients were followed throughout their postoperative periods to assess the incidence and etiology of postcardiotomy delirium. Factors evaluated were: age, sex, history of previous psychiatric illness, history of cerebrovascular disease, cardiac diagnosis and operation, time of anesthesia, time of bypass, time spent in the intensive-care unit, and amount of sleep during the postoperative period. Six patients developed delirium, five of whom had a lucid postoperative interval; four patients had perceptual disturbances only, without loss of contact with reality; three had neurological symptoms with mild confusion; 87 kept a clear mental state. The following factors tended to be related to the occurrence of delirium and perceptual disturbances: history of preoperative psychiatric illness, advanced age, severity of preoperative and postoperative illness, and time spent in the intensive-care unit. Sleep deprivation consistently preceded onset of these symptoms with one exception. Operative factors did not seem to be of major importance. While postoperative delirium probably has multidetermined causes, the author believes that sleep deprivation superimposed on the other contributory condition is a common precipitating factor. Suggestions about the prevention and treatment of delirium are made. PMID:1177486

  16. [Surgical controversy. Limiting postoperative scarring].

    PubMed

    Lachkar, Y

    2005-06-01

    Postoperative follow-up of glaucoma surgery must be rigorous and carried out over the long term. Data acquired on the make-up of the filtering bleb justifies using postoperative anti-inflammatory drugs, even if the eye is clinically quiet. When using antimetabolites, the risk factors for failure must be well known and either 5-fluorouracile or mitomycin should be chosen depending on the level of risk of scarring. Their use in needle revision must be adapted case by case. anti-TGF-beta-2 antibody, currently being investigated, may prove advantageous in the very near future. PMID:16208245

  17. Postoperative Pain in Children After Dentistry Under General Anesthesia.

    PubMed

    Wong, Michelle; Copp, Peter E; Haas, Daniel A

    2015-01-01

    The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics. PMID:26650492

  18. Postoperative Care of the Facial Laceration

    PubMed Central

    Medel, Nicholas; Panchal, Neeraj; Ellis, Edward

    2010-01-01

    The purpose of this investigation is to examine factors involved in the postoperative care of traumatic lacerations. An evidence-based comprehensive literature review was conducted. There are a limited number of scientifically proven studies that guide surgeons and emergency room physicians on postoperative care. Randomized controlled trials must be conducted to further standardize the postoperative protocol for simple facial lacerations. PMID:22132257

  19. Neuroimaging of the Postoperative Spine.

    PubMed

    Bellini, Matteo; Ferrara, Marco; Grazzini, Irene; Cerase, Alfonso

    2016-08-01

    Operative treatments of the spine are becoming increasingly more common for the availability of a wide range of surgical and minimally invasive procedures. MR imaging allows for excellent evaluation of both normal and abnormal findings in the postoperative spine. This article provides the basic tools to evaluate complications after different operative procedures and offers an overview on the main topics a radiologist may encounter during his or her professional carrier. PMID:27417403

  20. Risk factors for postoperative ileus

    PubMed Central

    Kutun, Suat; Ulucanlar, Haluk; Tarcan, Oguz; Demir, Abdullah; Cetin, Abdullah

    2011-01-01

    Purpose This study aimed to examine extended postoperative ileus and its risk factors in patients who have undergone abdominal surgery, and discuss the techniques of prevention and management thereof the light of related risk factors connected with our study. Methods This prospective study involved 103 patients who had undergone abdominal surgery. The effects of age, gender, diagnosis, surgical operation conducted, excessive small intestine manipulation, opioid analgesic usage time, and systemic inflammation on the time required for the restoration of intestinal motility were investigated. The parameters were investigated prospectively. Results Regarding the factors that affected the restoration of gastrointestinal motility, resection operation type, longer operation period, longer opioid analgesics use period, longer nasogastric catheter use period, and the presence of systemic inflammation were shown to retard bowel motility for 3 days or more. Conclusion Our study confirmed that unnecessary analgesics use in patients with pain tolerance with non-steroid anti-inflammatory drugs, excessive small bowel manipulation, prolonged nasogastric catheter use have a direct negative effect on gastrointestinal motility. Considering that an exact treatment for postoperative ileus has not yet been established, and in light of the risk factors mentioned above, we regard that prevention of postoperative ileus is the most effective way of coping with intestinal dysmotility. PMID:22111079

  1. [Postoperative pulmonary complications: prophylaxis after noncardiac surgery].

    PubMed

    Hofer, S; Plachky, J; Fantl, R; Schmidt, J; Bardenheuer, H J; Weigand, M A

    2006-04-01

    Postoperative pulmonary complications are a major problem after upper abdominal or thoracoabdominal surgery. They lead to a prolonged ICU stay as well as increased costs and are one of the main causes of early postoperative mortality. Even after uncomplicated operations, postoperative hypoxemia occurs in 30-50% of patients. Acute respiratory failure involves a disturbance in gas exchange. The mortality ranges from 10 to 60% according to the severity of respiratory failure. The most important complications are interstitial and alveolar pulmonary edema, atelectasis, postoperative pneumonia, hypoventilation, and aspiration. Preoperative optimization, postoperative prophylaxis according to a stepwise approach, and early mobilization decrease the rate of complications. PMID:16575614

  2. Postoperative analgesia in elderly patients.

    PubMed

    Falzone, Elisabeth; Hoffmann, Clément; Keita, Hawa

    2013-02-01

    Elderly people represent the fastest-growing segment of our society and undergo surgery more frequently than other age groups. Effective postoperative analgesia is essential in these patients because inadequate pain control after surgery is associated with adverse outcomes in elderly patients. However, management of postoperative pain in older patients may be complicated by a number of factors, including a higher risk of age- and disease-related changes in physiology and disease-drug and drug-drug interactions. Physiological changes related to aging need to be carefully considered because aging is individualized and progressive. Assessment of pain management needs to include chronological age, biological age with regard to renal, liver and cardiac functions, and the individual profile of pathology and prescribed medications. In addition, ways in which pain should be assessed, particularly in patients with cognitive impairment, must be considered. Cognitively intact older patients can use most commonly used unidimensional pain scales such as the visual analogue scale (VAS), verbal rating scale (VRS), numeric rating scale (NRS) and facial pain scale (FPS). VRS and NRS are the most appropriate pain scales for the elderly. In older patients with mild to moderate cognitive impairment, the VRS is a better tool. For severe cognitively impaired older patients, behavioural scales validated in the postoperative context, such as Doloplus-2 or Algoplus, are appropriate. For postoperative pain treatment, most drugs (e.g. paracetamol, nonsteroidal anti-inflammatory drugs, nefopam, tramadol, codeine, morphine, local anaesthetics), techniques (e.g. intravenous morphine titration, subcutaneous morphine, intravenous or epidural patient-controlled analgesia, intrathecal morphine, peripheral nerve block) and strategies (e.g. anticipated intraoperative analgesia or multimodal analgesia) used for acute pain management can be used in older patients. However, in view of pharmacokinetic

  3. Postoperative analgesia for cleft lip and palate repair in children

    PubMed Central

    Reena; Bandyopadhyay, Kasturi Hussain; Paul, Abhijit

    2016-01-01

    Acute pain such as postoperative pain during infancy was ignored approximately three decades ago due to biases and misconceptions regarding the maturity of the infant's developing nervous system, their inability to verbally report pain, and their perceived inability to remember pain. More recently, these misconceptions are rarely acknowledged due to enhanced understanding of the developmental neurobiology of infant pain pathways and supraspinal processing. Cleft lip and palate is one of the most common congenital abnormalities requiring surgical treatment in children and is associated with intense postoperative pain. The pain management gets further complicated due to association with postsurgical difficult airway and other congenital anomalies. Orofacial blocks like infraorbital, external nasal, greater/lesser palatine, and nasopalatine nerve blocks have been successively used either alone or in combinations to reduce the postoperative pain. Since in pediatric population, regional anesthesia is essentially performed under general anesthesia, association of these two techniques has dramatically cut down the risks of both procedures particularly those associated with the use of opioids and nonsteroidal anti-inflammatory drugs. Definitive guidelines for postoperative pain management in these patients have not yet been developed. Incorporation of multimodal approach as an institutional protocol can help minimize the confusion around this topic. PMID:27006533

  4. Postoperative endophthalmitis by Flavimonas oryzihabitans.

    PubMed

    Tsai, Chien-Kuang; Liu, Chi-Chang; Kuo, Hsi-Kung

    2004-11-01

    A 55-year-old man suffered from blurred vision of the left eye (visual acuity was counting fingers/5-10 cm) 8 days after undergoing cataract surgery. After thorough ophthalmologic examinations with gram-negative bacillus justified on smear of vitreous specimen, postoperative endophthalmitis (os) was impressed. Intravitreous injection of 1.0 mg of vancomycin, 0.4 mg of amikacin, and 0.4 mg of dexamethasone was given twice and vitreous fluid culture was also performed. However, the inflammatory condition was not well controlled. Because the results of vitreous fluid culture revealed Flavimonas oryzihabitans infection which is sensitive to piperacillin, we performed the 3rd intravitreous injection of 1.0 mg of piperacillin and 0.4 mg of dexamethasone. The inflammatory condition was under control and the visual acuity of left eye improved. For patients with ocular diseases, postoperative endophthalmitis by Flavimonas oryzihabitans is a rare condition. According to the results of this case, intravitreous injection of piperacillin was effective against the pathogen. PMID:15796259

  5. [Postoperative radiotherapy of prostate cancer].

    PubMed

    Guérif, S; Latorzeff, I; Lagrange, J-L; Hennequin, C; Supiot, S; Garcia, A; François, P; Soulié, M; Richaud, P; Salomon, L

    2014-10-01

    Between 10 and 40% of patients who have undergone a radical prostatectomy may have a biologic recurrence. Local or distant failure represents the possible patterns of relapse. Patients at high-risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration or high Gleason score at pathology. Three phase-III randomized clinical trials have shown that, for these patients, adjuvant irradiation reduces the risk of tumoral progression without higher toxicity. Salvage radiotherapy for late relapse allows a disease control in 60-70% of the cases. Several research in order to improve the therapeutic ratio of the radiotherapy after prostatectomy are evaluate in the French Groupe d'Étude des Tumeurs Urogénitales (Gétug) and of the French association of urology (Afu). The Gétug-Afu 17 trial will provide answers to the question of the optimal moment for postoperative radiotherapy for pT3-4 R1 pN0 Nx patients, with the objective of comparing an immediate treatment to a differed early treatment initiated at biological recurrence. The Gétug-Afu 22 questions the place of a short hormonetherapy combined with image-guided, intensity-modulated radiotherapy (IMRT) in adjuvant situation for a detectable prostate specific antigen (PSA). The implementation of a multicenter quality control within the Gétug-Afu in order to harmonize a modern postoperative radiotherapy will allow the development of a dose escalation IMRT after surgery. PMID:25195116

  6. Nurses management of post-operative pain.

    PubMed

    Buckley, H

    2000-06-01

    Nurses have the responsibility of adequately managing patients' post-operative pain. This literature review assesses whether nurses' management of post-operative pain is adequate or not, according to the literature findings. The findings reveal that nurses' management of patients' post-operative pain is not adequate and implies the concurrent need for improved nurse education and practice. The findings also indicate a need for ongoing research of this phenomenon. PMID:11855003

  7. Anxiolytic use in the postoperative care unit.

    PubMed

    Jellish, W Scott; O'Rourke, Michael

    2012-09-01

    Postoperative anxiety has received less attention historically than preoperative anxiety. Recognition that anxiety occurs throughout the perioperative period has led to increased interest in identifying and treating anxiety in the postoperative period. This article outlines the causes of postoperative anxiety, how it is classified, the effects of anxiety on outcomes after surgery, and some of the clinical procedures that produce the highest levels of anxiety for patients. In addition, an attempt is made to delineate the major risk factors for developing postoperative anxiety and the classic therapeutic modalities used to reduce symptoms and treat the psychological manifestations of anxiety. PMID:22989589

  8. Modified Stumper technique for acute postoperative bifurcation stenosis causing right ventricular failure after Ross procedure

    PubMed Central

    Divekar, Abhay A

    2016-01-01

    In this report, we describe a 15-year-old patient who underwent a Ross procedure for a regurgitant bicuspid aortic valve and ascending aortic dilation. After the operation was over, he could not be separated from cardiopulmonary bypass and was noted to have isolated right ventricular failure. This report takes the reader through the diagnostic evaluation, highlights the importance of invasive assessment in the immediate postoperative period, and discusses successful transcatheter intervention in the acute postoperative setting. PMID:27625524

  9. Ethics of treating postoperative pain.

    PubMed

    Jones, James W; McCullough, Laurence B

    2012-02-01

    You received a call advising that Mr S. H. Irk was in the emergency room having considerable wound pain following an above-knee amputation you performed 6 months ago. You discharged him from your clinic 6 weeks postoperatively to his primary care physician, still complaining of more pain than usual. Your examination, clinical lab tests, and X-rays do not reveal any serious problems, but he is writhing in pain and begging for relief. Mr Irk has been to a number of different physicians in the interlude including a chiropractor, a pain specialist, several primary care physicians, and a psychiatrist without relief. He has braced up with increasing amounts of analgesics, the latest of which was oral Dilaudid. His last source of pain meds on the street has dried up. You admit him with orders for analgesics. What should your treatment plan be? PMID:22264808

  10. Self-care and postoperative dressing management.

    PubMed

    Dawn Hunt, Sharon

    2016-08-11

    As the increasing burden on healthcare costs continues to rise, posing clinical and financial challenges for all healthcare providers attempting to provide optimal, evidence-based wound care, the situation appears to be reaching the tipping point with regard to reduced resources, increasing patient groups with complex wounds and financial restraints. It is clearly time for action and new ways of working that include empowering patients and carers to take appropriate ownership within their personal wound-care journey. This observational evaluation explores 10 community-based patients presenting with postoperative acute surgical wounds; it examines and evaluates the patients' experience with regard to self-care satisfaction, Leukomed Control product satisfaction and actual traditional/personal costs incurred up to a 4-week period. The evaluation highlights not only an overall positive improvement within patient satisfaction and experience, alongside optimised wound progression and related cost savings, but also offers a valuable insight into the promotion and success of patients taking ownership of their wound-care journey. PMID:27523771

  11. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  12. Improving the management of postoperative pain.

    PubMed

    Layzell, Mandy

    Despite developments in knowledge of pain control, many patients still experience unnecessary postoperative pain. This article reports on an audit of postoperative pain and its management in one trust. The results led to the development of a new system using standard prescriptions to empower nurses to manage patients' pain. PMID:16010842

  13. Covered Metallic Stent Placement in the Treatment of Postoperative Fistula Resistant to Conservative Management after Billroth I Operation

    SciTech Connect

    Kang, Yun Jung; Oh, Joo Hyeong Yoon, Yup; Kim, Eui Jong; Ryu, Kyung Nam; Lim, Joo Won; Kim, Deog Yoon; Kang, Heung Sun

    2005-01-15

    A 55-year-old man presented with a case of postoperative enterocutaneous fistula with anastomotic stenosis after a Billroth I operation that was resistant to conservative treatment. This fistula was successfully treated with the placement of a covered metallic stent under fluoroscopic guidance. To our knowledge, this is the first report of postoperative enterocutaneous fistula that was successfully treated with a covered metallic stent.

  14. Postoperative recurrence of cystic hydatidosis

    PubMed Central

    Prousalidis, John; Kosmidis, Christophoros; Anthimidis, Georgios; Kapoutzis, Konstantinos; Karamanlis, Eleutherios; Fachantidis, Epaminondas

    2012-01-01

    Background Surgical management is the basic treatment for hydatid disease. Overall, the recurrence rate appears to be high (4.6%–22.0%). The purpose of this study was to report our results in the management of recurrent hydatid disease, evaluating the methods for identifying recurrence, prognostic factors and therapeutic options. Methods We retrospectively reviewed the medical records of patients who underwent surgery for cystic hydatidosis between 1970 and 2003. Results Of the 584 patients who underwent surgery during our study period, follow-up was complete for 484 (82.8%). Cysts recurred in 51 patients (8.7%). Abdominal ultrasonography and computed tomography appeared to be efficient for diagnosing recurrence. The 2 most important determinants for recurrence were minute spillage of the hydatid cyst and inadequate treatment owing to missing cysts or incomplete pericystectomy. All but 2 recurrences required surgery. There were 14 postoperative complications for a rate of 27.0%. Thirteen re-recurrences were observed in the follow-up of these patients and also required surgery. Conclusion Avoidance of minute spillage of cyst contents and cautious removal of the parasite with as much of the pericyst as possible are fundamental objectives of primary hydatid surgery. Conservative surgery (removal of the cyst contents plus partial pericystectomy with drainage when necessary) plus chemotherapy and local sterilization is suggested for both primary and secondary operations and appears to achieve satisfactory long-term results. Radical surgery (resection, cystopericystectomy) is preferred only in select patients. PMID:21939605

  15. Postoperative pain: nurses' knowledge and patients' experiences.

    PubMed

    Francis, Lavonia; Fitzpatrick, Joyce J

    2013-12-01

    The aim of this study was to determine nurses' knowledge and attitudes regarding postoperative pain and identify postoperative patients' pain intensity experiences. The assessment and management of acute postoperative pain is important in the care of postoperative surgical patients. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing. A pilot study with an exploratory design was conducted at a large teaching hospital in the eastern United States. The convenience samples included 31 nurses from the gastrointestinal and urologic surgical units and 14 first- and second-day adult postoperative open and laparoscopic gastrointestinal and urologic patients who received patient-controlled analgesia (PCA). The Knowledge and Attitudes Survey Regarding Pain was used to measure nurses' knowledge about pain management. The Short-Form McGill Pain Questionnaire (SF-MPQ) was used to measure patients' pain intensity. The nurses' mean score on the Knowledge and Attitudes Survey Regarding Pain was 69.3%. Patients experienced moderate pain, as indicated by the score on the SF-MPQ. There is a need to increase nurses' knowledge of pain management. PMID:24315258

  16. Clinical experimental studies of postoperative infusion analgesia.

    PubMed

    Knoche, E; Dick, W; Bowdler, I; Gundlach, G

    1983-01-01

    Thirty postoperative patients, after undergoing abdominal hysterectomy and standard general anesthesia, were randomly allocated to three groups and received, in the recovery ward, a continuous infusion of either pentazocine, piritramide, or ketamine. The patients rated their pain on a 15-cm visual analog scale. Patients in group 1 received pentazocine. Mean dosage was 0.12 mg/kg/hr on the day of operation, 0.1 mg/kg/hr on the first postoperative day, and only 0.07 mg/kg/hr on the second postoperative day. Pentazocine blood levels averaged 50 micrograms/L. Patients in group 2 received piritramide. Mean dosage was 0.038 mg/kg/hr on the day of operation, 0.024 mg/kg/hr on the first postoperative day, and 0.019 mg/kg/hr on the second postoperative day. Blood levels of piritramide were not determined because no satisfactory assay is available. Patients in group 3 received ketamine. Mean dosage was 0.32 mg/kg/hr on the day of operation, 0.28 mg/kg/hr on the first postoperative day, and 0.29 mg/kg/hr on the second postoperative day. Ketamine blood levels ranged between 120 and 180 micrograms/L. None of the three analgesics caused any important hemodynamic or respiratory side effects. Pentazocine and piritramide were more effective analgesics than ketamine was. Ketamine also had a higher incidence of side effects. PMID:6627285

  17. Injectable pullulan hydrogel for the prevention of postoperative tissue adhesion.

    PubMed

    Bang, Sumi; Lee, Eungjae; Ko, Young-Gwang; Kim, Won Il; Kwon, Oh Hyeong

    2016-06-01

    Methods for reducing and preventing postoperative abdominal adhesions have been researched for decades; however, despite these efforts, the formation of postoperative peritoneal adhesions is continuously reported. Adhesions cause serious complications such as postoperative pain, intestinal obstruction, and infertility. Tissue adhesion barriers have been developed as films, membranes, knits, sprays, and hydrogels. Hydrogels have several advantages when used as adhesion barriers, including flexibility, low tissue adhesiveness, biodegradability, and non-toxic degraded products. Furthermore, compared with preformed hydrogels, injectable hydrogels can fill and cover spaces of any shape and do not require a surgical procedure for implantation. In this study, pullulan was modified through reaction with 2,2,6,6-tetramethyl-1-piperidinyloxy (TEMPO) and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) to introduce carboxyl and phenyl groups as crosslinking sites. The grafting of tyramine on pullulan allows crosslinking branches on pullulan backbone. We successfully fabricated pullulan hydrogel with an enzymatic reaction using horseradish peroxidase (HRP) and hydrogen peroxide (H2O2). The chemical structure of modified pullulan was analyzed with ATR-FTIR and (1)H NMR spectroscopies. Rheological properties were tested by measuring storage modulus with varying H2O2, HRP, polymer solution concentrations and tyramine substitution rates. Cell viability and animal tests were performed. The modified pullulan hydrogel is an invaluable advance in anti-adhesion agents. PMID:26879910

  18. Post-operative strabismus control and motor alignment for basic intermittent exotropia

    PubMed Central

    Chew, Fiona Lee Min; Gesite-de Leon, Bhambi Uellyn; Quah, Boon Long

    2016-01-01

    AIM To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up. METHODS The medical records of 80 consecutive patients aged less than 17 years of age, who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed. Pre- and post-operative characteristics were documented at 1wk, 6mo, 1, 3 and 5y follow-up. Subjects at 5-year follow-up were assigned to the success group if they had a post-operative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test, and had moderate to good strabismus control. The remaining subjects were assigned to the failure group. RESULTS Post-operative surgical success at one week was 75%, which decreased to 41% at 5y follow-up. The success group was noted to have more patching pre-operatively (P=0.003). The duration of patching a day (P=0.020) and total duration of patching pre-operatively (P=0.030) was higher in the success group. Surgical success at 1y (P=0.004) and 3y (P=0.002) were associated with higher surgical success at 5y follow-up. CONCLUSION Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up. There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery. PMID:27500110

  19. Postoperative ultrasonography of the musculoskeletal system

    PubMed Central

    Chun, Kyung Ah; Cho, Kil-Ho

    2015-01-01

    Ultrasonography of the postoperative musculoskeletal system plays an important role in the Epub ahead of print accurate diagnosis of abnormal lesions in the bone and soft tissues. Ultrasonography is a fast and reliable method with no harmful irradiation for the evaluation of postoperative musculoskeletal complications. In particular, it is not affected by the excessive metal artifacts that appear on computed tomography or magnetic resonance imaging. Another benefit of ultrasonography is its capability to dynamically assess the pathologic movement in joints, muscles, or tendons. This article discusses the frequent applications of musculoskeletal ultrasonography in various postoperative situations including those involving the soft tissues around the metal hardware, arthroplasty, postoperative tendons, recurrent soft tissue tumors, bone unions, and amputation surgery. PMID:25971901

  20. Strategies in postoperative pain assessment: validation study.

    PubMed

    Sjöström, B; Dahlgren, L O; Haljamäe, H

    1999-10-01

    Pain assessment and management are major clinical problems that many categories of healthcare professionals have to deal with. Although there are many potentially successful approaches available for pain management, there is still a shortage of knowledge about the strategies used by staff members for the actual assessment of pain and how reliable these strategies are. The fact that patients often undergo a great deal of suffering from pain and lack of adequate pain relief may be considered an indicator of this shortage of knowledge. Clinical studies from different parts of the world reveal that the incidence of pain reported by patients is still high, with about 75% reporting moderate pain and an additional 15% severe pain. The aim of the present study was to validate different categories used in acute pain assessment and their accuracy in a new clinical sample and to explore further different dimensions of how staff members experience pain assessment. Intensive care nurses (n = 10) were carrying out pain assessment of postoperative patients (n = 30). Each pain assessment was followed by a detailed interview and indicating the estimated pain intensity on a visual analogue scale (VAS, 0-10 cm). The pain ratings by the nurses were compared to those of the patients to assess the accuracy of the pain assessments of the staff members. A previously developed category system for describing the initial empirical material regarding criteria the nurses relied on when assessing pain, combined with what experience has taught them in this respect, was used to assess the validity of previous observations. The results indicate that similar approaches were still used by the nurses but the accuracy of pain assessment had considerably improved. PMID:10808821

  1. [New approach to postoperative delirium treatment].

    PubMed

    Pasechnik, I N; Makhlaĭ, A V; Tepliakova, A N; Gubaĭdullin, R R; Sal'nikov, P S; Borisov, A Iu; Berezenko, M N

    2015-01-01

    The efficiency of different drugs for sedation was studied in 51 patients after large abdominal operations complicated by postoperative delirium. Diagnosis of postoperative delirium was established according to CAM-ICU criteria. Dexmedetomidine has demonstrated significantly decreased duration of delirium and hospital stay in intensive care unit in comparison with haloperidol. Besides, patients which received dexmedetomidine preserved opportunity for verbal contact. Also these patients interacted better with department's stuff. PMID:26031955

  2. Current issues in postoperative pain management.

    PubMed

    Rawal, Narinder

    2016-03-01

    Postoperative pain has been poorly managed for decades. Recent surveys from USA and Europe do not show any major improvement. Persistent postoperative pain is common after most surgical procedures, and after thoracotomy and mastectomy, about 50% of patients may experience it. Opioids remain the mainstay of postoperative pain treatment in spite of strong evidence of their drawbacks. Multimodal analgesic techniques are widely used but new evidence is disappointing. Regional anaesthetic techniques are the most effective methods to treat postoperative pain. Current evidence suggests that epidural analgesia can no longer be considered the 'gold standard'. Perineural techniques are good alternatives for major orthopaedic surgery but remain underused. Infiltrative techniques with or without catheters are useful for almost all types of surgery. Simple surgeon-delivered local anaesthetic techniques such as wound infiltration, preperitoneal/intraperitoneal administration, transversus abdominis plane block and local infiltration analgesia can play a significant role in improvement of postoperative care, and the last of these has changed orthopaedic practice in many institutions. Current postoperative pain management guidelines are generally 'one size fits all'. It is well known that pain characteristics such as type, location, intensity and duration vary considerably after different surgical procedures. Procedure-specific postoperative pain management recommendations are evidence based, and also take into consideration the role of anaesthetic and surgical techniques, clinical routines and risk-benefit aspects. The role of acute pain services to improve pain management and outcome is well accepted but implementation seems challenging. The need for upgrading the role of surgical ward nurses and collaboration with surgeons to implement enhanced recovery after surgery protocols with regular audits to improve postoperative outcome cannot be overstated. PMID:26509324

  3. Combined Endoscopic-Radiological Rendezvous for Distal Tail Postoperative Pancreatic Fistula (POPF).

    PubMed

    Lucatelli, Pierleone; Sacconi, Beatrice; Cereatti, Fabrizio; Argirò, Renato; Corona, Mario; Bezzi, Mario; Fanelli, Fabrizio; Fiocca, Fausto; Saba, Luca; Catalano, Carlo

    2016-09-01

    Postoperative pancreatic fistula (POPF) with leakage of pancreatic juice is a rare, severe complication following pancreatic resection or, less commonly, splenectomy. Definitive treatment can require multidisciplinary approaches. We report a case of stenosis of the main pancreatic duct with distal tail GRADE C POPF, occurred after splenectomy for Hodgkin lymphoma, successfully treated with combined radiological-endoscopic approach. PMID:27048486

  4. Emergency Balloon Embolization for Carotid Artery Rupture Secondary to Postoperative Infection

    SciTech Connect

    Hirai, Toshinori; Korogi, Yukunori; Sakamoto, Yuji; Hamatake, Satoshi; Murakami, Ryuji; Ikushima, Ichiro; Takahashi, Mutsumasa

    1996-11-15

    Two cases of carotid artery rupture due to postoperative infection were treated successfully with an emergency endovascular technique. A detachable balloon was attached to a 2 Fr microcatheter and was introduced through a 9 Fr guiding catheter. The balloons were detached at the rupture site and just proximal to the lesion. This technique has several advantages over surgical procedures.

  5. Nursing documentation of postoperative pain management.

    PubMed

    Idvall, Ewa; Ehrenberg, Anna

    2002-11-01

    Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware. PMID:12427178

  6. Capitol Success.

    PubMed

    Sorrel, Amy Lynn

    2015-08-01

    This legislative session, medicine resolved to ensure physicians can give their patients the best care possible. The hard work paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes. PMID:26263520

  7. Biomarkers of postoperative delirium and cognitive dysfunction

    PubMed Central

    Androsova, Ganna; Krause, Roland; Winterer, Georg; Schneider, Reinhard

    2015-01-01

    Elderly surgical patients frequently experience postoperative delirium (POD) and the subsequent development of postoperative cognitive dysfunction (POCD). Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers. PMID:26106326

  8. Peppermint oil: a treatment for postoperative nausea.

    PubMed

    Tate, S

    1997-09-01

    This paper describes a research study to investigate the efficacy of peppermint oil as a treatment for postoperative nausea. It uses a three-condition experimental design using statistical analysis to compare groups. The Kruskal-Wallis test was used to establish significance and the Mann-Whitney test to differentiate significance between the groups. The control, placebo and experimental groups of gynaecological patients were compared, using variables known to affect postoperative nausea. They were found to be homogeneous for the purposes of the study. A statistically significant differences was demonstrated on the day of operation, using the Kruskal-Wallis test, P = 0.0487. Using the Mann-Whitney test the difference was shown to be between the placebo and experimental group (U = 3; P = 0.02). The experimental group also required less traditional antiemetics and received more opioid analgesia postoperatively. The total cost of the treatment was 48 pence per person. PMID:9378876

  9. Recent Advances in Postoperative Pain Management

    PubMed Central

    Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak

    2010-01-01

    Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. Clinical wind up occurs from the processes of N-Methyl D-Aspartate (NMDA) activation, wind up central sensitization, long-term potentiation of pain (LTP), and transcription-dependent sensitization. Advances in the knowledge of molecular mechanisms have led to the development of multimodal analgesia and new pharmaceutical products to treat postoperative pain. The new pharmacological products to treat postoperative pain include extended-release epidural morphine and analgesic adjuvants such as capsaicin, ketamine, gabapentin, pregabalin dexmetomidine, and tapentadol. Newer postoperative patient-controlled analgesia (PCA) in modes such as intranasal, regional, transdermal, and pulmonary presents another interesting avenue of development. PMID:20351978

  10. MR imaging of the postoperative knee.

    PubMed

    Gnannt, Ralph; Chhabra, Avneesh; Theodoropoulos, John S; Hodler, Juerg; Andreisek, Gustav

    2011-11-01

    Advances in orthopedic and arthroscopic surgical procedures of the knee such as, knee replacement, ligamentous reconstruction as well as articular cartilage and meniscus repair techniques have resulted in a significant increase in the number of patients undergoing knee arthroscopy or open surgery. As a consequence postoperative MR imaging examinations increase. Comprehensive knowledge of the normal postoperative MR imaging appearances and abnormal findings in the knee associated with failure or complications of common orthopedic and arthroscopic surgical procedures currently undertaken is crucial. This article reviews the various normal and pathological postoperative MR imaging findings following anterior and posterior cruciate ligament, medial collateral ligament and posterolateral corner reconstruction, meniscus and articular cartilage surgery as well as total knee arthroplasty with emphasis on those surgical procedures which general radiologists will likely be faced in their daily clinical routine. PMID:22002752

  11. Evaluation for postoperative recurrence of Crohn disease.

    PubMed

    Swoger, Jason M; Regueiro, Miguel

    2012-06-01

    Disease recurrence following resective surgery for Crohn disease remains a challenging clinical problem, and more studies are needed to better define risk stratification and treatment recommendations in the postoperative setting. Endoscopy remains the gold standard for the assessment of postoperative disease recurrence, and all Crohn disease patients who undergo surgery should undergo ileocolonoscopy within 6 to 12 months of surgery. The degree of endoscopic recurrence in the neoterminal ileum during this procedure provides prognostic information regarding the severity of the future disease course. WCE, MRE, and SICUS are all promising noninvasive modalities to assess for postoperative Crohn disease activity. However, further studies are needed to better define scoring systems, operating characteristics and variability, and prognostic data for each of these modalities. In patients at risk for early disease recurrence, more aggressive prophylactic therapy should be considered, in hopes of delivering true “top-down” therapy that may offer maximum impact in altering the natural history of Crohn disease. PMID:22500519

  12. Metabolic dysfunction in lymphocytes promotes postoperative morbidity.

    PubMed

    Edwards, Mark R; Sultan, Pervez; del Arroyo, Ana Gutierrez; Whittle, John; Karmali, Shamir N; Moonesinghe, S Ramani; Haddad, Fares S; Mythen, Michael G; Singer, Mervyn; Ackland, Gareth L

    2015-09-01

    Perioperative lymphopenia has been linked with an increased risk of postoperative infectious complications, but the mechanisms remain unclear. We tested the hypothesis that bioenergetic dysfunction is an important mechanism underlying lymphopenia, impaired functionality and infectious complications. In two cohorts of patients (61-82 years old) undergoing orthopaedic joint replacement (n=417 and 328, respectively), we confirmed prospectively that preoperative lymphopenia (≤1.3 x 10(9)·l(-1); <20% white cell count; prevalence 15-18%) was associated with infectious complications (relative risk 1.5 (95% confidence interval 1.1-2.0); P=0.008) and prolonged hospital stay. Lymphocyte respirometry, mitochondrial bioenergetics and function were assessed (n=93 patients). Postoperative lymphocytes showed a median 43% fall (range: 26-65%; P=0.029; n=13 patients) in spare respiratory capacity, the extra capacity available to produce energy in response to stress. This was accompanied by reduced glycolytic capacity. A similar hypometabolic phenotype was observed in lymphocytes sampled preoperatively from chronically lymphopenic patients (n=21). This hypometabolic phenotype was associated with functional lymphocyte impairment including reduced T-cell proliferation, lower intracellular cytokine production and excess apoptosis induced by a range of common stressors. Glucocorticoids, which are ubiquitously elevated for a prolonged period postoperatively, generated increased levels of mitochondrial reactive oxygen species, activated caspase-1 and mature interleukin (IL)-1β in human lymphocytes, suggesting inflammasome activation. mRNA transcription of the NLRP1 inflammasome was increased in lymphocytes postoperatively. Genetic ablation of the murine NLRP3 inflammasome failed to prevent glucocorticoid-induced lymphocyte apoptosis and caspase-1 activity, but increased NLRP1 protein expression. Our findings suggest that the hypometabolic phenotype observed in chronically lymphopenic

  13. Pathogenesis of postoperative oral surgical pain.

    PubMed Central

    Ong, Cliff K. S.; Seymour, R. A.

    2003-01-01

    Pain is a major postoperative symptom in many oral surgical procedures. It is a complex and variable phenomenon that can be influenced by many factors. Good management of oral surgical pain requires a detailed understanding of the pathogenesis of surgical pain. This article aims at reviewing postoperative pain from a broad perspective by looking into the nociception, neuroanatomy, neurophysiology, and neuropharmacology of pain. Therapeutic recommendations are made after reviewing the evidence from the literature for maximizing the efficacy of pain management techniques for oral surgical pain. PMID:12722900

  14. [Some immunologic aspects in postoperative peritonitis].

    PubMed

    Perfil'ev, D F

    1998-01-01

    Examination of blood serum and cellular elements of 45 patients with postoperative diffuse purulent peritonitis shows that in the majority of examined persons before and in the first days after the operation immunodepression exists. The dynamics of immunologic disturbances (antibody titers, phagocytosis, immunoglobulines, T- and B-lymphocytes) are sufficiently informative and as a rule, correlate with clinical course of peritonitis. Adequate reaction of the organism to infection resulted in a favourable outcome. Low values of immunologic indices in postoperative period necessitate the use of stimulant therapy in combined treatment of this complication. PMID:9916429

  15. Postoperative Care and Monitoring of the Reconstructed Head and Neck Patient

    PubMed Central

    Salgado, Christopher J.; Chim, Harvey; Schoenoff, Shayla; Mardini, Samir

    2010-01-01

    Reconstruction of head and neck patients using free tissue transfer is perhaps the most challenging of areas in the human body. Although complications are inevitable in a percentage of patients, it is good postoperative care and monitoring that determines the success or failure of the reconstruction and also permits early salvage of a failing free flap. Teamwork and cooperation among members of the reconstructive team are critical. Here we review the significance of clinical care and monitoring of reconstructed head and neck patients in the intraoperative and postoperative periods. We also review different techniques and strategies for flap monitoring and anticoagulation used for free tissue transfers. PMID:22550449

  16. Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy

    PubMed Central

    Jeon, Hyun Woo; Kye, Yeo Kon; Kim, Kyung Soo

    2016-01-01

    Background Primary spontaneous pneumothorax (PSP) is a relatively common disorder in young patients. Although various surgical techniques have been introduced, recurrence after video-assisted thoracoscopic surgery (VATS) remains high. The aim of study was to identify the risk factors for postoperative recurrence after thoracoscopic bullectomy in the spontaneous pneumothorax. Methods From January 2011 through March 2013, two hundreds and thirty two patients underwent surgery because of pneumothorax. Patients with a secondary pneumothorax, as well as cases of single port surgery, an open procedure, additional pleural procedure (pleurectomy, pleural abrasion) or lack of medical records were excluded. The records of 147 patients with PSP undergoing 3-port video-assisted thoracoscopic bullectomy with staple line coverage using an absorbable polyglycolic acid (PGA) sheet were retrospectively reviewed. Results The median age was 19 years (range, 11−34 years) with male predominance (87.8%). Median postoperative hospital stay was 3 days (range, 1−10 days) without mortality. Complications were developed in five patients. A total of 24 patients showed postoperative recurrence (16.3%). Younger age less than 17 years old and immediate postoperative air leakage were risk factors for postoperative recurrence after thoracoscopic bullectomy by multivariate analysis. Conclusions Immediate postoperative air leakage was the risk factor for postoperative recurrence. However, further study will be required for the correlation of air leakage with recurrence. PMID:26904217

  17. Post-operative rehabilitation and nutrition in osteoarthritis.

    PubMed

    Musumeci, Giuseppe; Mobasheri, Ali; Trovato, Francesca Maria; Szychlinska, Marta Anna; Imbesi, Rosa; Castrogiovanni, Paola

    2014-01-01

    Osteoarthritis (OA) is a degenerative process involving the progressive loss of articular cartilage, synovial inflammation and structural changes in subchondral bone that lead to loss of synovial joint structural features and functionality of articular cartilage. OA represents one of the most common causes of physical disability in the world. Different OA treatments are usually considered in relation to the stage of the disease. In the early stages, it is possible to recommend physical activity programs that can maintain joint health and keep the patient mobile, as recommended by OA Research Society International (OARSI) and European League Against Rheumatism (EULAR). In the most severe and advanced cases of OA, surgical intervention is necessary. After, in early postoperative stages, it is essential to include a rehabilitation exercise program in order to restore the full function of the involved joint. Physical therapy is crucial for the success of any surgical procedure and can promote recovery of muscle strength, range of motion, coordinated walking, proprioception and mitigate joint pain. Furthermore, after discharge from the hospital, patients should continue the rehabilitation exercise program at home associated to an appropriate diet. In this review, we analyze manuscripts from the most recent literature and provide a balanced and comprehensive overview of the latest developments on the effect of physical exercise on postoperative rehabilitation in OA. The literature search was conducted using PubMed, Scopus, Web of Science and Google Scholar, using the keywords 'osteoarthritis', 'rehabilitation', 'exercise' and 'nutrition'. The available data suggest that physical exercise is an effective, economical and accessible to everyone practice, and it is one of the most important components of postoperative rehabilitation for OA. PMID:26962431

  18. Incidence of postoperative wound infections after open tendo Achilles repairs

    PubMed Central

    Marican, Mohd Mizan; Fook-Chong, Stephanie Man Chung; Rikhraj, Inderjeet Singh

    2015-01-01

    INTRODUCTION Tendo Achilles (TA), which is the confluence of the gastrocnemius and soleus muscles, is one of the most commonly injured tendons. The surgical repair of TA ruptures is associated with a significant risk of infection. This study examined several factors (i.e. gender, age, body mass index, history of diabetes mellitus, steroid use, acute or chronic TA injuries, type of surgical incision and type of sutures used) that may be associated with postoperative wound infection after open TA repair. METHODS This was a retrospective study involving 60 patients who underwent open TA repair over an 18-month period. Patients who had prior TA surgery or open TA injuries, or who needed soft tissues flaps were excluded. RESULTS Among the patients, 7 (11.7%) developed superficial wound infections that were successfully treated with oral antibiotics, while 3 (5.0%) developed deep wound infections that required at least one debridement procedure. No significant association was found between the risk of postoperative wound infection and gender, age, the presence of diabetes mellitus, acute or chronic ruptures, site of surgical incision and type of deep or superficial sutures used. CONCLUSION While diabetes mellitus and age did not appear to be associated with postoperative wound infections after open TA repair, obese patients were found to be two times more likely to develop a wound infection than normal-weight patients. The incidence of superficial wound infections in this study was similar to previously published results (11.7% vs. 8.2%–14.6%), but the incidence of deep infections was higher (5% vs. 1%–2%). PMID:26512146

  19. Sublingual Sufentanil: A Review in Acute Postoperative Pain.

    PubMed

    Frampton, James E

    2016-04-01

    The sufentanil sublingual tablet system (SSTS; Zalviso(®)) is a novel patient-controlled analgesia (PCA) device intended to overcome some of the drawbacks of opioid-based intravenous PCA (IV-PCA). Based on the results of three phase III studies, the SSTS has been approved in the EU for the management of acute moderate to severe postoperative pain in adults in a hospital setting. In a head-to-head comparison with morphine, the gold standard for opioid-based IV-PCA, the SSTS was associated with a more rapid onset of analgesia and higher rates of success, based on patient and healthcare professional global assessments of the method of pain control. Patients and healthcare professionals also rated the SSTS as being easier to use and expressed a greater level of overall satisfaction with this device. The SSTS was generally well tolerated, with an adverse event profile typical of that of other opioids and generally similar to that of placebo. By virtue of its preprogrammed, noninvasive design, the SSTS avoids the risk of pump programming errors and other complications (e.g. infections and analgesic gaps) that can occur with IV-PCA technology; it also imposes less restriction on postoperative mobility. As such, the SSTS provides an effective alternative to opioid-based IV-PCA for the management of acute moderate to severe postoperative pain. Future studies should ideally focus on evaluating the relative cost effectiveness of the SSTS and comparing it with other available needle-free PCA modalities. PMID:27067596

  20. Post-operative rehabilitation and nutrition in osteoarthritis

    PubMed Central

    Musumeci, Giuseppe; Mobasheri, Ali; Trovato, Francesca Maria; Szychlinska, Marta Anna; Imbesi, Rosa; Castrogiovanni, Paola

    2016-01-01

    Osteoarthritis (OA) is a degenerative process involving the progressive loss of articular cartilage, synovial inflammation and structural changes in subchondral bone that lead to loss of synovial joint structural features and functionality of articular cartilage. OA represents one of the most common causes of physical disability in the world. Different OA treatments are usually considered in relation to the stage of the disease. In the early stages, it is possible to recommend physical activity programs that can maintain joint health and keep the patient mobile, as recommended by OA Research Society International (OARSI) and European League Against Rheumatism (EULAR). In the most severe and advanced cases of OA, surgical intervention is necessary. After, in early postoperative stages, it is essential to include a rehabilitation exercise program in order to restore the full function of the involved joint. Physical therapy is crucial for the success of any surgical procedure and can promote recovery of muscle strength, range of motion, coordinated walking, proprioception and mitigate joint pain. Furthermore, after discharge from the hospital, patients should continue the rehabilitation exercise program at home associated to an appropriate diet. In this review, we analyze manuscripts from the most recent literature and provide a balanced and comprehensive overview of the latest developments on the effect of physical exercise on postoperative rehabilitation in OA. The literature search was conducted using PubMed, Scopus, Web of Science and Google Scholar, using the keywords ‘osteoarthritis’, ‘rehabilitation’, ‘exercise’ and ‘nutrition’. The available data suggest that physical exercise is an effective, economical and accessible to everyone practice, and it is one of the most important components of postoperative rehabilitation for OA. PMID:26962431

  1. Postoperative nausea and vomiting following orthognathic surgery

    PubMed Central

    Phillips, C.; Brookes, C. D.; Rich, J.; Arbon, J.; Turvey, T. A.

    2015-01-01

    The purpose of this study was to assess the incidence and risk factors associated with postoperative nausea (PON) and vomiting (POV) after orthognathic surgery. A review of the clinical records of consecutively enrolled subjects (2008–2012) at a single academic institution was conducted between 9/2013 and 3/2014. Data on the occurrence of PON and POV and potential patient-related, intraoperative, and postoperative explanatory factors were extracted from the medical records. Logistic models were used for the presence/absence of postoperative nausea and vomiting separately. Data from 204 subjects were analyzed: 63% were female, 72% Caucasian, and the median age was 19 years. Thirty-three percent had a mandibular osteotomy alone, 27% a maxillary osteotomy alone, and 40% had bimaxillary osteotomies. Sixty-seven percent experienced PON and 27% experienced POV. The most important risk factors for PON in this series were female gender, increased intravenous fluids, and the use of nitrous oxide, and for POV were race, additional procedures, and morphine administration. The incidence of PON and POV following orthognathic surgery in the current cohort of patients, after the introduction of the updated 2007 consensus guidelines for the management of postoperative nausea and vomiting, has not decreased substantially from that reported in 2003–2004. PMID:25655765

  2. [Postoperative nutritional management for esophageal cancer patients].

    PubMed

    Ikeda, Kenichiro; Kimura, Y

    2008-07-01

    High incidence of malnutrition is found in esophageal cancer patients. It is well known that to maintain good nutritional preoperative condition is very important to prevent postoperative morbidity and mortality. Hence, preoperative oral or nasogastric feeding is recommended when the patient is malnourished, at a total dose of 30 kcal/kg/day. During postoperative period, enteral nutrition should be primarily performed because of its favorable effects on immune-status and intestinal integrity to avoid septic complications. It is also important to keep circulatory volume sufficient to provide oxygen demand during catabolic phase, which leads earlier recovery from critical illness. Enteral nutrition should be immediately started afterward. An initial dose of 5-10 kcal/kg/day of the enteral nutrition is performed from the 1st or 2nd postoperative day and gradually increased to the full dose at 30 kcal/kg/ day. In cases of not administering scheduled dose of the enteral nutrition, either total or peripheral parenteral nutrition is required complementing total caloric intake. When total parenteral nutrition is used, blood glucose level should be controlled less than 150 mg/dl by pertinently administering insulin or limiting glycemic intake. Immunonutrition is promising nutritional management for critical surgical patients such as those performed esophageal cancer surgery. Continuing immune-enhancing diet at a dose of 750 to 1,000 ml/day for 5 to 7 days before surgery is necessary to bring good postoperative outcome. PMID:20715418

  3. [Clinical experimental studies of postoperative infusion analgesia].

    PubMed

    Dick, W; Knoche, E; Grundlach, G; Klein, I

    1983-06-01

    30 postoperative patients, who had undergone abdominal gynaecological surgery with standard general anaesthesia were randomly divided into three groups and received, in the recovery ward, a continuous infusion of either pentazocine, piritramid, or ketamine. The patients rated their pain on a 15 cm pain analogue score. Group I pentazocine: Mean dosage on the day of operation 0.12 mg/kg/h, 0.1 mg/kg/h on the first and only 0.07 mg/kg/h on the second postoperative day. Pentazocine blood levels were on average 50 micrograms/l. Group II piritramid: Mean dosage on the day of operation 0.038 mg/kg/h, 0.024 mg/kg/h on the first and 0.019 mg/kg/h on the second postoperative day. Blood levels of piritramid were not determined because there is no satisfactory assay available. Group III ketamine: mean dosage on the day of operation 0.32 mg/kg/h, 0.28 mg/kg/h on the first and 0.29 mg/kg/h on the second postoperative day. Ketamine blood levels lay between 120 and 180 micrograms/l. The three analgesics did not cause any important haemodynamic or respiratory side effects. Pentazocine and piritramid were the most effective analgesics, ketamine was the least effective with a high incidence of side effects. PMID:6412586

  4. Postoperative sore throat: a systematic review.

    PubMed

    El-Boghdadly, K; Bailey, C R; Wiles, M D

    2016-06-01

    Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre-existing lung disease, prolonged duration of anaesthesia and the presence of a blood-stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double-lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i-gel(™) supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence. PMID:27158989

  5. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  6. Management of common postoperative complications: delirium.

    PubMed

    Javedan, Houman; Tulebaev, Samir

    2014-05-01

    Delirium is a common postoperative surgical complication associated with poor outcomes. The complexity of delirium demands that each patient be assessed individually and a tailored prevention and treatment regimen be put in place. Nonpharmacologic and pharmacologic strategies are available to achieve this goal. PMID:24721366

  7. Immediate postoperative feeding in urological surgery.

    PubMed

    Seidmon, E J; Pizzimenti, K V; Blumenstock, F A; Huben, R P; Wajsman, Z; Pontes, J E

    1984-06-01

    The value of immediate postoperative enteral hyperalimentation with an elemental diet (high nitrogen Vivonex, full strength) at 125 cc per hour for 4 days was assessed in patients after radical urological surgery. Of 32 patients studied 21 received an elemental diet using a Vivonex Moss tube, which is a 3-lumen tube with esophagogastric decompression and simultaneous duodenal feeding, and the remaining 11 had a nasogastric tube only without nutritional support. We have used a selected group of parameters, including serum albumin, serum transferrin, creatinine height index, weight loss, total lymphocyte count, nitrogen balance and plasma fibronectin. All patients in the Moss tube group approached or achieved positive nitrogen balance by 4 days postoperatively, whereas the nasogastric tube group remained in negative nitrogen balance. Postoperative paralytic ileus was prevented in the majority of patients in the Moss tube group while receiving full nutritional support. We have found that the use of the Moss tube is a reasonable approach for postoperative alimentation. The tube is relatively easy to insert and well tolerated, and its use is a less expensive alternative to parenteral hyperalimentation. PMID:6427479

  8. Physiopathology and control of postoperative pain.

    PubMed

    Pflug, A E; Bonica, J J

    1977-06-01

    Potent systemic (narcotic) analgesics, when given in doses sufficient to produce ample pain relief, usually also produce mental and respiratory depression and, at times, circulatory impairment, that prolong postoperative morbidity. Complications due to morphine sulfate or meperidine hydrochloride can be minimized by titrating the patient's pain with small intravenous doses of narcotics (morphine sulfate, 2 to 3 mg, or meperidine hydrochloride, 15 to 25 mg) administered slowly at 15- to 20-minute intervals until the pain is relieved. On the third or fourth postoperative day, acetaminophen tablets usually suffice to provide relief of pain with little or no risk to patients. Continuous segmental epidural block or intercostal block, with or without splanchnic block, provide excellent pain relief that, in contrast to the narcotic, is complete. These are especially useful after operations on the chest or abdomen or the lower extremity. Regional analgesia is especially indicated in patients not adequately relieved from severe postoperative pain with narcotics, or when these drugs are contraindicated by advanced pulmonary, renal, or hepatic disease. Continuous caudal analgesia is also effective to completely releive severe postoperative pain in the lower limbs and perineum. PMID:871249

  9. Postoperative adjuvant therapy of breast cancer. Oncology Overview

    SciTech Connect

    Not Available

    1984-12-01

    Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature related to their research being published by other laboratories throughout the world. Each Oncology Overview represents a survey of the literature associated with a selected area of cancer research. It contains abstracts of articles which have been selected and organized by researchers associated with the field. Contents: Postoperative chemotherapy; Postoperative radiotherapy; Postoperative hormone therapy; Postoperative immunotherapy and chemoimmunotherapy; Postoperative multimodal therapy; Prognostic factors in postoperative adjuvant therapy.

  10. Project Success.

    ERIC Educational Resources Information Center

    Meredith, Larry D.

    Project Success consists of after-school, weekend, and summer educational programs geared toward minority and disadvantaged students to increase their numbers seeking postsecondary education from the Meadville, Pennsylvania area. The project is funded primarily through the Edinboro University of Pennsylvania, whose administration is committed to…

  11. Lower-extremity amputation with immediate postoperative prosthetic placement.

    PubMed

    Folsom, D; King, T; Rubin, J R

    1992-10-01

    To study the efficacy of an immediate postoperative prosthesis (IPOP) program, a retrospective review of 167 major lower-extremity amputations was performed. Patient enrollment in the IPOP program was based on the individual's potential for rehabilitation and participation in an aggressive postoperative physical therapy regimen, as determined by the surgeon, prosthetist, physical therapist, and social worker. Indications for amputation were intractable infection and/or severe unreconstructable arterial insufficiency. Sixty-five patients underwent 69 amputations with IPOP (59 below knee; 10 above knee). Successful program completion was defined as independent ambulation and occurred in 86% of those patients enrolled. The average interval from amputation to ambulation was 15.2 days for the below-knee amputees and 9.3 days for the above-knee amputees. Failure to complete the program occurred in 14% of patients and was due to noncompliance, stump infection, stump trauma, and death. The results of this review support the use of IPOP after major lower-extremity amputation. PMID:1415937

  12. A comparative study of intravenous paracetamol and intravenous tramadol for postoperative analgesia in laparotomies

    PubMed Central

    Shahid, Mohammed; Manjula, B. P.; Sunil, B. V.

    2015-01-01

    Background: Pain in the perioperative setting or thereafter plays a significant role in delaying an otherwise successful recovery. Hence, mitigation of such postoperative pain assumes importance. Among the various agents employed for such mitigation, opioids and non-steroidal anti-inflammatory drugs have for some time taken center stage. However, alas they are not without their share of adverse effects. This study was undertaken with the purpose of elucidating the efficacy of intravenous (IV) paracetamol as compared to IV tramadol in mitigating postoperative pain while observing its effect on hemodynamic stability and the presence of adverse drug reactions, if any. Materials and Methods: A total of 60 randomized cases aged ranges from 20 to 60 years of both sexes divided into two groups (each for paracetamol and tramadol) scheduled for laparotomies were administered IV paracetamol and tramadol for postoperative pain relief and assessed with visual analog scale (VAS) score and variations in vital parameters to ascertain extent of pain relief and post-operative nausea vomiting (PONV). Results: Data so collected was statistically interpreted, and observations extrapolated. Save for a perceptible decline in PONV with paracetamol group compared with tramadol group with a statistically significant P < 0.001, nothing statistically significant was observed in any other parameter, including VAS scores between either group. Conclusion: IV paracetamol is a safer alternative to tramadol with lesser PONV in the postoperative period translates into the lesser duration of hospitalization and hence earlier discharge. PMID:26712966

  13. Postoperative ventilatory and circulatory effects of heating after aortocoronary bypass surgery. Postoperative external heat supply.

    PubMed

    Joachimsson, P O; Nyström, S O; Tydén, H

    1987-08-01

    The effects of postoperative external heat supply on shivering, oxygen uptake, carbon dioxide production, ventilatory requirements and haemodynamic variables were studied postoperatively after aortocoronary bypass surgery in 24 men with stable angina pectoris. After hypothermic cardiopulmonary bypass (CPB) at 25 degrees C, the patients were rewarmed to a nasopharyngeal temperature of at least 38 degrees C, resulting in a rectal temperature of about 34 degrees C before termination of CPB. Twelve patients, forming the control group, were given no other external heat supply. In another group (n = 12), the "radiant heat supply group", additional external heat was provided postoperatively, the main source of which was a thermal ceiling supplemented with heated, humidified respiratory gases. In this latter group the postoperative rewarming was accomplished earlier and was converted into a mainly passive process. Shivering, oxygen uptake, CO2 production and ventilation volumes were significantly reduced compared with the control group. Cardiac index and stroke index were higher and systemic oxygen extraction was lower in the radiant heat supply group. Postoperative hypertension and vasoconstriction were greatly decreased, suggesting that residual hypothermia is an important cause of the postoperative vasoconstriction. PMID:3115049

  14. Impact of Postoperative Venous Thromboembolism on Postoperative Morbidity, Mortality, and Resource Utilization after Hepatectomy.

    PubMed

    Newhook, Timothy E; LaPar, Damien J; Walters, Dustin M; Gupta, Shruti; Jolissaint, Joshua S; Adams, Reid B; Brayman, Kenneth L; Zaydfudim, Victor M; Bauer, Todd W

    2015-12-01

    The impact of venous thromboembolism (VTE) after hepatectomy on patient morbidity, mortality, and resource usage remains poorly defined. Better understanding of thromboembolic complications is needed to improve perioperative management and overall outcomes. About 3973 patients underwent hepatectomy within NSQIP between 2005 and 2008. Patient characteristics, operative features, and postoperative correlates of VTE were compared with identify risk factors for VTE and to assess its overall impact on postoperative outcomes. Overall incidence of postoperative VTE was 2.4 per cent. Risk factors for postoperative VTE included older age, male gender, compromised functional status, degree of intraoperative blood transfusion, preoperative albumin level (all P < 0.05), and extent of hepatectomy (P = 0.004). Importantly, major postoperative complications, including acute renal failure, pneumonia, sepsis, septic shock, reintubation, prolonged ventilation, cardiac arrest, and reoperation were all associated with higher rates of VTE (all P < 0.05). Operative mortality was increased among patients with VTE (6.5% vs 2.4%, P = 0.03), and patients with VTE had a 2-fold increase in hospital length of stay (12.0 vs 6.0 days, P < 0.001). Postoperative VTE remains a significant source of morbidity, mortality, and increased resource usage after hepatectomy in the United States. Routine aggressive VTE prophylaxis measures are imperative to avoid development of VTE among patients requiring hepatectomy. PMID:26736156

  15. A Minimally Invasive Approach for Postoperative Pancreatic Fistula

    SciTech Connect

    Yamazaki, Shintaro Kuramoto, Kenmei; Itoh, Yutaka; Watanabe, Yoshika; Ueda, Toshisada

    2003-11-15

    Pancreas fistula is a well-known and severe complication of pancreaticoduodenectomy. It is difficult to control with conservative therapy, inducing further complications and severe morbidity. Until now, re-operation has been the only way to resolve pancreatic fistula causing complete dehiscence of the pancreatic-enteric anastomosis (complete pancreatic fistula). Percutaneous transgastric fistula drainage is one of the treatments for pancreatic fistula. This procedure allows both pancreas juice drainage and anastomosis re-construction at the same time. This is effective and minimally invasive but difficult to adapt to a long or complicated fistula. In particular, dilatation of the main pancreatic duct is indispensable. This paper reports the successful resolution of a postoperative pancreatic fistula by a two-way-approach percutaneous transgastric fistula drainage procedure. Using a snare catheter from the fistula and a flexible guidewire from the transgastric puncture needle, it can be performed either with or without main pancreatic duct dilatation.

  16. Critic appraisal. Postoperative sensitivity with indirect restorations.

    PubMed

    Farias, David; Walter, Ricardo; Swift, Edward J

    2014-01-01

    Postoperative sensitivity is characterized by short and sharp pain, and often experienced after cementation of indirect restorations. Factors associated with the occurrence of post-cementation sensitivity include type of cement, removal of smear layer by acid-etching, aggressive tooth preparation, inadequate provisional restorations, and patient's age. Its prevention is based on either interfering with mechanoreceptor activity or occluding the dentinal tubules. Regarding the latter, application of dentin desensitizers may be effective for blocking the tubules and significantly reducing dentin permeability and consequently postoperative sensitivity. This Critical Appraisal will present available clinical data where traditional materials such as zinc phosphate and glass ionomer cements (GIC) as well as self-adhesive resin-based cements were used. PMID:24761824

  17. Post-operative pulmonary complications after thoracotomy

    PubMed Central

    Sengupta, Saikat

    2015-01-01

    Pulmonary complications are a major cause of morbidity and mortality in the post-operative period after thoracotomy. The type of complications and the severity of complications depend on the type of thoracic surgery that has been performed as well as on the patient's pre-operative medical status. Risk stratification can help in predicting the possibility of the post-operative complications. Certain airway complications are more prone to develop with thoracic surgery. Vocal cord injuries, bronchopleural fistulae, pulmonary emboli and post-thoracic surgery non-cardiogenic pulmonary oedema are some of the unique complications that occur in this subset of patients. The major pulmonary complications such as atelectasis, bronchospasm and pneumonia can lead to respiratory failure. This review was compiled after a search for search terms within ‘post-operative pulmonary complications after thoracic surgery and thoracotomy’ on search engines including PubMed and standard text references on the subject from 2000 to 2015. PMID:26556921

  18. Limited efficacy of early postoperative jejunal feeding.

    PubMed

    Hayashi, J T; Wolfe, B M; Calvert, C C

    1985-07-01

    Twenty patients underwent placement of a jejunal catheter for early postoperative feeding at the time of upper abdominal operations, and a control group of 11 patients underwent operative procedures of similar magnitude without jejunostomy. Advancement of the rate of feeding to target intake over 6 to 7 days was attempted. Complications from the feeding led to cessation or curtailment of intake in 65 percent of the patients. Specific complications included abdominal pain and distention, diarrhea, and retrograde reflux of the feeding into the stomach. No statistically significant difference in nitrogen balance was demonstrated between the fed and unfed groups, presumably due to the limitations of nutrient delivery or absorption in the fed groups or elevated breath hydrogen excretion in patients with abdominal pain and distention suggests that the nature of the nutrients, particularly complex carbohydrates, is a factor in the development of feeding complications. Caution must be exercised in advancing the rate of postoperative jejunal feeding. PMID:3925800

  19. Cardiac risk assessment: decreasing postoperative complications.

    PubMed

    Thanavaro, Joanne L

    2015-02-01

    Preoperative cardiac assessment helps identify patients undergoing noncardiac surgery who are at risk for significant postoperative cardiac complications and those who may benefit from additional preoperative evaluation and perioperative care. Advanced practice nurses can identify surgery- and patient-related risks by conducting a thorough health history and physical examination. Multiple risk indices and evidence-based guidelines are available to inform health care providers regarding patient evaluation and strategies to reduce postoperative cardiac risk. In general, preoperative tests are recommended only if the findings will influence medical therapy or perioperative monitoring or will require postponement of surgery until a cardiac condition can be corrected or stabilized. Medication management is a crucial component of the preoperative assessment; providers may need to initiate the use of beta-blockers and make decisions regarding continuing or withholding antiplatelet and anticoagulant therapy. Preoperative cardiac risk stratification, medication reconciliation, and device management are essential for providing safe care for patients. PMID:25645037

  20. Perspectives on the importance of postoperative ileus.

    PubMed

    Sanfilippo, Filippo; Spoletini, Gabriele

    2015-04-01

    Post-operative ileus (POI) is a common condition after surgery. Failure to restore adequate bowel function after surgery generates a series of complications and it is associated to patients frustration and discomfort, worsening their perioperative experience. Even mild POI can be source of anxiety and could be perceived as a drop out from the "straight-forward" pathway. Enhanced recovery programmes have emphasized the importance of early commencement of oral diet, avoiding the ancient dogmata of prolonged gastric decompression and fasting. These protocols with early oral feeding and mobilization have led to improved perioperative management and have decreased hospital length of stay, ameliorating patient's postoperative experience as well. Nonetheless, the incidence of POI is still high especially after major open abdominal surgery. In order to decrease the incidence of POI, minimally-invasive surgical approaches and minimization of surgical manipulation have been suggested. From a pharmacological perspective, a meta-analysis of pro-kinetics showed beneficial results with alvimopan, although its use has been limited by the augmented risk of myocardial infarction and the high costs. A more simple approach based on the postoperative use of chewing-gum has provided some benefits in restoring bowel function. From an anaesthesiological perspective, epidural anaesthesia/analgesia does not only reduce the postoperative consumption of systemic opioids but directly improve gastrointestinal function and should be considered where possible, at least for open surgical procedures. POI represents a common and debilitating complication that should be challenged with multi-disciplinary approach. Prospective research is warranted on this field and should focus also on patient s reported outcomes. PMID:25753356

  1. Postoperative Chemoradiotherapy for Extrahepatic Bile Duct Cancer

    SciTech Connect

    Park, Jin-hong; Choi, Eun Kyung; Ahn, Seung Do; Lee, Sang-wook; Song, Si Yeol; Yoon, Sang Min; Kim, Young Seok; Lee, Yu Sun; Lee, Sung-Gyu; Hwang, Shin; Lee, Young-Joo; Park, Kwang-Min; Kim, Tae Won; Chang, Heung Moon; Lee, Jae-Lyun; Kim, Jong Hoon

    2011-03-01

    Purpose: To evaluate the effect of postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy and to identify the prognostic factors that influence survival in patients with extrahepatic bile duct cancer. Methods and Materials: We retrospectively analyzed the data from 101 patients with extrahepatic bile duct cancer who had undergone postoperative concurrent chemoradiotherapy using three-dimensional conformal radiotherapy. Of the 101 patients, 52 (51%) had undergone complete resection (R0 resection) and 49 (49%) had microscopic or macroscopic residual tumors (R1 or R2 resection). The median radiation dose was 50 Gy. Also, 85 patients (84%) underwent concurrent chemotherapy with 5-fluorouracil. Results: The median follow-up period was 47 months for the surviving patients. The 5-year overall survival rate was 34% for all patients. A comparison between patients with R0 and R1 resection indicated no significant difference in the 5-year overall survival (44% vs. 33%, p = .2779), progression-free survival (35% vs. 22%, p = .3107), or locoregional progression-free survival (75% vs. 63%, p = .2784) rates. An analysis of the first failure site in the 89 patients with R0 or R1 resection indicated isolated locoregional recurrence in 7 patients. Elevated postoperative carbohydrate antigen 19-9 level was an independent prognostic factor for overall survival (p = .001) and progression-free survival (p = .033). A total of 3 patients developed Grade 3 or greater late toxicity. Conclusion: Adjuvant concurrent chemoradiotherapy using three-dimensional conformal radiotherapy appears to improve locoregional control and survival in extrahepatic bile duct cancer patients with R1 resection. The postoperative carbohydrate antigen 19-9 level might be a useful prognostic marker to select patients for more intensified adjuvant therapy.

  2. Postoperative respiratory morbidity: identification and risk factors.

    PubMed

    Mitchell, C; Garrahy, P; Peake, P

    1982-04-01

    Two hundred consecutive patients admitted for general surgery were studied prospectively to evaluate the contribution of risk factors to postoperative respiratory morbidity (PORM). PORM was expressed both in terms of individual clinical features present on the second postoperative day (when the incidence was greatest), and as an aggregate score incorporating many clinical features. The importance of recognised risk factors, such as previous respiratory disease, cigarette smoking, upper abdominal procedures and the duration of surgery was confirmed, in that these factors were associated with some of the individual clinical features of PORM. The relative importance and independent contribution of these risk factors were assessed by their association with the aggregate score. A naso-gastric tube (NGT) present for 24 hours postoperatively was the factor more associated with PORM. The NGT identified patients at risk more clearly than, and independently of, the next most important factor, upper abdominal surgery. The duration of surgery did not contribute to PORM after the influence of NGT and site of surgery had been considered. Previous respiratory disease predisposed to PORM, and was best identified by, in order of importance, an observed productive cough, a reduced one second forced expiratory volume, and purulent sputum. After the incidence of these factors had been considered, cigarette smoking and a history of a chronic productive cough did not contribute further to PORM. PMID:6952867

  3. Postoperative irradiation in carcinoma of the prostate

    SciTech Connect

    Pilepich, M.V.; Walz, B.J.; Baglan, R.J.

    1984-10-01

    Twenty-eight patients received postoperative radiotherapy with curative intent following either radical prostatectomy (18 patients) or enucleative prostatectomy (10 patients). In patients undergoing radical prostatectomy, the indications for postoperative radiotherapy included positive margins in 13, close margins in 2, and seminal vesicle involvement in 3 patients. The majority of patients (82%) received total dose to the prostatic bed in excess of 6500 rad. In over 80% of the patients, the pelvic lymphatics are also treated (to a total dose of 4000-5000 rad). All of the patients irradiated after radical prostatectomy clinically remained disease-free locally. Approximately one-half of the patients in both the enucleation and radial prostatectomy groups developed evidence of distant metastases. The complications of treatment have been comparable to those in patients treated with radiotherapy only. The continence status has not been affected significantly. All patients with incontinence following completion of radiotherapy had documented impairment of continence prior to radiotherapy. Postoperative radiotherapy administered following either radical or enucleative prostatectomy was tolerated well and resulted in excellent local control.

  4. Pathophysiology and prevention of postoperative peritoneal adhesions

    PubMed Central

    Arung, Willy; Meurisse, Michel; Detry, Olivier

    2011-01-01

    Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions. PMID:22147959

  5. Adjuvant postoperative radiation therapy for colonic carcinoma.

    PubMed Central

    Willett, C G; Tepper, J E; Skates, S J; Wood, W C; Orlow, E C; Duttenhaver, J R

    1987-01-01

    One hundred thirty-three patients with Stage B2, B3, and C colonic carcinoma had resection for curative intent followed by adjuvant postoperative radiotherapy to the tumor bed. The 5-year actuarial local control and disease-free survival rates for these 133 patients were 82% and 61%, respectively. Stage for stage, the development of local regional failure was reduced for patients receiving postoperative radiotherapy compared with a historic control series. Local recurrence occurred in 8%, 21%, and 31% of patients with Stage B3, C2, and C3 tumors who had radiation therapy, respectively, whereas the local failure rates were 31%, 36%, and 53% in patients treated with surgery alone. There was a 13% and 12% improvement in the 5-year disease-free survival rate in the patients with Stage B3 and C3 lesions who had radiotherapy compared with the historic controls. For patients with Stage C disease, local control and disease-free survival rates decreased progressively with increasing nodal involvement; however, local control and disease-free survival rates were higher in the patients who had radiotherapy than in those who had surgery alone. Failure patterns in the patients who had radiotherapy did not show any notable changes compared with those for patients who had surgery alone. Postoperative radiation therapy for Stage B3, C2, and C3 colonic carcinoma is a promising treatment approach that deserves further investigation. PMID:3689006

  6. [Intraoperative and postoperative complications of splenectomy].

    PubMed

    Petrović, M; Popovic, M; Knezević, S; Matić, S; Gotić, M; Milovanović, A; Zuvela, M; Artiko, V; Dugalić, V; Ranković, V

    2002-01-01

    Spleen is being surgically removed because of trauma, in diagnostic and-or therapeutical purposes because of the benignant and malignant diseases. The percentage of morbidity during and after splenectomy is relatively low. During surgery might occur bleeding, trauma of the pancreatic tail, stomach, lineal flexure of the colon, left hemidiafragm, left suprarenal gland and upper pole of the left kidney, which must be correspondingly reclaimed during the same intervention. In the early postoperative period, postoperative bleeding, subfrenic abscess, pulmonal atelectasis, bronchopneumonia and left pleural extravasations might occur. Especially is important notification of these events in due time and adequate conservative and surgical treatment. After splenectomy, there is an increase of the number of trombocytes, which might lead to the tromboembolic complications. In the prevention of these complications in the postoperative period prolonged antiagregation therapy is suggested. Postsplenectomy sepsis is very late, general complication of splenectomy, which occurs because of the lower immunity in the child age. To prevent these complications, partial splenectomies, reimplantations of the spleen, prolonged application of the penicillin medicines after splenectomy and antipneumococcal vaccine are performed. PMID:12587454

  7. Postoperative Autologous Reinfusion in Total Knee Replacement

    PubMed Central

    Crescibene, A.; Martire, F.; Gigliotti, P.; Rende, A.; Candela, M.

    2015-01-01

    Surgeries for total knee replacement (TKR) are increasing and in this context there is a need to develop new protocols for management and use of blood transfusion therapy. Autologous blood reduces the need for allogeneic blood transfusion and the aim of the present study was to verify the safety and the clinical efficacy. An observational retrospective study has been conducted on 124 patients, undergoing cemented total knee prosthesis replacement. Observed population was stratified into two groups: the first group received reinfusion of autologous blood collected in the postoperative surgery and the second group did not receive autologous blood reinfusion. Analysis of data shows that patients undergoing autologous blood reinfusion received less homologous blood bags (10.6% versus 30%; p = 0.08) and reduced days of hospitalization (7.88 ± 0.7 days versus 8.96 ± 2.47 days for the control group; p = 0.03). Microbiological tests were negative in all postoperatively salvaged and reinfused units. Our results emphasize the effectiveness of this procedure and have the characteristics of simplicity, low cost (€97.53 versus €103.79; p < 0.01), and easy reproducibility. Use of autologous drainage system postoperatively is a procedure that allows reducing transfusion of homologous blood bags in patients undergoing TKR. PMID:26442168

  8. Optimizing postoperative sexual function after radical prostatectomy

    PubMed Central

    Tutolo, Manuela; Briganti, Alberto; Suardi, Nazareno; Gallina, Andrea; Abdollah, Firas; Capitanio, Umberto; Bianchi, Marco; Passoni, Niccolò; Nini, Alessandro; Fossati, Nicola; Rigatti, Patrizio

    2012-01-01

    Erectile dysfunction (ED) is one of the complications associated with pelvic surgery. The significance of ED as a complication following pelvic surgery, especially radical prostatectomy (RP), lies in the negative impact that it has on patients’ sexual and overall life. In the literature, rates of ED following RP range from 25% to 100%. Such variety is associated with pelvic dissection and conservation of neurovascular structures. Another important factor impacting on postoperative ED is the preoperative erectile function of the patient. Advances in the knowledge of pelvic anatomy and pathological mechanisms led to a refinement of pelvic surgical techniques, with attention to the main structures that if damaged compromise erectile function. These improvements resulted in lower postoperative ED rates and better erectile recovery, especially in patients undergoing RP. Furthermore, surgery alone is not sufficient to prevent this complication, and thus, several medical strategies have been tested with the aim of maximizing erectile function recovery. Indeed it seems that prevention of postoperative ED must be addressed by a multimodal approach. The aim of this review is to give a picture of recent knowledge, novel techniques and therapeutic approaches in order to reach the best combination of treatments to reduce the rate of ED after pelvic surgery. PMID:23205061

  9. Takotsubo Cardiomyopathy Occurring in the Postoperative Period.

    PubMed

    Deniz, Süleyman; Bakal, Ömer; İnangil, Gökhan; Şen, Hüseyin; Özkan, Sezai

    2015-02-01

    Takotsubo cardiomyopathy simulates acute myocardial infarction, and it is characterised by reversible left ventricular failure. A case of Takotsubo cardiomyopathy diagnosed after emergency angiography performed in a patient with evidence of acute myocardial infarction in the postoperative period will be described in this report. Transurethral resection of a bladder tumour (TUR-BT) was performed in a 92-year-old male patient by the urology clinic. The patient was transferred to the post-anaesthesia care unit after the operation. An echocardiography was performed because of the sudden onset of dyspnoea, tachycardia (140-150 beats per minute, rhythm-atrial fibrillation) and ST-segment elevation on electrocardiography (ECG) at the first postoperative hour, and midapical dyskinesia was detected at the patient. An immediate angiography was performed due to suspicion of acute coronary syndrome. Patent coronary arteries and temporary aneurysmatic dilatation of the apex of the heart were revealed by angiography. As a result of these findings, the patient was diagnosed with Takotsubo cardiomyopathy by the cardiology service. The patient was discharged uneventfully following 10 days in the intensive care unit. Aneurysm of the apex of the left ventricle and normal anatomy of the coronary arteries in the angiography have diagnostic value for Takotsubo cardiomyopathy. Diuretics (furosemide) and beta-blockers (metoprolol) are commonly used for the treatment of Takotsubo cardiomyopathy. Even though Takotsubo cardiomyopathy is a rare and benign disease, it should be kept in mind in patients suspected for acute myocardial infarction in the postoperative period. PMID:27366464

  10. Succession planning.

    PubMed

    Catanzaro, Thomas E

    2006-03-01

    This article provides the reader with an appreciation of the diverse elements that go into a buy-sell, affiliation, or merger situation for veterinary practices. In the changing market place of American veterinary medicine, old paradigms no longer hold comfort. The generational differences are briefly explored herein as well as the new economic realities. A few examples are offered to illustrate just how much variability exists in the current business of veterinary medicine and the subsequent practice transitions needed to enhance value. Functioning models are explored, as well as affiliation and merger options. Practice valuation is discussed in general terms, referencing the cutting-edge factors. The six-point summary provides almost all practices a solid operational base for daily operations and succession planning. PMID:16442447

  11. The effect of perioperative esmolol infusion on the postoperative nausea, vomiting and pain after laparoscopic appendectomy

    PubMed Central

    Lee, Sang-Jun

    2010-01-01

    Background Perioperative opioid administration results in postoperative nausea and vomiting (PONV) and acute opioid tolerance that manifests in increased postoperative pain. Esmolol is an ultra short acting cardioselective β1-adrenergic receptor antagonist, and it has been successfully used for perioperative sympatholysis and it reduces the opioid requirement during total intravenous anesthesia. We tested the hypothesis that perioperative esmolol administration results in decreased PONV and postoperative pain. Methods Sixty patients undergoing laparoscopic appendectomy were randomly assigned to two groups (Group E and Group C). The Group E patients were administered 5-10 µg/kg/min esmolol with remifentanil that was titrated to the autonomic response. The Group C patients received normal saline that was of the same volume as the esmolol in Group E, and the remifentanil was also titrated to the vital sign. Before intubation and extubation, the Group E patients were administered 1.0 mg/kg esmolol, and the Group C patients were administered normal saline of the same volume. The incidence and severity of PONV, the pain score, the rescue antiemetics and the rescue analgesics were assessed 30 min, 6 h and 24 h after surgery. The mean arterial pressure and heart rate under anesthesia were also recorded. Results PONV and postoperative pain were significantly increased in Group C. These patients needed more antiemetics and analgesics in the first 24 postoperative hours. The mean arterial pressure and heart rate were significantly higher in Group C at the time of intubation and extubation. Conclusions Perioperative esmolol administration contributes to the significant decrease in PONV and postoperative pain, and so this facilitates earlier discharge. PMID:20877702

  12. Postoperative Prostate-Specific Antigen Velocity Independently Predicts for Failure of Salvage Radiotherapy After Prostatectomy

    SciTech Connect

    King, Christopher R. Presti, Joseph C.; Brooks, James D.; Gill, Harcharan; Spiotto, Michael T.

    2008-04-01

    Purpose: Identification of patients most likely to benefit from salvage radiotherapy (RT) using postoperative (postop) prostate-specific antigen (PSA) kinetics. Methods and Materials: From 1984 to 2004, 81 patients who fit the following criteria formed the study population: undetectable PSA after radical prostatectomy (RP); pathologically negative nodes; biochemical relapse defined as a persistently detectable PSA; salvage RT; and two or more postop PSAs available before salvage RT. Salvage RT included the whole pelvic nodes in 55 patients and 4 months of total androgen suppression in 56 patients. The median follow-up was >5 years. All relapses were defined as a persistently detectable PSA. Kaplan-Meier and Cox proportional hazards multivariable analysis were performed for all clinical, pathological, and treatment factors predicting for biochemical relapse-free survival (bRFS). Results: There were 37 biochemical relapses observed after salvage RT. The 5-year bRFS after salvage RT for patients with postop prostate-specific antigen velocity {<=}1 vs. >1 ng/ml/yr was 59% vs. 29%, p = 0.002. In multivariate analysis, only postop PSAV (p = 0.0036), pre-RT PSA level {<=}1 (p = 0.037) and interval-to-relapse >10 months (p = 0.012) remained significant, whereas pelvic RT, hormone therapy, and RT dose showed a trend (p = {approx}0.06). PSAV, but not prostate-specific antigen doubling time, predicted successful salvage RT, suggesting an association of zero-order kinetics with locally recurrent disease. Conclusions: Postoperative PSA velocity independently predicts for the failure of salvage RT and can be considered in addition to high-risk features when selecting patients in need of systemic therapy following biochemical failure after RP. For well-selected patients, salvage RT can achieve high cure rates.

  13. Boston type 1 keratoprosthesis from patient selection through postoperative management: a review for the keratoprosthetic surgeon

    PubMed Central

    Williamson, Samantha L; Cortina, M Soledad

    2016-01-01

    For the anterior segment surgeon, the implantation of Boston type 1 keratoprosthesis is a multistep process that begins with careful patient selection. Success depends on thorough preoperative evaluation, detailed surgical planning, and frequent postoperative follow-up. New practice patterns have emerged for each of these phases as the international experience with keratoprosthesis grows. This review details special considerations that can improve outcomes and also allow surgeons to consider its use in challenging patient populations at each step. PMID:27041986

  14. Reiki therapy for postoperative oral pain in pediatric patients: Pilot data from a double-blind, randomized clinical trial

    PubMed Central

    Kundu, Anjana; Lin, Yuting; Oron, Assaf P.; Doorenbos, Ardith Z.

    2014-01-01

    Purpose To examine the effects of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. Methods This was a double-blind, randomized controlled study of children undergoing dental procedures. Participants were randomly assigned to receive either Reiki therapy or the control therapy (sham Reiki) preoperatively. Postoperative pain scores, opioid requirements, and side effects were assessed. Family members were also asked about perioperative care satisfaction. Multiple linear regressions were used for analysis. Results Thirty-eight children participated. The blinding procedure was successful. No statistically significant difference was observed between groups on all outcome measures. Implications Our study provides a successful example of a blinding procedure for Reiki therapy among children in the perioperative period. This study does not support the effectiveness of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. PMID:24439640

  15. The preoperative evaluation prevent the postoperative complications of thyroidectomy

    PubMed Central

    Huang, Chien-Feng; Jeng, Yachung; Chen, Kuo-Dong; Yu, Ji-Kuen; Shih, Chao-Ming; Huang, Shih-Ming; Lee, Chen-Hsen; Chou, Fong-Fu; Shih, Ming-Lang; Jeng, Kee-Ching; Chang, Tzu-Ming

    2014-01-01

    Objective Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR) = 0.5 and 0.65, [95% confidence interval (CI) 0.331–0.768 and 0.459–0.911], P = 0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393–0.763 and 1.356–3.4], P < 0.001 and 0.0012, respectively. Conclusions The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations

  16. Alvimopan, for Postoperative Ileus Following Bowel Resection

    PubMed Central

    Delaney, Conor P.; Wolff, Bruce G.; Viscusi, Eugene R.; Senagore, Anthony J.; Fort, John G.; Du, Wei; Techner, Lee; Wallin, Bruce

    2007-01-01

    Objective: To obtain further analysis regarding specific outcomes and alvimopan doses in bowel resection (BR) patients. Summary Background Data: Although postoperative ileus (POI) is common after BR, there is currently no recognized treatment or prevention available. Alvimopan, a novel, peripherally active mu-opioid receptor antagonist, accelerated GI recovery after BR or hysterectomy in 3 phase III trials. Methods: A pooled retrospective subset analysis of BR patients in alvimopan phase III trials was performed. Randomized BR patients received alvimopan 6 mg (n = 397), 12 mg (n = 413), or placebo (n = 402) ≥2 hours before surgery and twice daily until hospital discharge for ≤7 days. The primary endpoint of each trial was time to recovery of GI function. Hospital discharge order (DCO) written, readmission, and morbidities were also assessed. Cox proportional hazard models were used to analyze treatment effects on time-to-event endpoints. Results: Alvimopan (6 or 12 mg) significantly accelerated GI recovery (GI-3; hazard ratio = 1.28 and 1.38, respectively; P ≤ 0.001 for both). Alvimopan significantly accelerated time to DCO written by 16 hours for 6 mg and 18 hours for 12 mg (P < 0.001 for both) from a mean of 147 hours for placebo. Alvimopan-treated patients had reduced postoperative morbidity compared with placebo, and incidence of prolonged hospital stay or readmission was significantly reduced (P < 0.001). Tolerability profiles were similar among groups. Conclusions: Alvimopan significantly accelerated GI recovery in BR patients. A 12-mg dose provided more consistent benefits across both sexes and all ages. Postoperative morbidity rates, prolonged hospital stay, and rates of hospital readmission were significantly reduced. Alvimopan reduces the consequences of POI after BR. PMID:17435541

  17. [Postoperative pain therapy in Germany. Status quo].

    PubMed

    Pogatzki-Zahn, E M; Meissner, W

    2015-10-01

    A great deal of progress has been made in the field of postoperative pain therapy in the last 20 years. Beginning from clinical trials on the effectiveness of individual procedures, such as epidural anesthesia and patient-controlled analgesia, a wide range of healthcare services research as well as basic research with human and animal experiments has been established. Whereas health services research in the 1980s and 1990s focused more on the implementation of acute pain services, outcome-oriented research approaches are nowadays the center of attention. Acute pain registries and pain certification projects initiated in Germany have to be mentioned particularly in this respect. Basic research papers from recent years increasingly address specific aspects of acute postoperative pain and have provided translational approaches that are applied around the world for studying neurobiological mechanisms of postoperative pain. At the same time, interdisciplinary cooperation in research projects has led to a better understanding of complex correlations regarding predictors and mechanisms (including psychosocial aspects) of acute and in recent times also chronic pain after surgery. In parallel, evidence-based medicine has found its way into acute pain medicine in Germany. In 2007, clinical acute pain therapy in Germany was enhanced by S3 level guidelines for the first time; however, the implementation is still incomplete. In future, questions concerning mechanism-based therapy of acute pain need to be equally in the center of attention of research, such as prevention of persisting pain after surgery and acute pain of different origins. PMID:26289394

  18. Postoperative pain management after supratentorial craniotomy.

    PubMed

    Verchère, Eric; Grenier, Bruno; Mesli, Abdelghani; Siao, Daniel; Sesay, Mussa; Maurette, Pierre

    2002-04-01

    The aim of this study was to compare the analgesic efficacy of three different postoperative treatments after supratentorial craniotomy. Sixty-four patients were allocated prospectively and randomly into three groups: paracetamol (the P group, n = 8), paracetamol and tramadol (the PT group, n = 29), and paracetamol and nalbuphine (the PN group, n = 27). General anesthesia was standardized with propofol and remifentanil using atracurium as the muscle relaxant. One hour before the end of surgery, all patients received 30 mg/kg propacetamol intravenously then 30 mg/kg every 6 hours. Patients in the PT group received 1.5 mg/kg tramadol 1 hour before the end of surgery. For patients in the PN group, 0.15 mg/kg nalbuphine was injected after discontinuation of remifentanil, because of its mu-antagonist effect. Postoperative pain was assessed in the fully awake patient after extubation (hour 0) and at 1, 2, 4, 8, and 24 hours using a visual analog scale (VAS). Additional tramadol (1.5 mg/kg) or 0.15 mg/kg nalbuphine was administered when the VAS score was > or = 30 mm. Analgesia was compared using the Mantha and Kaplan-Meier methods. Adverse effects of the drugs were also measured. The three groups were similar with respect to the total dose of remifentanil received (0.27 +/- 0.1 mircog/kg/min). In all patients, extubation was obtained within 6 +/- 3 minutes after remifentanil administration. Postoperative analgesia was ineffective in the P group; therefore, inclusions in this group were stopped after the eighth patient. Postoperative analgesia was effective in the two remaining groups because VAS scores were similar, except at hour 1, when nalbuphine was more effective (P = .001). Nevertheless, acquiring such a result demanded significantly more tramadol than nalbuphine (P < .05). More cases of nausea and vomiting were observed in the PT group but the difference was not significant (P < .06). In conclusion, pain after supratentorial neurosurgery must be taken into account

  19. Successful Lecturing

    PubMed Central

    Copeland, H Liesel; Longworth, David L; Hewson, Mariana G; Stoller, James K

    2000-01-01

    OBJECTIVE In a study conducted over 3 large symposia on intensive review of internal medicine, we previously assessed the features that were most important to course participants in evaluating the quality of a lecture. In this study, we attempt to validate these observations by assessing prospectively the extent to which ratings of specific lecture features would predict the overall evaluation of lectures. MEASUREMENTS AND MAIN RESULTS After each lecture, 143 to 355 course participants rated the overall lecture quality of 69 speakers involved in a large symposium on intensive review of internal medicine. In addition, 7 selected participants and the course directors rated specific lecture features and overall quality for each speaker. The relations among the variables were assessed through Pearson correlation coefficients and cluster analysis. Regression analysis was performed to determine which features would predict the overall lecture quality ratings. The features that most highly correlated with ratings of overall lecture quality were the speaker's abilities to identify key points (r = .797) and be engaging (r = .782), the lecture clarity (r = .754), and the slide comprehensibility (r = .691) and format (r = .660). The three lecture features of engaging the audience, lecture clarity, and using a case-based format were identified through regression as the strongest predictors of overall lecture quality ratings (R2= 0.67, P = 0.0001). CONCLUSIONS We have identified core lecture features that positively affect the success of the lecture. We believe our findings are useful for lecturers wanting to improve their effectiveness and for educators who design continuing medical education curricula. PMID:10886470

  20. Prevention and management of postoperative urinary retention after urogynecologic surgery

    PubMed Central

    Geller, Elizabeth J

    2014-01-01

    Postoperative urinary retention (POUR) is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%–43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function – the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4–6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk – either due to the procedures being performed or their clinical risk factors – should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it is easily diagnosed and typically self-resolves. Clinician awareness of the condition and vigilance in its diagnosis are the key factors to successful care for patients undergoing surgical repair. PMID:25210477

  1. Cognitive Function is Linked to Adherence to Bariatric Postoperative Guidelines

    PubMed Central

    Spitznagel, Mary Beth; Galioto, Rachel; Limbach, Kristen; Gunstad, John; Heinberg, Leslie

    2013-01-01

    Background Impairment in cognitive function is found in a significant subset of individuals undergoing bariatric surgery and recent work shows this impairment is associated with smaller postoperative weight loss. Reduced cognitive function could contribute to poorer adherence to postoperative guidelines, though this has not been previously examined. Objectives The current study examined the relationship between cognitive function and adherence to bariatric postoperative guidelines. We expected that higher cognitive function would be associated with better adherence to postoperative guidelines. Setting Data were collected through the bariatric service of a major medical center. Methods Thirty-seven bariatric surgery patients completed cognitive testing and a self-report measure of adherence to postoperative bariatric guidelines during their 4–6 week postoperative appointment. Results Strong correlations were observed between adherence to postoperative guidelines and cognitive indices of attention, executive function, and memory. Conclusions Results demonstrate that cognitive performance is strongly associated with adherence to postoperative guidelines shortly after bariatric surgery. Further work is needed to clarify if this relationship is present at later postoperative stages, and the degree to which this relationship mediates postoperative weight loss outcomes. PMID:23791534

  2. Resident involvement in postoperative conversations: an underused opportunity

    PubMed Central

    Lorenzen, Allison W.; Sherman, Scott K.; Rosenbaum, Marcy; Kapadia, Muneera R.

    2016-01-01

    Background Because of established attending-patient and family relationships and time constraints, residents are often excluded from the immediate postoperative conversation with family. Interpersonal and communication skills are a core competency, and the postoperative conversation is an opportunity to develop these skills. Our objective is to assess attitudes, experience, and comfort regarding resident participation during postoperative conversations with families. Materials and methods Residents and attending surgeons in an academic surgery center were surveyed regarding resident involvement in the postoperative conversation with families. Paper surveys wereadministeredanonymously.Nonparametricstatisticscomparedresponses. Results There were 45 survey respondents (23 residents, 22 attendings). All residents rated postoperative conversations with families, as “important” or “very important”. Residents reported being “comfortable” or “very comfortable” with postoperative conversations. However, on average, residents reported fewer than 10 postoperative conversation experiences per year. Feedback was received by <30% on postoperative communication skills, but 88% wanted feedback. Most attendings reported it is “important” or “very important” for residents to communicate well with families during postoperative conversations, but rated residents’ performance as significantly lower than the residents’ self-assessments (P < 0.001). Attendings on average were only “somewhat comfortable” or “moderately comfortable” with residents conducting postoperative conversations with families, and only 68% reported allowing residents to do so. When bad news was involved, only 27% allowed resident participation. Most attendings (86%) believed residents need more opportunities with postoperative conversations. Conclusions Although most residents reported being comfortable with postoperative conversations, these survey results indicate that they have

  3. Systemic Trans- and Postoperative Evaluations of Patients Undergoing Dental Implant Surgery

    PubMed Central

    Goiato, Marcelo Coelho; Junior, Joel Ferreira Santiago; Pellizzer, Eduardo Piza; Moreno, Amália; Villa, Luiz Marcelo Ribeiro; de Carvalho Dekon, Stefan Fiuza; de Carvalho, Paulo Sérgio Perri; dos Santos, Daniela Micheline

    2016-01-01

    OBJECTIVE: The aims of this study were to examine the trans- and postoperative systemic characteristics of patients undergoing dental implant surgery and to investigate the relationship between pre- and post- surgery anxiety levels. MATERIAL AND METHODS: Thirty-nine patients were analyzed in 3 call centers to determine anxiety levels, pain levels, and preoperative and postoperative histories using the State–Trait (STAI) questionnaire. RESULTS: A total of 93 dental implants were installed, with a success rate of 100%. The most frequently reported systemic disease was hypertension. There was a significantly higher rate of effective clamping (torque) to the mandibular bone than to the maxillary bone. The association between postoperative surgical complications and longer operative time was not significant, but there was a significant correlation between the alteration of mouth opening and daily routine activities and a significant decrease in anxiety levels between the day of surgery and the postoperative time point (p=0.006). CONCLUSION: A longer surgical time was associated with surgery-related complications and with a higher anxiety index on the preoperative evaluation. PMID:27074177

  4. Circadian variation in unexpected postoperative death.

    PubMed

    Rosenberg, J; Pedersen, M H; Ramsing, T; Kehlet, H

    1992-12-01

    Unexpected deaths still occur following major surgical procedures. The cause is often unknown but may be cardiac or thromboembolic in nature. Postoperative ischaemia, infarction and sudden cardiac death may be triggered by episodic or constant arterial hypoxaemia, which increases during the night. This study examined the circadian variation of sudden unexpected death following abdominal surgery between 1985 and 1989 inclusive. Deaths were divided into those occurring during the day (08.00-16.00 hours), evening (16.00-24.00 hours) and night (24.00-08.00 hours). Twenty-three deaths were considered to have been totally unexpected. Of 16 such patients undergoing autopsy, pulmonary embolism was the cause of death in five. In the remaining 11 patients, death occurred at night in eight (P < 0.005). Five of the seven patients without an autopsy died at night (P < 0.04); overall, 13 of 18 unexpected deaths occurred at night-time. These results suggest a need for further studies of sleep- and respiration-related effects on postoperative nocturnal cardiac function. The efficacy of monitoring during this apparent high-risk period should be evaluated. PMID:1486424

  5. Postoperative delirium in the elderly surgical patient.

    PubMed

    Sieber, Frederick E

    2009-09-01

    Delirium is a common complication in the geriatric population following cardiac and noncardiac procedures. Postoperative delirium is a significant financial burden on the United States health care system and is independently associated with prolonged hospital stay, increased risk of early and long term mortality, increased physical dependence, and an increased rate of nursing home placement. The Confusion Assessment Method (CAM) is a bedside rating scale developed to assist nonpsychiatrically trained clinicians in the rapid and accurate diagnosis of delirium. The CAM has been adapted for use in ventilated intensive care unit (ICU) patients in the form of the CAM-ICU. The onset of delirium involves an interaction between predisposing and precipitating risk factors for delirium. The mainstay of delirium management is prevention. The approach involves control or elimination of modifiable risk factors. It is controversial whether anesthetic technique determines delirium. However, important modifiable risk factors under the anesthesiologist's control include adequate postoperative pain management, careful drug selection, and embracing and participating in a multidisciplinary care model for these complicated patients. PMID:19825486

  6. Novel delivery systems for postoperative analgesia.

    PubMed

    Palmer, Pamela P; Royal, Mike A; Miller, Ronald D

    2014-03-01

    Moderate-to-severe postoperative pain is usually controlled using a multimodal approach, including opioids. Intravenously administered patient-controlled analgesia (IV PCA) with opioids, popular for over 40 years, enables patients to control their level of analgesia and has advantages over a nurse-administered approach, including more satisfied patients and improved pain relief. Unfortunately, IV PCA has drawbacks such as device programming errors, medication prescribing errors, pump malfunction, limitations on patient mobility, IV patency issues, and transmission of infection. Furthermore, the setup of an infusion pump is often complex, time-consuming, and requires witnessed confirmation. Complicating IV PCA is the problem of commonly used compounds, morphine and hydromorphone, having significantly reduced brain/effector-site permeability and active metabolites, both of which create the risk of delayed adverse events. Novel patient-controlled modalities that incorporate rapid effector site-permeating opioids and non-invasive routes of administration offer great promise to enhance both patient and caregiver experiences with postoperative analgesia systems. PMID:24815968

  7. Pharmacological and psychosomatic treatments for an elderly patient with severe nausea and vomiting in reaction to postoperative stress.

    PubMed

    Otera, Masako; Machida, Takatsugu; Machida, Tomomi; Abe, Mai; Ichie, Masayoshi; Fukudo, Shin

    2015-10-01

    Here we present a case of successful treatment employing a mixed approach including pharmacological and psychosomatic treatments for a 72-year-old woman who experienced severe nausea and vomiting in reaction to postoperative stress from gastric cancer surgery. This case demonstrates that appropriate provision of psychosomatic treatments, including a psychotherapeutic session and autogenic training, enhances the efficacy of pharmacotherapy. PMID:26259848

  8. Successful Predictions

    NASA Astrophysics Data System (ADS)

    Pierrehumbert, R.

    2012-12-01

    In an observational science, it is not possible to test hypotheses through controlled laboratory experiments. One can test parts of the system in the lab (as is done routinely with infrared spectroscopy of greenhouse gases), but the collective behavior cannot be tested experimentally because a star or planet cannot be brought into the lab; it must, instead, itself be the lab. In the case of anthropogenic global warming, this is all too literally true, and the experiment would be quite exciting if it weren't for the unsettling fact that we and all our descendents for the forseeable future will have to continue making our home in the lab. There are nonetheless many routes though which the validity of a theory of the collective behavior can be determined. A convincing explanation must not be a"just-so" story, but must make additional predictions that can be verified against observations that were not originally used in formulating the theory. The field of Earth and planetary climate has racked up an impressive number of such predictions. I will also admit as "predictions" statements about things that happened in the past, provided that observations or proxies pinning down the past climate state were not available at the time the prediction was made. The basic prediction that burning of fossil fuels would lead to an increase of atmospheric CO2, and that this would in turn alter the Earth's energy balance so as to cause tropospheric warming, is one of the great successes of climate science. It began in the lineage of Fourier, Tyndall and Arrhenius, and was largely complete with the the radiative-convective modeling work of Manabe in the 1960's -- all well before the expected warming had progressed far enough to be observable. Similarly, long before the increase in atmospheric CO2 could be detected, Bolin formulated a carbon cycle model and used it to predict atmospheric CO2 out to the year 2000; the actual values come in at the high end of his predicted range, for

  9. Predictive Factors of Postoperative Pain and Postoperative Anxiety in Children Undergoing Elective Circumcision: A Prospective Cohort Study

    PubMed Central

    Tsamoudaki, Stella; Ntomi, Vasileia; Yiannopoulos, Ioannis; Christianakis, Efstratios; Pikoulis, Emmanuel

    2015-01-01

    Background Although circumcision for phimosis in children is a minor surgical procedure, it is followed by pain and carries the risk of increased postoperative anxiety. This study examined predictive factors of postoperative pain and anxiety in children undergoing circumcision. Methods We conducted a prospective cohort study of children scheduled for elective circumcision. Circumcision was performed applying one of the following surgical techniques: sutureless prepuceplasty (SP), preputial plasty technique (PP), and conventional circumcision (CC). Demographics and base-line clinical characteristics were collected, and assessment of the level of preoperative anxiety was performed. Subsequently, a statistical model was designed in order to examine predictive factors of postoperative pain and postoperative anxiety. Assessment of postoperative pain was performed using the Faces Pain Scale (FPS). The Post Hospitalization Behavior Questionnaire study was used to assess negative behavioral manifestations. Results A total of 301 children with a mean age of 7.56 ± 2.61 years were included in the study. Predictive factors of postoperative pain measured with the FPS included a) the type of surgical technique, b) the absence of siblings, and c) the presence of postoperative complications. Predictive factors of postoperative anxiety included a) the type of surgical technique, b) the level of education of mothers, c) the presence of preoperative anxiety, and d) a history of previous surgery. Conclusions Although our study was not without its limitations, it expands current knowledge by adding new predictive factors of postoperative pain and postoperative anxiety. Clearly, further randomized controlled studies are needed to confirm its results. PMID:26495079

  10. Successful microsurgical replantation of an amputated penis

    PubMed Central

    Garg, Sanchit; Date, Shivprasad V.; Gupta, Arunesh; Baliarsing, Amresh S.

    2016-01-01

    Penile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the “standard” method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V. PMID:27274131

  11. Postoperative Controversies in the Management of Free Flap Surgery in the Head and Neck.

    PubMed

    Cannady, Steven B; Hatten, Kyle; Wax, Mark K

    2016-08-01

    Free tissue transfer is the gold standard for reconstructing head and neck defects. Free flap success approaches 95% in centers with experience, affording unparalleled ability to restore form and function in cancer, trauma, or other major composite tissue loss. It is critical to manage the perioperative variables that predict success; several areas of controversy have not yet reached consensus. This review focuses on postoperative anticoagulation, fluid management, and flap monitoring methods. These areas of controversy potentially influence flap survival. We review published practices considered within the standard of care, why controversy remains, and future directions to reach standardization. PMID:27400844

  12. Percutaneous transhepatic cholangiography in the investigation of the persistent postoperative bile leak.

    PubMed

    Kissin, C M; Grundy, A

    1987-01-01

    Percutaneous transhepatic cholangiography (PTHC) is now a widely available, inexpensive investigation with a low incidence of complications, especially in the nonobstructed system, and a high success rate. Its role in the management of obstructive jaundice is well established but it is only infrequently performed in the investigation of persistent bile leakage following biliary tract surgery. Four cases are reported in which the superior demonstration of biliary anatomy provided by PTHC allowed successful identification of the site of postoperative biliary leakage. We compared PTHC with other diagnostic imaging techniques available and conclude that it is a safe, accurate, and reliable technique. PMID:3596138

  13. A team approach to the prevention of unplanned postoperative hypothermia.

    PubMed

    Bitner, Jason; Hilde, Leana; Hall, Kenneth; Duvendack, Tammy

    2007-05-01

    Postoperative hypothermia (ie, a core temperature lower than 96.8 degrees F [36 degrees C]), is a problem frequently seen in surgical patients, especially those undergoing total joint replacement. Patients who experience hypothermia may have increased recovery times and postoperative complications. A team of clinical staff members and personnel from the performance improvement (PI) department of a hospital used a PI model to incorporate use of preoperative forced-air warming blankets that resulted in improved postoperative core temperatures. PMID:17499055

  14. Single dose dipyrone for acute postoperative pain

    PubMed Central

    Derry, Sheena; Faura, Clara; Edwards, Jayne; McQuay, Henry J; Moore, R Andrew

    2014-01-01

    Background Dipyrone (metamizole) is a non-steroidal anti-inflammatory drug used in some countries to treat pain (postoperative, colic, cancer, and migraine); it is banned in others because of an association with life-threatening blood agranulocytosis. This review updates a 2001 Cochrane review, and no relevant new studies were identified, but additional outcomes were sought. Objectives To assess the efficacy and adverse events of single dose dipyrone in acute postoperative pain. Search methods The earlier review searched CENTRAL, MEDLINE, EMBASE, LILACS and the Oxford Pain Relief Database to December 1999. For the update we searched CENTRAL, MEDLINE,EMBASE and LILACS to February 2010. Selection criteria Single dose, randomised, double-blind, placebo or active controlled trials of dipyrone for relief of established moderate to severe postoperative pain in adults. We included oral, rectal, intramuscular or intravenous administration of study drugs. Data collection and analysis Studies were assessed for methodological quality and data extracted by two review authors independently. Summed total pain relief over six hours (TOTPAR) was used to calculate the number of participants achieving at least 50% pain relief. Derived results were used to calculate, with 95% confidence intervals, relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over six hours. Use and time to use of rescue medication were additional measures of efficacy. Information on adverse events and withdrawals was collected. Main results Fifteen studies tested mainly 500 mg oral dipyrone (173 participants), 2.5 g intravenous dipyrone (101), 2.5 g intramuscular dipyrone (99); fewer than 60 participants received any other dose. All studies used active controls (ibuprofen, paracetamol, aspirin, flurbiprofen, ketoprofen, dexketoprofen, ketorolac, pethidine, tramadol, suprofen); eight used placebo controls. Over 70% of participants

  15. Hair Transplantation: Preventing Post-operative Oedema.

    PubMed

    Gholamali, Abbasi; Sepideh, Pojhan; Susan, Emami

    2010-05-01

    Swelling or oedema of forehead or eyelids is a common consequence of hair transplantation surgery. However, this results in increased morbidity and absence from work due to unaesthetic appearance. To study various physical and therapeutic modalities to reduce or completely prevent the occurrence of such oedema. Three hundred forty hair transplant patients were recruited in the study and were categorized into 8 groups depending upon the intervention employed. There were 32 dropouts in the study due to various reasons. Patients who were administered steroid with tumescent solution had the highest number of patients without oedema, with only 3 out of 117 patients developing oedema. Physical measures like position of head during sleeping, application of occlusion bands or ice packs did not show satisfactory results. Addition of triamcinolone to tumescent anaesthetic solution is a very effective technique of preventing post-operative swelling. PMID:21031066

  16. [Impulse galvanization in postoperative urination disorders].

    PubMed

    Kölbl, H; Riss, P

    1988-03-01

    In this study we examined the therapeutic effect of impulse-galvanization in patients with voiding difficulties after anterior vaginal repair. Patients (n = 56/79) revealing residual urine until the sixth postoperative day were studied. Considering the onset of the first spontaneous micturition and the lack of residual urine no significant difference was found in the group undergoing impulse-galvanization (n = 19) compared to a group without therapy (n = 37). By adjuvant treatment with alpha-sympathicolytics, spasmolytics or tranquilizers patients with impulse-galvanization and the comparative group were found to be without residual urine 11.2 and 13 days after surgery, respectively (p less than 0.001). PMID:3259522

  17. [How to control postoperative pain: intravenous route].

    PubMed

    Occella, P; Vivaldi, F

    2003-12-01

    Intravenous administration of analgesic drugs is one of the most common ways to control post-operative pain. It can be used in almost all kinds of surgical interventions and particularly those of medium and high complexity. Besides, when other techniques are contraindicated because of clinical and/or managing problems, intravenous way finds its best application. Among analgesic drugs NSAID (ketorolac) and opioids (tramadol, morphine, buprenorphine) are most frequently used. As to administration techniques, elastomeric pump is, according to personal experience, a simple-to-manage, practical and precise device with lower cost respect to other administration set. Elastomeric pump is a single use reservoir that allows continuous administration of drugs with a uniform pre-set infusion speed. Finally, guide-lines, showing pre-load and infusion doses of analgesic drugs, based on pain intensity, are presented. PMID:14663417

  18. Postoperative radionuclide evaluation of osteoid osteomas

    SciTech Connect

    Ghelman, B.; Vigorita, V.J.

    1983-02-01

    Five cases of clinically suspected osteoid osteomas were studied by preoperative injection of technetium-99m methylene disphosphonate, intraoperative localization with a radiation-sensitive scintillation probe, and postoperative examination of the entire tissue specimen (including the presumed nidus and surrounding bone). Microradiography and light microscopy were also used. In addition, a new autoradiography technique was introduced in which the excised surgical specimen was placed on undeveloped x-ray film for pathologic localization, diagnosis of the lesions, and a study of the relative intensity of radioactive uptake in the nidus vs. surrounding bone. Autoradiography revealed that the nidus showed the greatest concentration of radioactivity, followed by the surrounding bone. The authors conclude that /sup 99m/Tc can be used clinically in localizing osteoid osteomas and that preoperative and intraoperative scanning can assist in conservative surgical excision. For small lesions, autoradiography assists the pathologist in identifying an osteoid osteoma.

  19. [ULTRASOUND MONITORING FEATURES OF POSTOPERATIVE HEPATIC ECHINOCOCCOSIS].

    PubMed

    Melia, Kh; Kokaia, N; Manjgaladze, M

    2016-01-01

    The aim of the study was to investigate ultrasound features (US) of liver after post operative anti-parasite recurrence treatment of patients with echinococcosis. The clinical analyses of 50 patients were carried out. It was concluded that the use of ultrasound can provide valuable data to the clinician to assess and monitor anti parasitic therapy echinococcosis of liver in post operative period. During the monitoring the positive dynamics of disease was observed in 94,5% of cases, in 5% оf cases toxic hepatites with septic complication was diagnosed, and in 0,5% of cases the disease recurrence was revealed. Ultrasound semiotics of liver after post operative anti-parasite recurrence treatment of patients with echinococcosis was presented. Control and monitoring of patients in the postoperative period echinococcosis with appropriate antirelapse antiparasitic therapy should be held not less than 1-5 years. PMID:26870968

  20. Acute Postoperative Endophthalmitis Caused by Staphylococcus lugdunensis▿

    PubMed Central

    Chiquet, C.; Pechinot, A.; Creuzot-Garcher, C.; Benito, Y.; Croize, J.; Boisset, S.; Romanet, J. P.; Lina, G.; Vandenesch, F.

    2007-01-01

    Acute postoperative endophthalmitis caused by Staphylococcus lugdunensis is infrequently reported in clinical studies. Five cases of acute postcataract surgery endophthalmitis caused by S. lugdunensis were taken from a multicenter prospective study conducted in four university-affiliated hospitals in France (2004 to 2005). These cases were characterized by severe ocular inflammation occurring with a mean delay of 7.6 days after cataract surgery, severe visual loss (hand motions or less in three cases), and dense infiltration of the vitreous. Each of these patients was initially treated by using a standard protocol with intravitreal (vancomycin and ceftazidime), systemic, and topical antibiotics. Given the severity of the endophthalmitis, even though bacteria were sensitive to intravitreal antibiotics, pars plana vitrectomy was needed in four cases. The final visual prognosis was complicated by severe retinal detachment in three cases. The microbiological diagnosis was reached by using conventional cultures with specific biochemical tests and eubacterial PCR amplification followed by direct sequencing. PMID:17392442

  1. Tryptophan Supplementation and Postoperative Delirium – A Randomized Controlled Trial

    PubMed Central

    Robinson, Thomas N.; Dunn, Christina L.; Adams, Jill C.; Hawkins, Carrie L.; Tran, Zung V.; Raeburn, Christopher D.; Moss, Marc

    2014-01-01

    Background/Objectives Tryptophan deficiency has been associated with increased incidence of postoperative delirium. Therefore, we hypothesized that the post-operative administration of tryptophan would be beneficial for elderly surgical patients who are at higher risk of developing post-operative delirium. Design Randomized, double-blind, placebo controlled trial. Setting: Participants A total of 325 individuals aged 60 years and older undergoing major elective operations requiring a postoperative intensive care unit admission. Intervention L-tryptophan, 1 gram orally, three times daily or placebo was started following the operation and continued for up to three days postoperatively. Measurements Delirium and its motor subtypes were measured using the Confusion Assessment Method-ICU and the Richmond Agitation and Sedation Scale. The primary outcome for between groups comparison was the incidence of excitatory (mixed and hyperactive) postoperative delirium. The secondary outcomes for comparison were the incidence and duration of overall postoperative delirium. Results The overall incidence of postoperative delirium was 39% (116) (95% confidence interval 34% to 44%). The percentages of patients with excitatory delirium in the tryptophan and placebo groups were 17% and 9% (p=0.176), and the duration of excitatory delirium was 3.3±1.7 and 3.1±1.9 days (p=0.741). The percentage of patients with overall delirium in the tryptophan and placebo groups was 40% and 37% (p=0.597), and the duration of overall delirium was 2.9±1.8 and 2.4±1.6 days (p=0.167). Conclusion Postoperative tryptophan supplementation in older adults undergoing major elective operations requiring postoperative intensive care unit admission demonstrated no efficacy in reducing the incidence of postoperative excitatory delirium or overall delirium, and the duration of excitatory or overall delirium. PMID:25112175

  2. Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix.

    PubMed

    Lambropoulos, V; Mylona, E; Mouravas, V; Tsakalidis, C; Spyridakis, I; Mitsiakos, G; Karagianni, P

    2016-01-01

    Introduction. Incisional hernias are a common complication appearing after abdominal wall defects reconstruction, with omphalocele and gastroschisis being the most common etiologies in children. Abdominal closure of these defects represents a real challenge for pediatric surgeons with many surgical techniques and various prosthetic materials being used for this purpose. Case Report. We present a case of repair of a postoperative ventral hernia occurring after congenital omphalocele reconstruction in a three-and-a-half-year-old child using an acellular, sterile, porcine dermal mesh. Conclusion. Non-cross-linked acellular porcine dermal matrix is an appropriate mesh used for the reconstruction of abdominal wall defects and their postoperative complications like large ventral hernias with success and preventing their recurrence. PMID:27110247

  3. Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix

    PubMed Central

    Mylona, E.; Tsakalidis, C.; Spyridakis, I.; Mitsiakos, G.; Karagianni, P.

    2016-01-01

    Introduction. Incisional hernias are a common complication appearing after abdominal wall defects reconstruction, with omphalocele and gastroschisis being the most common etiologies in children. Abdominal closure of these defects represents a real challenge for pediatric surgeons with many surgical techniques and various prosthetic materials being used for this purpose. Case Report. We present a case of repair of a postoperative ventral hernia occurring after congenital omphalocele reconstruction in a three-and-a-half-year-old child using an acellular, sterile, porcine dermal mesh. Conclusion. Non-cross-linked acellular porcine dermal matrix is an appropriate mesh used for the reconstruction of abdominal wall defects and their postoperative complications like large ventral hernias with success and preventing their recurrence. PMID:27110247

  4. Endoscopic microwave coagulation therapy of postoperative hemorrhage from a stapled anastomosis.

    PubMed

    Umano, Yasukazu; Horiuchi, Tetsuya; Inoue, Masaya; Shono, Yoshiharu; Oku, Yoshimasa; Tanishima, Hiroyuki; Tsuji, Takeshi; Tabuse, Katsuyoshi

    2005-01-01

    We experienced three cases of postoperative hemorrhage from a stapled gastrointestinal anastomosis, and established endoscopic microwave coagulation therapy (EMCT) with a cylinder-type electrode. We were able to treat postoperative hemorrhage over the entire circumference of stapled anastomosis successfully. Two patients had undergone a lower third thoracic esophagogastrectomy through a left thoraco-abdominal approach for gastric cancer in the cardia, while the other case had undergone Billroth I gastrectomy. They each had fresh bleeding from the stapled anastomosis after the operation. Emergency endoscopic examination was immediately performed. Endoscopy revealed bleeding on the suture line. We performed hemostasis endoscopically with microwave coagulation therapy safely. They were discharged from the hospital without complications such as leakage and stenosis. Since EMCT with the cylinder-type electrode can coagulate shallowly and widely, it is very effective for hemorrhage from a stapled anastomosis. PMID:16334775

  5. Postoperative enteral hyperalimentation results in earlier elevation of serum branched-chain amino acid levels.

    PubMed

    Moss, G; Naylor, E D

    1994-07-01

    To objectively document the immediate maintenance and successful exploitation of postoperative gastrointestinal (GI) function, elemental diet was infused into the more distal duodenum of 30 cholecystectomy patients at 300 kcal per hour, beginning on arrival at the recovery room. Approximately 4,600 kcal and 190 grams of amino acids were absorbed during the initial 16 hours. Serum branched-chain amino acids (BCAAs) had risen above basal levels at 4 hours, statistically significant only for leucine (+64%). The higher concentrations had reached statistical significance for all BCAAs by 6 hours, when leucine had risen by 83%, isoleucine by 54%, and valine by 47%. The elevated BCAA and glucose levels sustained throughout the hyperalimentation period objectively verify that postoperative GI function can be safely exploited, and may contribute to improved wound healing and sepsis resistance. PMID:8024096

  6. Postoperative Change in Ocular Torsion in Intermittent Exotropia: Relationship with Postoperative Surgical Outcomes.

    PubMed

    Lee, Ju-Yeun; Hwang, Sungsoon; Oh, Shin Yeop; Park, Kyung-Ah; Oh, Sei Yeul

    2016-01-01

    The aim of this study was to determine whether objective ocular torsion in intermittent exotropia (IXT) changes after recession surgery, and to evaluate the relationship between change in ocular torsion and clinical parameters in IXT. Sixty patients between 3 and 14 years of age underwent lateral rectus (LR) recession for IXT. Digital fundus photographs were obtained from both eyes of each subject and the disc-foveal angle (ocular torsion) was calculated using image software. We compared the preoperative and postoperative amount of ocular torsion, and analyzed the correlation between the difference in ocular torsion (DOC) and clinical parameters including age, duration of strabismus, stereoacuity, amount of preoperative exodeviation, and mean dose response. We categorized the patients according to DOC value: positive DOC value as group 1, and negative DOC value as group 2. A correlation between ocular torsion dominance and fixation preference was also investigated using the Kappa test. The mean ocular torsion was 15.8 ± 4.6 degrees preoperatively and 13.7 ± 5.1 degrees postoperatively. Compared with preoperative values, the mean ocular torsion showed a significant decrease after LR recession (p<0.001), and a greater preoperative ocular torsion was significantly associated with the amount of DOC (r = 0.37, p<0.001). Degree of stereopsis, mean dose-response, and postoperative exodeviation were significantly different between group 1 (positive DOC) and group 2 (negative DOC) (p<0.001, 0.030, and 0.001 respectively). The Kappa test showed that there was a significant correlation between the dominance of ocular torsion and fixation preference (p = 0.020). Therefore, change in ocular torsion after LR recession can be a useful supplementary indicator for evaluating the degree of fusional control and for predicting postoperative surgical response in IXT. PMID:27622574

  7. Successful Use of Esophageal Stent Placement to Treat a Postoperative Esophageal Stricture in a Toddler.

    PubMed

    Gebrail, Rami; Absah, Imad

    2014-10-01

    Esophageal atresia (EA) is the most common type of gastrointestinal atresia. The most common variant (type C) consists of a blind esophageal pouch with a fistula between the trachea and the distal esophagus. Surgical repair can be complicated by the development of benign stricture. Most strictures are amenable to dilation, but refractory strictures may require surgical intervention. A 24-month-old boy born with tracheoesophageal fistula and EA underwent surgical repair on day 1 of life. He developed esophageal stricture that responded to esophageal stent placement. Endoscopic biliary accessories can be safely used to dilate refractory esophageal strictures in children, and should be considered prior to seeking other complex alternatives. PMID:26157909

  8. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    SciTech Connect

    Oh, Jung Suk Lee, Hae Giu Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

    2013-10-15

    Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.

  9. Postoperative Cerebrospinal Fluid Leakage Associated With Total En Bloc Spondylectomy.

    PubMed

    Yokogawa, Noriaki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Hayashi, Hiroyuki; Ishii, Takayoshi; Igarashi, Takashi; Fang, Xiang; Tsuchiya, Hiroyuki

    2015-07-01

    Cerebrospinal fluid (CSF) leakage is a serious postoperative complication associated with total en bloc spondylectomy. The authors examined the risk factors for CSF leakage after this procedure. A total of 72 patients underwent total en bloc spondylectomy at the authors' institution between May 2010 and April 2013. Postoperative CSF leakage was observed in 17 of the 72 patients (23.6%). The results of univariate analysis suggested that age 54 years or older, preoperative surgical site irradiation, resection of 3 or more vertebral bodies, and dural injury were significant risk factors for postoperative CSF leakage after total en bloc spondylectomy. Multivariate analysis showed that preoperative surgical site irradiation was the only significant risk factor for postoperative CSF leakage (adjusted odds ratio, 5.22; 95% confidence interval, 1.03-26.45, P=.046). The authors also assessed the course of treatment for postoperative CSF leakage in each patient. Of 17 patients with postoperative CSF leakage, 13 recovered without further complications, but 4 required reoperation (2 for wound dehiscence, 1 for surgical site infection, and 1 for severe intracranial hypotension). All 4 patients who required reoperation had a history of surgical site irradiation. Thus, this study suggests that careful consideration should be given to postoperative CSF leakage in patients with a history of surgical site irradiation. These findings may contribute to the management of postoperative CSF leakage associated with total en bloc spondylectomy and supplement the information given to the patient in the process of obtaining informed consent. PMID:26186316

  10. Clinical results of renal artery embolization to control postoperative hemorrhage after partial nephrectomy

    PubMed Central

    Jeon, Chang Ho; Yoon, Chang Jin; Byun, Seok-Soo; Lee, Sang Eun

    2016-01-01

    Background With the wider application of nephron-sparing surgery, there has been an increase in the occurrence of postoperative hemorrhage. However, despite such an increase, there are only a limited number of reports regarding renal artery embolization (RAE) for the management of postoperative bleeding after nephron-sparing surgery, especially after robot-assisted laparoscopic partial nephrectomy (RALPN). Purpose To evaluate the safety and clinical efficacy of transcatheter RAE for postoperative hemorrhage after open partial nephrectomy (OPN) and RALPN. Material and Methods A total of 29 patients (17 men, 12 women; age range, 31–70 years) who were referred to our hospital for postoperative hemorrhage after partial nephrectomy, between December 2003 and December 2014, were selected. We retrospectively reviewed patients’ clinical data, angiographic findings, embolization details, and clinical outcomes. Results Embolization was performed in patients who underwent OPN (25/29) and RALPN (4/29). The angiographic findings were as follows: renal artery pseudoaneurysm (n = 18), contrast extravasation (n = 8), and arteriovenous fistula (n = 3). Fiber-coated microcoil and n-butyl-2-cyanoacrylate (NBCA) was administered to the targeted bleeding renal arteries in 12 and 11 patients, respectively. In six patients, fiber-coated microcoil and NBCA were used concurrently. Technical and clinical successes were achieved in all patients (100%). Bleeding cessation was achieved in all patients, and no further relevant surgeries or interventions were required for hemorrhage control. There were no episodes of hemorrhagic recurrence during the follow-up period (median, 20 days; range, 7–108 days). Conclusion Angiography and RAE identified the origin of bleeding and could successfully preserve the residual renal function. PMID:27570638

  11. Evaluation of progestogens for postoperative adhesion prevention.

    PubMed

    Beauchamp, P J; Quigley, M M; Held, B

    1984-10-01

    Progesterone (P) has been shown to have potent antiinflammatory and immunosuppressive properties. Previous reports have suggested that the use of P decreases postoperative adhesion formation. To further evaluate the role of pharmacologic doses of progestogens in adhesion prevention, 42 mature New Zealand White rabbits underwent standardized injuries to the uterine horns, fimbriae, and pelvic peritoneum and received one of six treatments. Group S had intraperitoneal placement of normal saline (0.9%); group H received intraperitoneal placement of 32% dextran 70; group IM-P received intramuscular P-in-oil 10 days before and after laparotomy in addition to intraperitoneal saline; group IP-P had intraperitoneal placement of an aqueous P suspension; group DP received medroxyprogesterone acetate intraperitoneally; and group C received no intramuscular or intraperitoneal adhesion-prevention agents. The animals were sacrificed 6 weeks after laparotomy, and the adhesions were scored. Intraperitoneal saline (group S) significantly reduced the amount of adhesions when compared with the control group (C) (P less than 0.05). No significant difference was observed when group S was compared with group H. Intramuscular P added to saline (group IM-P) did not cause further reduction in adhesions when compared with group S. Both group IP-P and group DP had more adhesions than did group S (P less than 0.01). These data fail to support previous claims regarding adhesion prevention by the use of locally or parenterally administered progestogens. PMID:6237937

  12. Pterygia: Single-fraction postoperative beta irradiation

    SciTech Connect

    Beyer, D.C. )

    1991-02-01

    A retrospective evaluation was performed with records of 128 patients with 146 eyes that underwent applications of strontium-90 after pterygium excisions performed between 1982 and 1988. With a median follow-up of 13 months, 135 eyes were evaluable. Most pterygia (127 of 135) were treated with a single postoperative application of Sr-90 that delivered 3,000 cGy of beta radiation in one fraction. The actuarial freedom from relapse was 87%; all recurrences occurred within the first 18 months, and 46% of these within the first 3 months. Of the 13 recurrences, 10 have been re-treated with surgery and a second course of beta irradiation with excellent results. All eight eyes for which follow-up was available had no evidence of disease. The ultimate control rate was 96.3% for the series. Correlation of various treatment parameters, including age, bilaterality, prior recurrence, and interval from surgery to irradiation, was performed, and no statistically significant difference was seen. No serious complications have developed. Transient conjunctivitis and photophobia were almost universally seen, with five cases lasting beyond 5 months. The authors conclude that a single application of Sr-90 after surgery is effective and safe in managing pterygia.

  13. Postoperative radionuclide evaluation of osteoid osteomas

    SciTech Connect

    Ghelman, B.; Vigorita, V.J.

    1983-02-01

    Five cases of clinically suspected osteoid osteomas were studied by preoperative injectin of technetium-99m methylene disphosphonate, intraoperative localization with a radiation-sensitive scintillation probe, and postoperative examination of the entire tissue specimen (including the presumed nidus and surrounding bone). Microradiography and light microscopy were also used. In addition, a new autoradiography technique was introduced in which the excised surgical specimen was placed on undeveloped x-ray film for pathologic localizaton, diagnosis of the lesions, and a study of the relative intensity of radioactive uptake in the nidus vs. surrounding bone. Autoradiography revealed that the nidus showed the greatest concentration of radioactivity, followed by the surrounding bone. The authors conclude that lt. slashsup 99mlt. slashTc can be used clinically in localizing osteoid osteomas and that preoperative and intraoperative scanning can assist in conservative surgical excision, e.g., minimal extirpation of bone in delicate areas such as the spine. For small lesions, autoradiography assists the pathologist in identifying an osteoid osteoma.

  14. [Acute postop ischemic hepatitis and hypotension].

    PubMed

    Uzhva, V P

    2000-01-01

    The significance of the pronounced durable systemic arterial hypotension (SAH) in the origin of an acute postoperative ischemic hepatitis (APIH) was established, basing on the analysis of 40 clinical observations. Its occurrence is promoted by hemorrhage with 30% and more the circulating blood volume (CBV) deficiency, chronic cardiovascular system and pulmonary diseases, liver cirrhosis, shock, massive infusions of the blood and its components, the abdominal aorta atherosclerosis with stenosis of tr. coeliacus, a. hepatica. Forgoing SAH, the presence of promoting factors, jaundice, the transpherase activity raising in 3-5 times, the level of blood coagulating factors reduction, stable intestinal paresis were diagnostically significant symptoms. Experimental model of an APIH was elaborated in dogs, which occurs due to hypotension, caused by CBV reduction by 40% during two hours. The refractoriness of a. hepatica propria to the blood reinfusion was established. In the APIH occurrence threat the perftoran application in the 20 ml/kg dosage is the prophylaxis method as well as the method of the curative tactics choice. PMID:10857279

  15. Olfactory dysfunction is related to postoperative delirium in Parkinson's disease.

    PubMed

    Kim, Min Seung; Yoon, Jung Han; Kim, Hyun Jae; Yong, Seok Woo; Hong, Ji Man

    2016-06-01

    Operations often lead to delirium in elderly patients, particularly those with impaired cognition, suggesting that underlying neuropathology may play a role in the development of postoperative delirium. Olfactory dysfunction is a well-known marker of underlying Lewy body pathology in Parkinson's disease (PD). However, the prognostic value of olfaction for the development of postoperative delirium in PD remains unclear. 34 PD patients with or without postoperative delirium following surgery under general anesthesia were included in this study (n = 17 for each group). Cross-Cultural Smell Identification scores were lower in PD patients with postoperative delirium (4.4 ± 1.5) relative to the delirium-free controls (6.8 ± 2.4, p < 0.005). Multivariate logistic regression analysis revealed that olfaction and operation time were significant predictors of the development of postoperative delirium. Impaired olfaction is significantly associated with postoperative delirium in PD. Olfaction may be useful for identifying PD patients susceptible to postoperative delirium. PMID:27098668

  16. Success of myringoplasty: our experience.

    PubMed

    Kamath, M Panduranga; Sreedharan, Suja; Rao, A Raghavendra; Raj, Vinay; Raju, Krishnam

    2013-12-01

    The purpose of this study is to compare the efficacy of myringoplasty with or without cortical mastoidectomy in terms of freedom from discharge, graft take up and improvement in hearing. This is a Clinical prospective study of 120 patients from among a group of patients with chronic suppurative otitis media. A detailed history and examination was conducted including pure tone audiogram. Patients were randomly divided into two groups; group A would undergo myringoplasty only and group B would undergo cortical mastoidectomy with myringoplasty. Patients were reviewed after 3 weeks for inspection of the operated ear. Second post-operative review was at 3 months for clinicoaudiological assessment. Group B was found to have slightly more improvement as compared to the other group. No significant difference in the success rates of graft take-up in patients with unilateral or bilateral disease was found. Higher take up rates were seen in large (91.83 %) and medium perforations (90.69 %). In all our failed cases, post-operative ear discharge continued to be a persistent and troubling problem. The average audiological gain was 12.88 dB in group B, whereas it was 12.40 dB in group A. The reduction of air bone gap within each group was found to be significant. There is no statistical significant data indicating that tympanoplasty with mastoidectomy yields better results. When considering the addition of a mastoidectomy to a Tympanoplasty, the performing surgeon should consider not only the potential added benefit but also potential risks and costs to the patient. PMID:24427599

  17. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    PubMed

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of

  18. Promoting safety of postoperative orthopaedic patients with obstructive sleep apnea.

    PubMed

    Veney, Amy J

    2013-01-01

    Orthopaedic patients with obstructive sleep apnea are at risk for postoperative complications related to administration of pain medications, anxiolytics, and antiemetics. They are more likely to experience respiratory and cardiac complications, be transferred to an intensive care unit, or have an increased length of stay in the hospital. This informational article is for nurses who care for postoperative orthopaedic patients with obstructive sleep apnea. The focus is on promoting patient safety through communication, vigilant postoperative sedation assessment, and nursing interventions that include appropriate patient positioning, patient education, and involving patients and their families in care. PMID:24247310

  19. Remote Postoperative Epidural Hematoma after Brain Tumor Surgery

    PubMed Central

    Chung, Ho-Jung; Park, Jae-Sung; Jeun, Sin-Soo

    2015-01-01

    A postoperative epidural hematoma (EDH) is a serious and embarrassing complication, which usually occurs at the site of operation after intracranial surgery. However, remote EDH is relatively rare. We report three cases of remote EDH after brain tumor surgery. All three cases seemed to have different causes of remote postoperative EDH; however, all patients were managed promptly and showed excellent outcomes. Although the exact mechanism of remote postoperative EDH is unknown, surgeons should be cautious of the speed of lowering intracranial pressure and implement basic procedures to prevent this hazardous complication of brain tumor surgery. PMID:26605271

  20. Postoperative Therapy for Chronic Thumb Carpometacarpal (CMC) Joint Dislocation.

    PubMed

    Wollstein, Ronit; Michael, Dafna; Harel, Hani

    2016-01-01

    Surgical arthroplasty of thumb carpometacarpal (CMC) joint osteoarthritis is commonly performed. Postoperative therapeutic protocols aim to improve range of motion and function of the revised thumb. We describe a case in which the thumb CMC joint had been chronically dislocated before surgery, with shortening of the soft-tissue dynamic and static stabilizers of the joint. The postoperative protocol addressed the soft tissues using splinting and exercises aimed at lengthening and strengthening these structures, with good results. It may be beneficial to evaluate soft-tissue tension and the pattern of thumb use after surgery for thumb CMC joint osteoarthritis to improve postoperative functional results. PMID:26709434

  1. A Practical Approach to Preventing Postoperative Recurrence in Crohn's Disease.

    PubMed

    Hashash, Jana G; Regueiro, Miguel

    2016-05-01

    Postoperative Crohn's disease recurrence remains common, and preventing additional surgery remains a challenge. A critical step to postoperative management of Crohn's disease is being able to identify patients who should receive immediate postoperative therapy from the patients who can wait for recurrence prior to starting medications. All patients, regardless of their risk for recurrence, are advised to undergo a colonoscopy at 6 to 12 months after surgery to evaluate for endoscopic evidence of Crohn's disease. Further management of patients depends on symptoms and the presence or absence of endoscopic recurrence. PMID:27086006

  2. Factors affecting postoperative blood loss in children undergoing cardiac surgery.

    PubMed

    Faraoni, David; Van der Linden, Philippe

    2014-01-01

    We hypothesized that the influence of cyanotic disease on postoperative blood loss is closely related to age in children undergoing cardiac surgery. Here, we demonstrate that the presence of a cyanotic disease is associated with increased postoperative blood loss in children aged 1 to 6 months. Children with cyanotic disease and aged<1 month who received fresh frozen plasma during cardiopulmonary bypass had less postoperative blood loss and higher maximal clot firmness on FIBTEM than cyanotic children from all other groups. Additional studies are needed to define optimal pathophysiology-based management in children undergoing cardiac surgery. PMID:24512988

  3. Use of Postoperative Palatal Obturator After Total Palatal Reconstruction With Radial Forearm Fasciocutaneous Free Flap.

    PubMed

    Jeong, Euicheol C; Jung, Young Ho; Shin, Jin-yong

    2015-07-01

    A 67-year-old-male patient visited our hospital for a mass on the soft palate of approximately 5.0 × 6.0  cm in size. He was diagnosed with adenoid cystic carcinoma and reconstruction after total palate resection was planned. After ablative surgery, a radial forearm free flap procedure was successfully performed to cover the hard and soft palates. However, wound disruption occurred twice during the postoperative period. When a palate defect is reconstructed using a soft tissue free flap, flap drooping by gravitation and the flap itself can generate irregularity in the lower contour of the palate and, in the long-term, insufficiencies of velopharyngeal function, speech, and mastication. To complement such functional and aesthetic problems caused by flap drooping, conventional prosthetics and new operative techniques have been discussed. However, overcoming wound disruption caused by flap drooping in the acute postoperative period has not been discussed. In this case, the temporary use of a palatal obturator during the postoperative period was beneficial after soft tissue reconstruction of the palate. PMID:26114541

  4. Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery

    PubMed Central

    Siddiqui, Ali Sarfraz; Dogar, Samie Asghar; Lal, Shankar; Akhtar, Shabbir; Khan, Fauzia Anis

    2016-01-01

    Background and Aims: General anesthesia and airway management of patients for head and neck cancer surgery is a challenge for the anesthesiologist. Appropriate assessment and planning are essential for successful airway management. Our objectives were to review airway management strategies in patients undergoing head and neck cancer surgery in our tertiary care institution and also to observe the effect of airway management techniques on postoperative length of hospital stay (PLOS). Material and Methods: A retrospective medical record review of 400 patients who underwent major head and neck cancer surgery in our institution was conducted. A special form was used, and records were searched for airway and anesthetic management in the operating room and recovery room, and for PLOS. Results: 289 (72.25%) of the patients were male, and 111 (27.75%) female. 49.8% of patients had Mallampati score of 3 and 4. Airway was managed with tracheostomy in 81 (20.25%) patients; nasal intubation was performed in 177 (44.25%) and oral intubation in 142 (35.5%) patients. Postoperative emergency tracheostomy was not done in any of the patients. Conclusion: Median postoperative hospital stay was significantly longer (P = 0.0005) in patients who had a tracheostomy performed compared with those where the airway was managed without it. PMID:27006541

  5. Postoperative Outcomes After Robotic Versus Abdominal Myomectomy

    PubMed Central

    Griffin, Leanne; Feinglass, Joe; Garrett, Ariane; Henson, Anne; Cohen, Leeber; Chaudhari, Angela

    2013-01-01

    Background and Objectives: Differences in postoperative outcomes comparing robotic-assisted laparoscopic myomectomy (RALM) with abdominal myomectomy (AM) have rarely been reported. The objective of this study was to compare surgical, quality-of-life, and residual fibroid outcomes after RALM and AM. Methods: Consecutive patients who underwent RALM (n = 16) were compared with AM patients (n = 23) presenting with a uterine size of <20 weeks. Study patients participated in a telephone interview at 6 weeks and underwent a no-cost ultrasonographic examination at 12 weeks after surgery to obtain quality-of-life and residual fibroid outcomes. Medical records were reviewed to obtain surgical outcomes. Results: Longer operative times (261.1 minutes vs 124.8 minutes, P < .001) and a 3-fold unfavorable difference in operative efficiency (73.7 g vs 253.0 g of specimen removed per hour, P < .05) were observed with RALM compared with AM. Patients undergoing RALM had shorter lengths of hospital stay (1.5 days vs 2.7 days, P < .001). Reduction of patient symptoms and overall satisfaction were equal. RALM patients were more likely to be back to work within 1 month (85.7% vs 45.0%, P < .05). Residual fibroid volume in the RALM group was 5 times greater than that in the AM group (17.3 cm3 vs 3.4 cm3, P < .05). Conclusion: RALM and AM were equally efficacious in improving patient symptoms. Although operative times were significantly longer with RALM, patients had a quicker recovery, demonstrated by shortened lengths of stay and less time before returning to work. However, greater residual fibroid burden was observed with RALM when measured 12 weeks after surgery. PMID:24018077

  6. Survival analysis following early surgical success in intermittent exotropia surgery

    PubMed Central

    Lee, Joo Yeon; Ko, Sung Ju; Baek, Sung Uk

    2014-01-01

    AIM To assess the consecutive recurrence following early success of intermittent exotropia surgery and to determine the clinical factors that affect the survival. METHODS One hundred and thirty-five patients who underwent intermittent exotropia surgery and experienced early surgical success [≤5 prism diopters (PD) esophoria (E) to ≤10 PD exophoria (X) on the postoperative sixth month] were enrolled in this study. Their consecutive survival on the postoperative first year, second year and third year and at the last visit of fourth year or more, and the factors that might affect their survival, were analyzed. The final surgical outcomes after the postoperative fourth year were also investigated by dividing the patients into the success group (≤5 PD E to ≤10 PD X) and the failure group (>5 PD esodeviation or >10 PD exodeviation) RESULTS The survival rates from the Kaplan-Meier analysis were 97.78%, 92.89%, 83.70% and 50.49% on the postoperative first, second and third years and fourth year or more, respectively. None of the clinical factors was determined to have affected the survival. The amount of the exodrift was largest (2.29 PD) between the first year and the second year, and smallest (1.47 PD) between the fourth year and the last visit. Sixty-three patients had their final visit after the postoperative fourth year, and 29 of them were in the failure group. Twenty-five patients in the failure group had an intermittent exotropia (IXT) of <20 PD with good to fair distant fusion; two had an IXT of <20 PD with poor distant fusion; one had an IXT of ≥20 PD with fair distant fusion; and another had delayed-onset consecutive esotropia. The exodeviation on the postoperative sixth month was smaller in the success group than in the failure group (2.81 PD vs 5.86 PD, P=0.012). The reoperation rate for recurrent IXT was 3.7%. CONCLUSION The survival rate steadily decreases with the exodrift, but the amount of the exodrift decreases with long-term follow-up. The

  7. [Research advance in causes of postoperative gastrointestinal dysfunction].

    PubMed

    Tan, Shanjun; Wu, Guohao; Yu, Wenkui; Li, Ning

    2016-03-01

    Gastrointestinal dysfunction is a common and major complication after surgery. The syndrome covers a wide spectrum of clinical signs, ranges from mild feeling to severe discomfort and varies from person to person. The mild patients need no care, but severe ones may have long hospital stay, and even suffer from multiple organ dysfunction syndrome, severely affecting postoperative rehabilitation. However, the etiology of postoperative gastrointestinal dysfunction has not been fully elucidated. Much research demonstrates that many factors, such as operative procedures, surgical operation, homeostasis disturbance, anesthesia and analgesia, blood perfusion, inflammation, and neuroendocrine factors, are responsible for the development and progression of postoperative gastrointestinal dysfunction. This study therefore reviewed the causes of postoperative gastrointestinal dysfunction in the published literatures. PMID:27003660

  8. [PRINCIPLES OF POSTOPERATIVE DRUG THERAPY OF COMPLICATED DUODENAL ULCERS].

    PubMed

    Denisova, E V; Nazarov, V E

    2015-01-01

    The article highlights the principles of individualized drug therapy of complicated duodenal ulcers in the postoperative period, based on the removal of the pathophysiological changes that occurred after different types of medical or surgical benefits. PMID:26415272

  9. Addiction Risk Low for Seniors Taking Post-Op Opioids

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_160358.html Addiction Risk Low for Seniors Taking Post-Op Opioids: ... many worry that post-surgical use might trigger addiction. But a new study suggests that painkiller abuse ...

  10. Bilateral postoperative maxillary cysts after orthognathic surgery: A case report

    PubMed Central

    Lee, Jung-Hye; Huh, Kyung-Hoe; Yi, Won-Jin; Heo, Min-Suk; Lee, Sam-Sun

    2014-01-01

    Postoperative maxillary cysts are locally aggressive lesions, usually developing as delayed complications many years after radical antral surgery. This report describes a case of bilateral postoperative maxillary cysts following orthognathic surgery performed approximately 21 years previously. The patient complained of stinging pain on her right cheek. Radiographic examination revealed low-attenuation lesions on both maxillary sinuses with discontinuously corticated margins without distinct expansion or bone destruction. The cysts were enucleated with the removal of metal plates and screws for pain relief. Histopathological examination confirmed the diagnosis of postoperative maxillary cysts lined by ciliated, pseudostratified columnar cells. The patient has remained asymptomatic thus far, and there was no evidence of local recurrence at 21 months of postoperative follow-up. PMID:25473641

  11. Post-operative epidural analgesia: effects on lung volumes.

    PubMed

    Wahba, W M; Don, H F; Craig, D B

    1975-07-01

    A study was undertaken to assess the role of post-operative pain in reducing Functional Residual Capacity (FRC) and Vital Capacity (VC). The efficacy of post-operative epidural analgesia in reversing these changes was measured in eight subjects after upper abdominal operations. With pain, FRC and VC were 78 per cent and 37 per cent of control respectively. Following epidural analgesia, the values were 84 per cent and 55 per cent. These figures indicate the pain component in the post-operative reduction of these two lung capacities. This partial restoration may be of value in the prevention of post-operative pulmonary complications by avoiding closure of small airways during tidal breathing and by increasing the effectiveness of deep breathing and coughing in the removal of secretions and the reversal of atelectasis. PMID:1095163

  12. Comparison of methods to facilitate postoperative bowel function.

    PubMed

    Crainic, Christina; Erickson, Kathie; Gardner, Janet; Haberman, Sheri; Patten, Pam; Thomas, Pat; Hays, Victoria

    2009-01-01

    Improving postoperative return of bowel function after abdominal surgery is an important nursing and medical goal. One promising intervention to achieve this goal is to have patients chew gum several times per day in the early postoperative period to stimulate the cephalic-vagal reflex and bowel peristalsis. A study to determine if return of gastrointestinal function after abdominal surgery could be hastened by the simple intervention of chewing gum or sucking on hard candy three times per day is described. PMID:20552850

  13. Fosaprepitant for the Treatment of Refractory Postoperative Nausea and Vomiting

    PubMed Central

    Cudny, Magdalena; Ngo, Dat; Patel, Samit; Lam, Manuel Y.

    2015-01-01

    Abstract Postoperative nausea and vomiting (PONV) is a debilitating condition that occurs in approximately 30% of patients undergoing general anesthesia. Premedication with 5-HT3 receptor antagonists and glucocorticoids is effective in clinical practice; however, 10% to 20% of patients still develop PONV. Currently, little is known about the treatment of refractory PONV. We present a case that illustrates the use of fosaprepitant for the treatment of refractory postoperative nausea and vomiting. PMID:26405312

  14. Influence of the Preoperative Decision-Making Process on the Postoperative Outcome after Hysterectomy for Benign Uterine Pathologies

    PubMed Central

    Radosa, J. C.; Radosa, C. G.; Kastl, C.; Mavrova, R.; Gabriel, L.; Gräber, S.; Wagenpfeil, G.; Baum, S.; Hamza, A.; Joukhadar, R.; Juhasz-Böss, I.; Heimes, A.-S.; Meyberg-Solomayer, G.; Solomayer, E.-F.; Radosa, M. P.

    2016-01-01

    Introduction: The aim of this study was to assess whether the preoperative decision-making process might influence treatment success in premenopausal women undergoing hysterectomy for benign uterine pathologies Materials and Methods: All premenopausal women treated with hysterectomy for benign uterine pathologies between April 2011 and June 2013 at a tertiary university center were enrolled in this prospective observational cohort study. Five parameters of the preoperative decision-making process were assessed upon their correlation with postoperative quality of life, sexual function and patientsʼ satisfaction. These outcome measures were assessed for the pre- and postoperative (six months after surgery) status using two validated questionnaires (EQ-5D and “female sexual function index” (FSFI). Patientsʼ satisfaction with the postoperative outcome was assessed with a self-developed questionnaire. Results: 255 of 402 (63 %) patients completed the study. A correlation between the co-variables “interval between first counseling and decision to surgery”, “subjectively perceived quality of the preoperative counseling” and “certainty in the decision for the intervention” and postoperative outcomes were found. The co-variables “person mainly responsible for election of hysterectomy mode” and “discussion of decision for surgery with others” showed no influence on postoperative patients-reported outcomes. Conclusion: We found a correlation between certain parameters of the preoperative decision-making process and postoperative patient-reported sexual function, quality of life and patientsʼ satisfaction in premenopausal women undergoing hysterectomy for benign uterine pathologies. An optimization of these factors could contribute to an improvement in treatment outcomes. PMID:27134293

  15. Clinical value of CT-based preoperative software assisted lung lobe volumetry for predicting postoperative pulmonary function after lung surgery

    NASA Astrophysics Data System (ADS)

    Wormanns, Dag; Beyer, Florian; Hoffknecht, Petra; Dicken, Volker; Kuhnigk, Jan-Martin; Lange, Tobias; Thomas, Michael; Heindel, Walter

    2005-04-01

    This study was aimed to evaluate a morphology-based approach for prediction of postoperative forced expiratory volume in one second (FEV1) after lung resection from preoperative CT scans. Fifteen Patients with surgically treated (lobectomy or pneumonectomy) bronchogenic carcinoma were enrolled in the study. A preoperative chest CT and pulmonary function tests before and after surgery were performed. CT scans were analyzed by prototype software: automated segmentation and volumetry of lung lobes was performed with minimal user interaction. Determined volumes of different lung lobes were used to predict postoperative FEV1 as percentage of the preoperative values. Predicted FEV1 values were compared to the observed postoperative values as standard of reference. Patients underwent lobectomy in twelve cases (6 upper lobes; 1 middle lobe; 5 lower lobes; 6 right side; 6 left side) and pneumonectomy in three cases. Automated calculation of predicted postoperative lung function was successful in all cases. Predicted FEV1 ranged from 54% to 95% (mean 75% +/- 11%) of the preoperative values. Two cases with obviously erroneous LFT were excluded from analysis. Mean error of predicted FEV1 was 20 +/- 160 ml, indicating absence of systematic error; mean absolute error was 7.4 +/- 3.3% respective 137 +/- 77 ml/s. The 200 ml reproducibility criterion for FEV1 was met in 11 of 13 cases (85%). In conclusion, software-assisted prediction of postoperative lung function yielded a clinically acceptable agreement with the observed postoperative values. This method might add useful information for evaluation of functional operability of patients with lung cancer.

  16. Postoperative pain relief following hysterectomy: A randomized controlled trial

    PubMed Central

    Raghvendra, K. P.; Thapa, Deepak; Mitra, Sukanya; Ahuja, Vanita; Gombar, Satinder; Huria, Anju

    2016-01-01

    Background: Women experience moderate to severe postoperative pain following total abdominal hysterectomy (TAH). The transversus abdominis plane (TAP) block is a new modality for providing postoperative pain relief in these patients. Materials and Methods: The present study was a single center, prospective randomized trial. After the Institutional Ethics Committee approval and informed consent, patients were randomized to either epidural group: Epidural block placement + general anesthesia (GA) or TAP group: Single shot TAP block + GA. Patients in both the groups received standard general anesthetic technique and intravenous tramadol patient-controlled analgesia in the postoperative period. Patients were monitored for tramadol consumption, visual analog scale (VAS) both at rest and on coughing, hemodynamics, and side effects at 0, 2, 4, 6, 8, 12, and 24 h postoperatively. Results: The total consumption of tramadol in 24 h was greater in TAP group as compared to epidural group (68.8 [25.5] vs. 5.3 [11.6] mg, P < 0.001). The VAS scores at rest and on coughing were higher in TAP group as compared to the epidural group at 6, 8, 12, and 24 h postoperatively (P < 0.05). None of the patients in either group had any adverse effects. Conclusion: Epidural analgesia provided greater tramadol-sparing effect with superior analgesia postoperatively as compared to TAP block in patients up to 24 h following TAH. PMID:27499592

  17. Risk of postoperative recurrence and postoperative management of Crohn’s disease

    PubMed Central

    Spinelli, Antonino; Sacchi, Matteo; Fiorino, Gionata; Danese, Silvio; Montorsi, Marco

    2011-01-01

    Crohn’s disease (CD) is a chronic inflammatory disease of the digestive tract with systemic manifestations. Etiology is unknown, even if immunological, genetic and environmental factors are involved. The majority of CD patients require surgery during their lifetime due to progressive bowel damage, but, even when all macroscopic lesions have been removed by surgery, the disease recurs in most cases. Postoperative management represents therefore a crucial mean for preventing recurrence. Several drugs and approaches have been proposed to achieve this aim. Endoscopic inspection of the ileocolic anastomosis within 1 year from surgery is widely encouraged, given that endoscopic recurrence is one of the greatest predictors for clinical recurrence. A strategy should be planned only after stratifying patients according to their individual risk of recurrence, avoiding unnecessary therapies when possible benefits are reduced, and selecting high-risk patients for more aggressive intervention. PMID:21912470

  18. Ipsilateral Irradiation for Oral and Oropharyngeal Carcinoma Treated With Primary Surgery and Postoperative Radiotherapy

    SciTech Connect

    Vergeer, Marije R.; Doornaert, Patricia; Jonkman, Anja; Kaanders, Johannes H.A.M.; Ende, Piet L.A. van den; Jong, Martin A. de; Leemans, C. Rene; Langendijk, Johannes A.

    2010-11-01

    Purpose: The purpose was to evaluate the contralateral nodal control (CLNC) in postoperative patients with oral and oropharyngeal cancer treated with ipsilateral irradiation of the neck and primary site. Late radiation-induced morbidity was also evaluated. Methods and Materials: The study included 123 patients with well-lateralized squamous cell carcinomas treated with surgery and unilateral postoperative irradiation. Most patients had tumors of the gingiva (41%) or buccal mucosa (21%). The majority of patients underwent surgery of the ipsilateral neck (n = 102 [83%]). The N classification was N0 in 73 cases (59%), N1 or N2a in 23 (19%), and N2b in 27 cases (22%). Results: Contralateral metastases developed in 7 patients (6%). The 5-year actuarial CLNC was 92%. The number of lymph node metastases was the only significant prognostic factor with regard to CLNC. The 5-year CLNC was 99% in N0 cases, 88% in N1 or N2a cases, and 73% in N2b cases (p = 0.008). Borderline significance (p = 0.06) was found for extranodal spread. Successful salvage could be performed in 71% of patients with contralateral metastases. The prevalence of Grade 2 or higher xerostomia was 2.6% at 5 years. Conclusions: Selected patients with oral or oropharyngeal carcinoma treated with primary surgery and postoperative ipsilateral radiotherapy have a very high CLNC with a high probability of successful salvage in case of contralateral metastases. However, bilateral irradiation should be applied in case of multiple lymph node metastases in the ipsilateral neck, particularly in the presence of extranodal spread. The incidence of radiation-induced morbidity is considerably lower as observed after bilateral irradiation.

  19. Postoperative Care of the Transplanted Patient

    PubMed Central

    Schumacher, Kurt R; Gajarski, Robert J

    2011-01-01

    The successful delivery of optimal peri-operative care to pediatric heart transplant recipients is a vital determinant of their overall outcomes. The practitioner caring for these patients must be familiar with and treat multiple simultaneous issues in a patient who may have been critically ill preoperatively. In addition to the complexities involved in treating any child following cardiac surgery, caretakers of newly transplanted patients encounter multiple transplant-specific issues. This chapter details peri-operative management strategies, frequently encountered early morbidities, initiation of immunosuppression including induction, and short-term outcomes. PMID:22548034

  20. Postoperative Granulomas at Liposuction Incision Sites.

    PubMed

    Weniger, Frederick G; White, Peter F; Barrero Castedo, Carlos E

    2016-02-01

    Since most liposuction incisions heal uneventfully, difficult healing in such incisions must be investigated. In the cases of two gynecomastia liposuction patients in which a water-based lubricating gel was used on the liposuction incisions, the incisions failed to heal. For both patients, workup uncovered palisading granulomas at the lateral inframammary fold incision sites several months after otherwise successful surgeries. These two cases are presented and the previous literature is reviewed, with consideration given to the etiology and prevention of such granulomas. LEVEL OF EVIDENCE 5: Risk. PMID:26647136

  1. Postoperative problems 2011: fundoplication and obesity surgery.

    PubMed

    Rohof, W O; Bisschops, R; Tack, J; Boeckxstaens, G E

    2011-12-01

    Although the surgical treatment of both GERD and obesity is very successful, these procedures have a significant impact on the physiology and function of the proximal GI tract. With the increasing prevalence of both GERD and obesity, more and more patients present at the motility outpatient clinic with symptoms related to surgical interventions for these medical problems. In this review, we describe the main complications following antireflux surgery: dysphagia, gas bloat syndrome, recurrent (persistent) GERD symptoms, and dyspeptic symptoms. The most common motility-related complications of obesity surgery are dumping syndrome and esophageal dysmotility. PMID:22100119

  2. Postoperative Abdominal Infection Caused by Corynebacterium minutissimum

    PubMed Central

    Shin, Ji Young; Lee, Woon Kee; Seo, Yiel-Hea

    2014-01-01

    Corynebacterium minutissimum is a non-spore forming, gram-positive, aerobic or facultative anaerobic bacillus. It is the causative organism of erythrasma, a common superficial infection of skin, which typically presents as reddish-brown macular patches. To date, it has rarely been found to cause invasive disease, although other non-diphtheria corynebacteria are becoming increasingly common as opportunistic pathogens. We report on a rare case of abdominal infection due to C. minutissimum in an immunocompetent adult who was successfully treated with intravenous amoxicillin/sulbactam. PMID:25566407

  3. Postoperative Abdominal Infection Caused by Corynebacterium minutissimum.

    PubMed

    Shin, Ji Young; Lee, Woon Kee; Seo, Yiel-Hea; Park, Yoon Soo

    2014-12-01

    Corynebacterium minutissimum is a non-spore forming, gram-positive, aerobic or facultative anaerobic bacillus. It is the causative organism of erythrasma, a common superficial infection of skin, which typically presents as reddish-brown macular patches. To date, it has rarely been found to cause invasive disease, although other non-diphtheria corynebacteria are becoming increasingly common as opportunistic pathogens. We report on a rare case of abdominal infection due to C. minutissimum in an immunocompetent adult who was successfully treated with intravenous amoxicillin/sulbactam. PMID:25566407

  4. 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

  5. Risk factors for postoperative ileus after urologic laparoscopic surgery

    PubMed Central

    Kim, Myung Joon; Min, Gyeong Eun; Yoo, Koo Han; Chang, Sung-Goo

    2011-01-01

    Purpose Although its incidence has decreased with the widespread use of less invasive surgical techniques including laparoscopic surgery, postoperative ileus remains a common postoperative complication. In the field of urologic surgery, with the major exception of radical cystectomy, few studies have focused on postoperative ileus as a complication of laparoscopic surgery. The present study aims to offer further clues in the management of postoperative ileus following urological laparoscopic surgery through an assessment of the associated risk factors. Methods The medical records of 267 patients who underwent laparoscopic surgery between February 2004 and November 2009 were reviewed. After excluding cases involving radical cystectomy, combined surgery, open conversion, and severe complications, a total of 249 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. The gender and age distribution, duration of anesthesia, American Society of Anesthesiologists Physical Status Classification Score, body mass index, degree of operative difficulty, presence of complications, surgical procedure and total opiate dosage were compared between the two groups. Results Of the 249 patients, 10.8% (n = 27) experienced postoperative ileus. Patients with ileus had a longer duration of anesthesia (P = 0.019), and perioperative complications and blood loss were all correlated with ileus (P = 0.000, 0.004, respectively). Multiple linear regression analysis showed that the modified Clavien classification was an independent risk factor for postoperative ileus (odds ratio, 5.372; 95% confidence interval, 2.084 to 13.845; P = 0.001). Conclusion Postoperative ileus after laparoscopic urologic surgery was more frequent in patients who experienced more perioperative complications. PMID:22066064

  6. Successful renal transplantation in primary hyperoxaluria.

    PubMed Central

    O'Regan, P.; Constable, A. R.; Joekes, A. M.; Kasidas, G. P.; Rose, G. A.

    1980-01-01

    A successful live related renal transplant in a 29-year-old male patient with Type 1 primary hyperoxaluria, who remains well 32 months postoperatively, is described. The plasma oxalate and exchangeable oxalate pool before transplantation were 160 mumol/1 and 4429 mumol respectively. Since the transplant these have been greatly reduced although they remain elevated above the normal by a factor of 2. Pyridoxine therapy and the avoidance of oxalate-rich foods have been effective in maintaining these reduced levels and the 24-hr urinary oxalate excretion has also been maintained close to normal levels on this regime. After review of the previously reported transplants in patients with well documented primary hyperoxaluria and from the experience with this patient, the following guidelines for successful renal transplantation in primary hyperoxaluria are suggested: transplants should only be carried out in those who have shown a response to adequate pyrodoxine therapy; frequent haemodialysis pre-operatively and during periods of oliguria postoperatively is necessary; oxalate-rich foods should be avoided and a high fluid intake should be maintained after transplantation. If these guidelines are followed there is no contra-indicatin to live related renal transplants in primary hyperoxaluric patients. Images Fig. 1 Fig. 2 PMID:7001421

  7. Increased Post-Operative Stiffness after Arthroscopic Suprapectoral Biceps Tenodesis

    PubMed Central

    Werner, Brian C.; Pehlivan, Hakan C.; Hart, Joseph M.; Carson, Eric W.; Diduch, David R.; Miller, Mark D.; Brockmeier, Stephen F.

    2014-01-01

    Objectives: Biceps tenodesis can be performed open or arthroscopically and can be positioned in a suprapectoral or subpectoral position. Suprapectoral tenodesis can be carried out arthroscopically, whereas the subpectoral tenodesis is performed as an open procedure. The goal of this study is to compare the incidence of postoperative stiffness between arthroscopic suprapectoral and open subpectoral biceps tenodesis and evaluate risk factors for its occurrence. Methods: Study Design: The charts of all patients who underwent arthroscopic or open biceps tenodesis who were a minimum of two years post-procedure were reviewed. Patients with preoperative frozen shoulder, prior shoulder surgery, or massive rotator cuff tears which required longer post-operative immobilization were excluded. Post-operative stiffness was defined as persistent range of motion deficit (<100oof forward flexion and abduction; <40o of internal or external rotation) and pain resulting in a diagnosis of post-operative frozen shoulder and requiring either an injection, lysis of adhesions/manipulation, or both. Analysis: Means were calculated for continuous variables and compared using Students t test. Frequencies for categorical variables were compared using chi square tests. Results: We identified 249 consecutive biceps tenodeses from 2008-11 (106 arthroscopic, 143 open) that met inclusion and exclusion criteria. A significantly increased incidence of post-operative stiffness was found in the arthroscopic tenodesis cohort as compared to the open cohort (17.9% vs. 5.6%, p=0.002). The groups were otherwise well matched. (Table I). Further analysis was performed comparing patients with and without post-operative stiffness within the arthroscopic cohort. (Table II) Female gender (63.2% vs 33.3%, p = 0.016) and smoking (36.8% vs 16.1%, p = 0.040) were independent risk factors for post-operative stiffness after arthroscopic tenodesis. Location of the tenodesis from the top of the humeral head as measured

  8. Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care.

    PubMed

    Wolfe, Robert M; Pomerantz, Jonathan; Miller, Deborah E; Weiss-Coleman, Rebecca; Solomonides, Tony

    2016-01-01

    The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed. For adults, preoperative screening using the STOP or STOP-Bang questionnaires can help to identify adult patients at increased risk of OSA. In the pediatric setting, a question about snoring should be part of every preoperative examination. For patients with known OSA, continuous positive airway pressure should be continued postoperatively. Continuous pulse oximetry monitoring with an alarm system can help to prevent apneic catastrophes caused by OSA in the postoperative period. PMID:26957384

  9. Postoperative sleep disruptions: a potential catalyst of acute pain?

    PubMed

    Chouchou, Florian; Khoury, Samar; Chauny, Jean-Marc; Denis, Ronald; Lavigne, Gilles J

    2014-06-01

    Despite the substantial advances in the understanding of pain mechanisms and management, postoperative pain relief remains an important health care issue. Surgical patients also frequently report postoperative sleep complaints. Major sleep alterations in the postoperative period include sleep fragmentation, reduced total sleep time, and loss of time spent in slow wave and rapid eye movement sleep. Clinical and experimental studies show that sleep disturbances may exacerbate pain, whereas pain and opioid treatments disturb sleep. Surgical stress appears to be a major contributor to both sleep disruptions and altered pain perception. However, pain and the use of opioid analgesics could worsen sleep alterations, whereas sleep disruptions may contribute to intensify pain. Nevertheless, little is known about the relationship between postoperative sleep and pain. Although the sleep-pain interaction has been addressed from both ends, this review focuses on the impact of sleep disruptions on pain perception. A better understanding of the effect of postoperative sleep disruptions on pain perception would help in selecting patients at risk for more severe pain and may facilitate the development of more effective and safer pain management programs. PMID:24074687

  10. Effects of Anesthetic Agent Propofol on Postoperative Sex Hormone Levels

    PubMed Central

    Kim, H.; Ku, S.-Y.; Kim, H. C.; Suh, C. S.; Kim, S. H.; Choi, Y. M.

    2016-01-01

    Introduction: Several studies have found anesthetic agents including propofol in ovarian follicular fluid. However, little is known about the effect of anesthetic agents on ovarian function. We aimed to investigate whether there were differences in the postoperative levels of sex hormones when propofol was used as the anesthetic agent. Methods: A retrospective review was done of 80 patients who underwent ovarian surgery, with 72 infertile women serving as controls. Patients were included in the study if their serum estradiol (E2) and follicle stimulating hormone (FSH) levels were measured during their first postoperative menstrual cycle. Results: Patients were grouped according to the use or non-use of propofol as follows: propofol group (n = 39) and non-propofol group (n = 41). The control group did not undergo surgery. Postoperative E2 levels did not differ between the three groups, but FSH levels were significantly higher in the patients who had undergone surgery compared to controls (p < 0.05). Post-hoc analysis of E2 and FSH levels in the propofol and non-propofol groups did not show any significant differences. Conclusions: The use of propofol did not result in any differences compared to other anesthetic agents in terms of postoperative sex hormone levels after gynecologic surgery. The type of anesthetic agent does not seem to affect the postoperative levels of female sex hormones. PMID:27134297

  11. A prospective study on postoperative pain after cataract surgery

    PubMed Central

    Porela-Tiihonen, Susanna; Kaarniranta, Kai; Kokki, Merja; Purhonen, Sinikka; Kokki, Hannu

    2013-01-01

    Purpose To evaluate postoperative pain and early recovery in cataract patients. Patients and methods A total of 201 patients who underwent elective first eye cataract extraction surgery were enrolled, and 196 were included in the final analysis. The study design was a single-center, prospective, follow-up study in a tertiary hospital in eastern Finland. Postoperative pain was evaluated with the Brief Pain Inventory at four time points: at baseline, and at 24 hours, 1 week, and 6 weeks postsurgery. Results Postoperative pain was relatively common during the first hours after surgery, as it was reported by 67 (34%) patients. After hospital discharge, the prevalence decreased; at 24 hours, 1 week, and 6 weeks, 18 (10%), 15 (9%) and 12 (7%) patients reported having ocular pain, respectively. Most patients with eye pain reported significant pain, with a score of ≥4 on a pain scale of 0–10, but few had taken analgesics for eye pain. Those who had used analgesics rated the analgesic efficacy of paracetamol and ibuprofen as good or excellent. Other ocular irritation symptoms were common after surgery; as a new postoperative symptom, foreign-body sensation was reported by 40 patients (22%), light sensitivity by 29 (16%), burning by 15 (8%), and itching by 15 (8%). Conclusion Moderate or severe postoperative pain was relatively common after cataract surgery. Thus, all patients undergoing cataract surgery should be provided appropriate counseling on pain and pain management after surgery. PMID:23885165

  12. Effect of postoperative delirium on outcome after hip fracture.

    PubMed

    Edelstein, David M; Aharonoff, Gina B; Karp, Adam; Capla, Edward L; Zuckerman, Joseph D; Koval, Kenneth J

    2004-05-01

    Nine-hundred twenty-one community-dwelling patients 65 years of age or older, who sustained an operatively treated hip fracture from July 1, 1987 to June 30, 1998 were followed up for the development of postoperative delirium. The outcomes examined in the current study were postoperative complication rates, in-hospital mortality, hospital length of stay, hospital discharge status, 1-year mortality rate, place of residence, recovery of ambulatory ability, and activities of daily living 1 year after surgery. Forty-seven (5.1%) patients were diagnosed with postoperative delirium. Patients who had delirium develop were more likely to be male, have a history of mild dementia, and have had surgery under general anesthesia. Patients who had postoperative delirium develop had a significantly longer length of hospitalization. They also had significantly higher rates of mortality at 1 year, were less likely to recover their prefracture level of ambulation, and were more likely to show a decline in level of independence in basic activities of daily living at the 1-year followup. There was no difference in the rate of postoperative complications, in-hospital mortality, discharge residence, and recovery of instrumental activities of daily living at 1 year. PMID:15187857

  13. Early Postoperative Pain After Keyless Abdominal Rope-Lifting Surgery

    PubMed Central

    Hüseyınoğlu, Ürfettin; Çıçek, Melek

    2015-01-01

    Background and Objectives: Keyless abdominal rope-lifting surgery is a novel, gasless, single-incision laparoscopic surgical technique. In this study we aimed to compare the postoperative pain from keyless abdominal rope-lifting surgery with carbon dioxide laparoscopy performed for benign ovarian cysts. Methods: During a 20-month period, 77 women underwent surgery for a benign ovarian cyst. Keyless abdominal rope-lifting surgery and conventional carbon dioxide laparoscopy techniques were used for the operations in 32 women and 45 women, respectively. The 2 operative techniques were compared with regard to demographic characteristics; preoperative, intraoperative, and postoperative data including early postoperative pain scores; and frequency of shoulder pain and analgesic requirements. Results: Data regarding demographic characteristics, preoperative findings, cyst diameters and rupture rates, intra-abdominal adhesions, intraoperative blood loss, and postoperative hospital stay did not differ between groups (P > .05). However, the mean operative and abdominal access times were significantly longer in the keyless abdominal rope-lifting surgery group (P < .05). Visual analog scale pain scores at initially and at the second, fourth, and 24th hours of the postoperative period were significantly lower in the keyless abdominal rope-lifting surgery group (P < .05). Similarly, keyless abdominal rope-lifting surgery caused significantly less shoulder pain and additional analgesic use (P < .05). Conclusion: Keyless abdominal rope-lifting surgery seems to cause less pain in the management of benign ovarian cysts in comparison with conventional carbon dioxide laparoscopy. PMID:25848177

  14. Pre- and Postoperative Imaging of the Aortic Root.

    PubMed

    Hanneman, Kate; Chan, Frandics P; Mitchell, R Scott; Miller, D Craig; Fleischmann, Dominik

    2016-01-01

    Three-dimensional datasets acquired using computed tomography and magnetic resonance imaging are ideally suited for characterization of the aortic root. These modalities offer different advantages and limitations, which must be weighed according to the clinical context. This article provides an overview of current aortic root imaging, highlighting normal anatomy, pathologic conditions, imaging techniques, measurement thresholds, relevant surgical procedures, postoperative complications and potential imaging pitfalls. Patients with a range of clinical conditions are predisposed to aortic root disease, including Marfan syndrome, bicuspid aortic valve, vascular Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Various surgical techniques may be used to repair the aortic root, including placement of a composite valve graft, such as the Bentall and Cabrol procedures; placement of an aortic root graft with preservation of the native valve, such as the Yacoub and David techniques; and implantation of a biologic graft, such as a homograft, autograft, or xenograft. Potential imaging pitfalls in the postoperative period include mimickers of pathologic processes such as felt pledgets, graft folds, and nonabsorbable hemostatic agents. Postoperative complications that may be encountered include pseudoaneurysms, infection, and dehiscence. Radiologists should be familiar with normal aortic root anatomy, surgical procedures, and postoperative complications, to accurately interpret pre- and postoperative imaging performed for evaluation of the aortic root. Online supplemental material is available for this article. PMID:26761529

  15. Attitudes of Success.

    ERIC Educational Resources Information Center

    Pendarvis, Faye

    This document investigates the attitudes of successful individuals, citing the achievement of established goals as the criteria for success. After offering various definitions of success, the paper focuses on the importance of self-esteem to success and considers ways by which the self-esteem of students can be improved. Theories of human behavior…

  16. Measuring research success.

    PubMed

    Halcomb, Elizabeth

    2016-03-01

    Defining successful research can be complex. For novice researchers, success may involve completing research projects and publishing in peer-reviewed journals, but for experienced researchers more complex measures of success come into play. Each researcher's reputation, future grant funding and career prospects depend on the success of each project, and the quality of the researcher's track record. PMID:26997227

  17. Effect of tourniquet time on postoperative quadriceps function.

    PubMed

    Saunders, K C; Louis, D L; Weingarden, S I; Waylonis, G W

    1979-09-01

    Postoperative weakness of quadriceps function following knee arthrotomy has often been attributed to pain inhibition or lack of motivation. However, the delayed recovery may be the result of a slowly resolving axonal compression syndrome caused by the pneumatic tourniquet. Forty-eight patients who underwent knee arthrotomy were evaluated including postoperative electromyographic testing and clinical follow-up. Thirty of these patients (62.5%) developed postoperative EMG changes. Abnormalities were noted in various muscle groups but most commonly involved the quadriceps alone or quadriceps and gastrocnemius. An effort was made in 20 patients to substantially decrease the duration of tourniquet compression by limiting tourniquet inflation to intracapsular portions of the procedures. Fewer EMG changes and more rapid clinical recovery were noted in patients with decreased tourniquet times, suggesting that it is beneficial to minimize the duration of tourniquet compression. In all patients who returned for serial testing, the EMG abnormalities eventually resolved. PMID:509826

  18. Postoperative splinting for isolated digital nerve injuries in the hand.

    PubMed

    Vipond, Nicole; Taylor, William; Rider, Mark

    2007-01-01

    Digital nerve injuries in the hand are common and can result in significant impairment and functional restriction. Despite this, there is relatively little literature, particularly with respect to postoperative rehabilitation. Splinting after repair, purported to protect the repaired nerve from excessive stretch is still commonly used. Recent cadaveric studies indicate postoperative rehabilitation is not necessary with resection up to 2.5mm. A randomized controlled trial was therefore undertaken to determine whether splinting after isolated 5th degree digital nerve transection is in fact necessary. Twenty-six subjects were recruited over a two-year period and randomized to either three weeks of hand-based splinting or free active motion. ANCOVA indicated no differences in sensibility at six months between the two groups. Subjects also reported their greatest functional limitations were because of hyperesthesia. Although this study is underpowered, these limited results suggest splinting may not be required postoperatively. PMID:17658415

  19. Influences on nurses' scoring of children's post-operative pain.

    PubMed

    Simons, Joan; Moseley, Laurence

    2009-06-01

    There is a lack of clarity as to why some nurses are not delivering optimal pain management to children post-operatively. This retrospective chart review study examined nurses' pain scoring on 175 children during the first 24 hours post-operatively. Data were analysed on the amount of assessments made, assessment scores recorded, as well as the age, gender and type of surgery performed. One-quarter of children had no assessment record of their pain in the first 24 hours post-operatively. When the pain tool was part of an observation chart, nurses recorded more pain scores. Nurses' scoring of children's pain is influenced positively by children under five years of age and those who undergo abdominal surgery. Nurses who had access to one document for recording vital signs as well as pain scores were more likely to assess and record a child's pain score than nurses who had to use a separate chart. PMID:19458166

  20. Guidelines for the Diagnosis, Treatment and Prevention of Postoperative Infections

    PubMed Central

    Hager, W. David; Livengood, Charles H.; Hoyme, Udo

    2003-01-01

    Bacterial contamination of the operative site is a common occurrence in obstetrics and gynecology. The widespread use of antibiotic prophylaxis has reduced but not eliminated serious postoperative infections. For most operations, a single dose of a limited-spectrum drug has been as effective as a multidose regimen. In the differential diagnosis it is important to consider cellulitis, abscess, necrotizing fasciitis and septic pelvic thrombophlebitis. Abscess and necrotizing fasciitis are expected to require invasive therapy in addition to antibiotics, while cellulitis and septic pelvic thrombophlebitis should respond to medical management alone. Although a postoperative fever is a warning sign of possible infection, it may also be caused by the antibiotics that are given for treatment. The use of prolonged courses of antibiotics once the patient is clinically well is discouraged. While clinical guidelines are provided for use in the diagnosis and management of postoperative infections, these recommendations are intended for general direction and not as an exclusive management plan. PMID:12839635

  1. Postoperative radiation of open head and neck wounds

    SciTech Connect

    Isaacs, J.H. Jr.; Thompson, W.B.; Cassisi, N.J.; Million, R.R.

    1987-03-01

    Complication rates are lower using postoperative radiation therapy and cure rates at least compatible to preoperative radiation therapy. However, one of the concerns with postoperative radiation treatment is the possibility of delay in beginning the treatment because of an unhealed surgical wound. A delay of more than 6 weeks is detrimental. In order to study the effect of radiation therapy on incompletely healed wounds, a retrospective chart review of such cases during the period 1977 to 1984 was undertaken. One hundred and eighty-five patients had planned postoperative radiation therapy, and 13 of these began radiation therapy with an unhealed wound or fistula. Six of 10 wounds closed spontaneously, 4 required surgical closure, and 3 failed to heal. Seven patients in this study died with cancer, 2 died of other causes, 3 are alive without disease, and 1 patient remains alive with disease. We conclude that giving radiation therapy to an open wound with appropriate precaution can be done without serious complications.

  2. Postoperative diet advancement: surgical dogma vs evidence-based medicine.

    PubMed

    Warren, Jeremy; Bhalla, Varun; Cresci, Gail

    2011-04-01

    Postoperative ileus is a natural part of recovery following abdominal and intestinal surgery. Research in the laboratory and clinical arenas has challenged the long-held belief that enteral nutrition (EN) should not be administered until bowel function has resumed, which is typically judged by a subjective bowel function assessment. Traditional postoperative management begins with clinical monitoring of return of bowel function, followed by a clear liquid diet that is advanced to regular solid food as tolerated. Studies have consistently demonstrated that early EN is safe and well tolerated, showing a reduction in wound morbidity and healing, fewer septic complications, diminished weight loss, and improved protein kinetics in patients administered early EN. Barriers to early enteral feeding include fear of GI morbidity, anastomotic disruption or leak but have not been proven valid in clinical or experimental trials. A clear liquid diet is the most frequently ordered first postoperative meal regardless of early or delayed administration. Although generally well tolerated, this diet fails to provide adequate nutrients to the postsurgical patient. In contrast, advancement to a regular diet as the initial meal has been shown to be well tolerated and provides significantly more nutrients than a clear liquid diet. This article reviews basic GI physiology, including motility, nutrient absorption, and the changes that occur in regulation and function of the GI tract following surgery, as well as clinical data regarding postoperative GI function and diet advancement. This will be applied to the clinical practices of postoperative dietary advancement to discuss the timing and choice of initial feeding in the postoperative patient. PMID:21447763

  3. Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy

    PubMed Central

    Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.

    1999-01-01

    Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased

  4. Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea.

    PubMed

    Burgess, L P; Derderian, S S; Morin, G V; Gonzalez, C; Zajtchuk, J T

    1992-01-01

    A study was conducted to assess oxygenation and respiratory changes on the first and second postoperative nights after uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). Twelve patients were postoperatively evaluated with 8-hour nocturnal polysomnography on four occasions: (1) PREOP--night before UPPP, (2) POPN1--first postoperative night, (3) POPN2--second postoperative night, and (4) 3MOS--3-month follow-up study. Results demonstrate that apnea index (AI) and respiratory disturbance index (RDI) were significantly improved at 3MOS from PREOP levels: AI (p less than 0.01) and RDI (p less than 0.05). There were no statistical differences from PREOP to POPN1 or POPN2 for AI, RDI, lowest oxyhemoglobin saturation (LSAT), or number of desaturations (#DESAT). One of twelve patients dropped LSAT greater than 10% from PREOP to POPN1 or POPN2 (82% PREOP to 71% POPN2). Patients were grouped by PREOP LSAT greater than or equal to 80% or less than 80%, and the postoperative change in LSAT was evaluated by comparing PREOP to a value averaging POPN1 and POPN2. Patients with LSAT greater than or equal to 80% decreased by 2.6%; patients with LSAT less than 80% improved by 6.2%. This change in LSAT between groups was statistically different (p = 0.02). These data suggest that in the majority of patients, preoperative indices remain unchanged for at least 2 days after surgery, even for patients who demonstrated improvement at 3 months. However, worsening does occur in some patients. On the basis of the results of this study and clinical experience with the postoperative course, a selective management protocol is outlined. PMID:1734375

  5. 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

  6. Tolerance of gastric mucosal flap to postoperative irradiation

    SciTech Connect

    Devineni, V.R.; Hayden, R.; Fredrickson, J.; Sicard, G. )

    1991-05-01

    When malignant lesions of the oral cavity, base of tongue, and oropharynx are treated with radical resection, adequate reconstruction is required. The free gastric mucosal flap with microvascular transfer is being used with increasing frequency at Washington University Medical Center. Because of the advanced nature of the primary lesions, most patients also require postoperative radiation therapy. In this paper the tolerance of the gastric mucosal flap to postoperative radiation therapy is reviewed. The changes resulting from radiation therapy in the mucosal flap were found to be acceptable, and no major complications were encountered.

  7. Optimising postoperative pain management in the ambulatory patient.

    PubMed

    Shang, Allan B; Gan, Tong J

    2003-01-01

    Over 60% of surgery is now performed in an ambulatory setting. Despite improved analgesics and sophisticated drug delivery systems, surveys indicate that over 80% of patients experience moderate to severe pain postoperatively. Inadequate postoperative pain relief can prolong recovery, precipitate or increase the duration of hospital stay, increase healthcare costs, and reduce patient satisfaction. Effective postoperative pain management involves a multimodal approach and the use of various drugs with different mechanisms of action. Local anaesthetics are widely administered in the ambulatory setting using techniques such as local injection, field block, regional nerve block or neuraxial block. Continuous wound infusion pumps may have great potential in an ambulatory setting. Regional anaesthesia (involving anaesthetising regional areas of the body, including single extremities, multiple extremities, the torso, and the face or jaw) allows surgery to be performed in a specific location, usually an extremity, without the use of general anaesthesia, and potentially with little or no sedation. Opioids remain an important component of any analgesic regimen in treating moderate to severe acute postoperative pain. However, the incorporation of non-opioids, local anaesthetics and regional techniques will enhance current postoperative analgesic regimens. The development of new modalities of treatment, such as patient controlled analgesia, and newer drugs, such as cyclo-oxygenase-2 inhibitors, provide additional choices for the practitioner. While there are different routes of administration for analgesics (e.g. oral, parenteral, intramuscular, transmucosal, transdermal and sublingual), oral delivery of medications has remained the mainstay for postoperative pain control. The oral route is effective, the simplest to use and typically the least expensive. The intravenous route has the advantages of a rapid onset of action and easier titratibility, and so is recommended for the

  8. Anesthetic and postoperative management of the obstructive sleep apnea patient.

    PubMed

    Mickelson, Samuel A

    2009-11-01

    Sleep apnea patients pose a challenge for surgeons, anesthesiologists, and surgical facilities as there is increased risk for anesthetic and postoperative complications. Precautions before and after surgery minimize these risks. Screening for sleep apnea should be done for all surgical patients. Safe perioperative management requires judicious use of narcotics and sedating medications, reducing upper airway edema, prevention of aspiration and deep vein thrombosis, blood pressure control, use of positive airway pressure, and proper postoperative monitoring. Although the literature lacks specific recommendations, the guidelines presented in this article are based on more than 20 years of experience and supported by peer-reviewed medical literature. PMID:19944343

  9. The effect of postoperative positive end-expiratory pressure on postoperative bleeding after off-pump coronary artery bypass grafting

    PubMed Central

    Salihoglu, Ece; Celik, Sezai; Ugurlucan, Murat; Caglar, Ilker Murat; Turhan-Caglar, Fatma Nihan; Isik, Omer

    2014-01-01

    Introduction To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery. Material and methods Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H2O (group 1) or 8 cm H2O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared. Results Low- and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 ±37 ml vs. 69 ±29 ml, p = 0.03) and pericardial fluid (17 ±5 ml vs. 14 ±6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 ±1.21 days vs. 5.25 ±0.91 days, p = 0.03). Conclusions Prophylactic administration of postoperative PEEP levels of 8 cm H2O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients. PMID:25395944

  10. Continuous Postoperative Pericardial Flushing: A Pilot Study on Safety, Feasibility, and Effect on Blood Loss

    PubMed Central

    Manshanden, Johan S.J.; Gielen, Chantal L.I.; de Borgie, Corianne A.J.M.; Klautz, Robert J.M.; de Mol, Bas A.J.M.; Koolbergen, David R.

    2015-01-01

    Background Prolonged or excessive blood loss is a common complication after cardiac surgery. Blood remnants and clots, remaining in the pericardial space in spite of chest tube drainage, induce high fibrinolytic activity that may contribute to bleeding complications. Continuous postoperative pericardial flushing (CPPF) with an irrigation solution may reduce blood loss by preventing the accumulation of clots. In this pilot study, the safety and feasibility of CPPF were evaluated and the effect on blood loss and other related complications was investigated. Methods Between November 2011 and April 2012 twenty-one adult patients undergoing surgery for congenital heart disease (CHD) received CPPF from sternal closure up to 12 h postoperative. With an inflow Redivac drain that was inserted through one of the chest tube incision holes, an irrigation solution (NaCl 0.9% at 38 °C) was delivered to the pericardial cavity using a volume controlled flushing system. Safety aspects, feasibility issues and complications were registered. The mean actual blood loss in the CPPF group was compared to the mean of a retrospective group (n = 126). Results CPPF was successfully completed in 20 (95.2%) patients, and no method related complications were observed. Feasibility was good in this experimental setting. Patients receiving CPPF showed a 30% (P = 0.038) decrease in mean actual blood loss 12 h postoperatively. Conclusions CPPF after cardiac surgery was found to be safe and feasible in this experimental setting. The clinically relevant effect on blood loss needs to be confirmed in a randomized clinical trial. PMID:26501121

  11. Fertility Clinic Success Rates

    MedlinePlus

    ... 2013 Assisted Reproductive Technology Fertility Clinic Success Rates Report Recommend on Facebook Tweet Share Compartir 2013 ART Fertility Clinic Success Rates Report [PDF - 1MB] Bookmarks and thumbnails are available within ...

  12. Teaching Succession with Forests.

    ERIC Educational Resources Information Center

    Stronck, David R.

    1982-01-01

    Suggesting advantages of using forests to teach succession, briefly outlines procedures for gathering evidence of succession including numbers, ages, and sizes of trees. Five plot studies conducted by students at the University of Victoria are also described. (DC)

  13. Custom made orthotic device for maintaining skull architecture during the postoperative period in infants undergoing craniosynostosis surgery

    PubMed Central

    Gopal, Venu; Ganesh, Praveen; Nagarjuna, Muralidhara; Kumar, Kiran; Shetty, Samarth; Salins, Paul C.

    2015-01-01

    Aim To fabricate a cost effective, indigenous and simple orthotics helmet for post-operative cranial molding in patients with craniosynostosis surgery. Methods We present a case of 15 month old infant with secondary cranial vault deformity. Cranial vault remodeling surgery involving the posterior skull was planned and executed to increase the posterior gap, so that brain growth would be facilitated towards this empty space. Materials such as thermoplastic sponge, thermoplastic ionomer resin sheet, soft sponge and Velcro straps are used to fabricate a cranial orthotics helmet. Results We have successfully used the above materials to fabricate the orthotics helmet for post-operative cranial molding. Conclusion The technique described in this article is simple and cost effective. It can be custom made according to the demands of the surgical technique and the type of synostosis. It favors an individualistic prognosis, and proves worthwhile as every synostosis requires a unique treatment plan. It is an excellent adjuvant to craniosynostosis remodeling surgery. PMID:26258018

  14. Long-standing meningomyelocele can be a predictor of difficult airway and postoperative hypoventilation: challenge to the anaesthesiologist.

    PubMed

    Sardar, Arijit; Khanna, Puneet; Singh, Abhishek; Sharma, Ankur

    2016-01-01

    A 15-year-old female patient presented with severe pain in the abdomen and obstructive uropathy. She underwent Yang-Monti ileovesicostomy under general anaesthesia. She is a known case of long-standing meningomyelocele (MMC) and presented with its potential complications such as difficult airway and restrictive lung disease. We describe the successful anaesthetic management of a case of anticipated difficult airway and postoperative hypoventilation as a sequel of kyphosis due to MMC. Her airway was secured with fibre optic-guided intubation in a semirecumbent position. Postoperative hypoventilation, hypercarbia and respiratory acidosis were managed conservatively, followed by staged weaning in the intensive care unit. Obstruction of the catheterisable continent channel of the neurogenic bladder itself may present with uropathy and urosepsis, which were also taken care of preoperatively. PMID:26884079

  15. Transdermal Buprenorphine Patches for Postoperative Pain Control in Abdominal Surgery

    PubMed Central

    Kumar, Santosh; Singh, Prithvi Kumar; Verma, Reetu; Chandra, Girish; Bhatia, Vinod Kumar; Singh, Dinesh; Bogra, Jaishri

    2016-01-01

    Introduction Buprenorphine is a semi-synthetic derivative of thebaine; its low concentration is sufficient to provide effective pain relief. Aim To evaluate the efficacy of transdermal buprenorphine patch in postoperative pain management. Materials and Methods After ethical approval and taking informed consent from the patients, they were randomized into three groups (n=30 in each group) using a computer generated random number table. Group A: placebo patch; Group B: buprenorphine (10mg) patch and Group C: buprenorphine (20mg) patch. Haemodynamic and analgesic effects were compared by using analysis of variance (ANOVA) followed by Turkey’s post hoc test. The proportion of side effects was compared using the Chi-square test. Results Haemodynamic changes were not statistically different in all the three groups A, B and C, whereas at the end of surgery VAS score of Group A subjects was significantly higher (4.93±0.98) as compared to Group B (1.73±0.64) and Group C (1.40±0.50). On 2nd postoperative day, no pain was reported by the Group C patients and on 4th day after surgery, no pain was reported by Group B patients. Conclusion The transdermal buprenorphine patch (20mg) was effective in attenuating postoperative pain, maintaining haemodynamic stability requiring no rescue analgesia, with fewer postoperative rescue analgesic requirements in low dose of buprenorphine patch (10mg) group. PMID:27504383

  16. A novel postoperative immobilization model for murine Achilles tendon sutures.

    PubMed

    Shibuya, Yoichiro; Takayama, Yuzo; Kushige, Hiroko; Jacinto, Sandra; Sekido, Mitsuru; Kida, Yasuyuki S

    2016-08-01

    The body's motion and function are all in part effected by a vital tissue, the tendon. Tendon injury often results in limited functioning after postoperative procedures and even for a long time after rehabilitation. Although numerous studies have reported surgical procedures using animal models which have contributed to both basic and clinical research, modeling of tendon sutures or postoperative immobilizations has not been performed on small experimental animals, such as mice. In this study we have developed an easy Achilles tendon suture and postoperative ankle fixation model in a mouse. Right Achilles tendons were incised and 10-0 nylons were passed through the proximal and distal ends using a modified Kessler method. Subsequently, the right ankle was immobilized in a plantarflexed position with novel splints, which were made from readily available extension tubes. Restriction of the tendon using handmade splints reduced swelling, as opposed to fixating with the usual plaster of Paris. Using this method, the usage of the right Achilles tendons began on postoperative days 13.5 ± 4.6, which indicated healing within two weeks. Therefore our simple short-term murine Achilles tendon suture procedure is useful for studying immediate tendon repair mechanisms in various models, including genetically-modified mice. PMID:26678297

  17. Desmoplastic small round cell tumor: postoperative retroperitoneal mass.

    PubMed

    Shen, Colette J; Loeb, David M; Terezakis, Stephanie A

    2016-09-01

    We describe the case of a 14-year-old boy who presented with a large, 17.6-cm retroperitoneal mass, along with multiple metastases, and was diagnosed with desmoplastic small round cell tumor. After initial chemotherapy, he underwent gross total resection with a positive margin. On postoperative radiation planning computed tomography, a 6.8-cm heterogeneous mass was noted in the surgical bed. Given the tumor's aggressive nature and positive surgical margins, there was real concern for recurrent disease. Further evaluation with magnetic resonance imaging elucidated that the mass consisted of simple fluid and fat, without contrast enhancement, suggesting a postoperative fluid collection. He was able to continue with adjuvant treatment as planned. This case example illustrates that even large postoperative heterogeneous masses may still be related to postoperative fluid collection in patients with aggressive tumor. However, it is important to rule out recurrent disease before starting adjuvant therapy given improved outcomes with gross total resection in desmoplastic small round cell tumor. PMID:27594960

  18. Risk factors for postoperative complications following oral surgery

    PubMed Central

    SHIGEISHI, Hideo; OHTA, Kouji; TAKECHI, Masaaki

    2015-01-01

    Objective The objective of this study was to clarify significant risk factors for postoperative complications in the oral cavity in patients who underwent oral surgery, excluding those with oral cancer. Material and Methods This study reviewed the records of 324 patients who underwent mildly to moderately invasive oral surgery (e.g., impacted tooth extraction, cyst excision, fixation of mandibular and maxillary fractures, osteotomy, resection of a benign tumor, sinus lifting, bone grafting, removal of a sialolith, among others) under general anesthesia or intravenous sedation from 2012 to 2014 at the Department of Oral and Maxillofacial Reconstructive Surgery, Hiroshima University Hospital. Results Univariate analysis showed a statistical relationship between postoperative complications (i.e., surgical site infection, anastomotic leak) and diabetes (p=0.033), preoperative serum albumin level (p=0.009), and operation duration (p=0.0093). Furthermore, preoperative serum albumin level (<4.0 g/dL) and operation time (≥120 minutes) were found to be independent factors affecting postoperative complications in multiple logistic regression analysis results (odds ratio 3.82, p=0.0074; odds ratio 2.83, p=0.0086, respectively). Conclusion Our results indicate that a low level of albumin in serum and prolonged operation duration are important risk factors for postoperative complications occurring in the oral cavity following oral surgery. PMID:26398515

  19. [COGNITIVE ABNORMALITIES IN POSTOPERATIVE PERIOD OF THYROID SURGERY].

    PubMed

    Golub, I Ye; Beloborodov, V A; Sorokina, L V; Kur'yanov, A A; Borisova, V M

    2015-01-01

    An evaluation of cognitive functions was presented in 90 patients undergoing thyroid surgery. An attention deterioration, shot-term memory impairment and degradation were revealed after operation. It was shown that reduction of manifestations of cognitive dysfunction and stabilization of the haemodynamics indices were allowed due to application of cytoflavin during operation and in early postoperative period. PMID:26601519

  20. Postoperative outcome of Crohn's disease in 30 children

    PubMed Central

    Besnard, M; Jaby, O; Mougenot, J; Ferkdadji, L; Debrun, A; Faure, C; Delagausie, P; Peuchmaur, M; Aigrain, Y; Navarro, J; Cezard, J

    1998-01-01

    Background—Thirty children operated on for Crohn's disease (CD) were reviewed (1975-1994). The aim of the study was to assess their postoperative outcome. 
Patients—19 boys and 11 girls, aged 15.3 (2) years (range 11.3-20) at surgery were studied. 
Results—Surgical indications were acute complications of CD and chronic intestinal illness. Six months after surgery, 11 of 12 patients had been weaned off steroids, and 22 of 23 patients were weaned off nutritional support; 17 patients without recurrrence had a mean (SD) weight gain of 2.1 (8) kg and a height gain of 3.36 (3) cm. During 3.1 (2.7) years follow up, 12 patients (40%) had a recurrence of the disease after 19.4 (14) months (means (SD)): supra-anastomotic recurrence (six), severe perianal disease (two), and chronic illness (four). Six of 14 patients who were treated with mesalazine (13) or azathioprine (one) had recurrences. The postoperative recurrence rate was 50% at two years. 
Conclusion—Surgical treatment modifies the immediate outcome of severe or complicated CD, but does not prevent recurrence, despite localised resection or prophylactic postoperative treatment. Extension of the disease before surgery seems to be a major risk factor for postoperative recurrence in children. 

 Keywords: Crohn's disease; surgery; children PMID:9824343

  1. [The nature of postoperative complications in patients with peritonitis].

    PubMed

    Churpiĭ, I K

    2014-01-01

    We studied the postoperative period in patients with peritonitis. The structure of the most important factors that slow down the healing process and lead to mortality. Among the factors that affect the healing process is the most important character of fluid, and the prevalence of peritonitis (causative factor), which causes complications on the part of the internal organs and wounds. PMID:25906657

  2. Laser Acupuncture for Postoperative Pain Management in Cats

    PubMed Central

    Marques, Virgínia I.; Cassu, Renata N.; Nascimento, Felipe F.; Tavares, Rafaela C. P.; Crociolli, Giulliane C.; Guilhen, Rafael C.; Nicácio, Gabriel M.

    2015-01-01

    The aim of this study was to evaluate laser acupuncture as an adjuvant for postoperative pain management in cats. Twenty cats, undergoing ovariohysterectomy, were sedated with intramuscular (IM) ketamine (5 mg kg−1), midazolam (0.5 mg kg−1), and tramadol (2 mg kg−1). Prior to induction of anaesthesia, the subjects were randomly distributed into two groups of 10 cats: Laser: bilateral stomach 36 and spleen 6 acupoints were stimulated with infrared laser; Control: no acupuncture was applied. Anaesthesia was induced using intravenous propofol (4 mg kg−1) and maintained with isoflurane. Postoperative analgesia was evaluated by a blinded assessor for 24 h following extubation using the Dynamic Interactive Visual Analogue Scale and Multidimensional Composite Pain Scale. Rescue analgesia was provided with IM tramadol (2 mg kg−1), and the pain scores were reassessed 30 min after the rescue intervention. If the analgesia remained insufficient, meloxicam (0.2 mg kg−1 IM, single dose) was administered. Data were analyzed using t-tests, the Mann-Whitney test, and the Friedman test (P < 0.05). The pain scores did not differ between groups. However, postoperative supplemental analgesia was required by significantly more cats in the Control (5/10) compared with the Laser group (1/10) (P = 0.038). Laser acupuncture reduced postoperative analgesic requirements in cats undergoing ovariohysterectomy. PMID:26170879

  3. Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial

    PubMed Central

    2013-01-01

    Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317 PMID:23522373

  4. Evaluation of the efficacy and safety of intravenous ciprofloxacin versus meropenem in the treatment of postoperative infection.

    PubMed

    Kusachi, Shinya; Sumiyama, Yoshinobu; Takahashi, Yoshiki; Kato, Komei; Mashita, Keiji; Takeyama, Hiromitsu; Oda, Shigeto; Kobayashi, Shinichi

    2012-04-01

    Therapeutic options for postoperative infection in gastrointestinal surgery are limited. To identify new treatment alternatives, the Japan Society for Surgical Infection conducted a multicenter prospective, randomized, controlled clinical trial comparing the efficacy of intravenous ciprofloxacin (CIP IV) and intravenous meropenem (MEM IV). Between July 2005 and May 2008, the trial recruited patients who developed postoperative infection or had suspected infectious systemic inflammatory response syndrome after elective clean-contaminated gastrointestinal surgery. All patients had received prophylactic postoperative antibiotic treatment. Patients received either intravenous CIP IV 300 mg b.i.d. or MEM IV 500 mg b.i.d. A total of 205 patients from 31 institutions were enrolled. Of these, 101 were randomized to CIP IV and 104 to MEM IV. There were 100 and 102 in the intent-to-treat (ITT)/safety population and 75 and 77 in the per-protocol (PP) population. There was no significant difference between CIP IV and MEM IV in terms of clinical efficacy, bacteriological efficacy, incidence of adverse drug reactions, duration of antimicrobial treatment, or relapse/reactivation. Overall clinical success PP population) was high in both treatment groups: 85.3% (64/75) for CIP IV and 89.6% (69/77) for MEM IV, although the non-inferiority of CIP IV was not demonstrated (difference -4.3%, 95% CI -14.8, 6.2). In patients who had undergone upper gastrointestinal surgery, success was 88.5% (23/26) for CIP IV and 85.2% (23/27) for MEM IV. Intravenous ciprofloxacin is as effective as intravenous meropenem in the empiric therapy of postoperative infection after gastrointestinal surgery. PMID:22009525

  5. Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage

    PubMed Central

    Xu, Q Y; Yin, G W; Chen, S X; Jiang, F; Bai, X J; Wu, J D

    2012-01-01

    Objective The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL). Methods From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients’ nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube. Results The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49±0.42 g dl−1) to the post-enteral feeding (3.58±0.47 g dl−1) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months). Conclusion The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL. Advances in knowledge Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment. PMID:22806622

  6. Monitoring of Motor and Somatosensory Evoked Potentials During Spine Surgery: Intraoperative Changes and Postoperative Outcomes

    PubMed Central

    2016-01-01

    Objective To evaluate whether the combination of muscle motor evoked potentials (mMEPs) and somatosensory evoked potentials (SEPs) measured during spinal surgery can predict immediate and permanent postoperative motor deficits. Methods mMEP and SEP was monitored in patients undergoing spinal surgery between November 2012 and July 2014. mMEPs were elicited by a train of transcranial electrical stimulation over the motor cortex and recorded from the upper/lower limbs. SEPs were recorded by stimulating the tibial and median nerves. Results Combined mMEP/SEP recording was successfully achieved in 190 operations. In 117 of these, mMEPs and SEPs were stable and 73 showed significant changes. In 20 cases, motor deficits in the first 48 postoperative hours were observed and 6 patients manifested permanent neurological deficits. The two potentials were monitored in a number of spinal surgeries. For surgery on spinal deformities, the sensitivity and specificity of combined mMEP/SEP monitoring were 100% and 92.4%, respectively. In the case of spinal cord tumor surgeries, sensitivity was only 50% but SEP changes were observed preceding permanent motor deficits in some cases. Conclusion Intraoperative monitoring is a useful tool in spinal surgery. For spinal deformity surgery, combined mMEP/SEP monitoring showed high sensitivity and specificity; in spinal tumor surgery, only SEP changes predicted permanent motor deficits. Therefore, mMEP, SEP, and joint monitoring may all be appropriate and beneficial for the intraoperative monitoring of spinal surgery. PMID:27446784

  7. Postoperative respiratory depression associated with pregabalin: A case series and a preoperative decision algorithm

    PubMed Central

    Eipe, Naveen; Penning, John

    2011-01-01

    Pregabalin is gaining popularity in the perioperative period for its usefulness in treating neuropathic pain and its apparent opioid-sparing effect. The present report describes the perioperative course of three patients who received pregabalin and experienced significant respiratory depression in the postoperative period. All three patients consented to the report and publication of the present case series. The first patient was elderly with borderline renal dysfunction. She experienced respiratory arrest in the immediate postoperative period following a craniotomy for tumour excision. The second patient presented with severe respiratory depression 12 h after receiving a spinal anesthetic for joint replacement, and was later found to have clinically significant obstructive sleep apnea. The third patient, who was an otherwise healthy elderly individual on benzodiazepines for anxiety, experienced respiratory arrest in the postanesthesia care unit after an uneventful anesthesia for lumbar spine decompression. All of these patients were treated successfully with standard resuscitation measures. Although other causes of respiratory depression in these patients were considered, there appears to be an association between pregabalin and this complication. The present article briefly reviews the evidence regarding the perioperative use of pregabalin. Based on the authors’ experience and the available evidence, they believe that pregabalin may be useful in the management of acute pain in carefully selected patients undergoing certain surgeries. A clinical algorithm has been developed to guide the perioperative use of pregabalin. This algorithm may be helpful in increasing the safety of perioperative pregabalin use. PMID:22059207

  8. [Treatment of postoperative pain by balanced spinal analgesia].

    PubMed

    Polati, E; Finco, G; Bartoloni, A; Rigo, V; Gottin, L; Pinaroli, A M; Barzoi, G

    1995-01-01

    Postoperative pain relief has the aim to provide patient subjective comfort, to inhibit neuroendocrine and metabolic responses to surgical injury and to enhance restoration of function by allowing the patient to breathe, cough, move more easily and to begin enteral nutrition. Opioid analgesics, independently from the route of administration, are unable to provide all this. In addition to spinal opioids other drugs, such as local anesthetics, alpha 2-agonists and cholinergic drugs, may produce an antinociceptive effect when administered by spinal route. All these drugs may be administered in combination between them, realising the so called "balanced spinal analgesia". The aim of this study is to analyse the available methods for the evaluation of pharmacological interactions, the types of interaction among different spinal antinociceptive drugs and the role of balanced spinal analgesia in the treatment of postoperative pain. Analysis of the presented data shows that the spinal synergism between opioids-local anesthetics and opioids-alpha 2-agonists can be useful in the treatment of postoperative pain, because these drug combinations are able to provide a satisfactory pain control at low doses with a reduction of the adverse effects. Furthermore, the combined use of opioids-local anesthetics proved to be effective also in abolishing postoperative incident pain and in inhibiting neuroendocrine and metabolic responses to surgical injury. Especially in high risk patients this is related to a better outcome. Finally, even if the synergism between cholinergic drugs with opioids or a2-agonists have been proved, at the moment their use in man by spinal route in the treatment of postoperative pain is not advisable. PMID:9480192

  9. Postoperative biological and clinical outcomes following uncomplicated pancreaticoduodenectomy

    PubMed Central

    Lermite, Emilie; Wu, Tao; Sauvanet, Alain; Mariette, Christophe; paye, François; Muscari, Fabrice; Cunha, Antonio Sa; Sastre, Bernard; Arnaud, Jean-Pierre

    2016-01-01

    Backgrounds/Aims The aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign. Methods Between January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients. Results The mean postoperative length of hospital stay was 20.3±4 days. The mean number of days until removal of nasogastric tube was 6.3±1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866±236 IU/L versus 146±48 IU/L; p<0.001). For both γ-glutamyl transpeptidase and alkaline phosphatase, there was a fall on POD1, which persisted until POD 5, followed with a stabilization. Bilirubin decreased progressively from POD 1 onwards. Conclusions This study facilitates a standardized biological and clinical pathway of follow-up. Patients who do not follow this recovery indicator could be at risk of complications and additional exams should be made to prevent consequences of such complications. PMID:26925147

  10. Factors Associated with Postoperative Pain in Endodontic Therapy

    PubMed Central

    Sadaf, Durre; Ahmad, Muhammad Zubair

    2014-01-01

    Objective: To assess postoperative pain in endodontic therapy and its association with clinical factors such as gender, age, tooth type, pulpal diagnosis, and preoperative pain, length of obturation and sealer extrusion. Study Design: Cross-Sectional study. Place and Duration of Study: Dental section of the Aga khan university hospital, Karachi, Pakistan from January to December 2009. Methodology: One hundred and forty patients (140) requiring endodontic therapy for molar and premolar teeth were included in this study. Local Anesthesia (2% Lidocain with 1:80,000 Epinephrine) was administered. The tooth was isolated with rubber dam. Access cavity was prepared with the help of round carbide No. 2 bur. Canal preparation was completed using crown-down technique. Access was sealed with sterile dry cotton pallet and restored temporarily with double layer of Glass ionomer cement and Cavit. After one week patients were recalled and access was re-opened, obturation was done using cold lateral condensation technique. Ca(OH)2 based sealer was used. Postoperative radiographs were taken. Patients were recalled after 24 hours and postobturation pain was recorded using Visual analogue scale (VAS).Data was obtained on a structured Performa. χ2 test was used for statistical analysis. Results: Pain was present in 42.9% of patients. Females more frequently experienced pain (65%) than males (35%). Preoperative pain was found to be significantly associated with postoperative pain (p value < 0.001). Obturation length was not found to be significantly associated with postoperative pain (p value 1.0). Sealer extrusion was not found to be significantly associated with postoperative (P value 0.547). PMID:25598754

  11. Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer

    SciTech Connect

    Wang, Jingya; Wei, Caimiao; Tucker, Susan L.; Myles, Bevan; Palmer, Matthew; Hofstetter, Wayne L.; Swisher, Stephen G.; Ajani, Jaffer A.; Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing; Lin, Steven H.

    2013-08-01

    Purpose: While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials: From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ{sup 2} or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results: The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions: The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.

  12. Markov chain evaluation of acute postoperative pain transition states.

    PubMed

    Tighe, Patrick J; Bzdega, Matthew; Fillingim, Roger B; Rashidi, Parisa; Aytug, Haldun

    2016-03-01

    Previous investigations on acute postoperative pain dynamicity have focused on daily pain assessments, and so were unable to examine intraday variations in acute pain intensity. We analyzed 476,108 postoperative acute pain intensity ratings, which were clinically documented on postoperative days 1 to 7 from 8346 surgical patients using Markov chain modeling to describe how patients are likely to transition from one pain state to another in a probabilistic fashion. The Markov chain was found to be irreducible and positive recurrent, with no absorbing states. Transition probabilities ranged from 0.0031, for the transition from state 10 to state 1, to 0.69 for the transition from state 0 to state 0. The greatest density of transitions was noted in the diagonal region of the transition matrix, suggesting that patients were generally most likely to transition to the same pain state as their current state. There were also slightly increased probability densities in transitioning to a state of asleep or 0 from the current state. An examination of the number of steps required to traverse from a particular first pain score to a target state suggested that overall, fewer steps were required to reach a state of 0 (range 6.1-8.8 steps) or asleep (range 9.1-11) than were required to reach a mild pain intensity state. Our results suggest that using Markov chains is a feasible method for describing probabilistic postoperative pain trajectories, pointing toward the possibility of using Markov decision processes to model sequential interactions between pain intensity ratings, and postoperative analgesic interventions. PMID:26588689

  13. Association of Comorbidities With Postoperative In-Hospital Mortality

    PubMed Central

    Kork, Felix; Balzer, Felix; Krannich, Alexander; Weiss, Björn; Wernecke, Klaus-Dieter; Spies, Claudia

    2015-01-01

    Abstract The purpose of this article is to evaluate the American Society of Anesthesiologists Physical Status (ASA PS) and the Charlson comorbidity index (CCI) for the prediction of postoperative mortality. The ASA PS has been suggested to be equally good as the CCI in predicting postoperative outcome. However, these scores have never been compared in a broad surgical population. We conducted a retrospective cohort study in a German tertiary care university hospital. Predictive accuracy was compared using the area under the receiver-operating characteristic curves (AUROC). In a post hoc approach, a regression model was fitted and cross-validated to estimate the association of comorbidities and intraoperative factors with mortality. This model was used to improve prediction by recalibrating the CCI for surgical patients (sCCIs) and constructing a new surgical mortality score (SMS). The data of 182,886 patients with surgical interventions were analyzed. The CCI was superior to the ASA PS in predicting postoperative mortality (AUROCCCI 0.865 vs AUROCASAPS 0.833, P < 0.001). Predictive quality further improved after recalibration of the sCCI and construction of the new SMS (AUROCSMS 0.928 vs AUROCsCCI 0.896, P < 0.001). The SMS predicted postoperative mortality especially well in patients never admitted to an intensive care unit. The newly constructed SMS provides a good estimate of patient's risk of death after surgery. It is capable of identifying those patients at especially high risk and may help reduce postoperative mortality. PMID:25715258

  14. Postoperative cognitive dysfunction: Involvement of neuroinflammation and neuronal functioning.

    PubMed

    Hovens, Iris B; Schoemaker, Regien G; van der Zee, Eddy A; Absalom, Anthony R; Heineman, Erik; van Leeuwen, Barbara L

    2014-05-01

    Postoperative cognitive dysfunction (POCD) has been hypothesized to be mediated by surgery-induced inflammatory processes, which may influence neuronal functioning either directly or through modulation of intraneuronal pathways, such as the brain derived neurotrophic factor (BDNF) mediated pathway. To study the time course of post-surgical (neuro)inflammation, changes in the BDNF-pathway and POCD, we subjected 3months old male Wistar rats to abdominal surgery and implanted a jugular vein catheter for timed blood sampling. Cognition, affective behavior and markers for (neuro)inflammation, BDNF and neurogenesis were assessed at 1, 2 and 3weeks following surgery. Rats displayed changes in exploratory activity shortly after surgery, associated with postoperatively elevated IL-6 plasma levels. Spatial learning and memory were temporarily impaired in the first 2weeks following surgery, whereas non-spatial cognitive functions seemed unaffected. Analysis of brain tissue revealed increased neuroinflammation (IL-1B and microgliosis) 7days following surgery, decreased BDNF levels on postoperative day 14 and 21, and decreased neurogenesis until at least 21days following surgery. These findings indicate that in young adult rats only spatial learning and memory is affected by surgery, suggesting hippocampal dependent cognition is especially vulnerable to surgery-induced impairment. The observed differences in time course following surgery and relation to plasma IL-6 suggest cognitive dysfunction and mood changes comprise distinct features of postoperative behavioral impairment. The postoperative changes in neuroinflammation, BDNF and neurogenesis may represent aspects of the underlying mechanism for POCD. Future research should be aimed to elucidate how these players interact. PMID:24517920

  15. Gender Affects Early Postoperative Outcomes of Rotator Cuff Repair

    PubMed Central

    Ye, Hee-Uk; Jung, Jae-Won; Lee, Young-Kuk

    2015-01-01

    Background The literature does not provide consistent information on the impact of patients' gender on recovery after rotator cuff repair. The purpose of this study was to determine whether gender affects pain and functional recovery in the early postoperative period after rotator cuff repair. Methods Eighty patients (40 men and 40 women) were prospectively enrolled. Pain intensity and functional recovery were evaluated, using visual analog scale (VAS) pain score and range of motion on each of the first 5 postoperative days, at 2 and 6 weeks and at 3, 6, and 12 months after surgery. Perioperative medication-related adverse effects and postoperative complications were also assessed. Results The mean VAS pain score was significantly higher for women than men at 2 weeks after surgery (p = 0.035). For all other periods, there was no significant difference between men and women in VAS pain scores, although women had higher scores than men. Mean forward flexion in women was significantly lower than men at 6 weeks after surgery (p = 0.033) and the mean degree of external rotation in women was significantly lower than men at 6 weeks (p = 0.007) and at 3 months (p = 0.017) after surgery. There was no significant difference in medication-related adverse effects or postoperative complications. Conclusions Women had more pain and slower recovery of shoulder motion than men during the first 3 months after rotator cuff repair. These findings can serve as guidelines for pain management and rehabilitation after surgery and can help explain postoperative recovery patterns to patients with scheduled rotator cuff repair. PMID:26217471

  16. Successful embolization of a suprascapular artery aneurysm.

    PubMed

    Bucci, Federico; P, Plagnol; B, Salvati; R, Capoano; L, Fiengo; A, Redler

    2014-01-01

    A 45-year-old woman was referred to our service because 9 months earlier she had developed a pulsating mass on the right supraclavicular fossa and torticollis. Ultrasounds and computed tomographic arteriography showed the presence of a subclavian collateral artery aneurysm with a diameter of 21 mm. On selective arteriography, an aneurysm of a suprascapular artery arising directly from the right subclavian artery was reported. The presence of thoracic outlet syndrome was excluded. The aneurysm was successfully treated with ethylene-vinyl alcohol polymer, a liquid embolic agent. The patient was discharged on postoperative day 1 in good general condition. After 12 months, control ultrasounds confirmed the complete thrombosis of the aneurysm sac. PMID:21620668

  17. Postoperative irrigation with bisphosphonates may reduce the recurrence of giant cell tumor of bone.

    PubMed

    Yang, Tao; Zheng, Xiao-Fei; Lin, Xi; Yin, Qing-Shui

    2013-11-01

    Giant cell tumor of bone (GCTB) is a common benign bone tumor characterized by local osteolysis and high proclivity for recurrence. Surgical excision is the preferred treatment. However, simple wide resection may cause functional and cosmetic deformities of the skeleton. Currently, intralesional curettage with adjuvant therapy is a popular treatment. Bisphosphonates are recommended as an effective adjuvant treatment, and their antitumor effects have been proved in laboratory studies. During clinical treatment, intravenous and peroral administration of bisphosphonates has been attempted and has been successful in reducing the tumor recurrence rate. However, the use of bisphosphonates in GCTB adjuvant therapy requires additional study. Irrigation is a classic method for focal clearance after surgery. Therefore, we hypothesize that postoperative irrigation with bisphosphonates may be a safe and effective treatment for GCTB. The efficacy and safety of this method are worthy of further investigation. PMID:23968573

  18. Gastrointestinal tract obstruction secondary to post-operative oedema: does dexamethasone administration help?

    PubMed Central

    Atie, M.; Khoma, O.; Dunn, G.; Falk, G.L.

    2016-01-01

    Oedema can occur in handled tissues following upper gastrointestinal surgery with anastomosis formation. Obstruction of the lumen may result in delayed return of enteric function. Intravenous steroid use may be beneficial. Three cases of delayed emptying following fundoplication, gastro-enteric and entero-enteric anastomoses are reviewed. Conservative management with supportive measures failed. Dexamethasone was administered to treat the oedematous obstruction. A literature review in PubMed, Cochrane database and Medline for English language publications on the use of dexamethasone in the treatment of acute post surgical oedema of the upper gastrointestinal was conducted. Administration of dexamethasone led to resolution of symptoms and successful outcome. No reports on the use of steroids in this context were identified in the literature. The use of dexamethasone may effectively treat intestinal obstruction due to inflammatory or oedematous cause in the early post-operative period. PMID:27554826

  19. Evaluation of efficacy of endoscopic incision method in postoperative benign anastomotic strictures of gastrointestinal system

    PubMed Central

    Ölmez, Şehmus; Pürnak, Tuğrul; Özaslan, Ersan; Altıparmak, Emin

    2015-01-01

    Introduction Postoperative benign anastomotic strictures (POBAS) which develop after surgical resections of the gastrointestinal system (GIS) present with symptoms depending on location of the stricture. Diagnosis is confirmed by endoscopic and radiological methods. Although bougie or balloon dilatation is preferred in management, the endoscopic incision method (EIM) is also used with considerable success. In this trial, we aimed to evaluate EIM, which is one of the endoscopic dilatation techniques used in postoperative anastomotic stricture of GIS. Material and methods A total of 20 POBAS patients, 12 men and 8 women, subjected to EIM intervention for strictures, were enrolled in the trial. The number of patients with upper GIS strictures was 6 (30%), while the number of cases with lower GIS strictures was 14 (70%). Results Dilatation of the stricture was achieved in 15 (75%) patients with one treatment session, while more than one session of EIM was needed in 5 (25%) cases. Mean duration of follow-up of patients was 10.65 ±5.86 (0–25) months. Procedure-related complications developed in 8 patients. Among them, 7 were minor complications and improved without any treatment. In only 1 (5%) patient, perforation was observed as a major complication. Following EIM, recurrence of POBAS was observed in 5 (25%) patients. The following parameters were found to have an impact on successful outcome in EIM: presence or absence of a tortuous lumen in POBAS (p = 0.035) and length of stricture (p = 0.02), complications during the procedure (if any), and presence of single or multiple strictures. Conclusions Endoscopic incision method may be regarded as a favorable approach among first choice treatment alternatives in uncomplicated anastomotic strictures of GIS, or it may be used as an adjunctive dilatation method. PMID:26528338

  20. Post-operative assessment in Deep Brain Stimulation based on multimodal images: registration workflow and validation

    NASA Astrophysics Data System (ADS)

    Lalys, Florent; Haegelen, Claire; Abadie, Alexandre; Jannin, Pierre

    2009-02-01

    Object Movement disorders in Parkinson disease patients may require functional surgery, when medical therapy isn't effective. In Deep Brain Stimulation (DBS) electrodes are implanted within the brain to stimulate deep structures such as SubThalamic Nucleus (STN). This paper describes successive steps for constructing a digital Atlas gathering patient's location of electrodes and contacts for post operative assessment. Materials and Method 12 patients who had undergone bilateral STN DBS have participated to the study. Contacts on post-operative CT scans were automatically localized, based on black artefacts. For each patient, post operative CT images were rigidly registered to pre operative MR images. Then, pre operative MR images were registered to a MR template (super-resolution Collin27 average MRI template). This last registration was the combination of global affine, local affine and local non linear registrations, respectively. Four different studies were performed in order to validate the MR patient to template registration process, based on anatomical landmarks and clinical scores (i.e., Unified Parkinson's disease rating Scale). Visualisation software was developed for displaying into the template images the stimulated contacts represented as cylinders with a colour code related to the improvement of the UPDRS. Results The automatic contact localization algorithm was successful for all the patients. Validation studies for the registration process gave a placement error of 1.4 +/- 0.2 mm and coherence with UPDRS scores. Conclusion The developed visualization tool allows post-operative assessment for previous interventions. Correlation with additional clinical scores will certainly permit to learn more about DBS and to better understand clinical side-effects.

  1. Behavioural measurement of postoperative pain after oral surgery.

    PubMed

    Coulthard, P; Pleuvry, B J; Dobson, M; Price, M

    2000-04-01

    The amount and type of postoperative analgesia prescribed depends on the clinician's judgement of the patient's need. Among other factors, this judgement is likely to be based on the patient's behaviour. The primary aim of this study was to investigate the validity of using behavioural measures to provide information about a patient's experience of pain during the early stages of recovery from oral surgery under general anaesthesia. Behavioural measures were not valid measures of acute postoperative pain, which suggests that while clinicians may build a better picture of a patient's experience of pain by including behavioural observation in their range of assessments, they should not rely on them when judging a patient's need for analgesia. The results also show differences between the sexes in their reaction to pain. Significantly more women than men showed signs of pain, despite little difference in self-rating pain scores. PMID:10864708

  2. Public perceptions of postoperative pain and its relief.

    PubMed

    Scott, N B; Hodson, M

    1997-05-01

    In order to evaluate the general public's knowledge of postoperative pain and its management, a simple questionnaire was devised and sent out to five general practices in Scotland and Yorkshire. Questionnaires were completed voluntarily by 529 people attending their general practitioner for reasons not related to surgery. Five hundred and fifteen completed questionnaires were analysed. Two hundred and thirty-nine (46.4%) responders had undergone previous major surgery whereas 267 (51.8%) had not. Attitudes to pain varied greatly and confirm the findings of other surveys that amongst the general public there is little or no understanding of the nature of postoperative pain or of the methods available to treat it. Despite the published literature, the public have a high degree of confidence in the ability of doctors and nurses to treat such pain. Widespread public and professional education is required before further improvements can be made to such a universal and basic clinical problem. PMID:9165962

  3. Effectiveness of preoperative analgesics on postoperative dental pain: a study.

    PubMed Central

    Zacharias, M.; Hunter, K. M.; Baker, A. B.

    1996-01-01

    Patients undergoing extractions of third molar teeth under general anesthesia were given a placebo, diclofenac (a nonsteroidal anti-inflammatory drug) 100 mg, or methadone (an opiate) 10 mg 60 to 90 min prior to surgery, and their pain scores and postoperative medication requirements were measured for 3 days. All patients received local anesthetic blocks and analgesic drugs during the perioperative period. There were no significant differences between the three groups in the pain scores and medication requirements during the period of study. It was concluded that preoperative use of nonsteroidal anti-inflammatory drugs and opiates may not offer a preemptive analgesic effect in patients who have had adequate analgesia during the surgery. Continued use of analgesic drugs during the postoperative period is perhaps more useful for this purpose. There appears to be a higher incidence of vomiting following opiates (methadone), precluding its clinical use in day-care patients. PMID:10323113

  4. Aspirin metabolism and efficacy in postoperative dental pain.

    PubMed Central

    Seymour, R A; Williams, F M; Ward, A; Rawlins, M D

    1984-01-01

    Aspirin 1200 mg was compared with placebo in a randomised, double-blind, crossover study in 15 patients with postoperative pain after removal of impacted lower third molars. Over a 5 h investigation period, patients reported significantly less pain (P less than 0.01) after treatment with aspirin, than after treatment with placebo. Peak concentrations of aspirin occurred at 15 min after dosage. Significant negative correlations were observed between plasma aspirin esterase activity and both AUC aspirin (r = -0.904, P less than 0.001) and AUC analgesia (r = -0.91, P less than 0.001). Similarly, a significant correlation was observed between AUC aspirin and AUC analgesia (r = 0.96, P less than 0.001). Evidence from this study would suggest that an individual's pain relief in postoperative dental pain is determined by the rate of aspirin hydrolysis to salicylate. PMID:6378231

  5. Effect of postoperative extradural morphine on lower urinary tract function.

    PubMed

    Husted, S; Djurhuus, J C; Husegaard, H C; Jepsen, J; Mortensen, J

    1985-02-01

    The effect of postoperative extradurally administered morphine on lower urinary tract function was studied in female patients undergoing uterine surgery. Urodynamic measurements were made on the day before and on the day after the operation, using a DISA 2-channel carbon dioxide (CO2) cystomictrograph. In ten patients without postoperative urinary retention no changes in cystometry were found during morphine administration, while two patients who developed acute urinary retention had a marked increase in bladder capacity and of detrusor pressure. In contrast, the urethral pressure profile was unchanged in both groups of patients. Intravenously administered naloxone tended to normalize the bladder capacity in the patients with urinary retention. These findings seem to indicate a marked effect in some patients of extradurally administered morphine and the acute urinary retention, following morphine administration, may be treated with naloxone. PMID:3976331

  6. Imaging panorama in postoperative complications after liver transplantation

    PubMed Central

    Sureka, Binit; Bansal, Kalpana; Rajesh, S; Mukund, Amar; Pamecha, Viniyendra; Arora, Ankur

    2016-01-01

    The liver is the second most-often transplanted solid organ after the kidney, so it is clear that liver disease is a common and serious problem around the globe. With the advancements in surgical, oncological and imaging techniques, orthotopic liver transplantation has become the first-line treatment for many patients with end-stage liver disease. Ultrasound, and Doppler are the most economical and cost-effective imaging modalities for evaluating postoperative fluid collections and vascular complications. Computed tomography (CT) is used to confirm the findings of ultrasound and look for pulmonary complications. Magnetic resonance imaging (MRI) is used for the diagnosis of biliary complications, bile leaks and neurological complications. This article illustrates the imaging options for diagnosing the various complications that can be encountered in the postoperative period after liver transplantation. PMID:26534929

  7. [Insomnia and its treatment during the postoperative period].

    PubMed

    Beliaev, D G; Shestokov, I P; Zadorozhnaia, O A; Fridman, M Kh

    1994-01-01

    A total of 108 patients have filled in questionnaires on falling asleep, sleeping, night awakenings and other characteristics. Their answers have been analysed and it was concluded that night sleep of patients especially in the postoperative period was characterized by prolonged period of falling asleep (over 30 min in 50% of patients), reduced duration, in 77% of patients night awakenings have been recorded. The use of analgin (1000 mg) in combination with dimedrol (10 mg), promedol (20 mg) for tramal (100 mg) for normalization of sleep in the postoperative period was of little efficacy. Therapy of night sleep disturbances will improve the patients' condition and enhance the efficacy of management after surgical interventions. PMID:8010509

  8. MR imaging of the postoperative meniscus: repair, resection, and replacement.

    PubMed

    Gopez, Angela G; Kavanagh, Eoin C

    2006-09-01

    Meniscal surgery is one of the most common orthopedic procedures performed in clinical practice today. Increasing awareness of the importance of the meniscus in knee function and stability has resulted in abandonment of the once common complete meniscectomy in favor of meniscus-preserving surgeries and, in some circumstances, meniscal replacement. Although the accuracy of magnetic resonance imaging in the diagnosis of meniscal tears is well established, imaging of the postoperative meniscus has proved more challenging, with debate about the optimal imaging technique. This article discusses normal meniscal anatomy and biomechanics to serve as the background for understanding meniscal pathology and treatment. This is followed by a review of meniscal surgery, with emphasis placed on meniscal repair, partial meniscectomy, and meniscal transplantation. Finally, imaging modalities utilized in the assessment of the postoperative meniscus are reviewed, including their advantages and disadvantages. PMID:17195131

  9. An outbreak of post-operative endophthalmitis in Lampang Hospital.

    PubMed

    Pitaksiripan, S; Butpongsapan, S; Pravithayakarn, L; Tippayadarapanich, D

    1995-07-01

    An outbreak of post-operative endophthalmitis involving 48 patients from October 1991 to October 1992 in Lampang Hospital was reported. There were 3 waves of clustered cases, i.e. from October 1991 to January 1992, April-June 1992, and August-October 1992. Investigation revealed several risk factors: defects in sterilization of surgical instruments, poor operating room hygiene, contaminated tap water and the use of multiple-dose fluids and medication. Bacteria isolated from vitreous fluid showed different bacteria, indicating multiple sources of infection or failure of asepsis. Each episode of infection was brought under control by removing the risk factors and emphasis on aseptic techniques. The value of an effective survey programme for the detection of post-operative endophthatmitis was emphasized. PMID:7561604

  10. Children's nurses' post-operative pain assessment practices.

    PubMed

    Panjganj, Donya; Bevan, Ann

    2016-06-01

    Pain assessment is crucial to achieving optimal pain management in children. Pain that is insufficiently controlled can have extensive short- and long-term repercussions. Many studies continue to report that children experience unnecessary post-operative pain when they are in hospital. The purpose of this literature review was to explore post-operative pain assessment practices used by children's nurses. A literature search of databases was undertaken and inclusion criteria identified. Four themes emerged: pain assessment tools; behavioural cues; documentation; and communication between child, parent/carer and nurse. The findings showed that pain assessment tools were inadequately used, that children's behavioural cues were misinterpreted, and that there was inconsistency in the documentation of pain scores and in communication about pain scores between children, parent/carer and nurse. Addressing the key issues identified from the articles reviewed can help improve nursing practice and care. PMID:27266751

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

    PubMed

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

    2011-01-01

    A new surgical method is available for colon and rectal surgery. Robotic surgery, using the daVinci Si HD Surgical System, offers surgical advances compared with the traditional open or laparoscopic surgical methods. The potential advantages of robotic technology continue to be explored and its most appropriate functions are yet to be determined. In clinical experience, the use of this surgical method has resulted in changes to postoperative nursing care management. This article describes changes in the management of postoperative patient care including fluid and electrolyte balance, and patient and staff education. Modifications were instituted in the clinical pathway to facilitate an accelerated standard of care. New discharge strategies were implemented to ensure ongoing fluid and electrolyte balance by the patient. A true team effort from a multitude of disciplines was required for the changes in patient care routine to be effective. Outcomes including length of stay and patient satisfaction are presented. PMID:21814060

  12. Intraoperative Dexmedetomidine Promotes Postoperative Analgesia in Patients After Abdominal Colectomy

    PubMed Central

    Ge, Dong-Jian; Qi, Bin; Tang, Gang; Li, Jin-Yu

    2015-01-01

    Abstract Surgery-induced acute postoperative pain may lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia following abdominal colectomy surgeries. Eighty patients scheduled for abdominal colectomy surgery under general anesthesia were divided into 2 groups, which were maintained using propofol/remifentanil/dexmedetomidine (PRD) or propofol/remifentanil/saline (PRS). During surgery, patients in the PRD group had a lower bispectral index (BIS) value, which indicated a deeper anesthetic state, and a higher sedation score right after extubation than patients in the PRS group. During the first 24 hours post surgery, PRD patients consumed less morphine in patient-controlled analgesia (PCA) and had a lower score in the visual analog scale (VAS) testing than their controls from the PRS group. Intraoperative administration of dexmedetomidine appears to promote the analgesic property of morphine-based PCA in patients after abdominal colectomy. PMID:26376397

  13. Postoperative Cognitive Dysfunction: Current Developments in Mechanism and Prevention

    PubMed Central

    Wang, Wei; Wang, Yan; Wu, Haibo; Lei, Liming; Xu, Shiqin; Shen, Xiaofeng; Guo, Xirong; Shen, Rong; Xia, Xiaoqiong; Liu, Yusheng; Wang, Fuzhou

    2014-01-01

    Postoperative cognitive dysfunction (POCD) is a subtle disorder of thought processes, which may influence isolated domains of cognition and has a significant impact on patient health. The reported incidence of POCD varies enormously due to lack of formal criteria for the assessment and diagnosis of POCD. The significant risk factors of developing POCD mainly include larger and more invasive operations, duration of anesthesia, advanced age, history of alcohol abuse, use of anticholinergic medications, and other factors. The release of cytokines due to the systemic stress response caused by anesthesia and surgical procedures might induce the changes of brain function and be involved in the development of postoperative cognitive dysfunction. The strategies for management of POCD should be a multimodal approach involving close cooperation between the anesthesiologist, surgeon, geriatricians, and family members to promote early rehabilitation and avoid loss of independence in these patients. PMID:25306127

  14. Thalamotemporal alteration and postoperative seizures in temporal lobe epilepsy

    PubMed Central

    Richardson, Mark P.; Schoene‐Bake, Jan‐Christoph; O'Muircheartaigh, Jonathan; Elkommos, Samia; Kreilkamp, Barbara; Goh, Yee Yen; Marson, Anthony G.; Elger, Christian; Weber, Bernd

    2015-01-01

    Objective There are competing explanations for persistent postoperative seizures after temporal lobe surgery. One is that 1 or more particular subtypes of mesial temporal lobe epilepsy (mTLE) exist that are particularly resistant to surgery. We sought to identify a common brain structural and connectivity alteration in patients with persistent postoperative seizures using preoperative quantitative magnetic resonance imaging and diffusion tensor imaging (DTI). Methods We performed a series of studies in 87 patients with mTLE (47 subsequently rendered seizure free, 40 who continued to experience postoperative seizures) and 80 healthy controls. We investigated the relationship between imaging variables and postoperative seizure outcome. All patients had unilateral temporal lobe seizure onset, had ipsilateral hippocampal sclerosis as the only brain lesion, and underwent amygdalohippocampectomy. Results Quantitative imaging factors found not to be significantly associated with persistent seizures were volumes of ipsilateral and contralateral mesial temporal lobe structures, generalized brain atrophy, and extent of resection. There were nonsignificant trends for larger amygdala and entorhinal resections to be associated with improved outcome. However, patients with persistent seizures had significant atrophy of bilateral dorsomedial and pulvinar thalamic regions, and significant alterations of DTI‐derived thalamotemporal probabilistic paths bilaterally relative to those patients rendered seizure free and controls, even when corrected for extent of mesial temporal lobe resection. Interpretation Patients with bihemispheric alterations of thalamotemporal structural networks may represent a subtype of mTLE that is resistant to temporal lobe surgery. Increasingly sensitive multimodal imaging techniques should endeavor to transform these group‐based findings to individualize prediction of patient outcomes. Ann Neurol 2015;77:760–774 PMID:25627477

  15. Descemetocele formation in a patient with a postoperative corneal dellen.

    PubMed

    Insler, M S; Tauber, S; Packer, A

    1989-01-01

    Dellen formation generally follows localized evaporation and dehydration of the cornea. The condition follows a disruption in the ocular tear film and usually can be managed conservatively with lubricants. We recently treated a patient with a postoperative dellen that progressed to a descemetocele and required a patch graft to prevent perforation. Recognition of this potential complication emphasizes the need to begin treatment immediately after the onset of dellen. PMID:2785445

  16. The Effect of Diclofenac Mouthwash on Periodontal Postoperative Pain

    PubMed Central

    Yaghini, Jaber; Abed, Ahmad Moghareh; Mostafavi, Seyed Abolfazl; Roshanzamir, Najmeh

    2011-01-01

    Background: The need to relieve pain and inflammation after periodontal surgery and the side effects of systemic drugs and advantages of topical drugs, made us to evaluate the effect of Diclofenac mouthwash on periodontal postoperative pain. Methods: In this double-blind, randomized clinical trial study 20 quadrants of 10 patients(n = 20) aged between 22-54 who also acted as their own controls, were treated using Modified Widman Flap procedure in two quadrants of the same jaw with one month interval between the operations. After the operation in addition to ibuprofen 400 mg, one quadrant randomly received Diclofenac mouthwash (0/01%) for 30 seconds, 4 times a day (for a week) and for the contrary quadrant, ibuprofen and placebo mouthwash was given to be used in the same manner. The patients scored the number of ibuprofen consumption and their pain intensity based on VAS index in a questionnaire in days 1, 2, 3 and the first week after operation. The findings were analysed using two-way ANOVA, t-test and Wilcoxon. P-value less than 0.05 considered to be significant. Results: There was a significant difference between the mean values of pain intensity of two quadrants in four periods (P = 0.031). But, there was no significant difference between the average ibuprofen consumption in two groups (P = 0.51). Postoperative satisfaction was not significantly different in two quadrants (P = 0.059). 60% of patients preferred Diclofenac mouthwash. Conclusion: Diclofenac mouthwash was effective in reducing postoperative periodontal pain but it seems that it isn’t enough to control postoperative pain on its own. PMID:22013478

  17. Preemptive morphine suppository for postoperative pain relief after laparoscopic cholecystectomy

    PubMed Central

    Rahimi, Mojtaba; Farsani, Daryoush Moradi; Naghibi, Khosrou; Alikiaii, Babak

    2016-01-01

    Background: Postoperative pain is a major problem following laparoscopic cholecystectomy, and there is no general agreement on the effective method of pain relief. Rectal morphine suppositories are one of the newly released morphine forms. The aim of this study is to compare the impact of suppository morphine with placebo on pain relief after laparoscopic cholecystectomy. Materials and Methods: Seventy patients scheduled for elective laparoscopic cholecystectomy under general anesthesia, were randomly allocated to two groups according to the drug used for postoperative analgesia: Group morphine suppository (MS - 10 mg) just before induction of anesthesia And Group placebo suppository (PS) (the pills were made from cocoa butter, physically similar to the real drug). Pain intensity based on visual analog scale (VAS) and opioid consumption were assessed 30 and 60 min, and 2, 4, 8, 16, and 24 h after arrival of the patient to the recovery room. Results: VAS scores were significantly lower in MS group (from 3.8 ± 1 to 5.3 ± 1.6) compared with PS group (from 4.9 ± 0.9 to 6.7 ± 1) from 30 min after arrival to the recovery room until 16 h postoperatively (P < 0.05). There were no additional analgesic requirements in the first 2 h after the entrance of the patient to the recovery room in MS group. The number of patients requiring pethidine was significantly different between two groups (P < 0.05) in all periods except for 24 h postoperatively. Conclusion: Suppository morphine administration is more effective than placebo to reduce pain and analgesic requirements after laparoscopic cholecystectomy. PMID:27110554

  18. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

    PubMed Central

    Kim, Sun Woo; Ahn, Ji Hoon; Yim, Sang Un; Cho, Yang Hyun; Shin, Bo Sung; Chung, Ho Seok; Yu, Ho Song; Oh, Kyung Jin; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

    2016-01-01

    Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis. PMID:27617316

  19. Postoperative exposure of bioresorbable GTR membranes: effect on healing results.

    PubMed

    Christgau, M; Bader, N; Schmalz, G; Hiller, K A; Wenzel, A

    1997-09-01

    The goal of this investigation was to evaluate the effect of postoperative exposure of two different bioresorbable membranes on the guided tissue regeneration (GTR) healing results compared to nonexposed sites. In each of 25 patients one pair of contralateral intrabony lesions was treated either with polylactic acid (PLA) or polyglactin 910 (PG-910) membranes. Postoperative exposure occurred in 9 PLA and 13 PG-910 sites. Standardized clinical [papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), probing attachment level (PAL)] and radiographic examinations (digital subtraction radiography) were performed immediately before (baseline) and 6 and 12 months postoperatively (p.o.). Subgingival bacterial samples from surgical sites were evaluated by culture at baseline, 6 weeks, and 6 and 12 months p.o. Six months after surgery the changes (delta) of REC were significantly (P < or = 0.05) greater in exposed than in nonexposed sites, independently of the membrane material (median): exposed sites, delta REC = -1 mm; nonexposed sites, delta REC = 0.0 mm. However, 12 months p.o. no significant differences were found due to a decrease in the initial recessions in exposed sites. Although a higher percentage of exposed than nonexposed sites harbored periodontal pathogens 6 weeks p.o. at the gingiva-faced membrane surface, membrane exposure did not have a significant negative effect on delta PPD, delta PAL, or radiographic bone density changes 6 and 12 months p.o. Both membranes showed significant gains in PAL and bone density in both exposed and nonexposed sites. In conclusion, this study demonstrates that with consistent infection control the postoperative exposure of PLA and PG-910 membranes has no significant negative effect on the regeneration outcome, although higher initial gingival recessions must be expected than in the nonexposed sites. However, in exposed sites plaque and infection control were clearly impeded by the rough, exposed

  20. Current Evidence for Spinal Opioid Selection in Postoperative Pain

    PubMed Central

    2014-01-01

    Background Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one. Methods The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic. Results Recent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil. Conclusions Results obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security. PMID:25031805

  1. Student Success. March 2006

    ERIC Educational Resources Information Center

    Online Submission, 2006

    2006-01-01

    "Student Success" is EPI's occasional e-magazine dedicated to the discussion of retaining students in higher education. Over the course of the next issues of "Student Success," the Educational Policy Institute (EPI) will explore three questions about retention on our college campuses. Part I will look at the barriers to student retention, both…

  2. Success in Library School.

    ERIC Educational Resources Information Center

    Magrill, Rose Mary; Rinehart, Constance

    1979-01-01

    Data on admission characteristics and performance in library school were collected for students entering the A.M.L.S. program at the University of Michigan. Success measures--completion of degree, G.P.A., and amount of time required to complete degree--showed little relation to admission variables in determining success. (Author/MBR)

  3. Student Success Center Toolkit

    ERIC Educational Resources Information Center

    Jobs For the Future, 2014

    2014-01-01

    "Student Success Center Toolkit" is a compilation of materials organized to assist Student Success Center directors as they staff, launch, operate, and sustain Centers. The toolkit features materials created and used by existing Centers, such as staffing and budgeting templates, launch materials, sample meeting agendas, and fundraising…

  4. Blueprint for Success.

    ERIC Educational Resources Information Center

    Smith, Curtis A.

    1992-01-01

    key to facilities planning and successful bond issues is involving public. Taxpayers are unlikely to support superintendent's plan but will certainly vote for their own plan. Success means ensuring fiscally uncluttered pathway, retaining an architect, and working with demographer. Appointing broad-based community task force of about 30 members,…

  5. Theme: Local Program Success.

    ERIC Educational Resources Information Center

    Camp, William G.; And Others

    1997-01-01

    Includes "Professional Propagation" (Camp); "Managing Human Resources with Local Program Success (LPS)" (Daley); "Profit Sharing with LPS" (Moses); "Partners for Success" (Mecey- Smith); "Achieving LPS by Collaborating with Partners, Allies and Volunteers" (Oglesby); LPS...Just What Agricultural Education Needs, Another Acronym" (Rist); "The…

  6. Measuring Student Success

    ERIC Educational Resources Information Center

    Baldwin, Christopher; Bensimon, Estela Mara; Dowd, Alicia C.; Kleiman, Lisa

    2011-01-01

    Student success is at the heart of both institutional effectiveness and the community college mission, yet measuring such success at community colleges is problematic. This article highlights three efforts to grapple with this problem--a multistate work group of system- and state-level policymakers to create an improved set of student success…

  7. The UKIRT Success Story

    NASA Astrophysics Data System (ADS)

    Ellis, Richard

    This is a personal overview of the great success of the UKIRT facility; a tribute to those who designed, built and operated it and helped put UK astronomy at the forefront of world infrared observations. I will illustrate this success with a small selection of science highlights.

  8. Swedish Successful Schools Revisited

    ERIC Educational Resources Information Center

    Hoog, Jonas; Johansson, Olof; Olofsson, Anders

    2009-01-01

    Purpose: The purpose of this paper is to describe the results of a follow-up study of two Swedish schools in which, five years previously, the principals had been successful leaders. Had this success been maintained? Design/methodology/approach: Two schools were revisited to enable the authors to interview principals and teachers as well as…

  9. Focused on Student Success

    ERIC Educational Resources Information Center

    California Community Colleges, Chancellor's Office, 2014

    2014-01-01

    In January 2011, the California Community Colleges Board of Governors formed a task force to chart a roadmap for system-wide focus on student success. The task force identified best practices and designed evidence-based recommendations to ensure student success is a driving theme in colleges. This comprehensive plan, known as the Student Success…

  10. The Student Success Coach

    ERIC Educational Resources Information Center

    Neuhauser, Claudia; Weber, Kendra

    2011-01-01

    An innovative position, a Student Success Coach, was created in response to a newly developed undergraduate-degree program on the recently established University of Minnesota Rochester campus. Student Success Coaches serve as the link between the academic and student affairs sides of the campus. They interact closely with students and faculty to…

  11. Momentum and Success

    ERIC Educational Resources Information Center

    Kunz, William

    2008-01-01

    Success begets success and opportunity begets opportunity. This principle is something that the author sees at work in his own life. One example of opportunities begetting opportunities is the experience he had at the Academy of Science and Technology to practice his programming skills. The Academy served as a great training ground for what would…

  12. Predictors of Postsecondary Success

    ERIC Educational Resources Information Center

    Hein, Vanessa; Smerdon, Becky; Sambolt, Megan

    2013-01-01

    The purpose of this brief is to provide information to state, district, and school personnel seeking support to determine whether their students are on a path to postsecondary success. The College and Career Readiness and Success Center (CCRS Center) has received technical assistance requests from a number of states regarding factors that predict…

  13. Principal Experiences of Succession

    ERIC Educational Resources Information Center

    Steele, Farla Gay

    2015-01-01

    This multiple case study explored the experiences of school principals and the usefulness of Peters' (2011) succession planning model. Ten purposefully selected principals from varying grade levels were interviewed; none reported a formal succession plan, and all had been assistant principals. The study concluded the assistant principal position…

  14. Leadership Succession. Essays

    ERIC Educational Resources Information Center

    Hargreaves, Andy

    2005-01-01

    One of the most significant events in the life of a school is a change in its leadership. Yet few things in education succeed less than leadership succession. Failure to care for leadership succession is sometimes a result of manipulation or self-centeredness; but more often it is oversight, neglect, or the pressures of crisis management that are…

  15. Getting Set for Success.

    ERIC Educational Resources Information Center

    Santa Rita, Emilio

    These career development materials consist of three booklets: the text, success portfolio, and facilitator's guide. Unit 1 in the text tests the students' coping skills. Contracts in the success portfolio for this unit enable the student to determine the sources of stress and ways of coping; describe different procedures for managing time; assess…

  16. Filling and shielding for postoperative gastric perforations of endoscopic submucosal dissection using polyglycolic acid sheets and fibrin glue

    PubMed Central

    Takimoto, Kengo; Hagiwara, Akeo

    2016-01-01

    Background and study aims: Many medical institutions in Japan perform endoscopic mucosal dissection (ESD) to treat early gastric cancer. Perforations can occur during ESD, and clipping has been reported as useful for treating small pinhole perforations. However, it is often difficult to close postoperative perforations because they usually have large diameters, and the muscle layer around the perforated region is often fragile, so additional open surgery is the only currently used method to treat large perforations and delayed perforations. Another method for large perforation is needed to treat perforations endoscopically. Ono et al. reported a case in which a postoperative perforation was closed using a polyglycolic acid (PGA) sheet and fibrin glue. In addition, it has been used by the authors’ group to repair duodenal injuries that occur during ESD. We report 3 cases in which PGA sheets and fibrin glue were successfully used to repair postoperative gastric perforations endoscopically. This method is simple, safe, and effective, and is a new way to treat large perforations and delayed perforations that occur following ESD. PMID:27556075

  17. Successful Treatment of Chronic Donor Site Pain

    PubMed Central

    Yanow, Jennifer H; Lorenzo, Luigi Di; Worosilo, Sharon C; Pappagallo, Marco

    2015-01-01

    Introduction: This is a case presentation of a 45-year-old male with chronic donor site pain following autologous iliac crest bone harvest successfully treated with superior cluneal nerve blockade. Donor site pain following autologous bone harvest is a common postoperative complication of lumbar fusion procedures that can cause significant morbidity and diminish quality of life, even in the context of an otherwise successful surgery. Dysfunction of the superior cluneal nerves is an etiology of this chronic pain. The patient’s medical history, attempted treatments, and literature were reviewed. Case Presentation: A 45-year-old male with a six year history of severe pain over the right iliac crest following an otherwise successful lumbar laminectomy and fusion underwent two sets of superior cluneal nerve blocks, with sustained relief of more than 80% at seven months follow up. Conclusions: Donor site pain following autologous iliac crest bone harvest is a common surgical complication that is often resistant to conservative treatments such as physical therapy and oral medications. Blockade of the superior cluneal nerves is a safe and technically simple procedure that may result in long-term pain relief, obviating the need to consider more invasive options. PMID:26587399

  18. Postoperative pain following the use of two different intracanal medications.

    PubMed

    Gama, Tulio G V; de Oliveira, Julio C Machado; Abad, Ernani C; Rôças, Isabela N; Siqueira, José F

    2008-12-01

    This study evaluated the incidence of postoperative pain after intracanal dressings with either 0.12% chlorhexidine digluconate gel (CHX) or a calcium hydroxide/camphorated paramonochlorophenol/glycerin paste (CH/CPMC). Overall, 138 asymptomatic teeth had their canals instrumented under irrigation with 2.5% NaOCl and then dressed with either CH/CPMC or CHX. The incidence of different intensity levels of postoperative pain was registered for the period between appointments. Data revealed that 84% of the total number of cases treated with either medicament showed absence of any level of pain. No case medicated with CH/CPMC and four cases (5.8%) medicated with CHX were categorized as flare-ups. There were no statistically significant differences between all possible comparisons involving the two medicaments in treatment/retreatment cases and teeth with/without apical periodontitis lesions. The low incidence of postoperative pain after the use of both medications, coupled to their antimicrobial effectiveness, gives support to using one or the other in routine treatment/retreatment. PMID:18401602

  19. Postoperative ileus: mechanisms and future directions for research.

    PubMed

    Vather, Ryash; O'Grady, Greg; Bissett, Ian P; Dinning, Phil G

    2014-05-01

    Postoperative ileus (POI) is an abnormal pattern of gastrointestinal motility characterized by nausea, vomiting, abdominal distension and/or delayed passage of flatus or stool, which may occur following surgery. Postoperative ileus slows recovery, increases the risk of developing postoperative complications and confers a significant financial load on healthcare institutions. The aim of the present review is to provide a succinct overview of the clinical features and pathophysiological mechanisms of POI, with final comment on selected directions for future research.Terminology used when describing POI is inconsistent, with little differentiation made between the obligatory period of gut dysfunction seen after surgery ('normal POI') and the more clinically and pathologically significant entity of a 'prolonged POI'. Both normal and prolonged POI represent a fundamentally similar pathophysiological phenomenon. The aetiology of POI is postulated to be multifactorial, with principal mediators being inflammatory cell activation, autonomic dysfunction (both primarily and as part of the surgical stress response), agonism at gut opioid receptors, modulation of gastrointestinal hormone activity and electrolyte derangements. A final common pathway for these effectors is impaired contractility and motility and gut wall oedema. There are many potential directions for future research. In particular, there remains scope to accurately characterize the gastrointestinal dysfunction that underscores an ileus, development of an accurate risk stratification tool will facilitate early implementation of preventive measures and clinical appraisal of novel therapeutic strategies that target individual pathways in the pathogenesis of ileus warrant further investigation. PMID:24754527

  20. Early diagnosis of acute postoperative renal transplant rejection

    SciTech Connect

    Tisdale, P.L.; Collier, B.D.; Kauffman, H.M.; Adams, M.B.; Isitman, A.T.; Hellman, R.S.; Rao, S.A.; Joestgen, T.; Krohn, L.

    1985-05-01

    A prospective evaluation of In-111 labeled autologous platelet scintigraphy for the early diagnosis of acute postoperative renal transplant rejection was undertaken. To date, 28 consecutive patients between 7 and 14 days post-op have been injected with 500..mu..Ci of In-111 platelets followed by imaging at 24 and 48 hours. Activity within the renal transplant exceeding activity in the adjacent iliac vessels was considered to be evidence of rejection, and both chemical evidence and clinical impression of rejection at 5 days after completion of imaging was accepted as proof of ongoing or incipient rejection at the time of scintigraphy. In addition, to visual inspection, independent quantitative analysis compared the area-normalized activity over the transplant with the adjacent iliac vessels (normal <1.0). For 5 patients, positive In-111 scintigraphy was present before convincing clinical evidence of rejection. In-111 platelet scintigraphy is useful not only to confirm the clinical diagnosis of rejection but also to establish the early, pre-clinical diagnosis of incipient acute postoperative renal transplant rejection.

  1. [Acute myocardial infarction in the postoperative period following pneumonectomy].

    PubMed

    López Alvarez, S; Bonome González, C; Izquierdo Villarroya, B; Barbeito Vilariño, M J; Etxainz Alvarez, A; Alvarez Refojo, F

    2002-11-01

    A 72-year-old man, smoker, with insuline-dependent diabetes and dislipemia underwent left pneumonectomy. Several episodes of intraoperative hemodynamic instability associated with electrocardiographic ST segment alterations were attributed to surgical manipulation; ischemia was not suspected. Cardiorespiratory failure, related to extensive anterior infarction, developed a few minutes after admission to the postoperative intensive care unit (PICU). Cardiopulmonary resuscitation and mechanical ventilation were required. The patient responded to treatment with beta blockers, platelet antiaggregants and statins. Tube was removed a few hours later and the patient was discharged from the PICU on the fifth day. Pneumonectomy has a high rate of morbidity and mortality, with complications mainly arising in the lung and heart. Risk from anesthesia is considered to be great in this procedure, and for that reason it is essential to identify intraoperative myocardial ischemia so that it can be treated aggressively. In patients at high cardiovascular risk who undergo lung resection, intraoperative episodes of myocardial ischemia are associated with a high incidence of postoperative miocardial infarction. Therefore, careful postoperative monitoring is needed and measures should be taken to prevent angina. Early extubation should be avoided. PMID:12516493

  2. Quality indicators in postoperative pain management: a validation study.

    PubMed

    Idvall, E; Hamrin, E; Sjöström, B; Unosson, M

    2001-01-01

    Quality indicators in postoperative pain management: a validation study. In a previous study, strategic and clinical quality indicators were developed from a tentative model to assess high quality in postoperative pain management. The aim of the present study was to investigate the content validity of these 15 indicators. The indicators were compiled in a questionnaire, and two groups of nurses (n=210, n=321) scored each indicator on a 5-point scale (strongly disagree to strongly agree) from three different standpoints: whether it was essential for achieving high quality, whether it was realistic to carry out, and whether it was possible for nurses to influence management. The respondents were also asked to choose the most crucial indicators for the quality of care. The results showed that both groups of nurses judged the 15 indicators to have content validity from all three standpoints. Both groups also found the same six indicators to be the most crucial. These indicators concerned detecting and acting on signs and symptoms, performing prescriptions, informing and educating, acting on behalf of patients, competence/knowledge, and attitudes. The validated indicators should be useful to consider when implementing a strategy for postoperative pain management and when planning to evaluate the quality of care. PMID:12453175

  3. Are children given insufficient pain-relieving medication postoperatively?

    PubMed

    Hamers, J P; Abu-Saad, H H; van den Hout, M A; Halfens, R J

    1998-01-01

    The literature often suggests and assumes that children are under-medicated postoperatively. A review of the literature leads to the conclusion that only a few studies answer the question of whether children's pain is relieved insufficiently. The lack of consensus on expected pain intensity after surgery and caution about prescribing analgesics could explain why analgesics are often prescribed on a pro re nata (prn) basis. Prescription on a prn basis, in fact, means that the nurse makes the decision whether or not an analgesic should be administered. Some studies suggest, however, that nurses under-medicate children and that postoperative pain is relieved insufficiently. In some situations, nurses under-estimate the child's pain, while in others, nurses' attitudes, beliefs and knowledge regarding pain relief strategies play an important role. On the basis of this review of the literature standard prescription of pain medication instead of prn is recommended. Furthermore, research on the incidence and prevalence of pain in children and on the effectiveness of analgesic administration postoperatively is warranted. PMID:9515606

  4. Postoperative nosocomial infections among children with congenital heart disease

    PubMed Central

    Zhang, Jian; Yuan, Yan; Li, Peiling; Wang, Tuanjie; Gao, Jun; Yao, Jinhua; Li, Shujun

    2014-01-01

    Objective: To study the pathogen distribution, antimicrobial susceptibility and risk factors of postoperative nosocomial infections among children with congenital heart disease. Methods: Three hundreds children with congenital heart disease admitted to our hospital to receive surgeries from February 2010 to February 2013 were selected. Results: A total of 120 children were tested as positive by sputum culture, with the infection rate of 40.0%. The top five most common pathogenic microorganisms included Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus, Pseudomonas aeruginosa, and Candida albicans. S. epidermidis, S. aureus and Enterococcus were highly resistant to penicillin, azithromycin and erythromycin, moderately susceptible to levofloxacin and cefazolin, and completely susceptible to vancomycin. Multivariate Logistic regression analysis showed that hospitalization stay length, combined use of antibiotics, systemic use of hormones, mechanical ventilation and catheter indwelling were the independent risk factors of postoperative nosocomial infections (P<0.05). Conclusion: Nosocomial infection, which was the most frequent postoperative complication of pediatric congenital heart disease, was predominantly induced by Gram-positive bacteria that were highly susceptible to cephalosporins and vancomycin. Particular attention should be paid to decrease relevant risk factors to improve the prognosis. PMID:24948978

  5. Extracellular RNAs as a chemical initiator for postoperative cognitive dysfunction.

    PubMed

    Chen, Chan; Cheng, Xu; Li, Ji; Chen, Hai; Zhang, Shu; Dong, Yuanlin; Gan, Lu; Liu, Jin; Zhu, Tao

    2016-09-01

    Postoperative cognitive dysfunction (POCD) is a common complication that presents in the postoperative stage, especially in elderly patients. Despite years of considerable progress, the detailed molecular mechanisms of POCD remain largely unknown. Neuroinflammation has been increasingly pointed out as one of the core mechanisms for the pathogenesis of POCD. However, application of anti-inflammatory drugs failed to show consistent beneficial effect in patients with cognitive decline. Hence, it might be of great importance to identify the inflammatory initiators that are involved in the mediation, amplification and perpetuation of postoperative neuroinflammatory reactions. Extracellular RNAs (exRNAs), released from necrotic cells, were demonstrated to initiate the inflammatory responses in various pathological conditions. Recent study has suggested neuroprotective and edema protective effects of ribonuclease (RNase), the counterpart of RNA, in acute stroke. It was theorized that RNase acted against endogenous RNA that was released from tissue damage. Similarly, we have observed significant attenuation of cognitive impairment by RNase in aged mice after unilateral nephrectomy. Damping the systemic initiators at early stages may help to prevent the chain reaction that triggers the central inflammatory or apoptotic response. Therefore, we propose the hypothesis that exRNAs released upon stress, through acting on the peripheral and/or central receptors, may trigger a damaging cascade leading to the development of POCD. Undoubtedly, further study is urgently needed to elucidated the exact signaling mechanisms and confirm the proposed hypothesis. PMID:27515198

  6. Postoperative Endophthalmitis Caused by Staphylococcus haemolyticus following Femtosecond Cataract Surgery.

    PubMed

    Wong, Margaret; Baumrind, Benjamin R; Frank, James H; Halpern, Robert L

    2015-01-01

    A 53-year-old Caucasian man underwent femtosecond cataract surgery and then presented with pain and hand motions vision 1 day following surgery. Anterior segment examination showed a 2-mm-layered hypopyon, a well-centered intraocular lens in the sulcus, and an obscured view to the fundus. B-scan ultrasonography showed significant vitritis and that the retina was attached. A tap and an injection of vancomycin 1 mg per 0.1 ml and of ceftazidime 2.25 mg per 0.1 ml were performed. The tap eventually yielded culture results positive for Staphylococcus haemolyticus, which was sensitive to vancomycin. We report a case of endophthalmitis that occurred on postoperative day 1 following complicated cataract surgery. This is an uncommon bacterium that is not widely reported in the literature as a cause of endophthalmitis in the postoperative period. We urge clinicians to consider S. haemolyticus as an offending agent, especially when the infection presents very early and aggressively in the postoperative period. PMID:26951642

  7. Treatment outcome of postoperative radiotherapy for retroperitoneal sarcoma

    PubMed Central

    Lee, Hyun Jin; Kwon, Tae-Won; Yook, Jeong Hwan; Kim, Song-Cheol; Han, Duck-Jong; Kim, Choung-Soo; Ahn, Hanjong; Chang, Heung Moon; Ahn, Jin-Hee; Jwa, Eun Jin; Lee, Sang-Wook; Kim, Jong Hoon; Choi, Eun Kyung; Shin, Seong Soo; Ahn, Seung Do

    2011-01-01

    Purpose To evaluate the treatment outcome and prognostic factor after postoperative radiotherapy in retroperitoneal sarcoma. Materials and Methods Forty patients were treated with surgical resection and postoperative radiotherapy for retroperitoneal sarcoma from August 1990 to August 2008. Treatment volume was judged by the location of initial tumor and surgical field, and 45-50 Gy of radiation was basically delivered and additional dose was considered to the high-risk area. Results The median follow-up period was 41.4 months (range, 3.9 to 140.6 months). The 5-year overall survival (OS) was 51.8% and disease free survival was 31.5%. The 5-year locoregional recurrence free survival was 61.9% and distant metastasis free survival was 50.6%. In univariate analysis, histologic type (p = 0.006) was the strongest prognostic factor for the OS and histologic grade (p = 0.044) or resection margin (p = 0.032) had also effect on the OS. Histologic type (p = 0.004) was unique significant prognostic factor for the actuarial local control. Conclusion Retroperitoneal sarcoma still remains as a poor prognostic disease despite the combined modality treatment including surgery and postoperative radiotherapy. Selective dose-escalation of radiotherapy or combination of effective chemotherapeutic agent must be considered to improve the treatment result especially for the histopathologic type showing poor prognosis. PMID:22984679

  8. Postoperative Endophthalmitis Caused by Staphylococcus haemolyticus following Femtosecond Cataract Surgery

    PubMed Central

    Wong, Margaret; Baumrind, Benjamin R.; Frank, James H.; Halpern, Robert L.

    2015-01-01

    A 53-year-old Caucasian man underwent femtosecond cataract surgery and then presented with pain and hand motions vision 1 day following surgery. Anterior segment examination showed a 2-mm-layered hypopyon, a well-centered intraocular lens in the sulcus, and an obscured view to the fundus. B-scan ultrasonography showed significant vitritis and that the retina was attached. A tap and an injection of vancomycin 1 mg per 0.1 ml and of ceftazidime 2.25 mg per 0.1 ml were performed. The tap eventually yielded culture results positive for Staphylococcus haemolyticus, which was sensitive to vancomycin. We report a case of endophthalmitis that occurred on postoperative day 1 following complicated cataract surgery. This is an uncommon bacterium that is not widely reported in the literature as a cause of endophthalmitis in the postoperative period. We urge clinicians to consider S. haemolyticus as an offending agent, especially when the infection presents very early and aggressively in the postoperative period. PMID:26951642

  9. Alternative Therapies for the Prevention of Postoperative Nausea and Vomiting.

    PubMed

    Stoicea, Nicoleta; Gan, Tong J; Joseph, Nicholas; Uribe, Alberto; Pandya, Jyoti; Dalal, Rohan; Bergese, Sergio D

    2015-01-01

    Postoperative nausea and vomiting (PONV) is a complication affecting between 20 and 40% of all surgery patients, with high-risk patients experiencing rates of up to 80%. Recent studies and publications have shed light on the uses of alternative treatment for PONV through their modulation of endogenous opioid neuropeptides and neurokinin ligands. In addition to reducing PONV, hypnosis was reported to be useful in attenuating postoperative pain and anxiety, and contributing to hemodynamic stability. Music therapy has been utilized to deepen the sedation level and decrease patient anxiety, antiemetic and analgesic requirements, hospital length of stay, and fatigue. Isopropyl alcohol and peppermint oil aromatherapy have both been used to reduce postoperative nausea. With correct training in traditional Chinese healing techniques, acupuncture (APu) at the P6 acupoint has also been shown to be useful in preventing early PONV, postdischarge nausea and vomiting, and alleviating of pain. Electro-acupuncture (EAPu), as with APu, provided analgesic and antiemetic effects through release and modulation of opioid neuropeptides. These non-pharmacological modalities of treatment contribute to an overall patient wellbeing, assisting in physical and emotional healing. PMID:26734609

  10. Alternative Therapies for the Prevention of Postoperative Nausea and Vomiting

    PubMed Central

    Stoicea, Nicoleta; Gan, Tong J.; Joseph, Nicholas; Uribe, Alberto; Pandya, Jyoti; Dalal, Rohan; Bergese, Sergio D.

    2015-01-01

    Postoperative nausea and vomiting (PONV) is a complication affecting between 20 and 40% of all surgery patients, with high-risk patients experiencing rates of up to 80%. Recent studies and publications have shed light on the uses of alternative treatment for PONV through their modulation of endogenous opioid neuropeptides and neurokinin ligands. In addition to reducing PONV, hypnosis was reported to be useful in attenuating postoperative pain and anxiety, and contributing to hemodynamic stability. Music therapy has been utilized to deepen the sedation level and decrease patient anxiety, antiemetic and analgesic requirements, hospital length of stay, and fatigue. Isopropyl alcohol and peppermint oil aromatherapy have both been used to reduce postoperative nausea. With correct training in traditional Chinese healing techniques, acupuncture (APu) at the P6 acupoint has also been shown to be useful in preventing early PONV, postdischarge nausea and vomiting, and alleviating of pain. Electro-acupuncture (EAPu), as with APu, provided analgesic and antiemetic effects through release and modulation of opioid neuropeptides. These non-pharmacological modalities of treatment contribute to an overall patient wellbeing, assisting in physical and emotional healing. PMID:26734609

  11. Postoperative complications and mortality after surgery for gastric cancer.

    PubMed Central

    Viste, A; Haùgstvedt, T; Eide, G E; Søreide, O

    1988-01-01

    Complication rates and postoperative mortality were studied in 1010 consecutive patients entered into the Norwegian Stomach Cancer Trial. Twenty-eight per cent of the patients had one or more complications (31% of the men and 21% of the women). General complications (pneumonia, thromboembolic, and cardiac) were most frequent. The postoperative mortality rate for resected patients was 8.3% (63 of 763). Complication and mortality rates were highest for proximal resections (52% and 16%) followed by total gastrectomy (38% and 8%), subtotal resection (28% and 10%), and distal resection (19% and 7%). By logistic regression analysis it was found that age, sex, operative procedure, prophylactic antibiotics, and splenectomy were significantly related to postoperative complications. The odds ratio for complication for men versus women was 1.75: for no antibiotics versus antibiotic prophylaxis it was 2.5. Relative to distal resection the odds ratio for complications after subtotal resection was 2.2, for total gastrectomy was 3.9, and for proximal resection was 7.6. Age and sex were the only factors that affected operative mortality. The odds ratio for mortality for men versus women was 2.3. The odds ratio for operative mortality was 2.2 when the age of the patient increased with 10 years. PMID:3337564

  12. Efficacy of Postoperative Prophylactic Antibiotic Therapy in Third Molar Surgery

    PubMed Central

    Reddy B, Praveen

    2014-01-01

    Introduction: Surgical extraction of mandibular third molar is the most frequently performed procedure in oral surgery. This procedure is associated with significant postoperative sequelae such as trismus, swelling, pain and infection. The need of antibiotic therapy during the removal of mandibular third molar has been a contentious issue. Method: This study investigated a regimen by using amoxycillin and metronidazole in one group and without using antibiotics in the other. Both the groups were assessed postoperatively on the 1st, 2nd, 5th, 7th and 10th days by the same observer for post operative mouth opening (interincisal distance), presence of a purulent discharge at the site of surgery, pain and swelling. Result: Overall, no statistically significant difference was seen between both the treatment groups when interincisal distance, pain, swelling and purulent discharge were considered. Conclusion: The results of this study failed to show any advantage which was associated with the routine postoperative use of antibiotics in asymptomatic third molar surgeries. PMID:24995236

  13. Cutting-Balloon Angioplasty in Transplant Renal Artery Stenosis as First-Line Treatment in the Early Postoperative Period

    SciTech Connect

    Ucar, Adem; Yahyayev, Aghakishi; Bakkaloglu, Huseyin; Agayev, Ayaz; Aydin, Ali Emin; Rozanes, Izzet

    2011-02-15

    Percutaneous transluminal angioplasty has been successfully used for the treatment of transplant renal artery stenosis (RAS). Cutting-balloon angioplasty (CBA) is being used as a second option in pressure-resistant stenosis. It is thought that CBA is less traumatic and therefore restenosis occurs less frequently than in conventional angioplasty. This case report describes the unusual use of a cutting balloon in transplant RAS as a first option in the early postoperative period. Long-term follow-up data are also presented.

  14. Outcomes of myringoplasty in Australian Aboriginal children and factors associated with success: a prospective case series.

    PubMed

    Mak, D; MacKendrick, A; Bulsara, M; Coates, H; Lannigan, F; Lehmann, D; Leidwinger, L; Weeks, S

    2004-12-01

    The objective of this study was to assess the outcomes of myringoplasties in Aboriginal children and to identify factors associated with a successful outcome with the use of prospective case series from primary health care clinics and hospitals in four rural and remote regions of Western Australia. All 58 Aboriginal children, aged 5-15 years, who underwent 78 myringoplasties between 1 January 2000 and 30 June 2001 were included in the study. Complete postoperative (post-op) follow-up was achieved following 78% of myringoplasties. The main outcome measures were (a) success, i.e. an intact tympanic membrane and normal hearing six or more months post-op in the operated ear, (b) closure of the perforation, (c) Post-op hearing improvement. Forty-nine per cent of myringoplasties were successful, 72% resulted in closure or reduction in the size of the perforation and 51% resulted in hearing improvement. After controlling for age, sex, clustering and number of previous myringoplasties, no association was observed between success or hearing improvement and perforation size, or the presence of serous aural discharge at the time of surgery. Myringoplasty resulted in hearing improvement and/or perforation closure in a significant proportion of children. Thus, primary school-aged Aboriginal children in whom conservative management of chronic suppurative otitis media has been unsuccessful should have access to myringoplasty because of the positive impact on their socialization, language and learning that results from improved hearing. PMID:15533146

  15. Successful salvage surgery for failed transforaminal lumbosacral interbody fusion using the anterior transperitoneal approach.

    PubMed

    Hozumi, Takashi; Orita, Sumihisa; Inage, Kazuhide; Fujimoto, Kazuki; Sato, Jun; Shiga, Yasuhiro; Kanamoto, Hirohito; Abe, Koki; Yamauchi, Kazuyo; Aoki, Yasuchika; Nakamura, Junichi; Matsuura, Yusuke; Suzuki, Takane; Takahashi, Kazuhisa; Ohtori, Seiji; Sainoh, Takeshi

    2016-05-01

    Transforaminal lumbar interbody fusion (TLIF) is a popular posterior spinal fusion technique, but sometimes require salvage surgery when implant failure occurs, which involves possible neural damage due to postoperative adhesion. The current report deals with successful anterior transperitoneal salvage surgery for failed L5-S TLIF with less neural invasiveness. PMID:27190611

  16. Predicting postoperative visual outcomes in cataract patients with maculopathy

    PubMed Central

    Macky, Tamer A; Mohamed, Abdel Moniem Hasaballah; Emarah, Ahmed M; Osman, Amr Abdellatif; Gado, Ahmed S

    2015-01-01

    Purpose: To assess the accuracy of the potential acuity meter (PAM) in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies. Study Design: Prospective interventional clinical trial. Patients and Methods: Patients scheduled for phacoemulsification had preoperative and 1 month postoperative best-corrected visual acuity (BCVA), PAM test, fluorescein angiography, and macular optical coherence tomography. Patients were grouped to following preoperative BCVA: PRE1: 0.29 and better, PRE2: 0.25–0.13, and PRE3: 0.1 or worse; age: G1 <60, G2 = 60–70, and G3 >70 years. PAM accuracy was divided into: Grade 1: Postoperative BCVA ≤1 or less line error of the PAM score, Grade 2: Between 1 and 2 lines error, and Grade 3: ≥3 lines or more error. Results: This study enrolled 57 patients with a mean age of 71.05 ± 6.78 years where 34 were females. There were 21 (36.84%) patients with diabetic maculopathy and 36 (63.16%) with age-related macular degeneration. The mean preoperative BCVA was 0.198 ± 0.12 (0.1–0.5). The mean PAM score was 0.442 ± 0.24 (0.1–1.3). The mean postoperative BCVA was 0.4352 ± 0.19 (0.17–1.00). The PAM score was in Grade 1, 2, and 3 in 46 (80.7%), 54 (94.7%), and 56 (98.2), respectively. There was a highly significant correlation between the PAM score and the postoperative BCVA (P < 0.001, Chi-square test). There was no correlation between the PAM test accuracy and age, gender, diagnosis, and preoperative BCVA (P = 0.661, 0.667, 0. 0.991, 0.833, Chi-square test; respectively). Conclusion: The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies. PMID:26655002

  17. Single dose oral piroxicam for acute postoperative pain

    PubMed Central

    Moore, R Andrew; Edwards, Jayne; Loke, Yoon; Derry, Sheena; McQuay, Henry J

    2014-01-01

    Background This is an updated version of the original Cochrane review published in Issue 2, 2000. Piroxicam is a non-steroidal anti-inflammatory drug (NSAID) with analgesic properties, and is used mainly for treating rheumatic disorders. Some drugs have been directly compared against each other within a trial setting to determine their relative efficacies, whereas other have not. It is possible, however, to compare analgesics indirectly by examining the effectiveness of each drug against placebo when used in similar clinical situations. Objectives To determine the analgesic efficacy and adverse effects of single-dose piroxicam compared with placebo in moderate to severe postoperative pain. To compare the effects of piroxicam with other analgesics. Search methods Published studies were identified from systematic searching of MEDLINE, Biological Abstracts, EMBASE, CENTRAL and the Oxford Pain Relief Database in December 2007. Additional studies were identified from the reference lists of retrieved reports. Selection criteria The following inclusion criteria were used: full journal publication, randomised placebo controlled trial, double-blind design, adult participants, postoperative pain of moderate to severe intensity at the baseline assessment, postoperative administration of oral or intramuscular piroxicam. Data collection and analysis Summed pain intensity and pain relief data were extracted and converted into dichotomous information to yield the number of participants obtaining at least 50% pain relief. This was used to calculate estimates of relative benefit and number-needed-to-treat-to-benefit (NNT) for one participant to obtain at least 50% pain relief. Information was collected on adverse effects and estimates of relative risk and number-needed-to-treat-to-harm (NNH) were calculated. Main results In this update no further studies were found. The original search identified three studies (141 participants) which compared oral piroxicam 20 mg with placebo and

  18. Early detection of postoperative residual tumor using image subtraction

    NASA Astrophysics Data System (ADS)

    Narayan, Suresh B.; Dhawan, Atam P.; Taha, Jamal M.; Gaskill-Shipley, Mary; Lamba, Michael; Sarwal, Alok; Chitre, Yateen S.

    1995-05-01

    The detection after surgery of residual tumor from magnetic resonance (MR) images is difficult due to the low contrast level of the images. Gadolinium-enhanced MR imaging has been found valuable in detecting residual enhancing tumor when performed within 72 hours after surgery. The patient is scanned by the MR scanner with and without infusion of gadolinium, a contrast agent. Usually, the estimation of post-operative tumor volume is done by visual comparison of the T1 MR images obtained with and without gadolinium infusion. The T1 MR images, in most cases, without contrast demonstrates areas of hyper intensities (high brightness levels), consistent with hemorrhage. These hyper intense areas often make it difficult to detect residual tumor in post contrast images. This is due to the presence of both acute hemorrhage and gadolinium enhancement which have high brightness levels in T1 MR images. Even in MR images taken within 72 hours after surgery, detection of tumor enhancement in areas of increased T1 signal produced by blood products or by postoperative changes can be difficult when performed by the naked eye. Due to these problems, the quantification of residual tumor becomes a subjective issue among neuro-radiologists. Thus to reduce errors produced by the human factor, an automated procedure to detect residual tumor is required. We have developed a technique to differentiate tumor enhancement from postoperative changes and blood products on MR imaging. The technique involves fusion of pre- and post-gadolinium MR images performed in the immediate postoperative period. Computerized slice based substraction is then done on the corresponding fused images of the two sets. The subtraction process results in a composite slice, which is examined for differences between pre- and post-gadolinium studies. The presented technique was tested on 14 cases in which MR images were obtained from brain tumor patients within 72 hours after surgery. The subtraction technique easily

  19. Combined parecoxib and I.V. paracetamol provides additional analgesic effect with better postoperative satisfaction in patients undergoing anterior cruciate ligament reconstruction

    PubMed Central

    Elseify, Zeinab Ahmed; El-Khattab, Salwa Omar; Khattab, Ahmed Metwally; Atta, Eman Mohammed; Ajjoub, Layal Fares

    2011-01-01

    Background: Adequacy of postoperative analgesia is one of the most important factors that determine early hospital discharge and patients’ ability to resume their normal activities postoperatively. The optimal non-opioid analgesic technique for postoperative pain management would reduce pain and enhance patient satisfaction, and it also facilitates earlier mobilization and rehabilitation by reducing pain-related complications after surgery. The aim of this study was to evaluate the analgesic efficacy of intravenous paracetamol and parecoxib when used alone, or in combination. Methods: Sixty American Society of Anesthesiology (ASA) physical status I and II adult patients who were scheduled for anterior cruciate ligament reconstruction were included in this study. Patients were allocated into three groups: group I patients received 1g intravenous paracetamol after induction and another 1 g 4 h later, group II received 40 mg parecoxib after induction, while group III received combination of both drugs (paracetamol 1 g and parecoxib 40 mg). Pain during rest and mobility was assessed in the immediate postoperative period, 2 h and 8 h successively using visual analog scale (VAS). Patient satisfaction was rated according to satisfaction score. Results: Total morphine requirements were lower in group III patients (6.9±2.7 mg) in comparison to group I patients (12.6±3.6 mg) or group II patients (9.8±2.8 mg). The least VAS scores were recorded during knee movement (3.8±1.1) in group III patients compared to group I (6.0±1.8) and group II patients (4.8±1.9). Eight hours postoperatively, group III patients were more satisfied regarding the postoperative pain management. Conclusion: Combination of intravenous paracetamol and parecoxib provided better analgesia and higher patient satisfaction than each drug when used separately. PMID:21655016

  20. Goodbye Career, Hello Success.

    ERIC Educational Resources Information Center

    Komisar, Randy

    2000-01-01

    Success in today's economy means throwing out the old career rules. The "noncareer" career is driven by passion for the work and has the fluidity and flexibility needed in the contemporary workplace. (JOW)

  1. Strategies for Success.

    ERIC Educational Resources Information Center

    Harris, J. Jerome

    1990-01-01

    Rather than use their energies to explain their failures, Blacks need to develop strategies for success. Uses examples from the Atlanta Public Schools to illustrate how Blacks can use effective schools research to improve urban, Black education. (FMW)

  2. Post-operative imaging in deep brain stimulation: A controversial issue.

    PubMed

    Saleh, Christian; Dooms, Georges; Berthold, Christophe; Hertel, Frank

    2016-08-01

    In deep brain stimulation (DBS), post-operative imaging has been used on the one hand to assess complications, such as haemorrhage; and on the other hand, to detect misplaced contacts. The post-operative determination of the accurate location of the final electrode plays a critical role in evaluating the precise area of effective stimulation and for predicting the potential clinical outcome; however, safety remains a priority in postoperative DBS imaging. A plethora of diverse post-operative imaging methods have been applied at different centres. There is neither a consensus on the most efficient post-operative imaging methodology, nor is there any standardisation for the automatic or manual analysis of the images within the different imaging modalities. In this article, we give an overview of currently applied post-operative imaging modalities and discuss the current challenges in post-operative imaging in DBS. PMID:27029393

  3. Forest succession models

    SciTech Connect

    Shugart, H.H. Jr.; West, D.C.

    1980-05-01

    Studies in succession attempt to determine the changes in species composition and other ecosystem attributes expected to occur over periods of time. Mathematical models developed in forestry and ecology to study ecological succession are reviewed. Tree models, gap models and forest models are discussed. Model validation or testing procedures are described. Model applications can involve evaluating large-scale and long-term changes in the ambient levels of pollutants and assessing the effects of climate change on the environment. (RJC)

  4. Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage

    PubMed Central

    Yin, Guowen; Chen, Shixi; Bai, Xiangjun; Jiang, Feng; Zhang, Qin; Xu, Lin; Xu, Weidong

    2012-01-01

    Objective To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). Materials and Methods From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. Results The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 ± 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). Conclusion Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary

  5. Continuous Right Thoracic Paravertebral Block Following Bolus Initiation Reduced Postoperative Pain After Right-Lobe Hepatectomy

    PubMed Central

    Chen, Hexiang; Liao, Zhipin; Fang, Yan; Niu, Ben; Chen, Amber; Cao, Fei; Mei, Wei; Tian, Yuke

    2014-01-01

    Background and Objectives We hypothesized that continuous right thoracic paravertebral block, following bolus initiation, decreases opioid consumption after right-lobe hepatectomy in patients receiving patient-controlled intravenous analgesia with sufentanil. Methods Patients undergoing right-lobe hepatectomy with a right thoracic paravertebral catheter placed at T7 30 minutes before surgery were randomly assigned to receive through this catheter either a 10-mL bolus of 0.2% ropivacaine before emergence, followed by a continuous infusion of 6 mL/h for 24 hours (PVB group), or saline at the same scheme of administration (control group). All patients were started on patient-controlled intravenous analgesia with sufentanil in the postanesthesia care unit. The primary outcome measure was total sufentanil consumption during the first 24 postoperative hours. P = 0.05 was considered as significant. For the multiple comparisons of data at 5 different time points, the P value for the 0.05 level of significance was adjusted to 0.01. Results Sixty-six patients were assessed for eligibility, and a PVB catheter was successfully placed for 48 patients. Data were analyzed on 22 patients in group PVB and 22 patients in the control group. The cumulative sufentanil consumption in the PVB group (54.3 ± 12.1 μg) at 24 postoperative hours was more than 20% less than that of the control group (68.1 ± 9.9 μg) (P < 0.001). There was also a significant difference in pain scores (numerical rating scale) between groups, where the PVB group had lower scores than did the control group at rest and with coughing for the first 24 hours (P < 0.001). Conclusions Continuous right thoracic paravertebral block, following bolus initiation, has an opioid-sparing effect on sufentanil patient-controlled intravenous analgesia for right-lobe hepatectomy patients and reduces numerical rating scale pain scores at rest and with coughing in the first 24 postoperative hours. PMID:25304475

  6. Hepatic resection is associated with reduced postoperative opioid requirement

    PubMed Central

    Moss, Caitlyn Rose; Caldwell, Julia Christine; Afilaka, Babatunde; Iskandarani, Khaled; Chinchilli, Vernon Michael; McQuillan, Patrick; Cooper, Amanda Beth; Gusani, Niraj; Bezinover, Dmitri

    2016-01-01

    Background and Aims: Postoperative pain can significantly affect surgical outcomes. As opioid metabolism is liver-dependent, any reduction in hepatic volume can lead to increased opioid concentrations in the blood. The hypothesis of this retrospective study was that patients undergoing open hepatic resection would require less opioid for pain management than those undergoing open pancreaticoduodenectomy. Material and Methods: Data from 79 adult patients who underwent open liver resection and eighty patients who underwent open pancreaticoduodenectomy at our medical center between January 01, 2010 and June 30, 2013 were analyzed. All patients received both general and neuraxial anesthesia. Postoperatively, patients were managed with a combination of epidural and patient-controlled analgesia. Pain scores and amount of opioids administered (morphine equivalents) were compared. A multivariate lineal regression was performed to determine predictors of opioid requirement. Results: No significant differences in pain scores were found at any time point between groups. Significantly more opioid was administered to patients having pancreaticoduodenectomy than those having a hepatic resection at time points: Intraoperative (P = 0.006), first 48 h postoperatively (P = 0.001), and the entire length of stay (LOS) (P = 0.002). Statistical significance was confirmed after controlling for age, sex, body mass index, and American Society of Anesthesiologists physical status classification (adjusted P = 0.006). Total hospital LOS was significantly longer after pancreaticoduodenectomy (P = 0.03). A multivariate lineal regression demonstrated a lower opioid consumption in the hepatic resection group (P = 0.03), but there was no difference in opioid use based on the type of hepatic resection. Conclusion: Patients undergoing open hepatic resection had a significantly lower opioid requirement in comparison with patients undergoing open pancreaticoduodenectomy. A multicenter prospective

  7. Postoperative wound infections after a proctectomy—Patient experiences

    PubMed Central

    Andersson, Kristin; Koinberg, Inga-Lill; Wennström, Berith

    2016-01-01

    Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61–87 years, median age 71 years) were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: “Managing postoperative complications,” “Being independent,” “Feeling safe,” and “Accepting the situation.” A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients’ lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery. PMID:26900139

  8. Postoperative hypofunctioning of the thyroid gland after total laryngectomy.

    PubMed

    Dutta, Sirshak; Biswas, Kaustuv Das; Ghatak, Soumya; Haldar, Dibakar; Sen, Indranil; Sinha, Ramanuj

    2016-08-01

    Primary laryngeal carcinoma is a common cancer, predominantly affecting males. Hypothyroidism is an undesirable sequela of both surgery and radiotherapy, the two most commonly used modalities of treatment. For advanced cases, standard treatment protocol includes total laryngectomy and neck dissection along with pre- or postoperative radiotherapy. Hemithyroidectomy is also routinely performed as an integral part of total laryngectomy. In the present study, assessment of the function of the remaining half of the thyroid gland has been done in cases of total laryngectomies in combination with uni- or bilateral neck dissection and pre- or postoperative radiotherapy. This prospective, observational study was carried out for a period of 5 years in the Otolaryngology Department of R.G. Kar Medical College and Hospital, Kolkata, India, involving a dynamic cohort of patients with advanced laryngeal carcinoma (stage T3 or T4a) who underwent total laryngectomy (including hemithyroidectomy) and bilateral or unilateral neck dissection for primary laryngeal cancer along with preoperative and postoperative radiotherapy. Assessment of the thyroid function was based on the measurement of serum thyroid-stimulating hormone and free thyroxine levels. The results revealed that 23.8%, 45.2%, and 73.8% patients developed either clinical or subclinical hypothyroid state at 6, 12, and 24 weeks, respectively, after the surgery. The estimation of relative risk (RR) was found to be most prominent among the group belonging to the "preoperative radiation with bilateral neck dissection" group at all levels of assessments, but all of the RRs were found to be insignificant per their 95% confidence intervals. Superiority of any method could not be established or refuted firmly due to the small sample size of the study. We presume that in the future, a study with a larger sample size, involving a meta-analysis of multicentric data, would be the most suitable method to throw some light on this issue

  9. Etiology of postoperative hyponatremia following pediatric intracranial tumor surgery.

    PubMed

    Williams, Cydni N; Riva-Cambrin, Jay; Bratton, Susan L

    2016-03-01

    OBJECT Cerebral salt wasting (CSW) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) cause postoperative hyponatremia in neurosurgery patients, can be difficult to distinguish clinically, and are associated with increased morbidity. The authors aimed to determine risk factors associated with CSW and SIADH among children undergoing surgery for intracranial tumors. METHODS This retrospective cohort study included children 0-19 years of age who underwent a first intracranial tumor surgery with postoperative hyponatremia (sodium ≤ 130 mEq/L). CSW was differentiated from SIADH by urine output and fluid balance, exclusive of other causes of hyponatremia. The CSW and SIADH groups were compared with basic bivariate analysis and recursive partitioning. RESULTS Of 39 hyponatremic patients, 17 (44%) had CSW and 10 (26%) had SIADH. Patients with CSW had significantly greater natriuresis compared with those with SIADH (median urine sodium 211 vs 28 mEq/L, p = 0.01). Age ≤ 7 years and female sex were significant risk factors for CSW (p = 0.03 and 0.04, respectively). Both patient groups had hyponatremia onset within the first postoperative week. Children with CSW had trends toward increased sodium variability and symptomatic hyponatremia compared with those with SIADH. Most received treatment, but inappropriate treatment was noted to worsen hyponatremia. CONCLUSIONS The authors found that CSW was more common following intracranial tumor surgery and was associated with younger age and female sex. Careful assessment of fluid balance and urine output can separate patients with CSW from those who have SIADH, and high urine sodium concentrations (> 100 mEq/L) support a CSW diagnosis. Patients with CSW and SIADH had similar clinical courses, but responded to different interventions, making appropriate diagnosis and treatment imperative to prevent morbidity. PMID:26613271

  10. Nurses' strategies for managing pain in the postoperative setting.

    PubMed

    Manias, Elizabeth; Bucknall, Tracey; Botti, Mari

    2005-03-01

    Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Nurses continue to rely on pharmacologic measures and tend to under-administer analgesics. The purpose of this study was to determine the strategies nurses used to manage patients' pain in the postoperative setting. It also sought to examine the effect of context, including organization of care, nurses' prioritization of work activities, and pressures during a working shift, on their pain-management strategies. An observational design was used in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were identified as key periods for pain activities, each comprising a 2-hour duration. An observation period was examined at least 12 times, resulting in the completion of 74 observations and the identification of 316 pain cases. Fifty-two nurses were observed during their normal day's work with postoperative patients. Six themes were identified: managing pain effectively; prioritizing pain experiences for pain management; missing pain cues for pain management; regulators and enforcers of pain management; preventing pain; and reactive management of pain. The findings highlighted the critical nature of communication between clinicians and patients and among clinicians. It also demonstrated the influence of time on management strategies and the relative importance that nurses place on nonpharmacologic measures in actual practice. This research, which portrays what happens in actual clinical practice, has facilitated the identification of new data that were not evident from other research studies. PMID:15917741

  11. Neurokinin-1 Receptor Antagonists in Preventing Postoperative Nausea and Vomiting

    PubMed Central

    Liu, Meng; Zhang, Hao; Du, Bo-Xiang; Xu, Feng-Ying; Zou, Zui; Sui, Bo; Shi, Xue-Yin

    2015-01-01

    Abstract Newly developed neurokinin-1 receptor (NK-1R) antagonists have been recently tried in the prevention of postoperative nausea and vomiting (PONV). This systematic review and meta-analysis was conducted to explore whether NK-1R antagonists were effective in preventing PONV. The PRISMA statement guidelines were followed. Randomized clinical trials (RCTs) that tested the preventive effects of NK-1R antagonists on PONV were identified by searching EMBASE, CINAHL, PubMed, and the Cochrane Library databases followed by screening. Data extraction was performed using a predefined form and trial quality was assessed using a modified Jadad scale. The primary outcome measure was the incidence of PONV. Meta-analysis was performed for studies using similar interventions. Network meta-analysis (NMA) was conducted to compare the anti-vomiting effects of placebo, ondansetron, and aprepitant at different doses. Fourteen RCTs were included. Meta-analysis found that 80 mg of aprepitant could reduce the incidences of nausea (3 RCTs with 224 patients, pooled risk ratio (RR) = 0.60, 95% confidence interval (CI) = 0.47 to 0.75), and vomiting (3 RCTs with 224 patients, pooled RR = 0.13, 95% CI = 0.04 to 0.37) compared with placebo. Neither 40 mg (3 RCTs with 1171 patients, RR = 0.47, 95% CI = 0.37 to 0.60) nor 125 mg (2 RCTs with 1058 patients, RR = 0.32, 95% CI = 0.13 to 0.78) of aprepitant showed superiority over 4 mg of ondansetron in preventing postoperative vomiting. NMA did not find a dose-dependent effect of aprepitant on preventing postoperative vomiting. Limited data suggested that NK-1R antagonists, especially aprepitant were effective in preventing PONV compared with placebo. More large-sampled high-quality RCTs are needed. PMID:25984662

  12. 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

  13. The effects of Western music on postoperative pain in Taiwan.

    PubMed

    Good, M; Chin, C C

    1998-02-01

    Music is a method nurses can use to help relieve pain, however little is known about its effectiveness across cultures. In this study, Western music was tested for its effectiveness in reducing postoperative pain in 38 Taiwanese patients, and its acceptability was explored. A pretest and post-test experimental design was used with visual analogue scales to measure sensation and distress of pain. Before surgery, subjects were randomly assigned to receive tape recorded music or the usual care. Those who were assigned to the music group chose among 5 types of sedative music. On postoperative Day 1 and Day 2, the effectiveness of the tape-recorded music was investigated during 15 minutes of rest in bed. Patients were interviewed on Day 3 to determine their liking for the music, its calming effects, and the helpfulness of the music. Repeated measures analysis of variance showed a significant interaction between time and group in the distress of pain on Day 1, but not on Day 2, and in pain sensation on Day 2, but not Day 1. Subjects from Taiwan were similar to subjects in a previous study in the United States in their liking for the music, and in reports of the helpfulness of the music for pain sensation and distress, but fewer Taiwanese found the music calming, and they had different choices: more chose harp music and fewer chose jazz than subjects in the U.S. study, and some would prefer Buddhist hymns or popular songs heard in Taiwan. Findings support the use of culturally acceptable music in addition to analgesic medication for the sensation and distress of postoperative pain. PMID:9542366

  14. Postoperative wound infections after a proctectomy--Patient experiences.

    PubMed

    Hassel, Karin; Andersson, Kristin; Koinberg, Inga-Lill; Wennström, Berith

    2016-01-01

    Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61-87 years, median age 71 years) were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: "Managing postoperative complications," "Being independent," "Feeling safe," and "Accepting the situation." A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients' lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery. PMID:26900139

  15. The effect of abdominal fat parameters on percutaneous nephrolithotomy success

    PubMed Central

    Cakmak, Ozgur; Tarhan, Huseyin; Cimen, Sertac; Ekin, Rahmi Gokhan; Akarken, Ilker; Oztekin, Ozgur; Can, Ertan; Suelozgen, Tufan; Ilbey, Yusuf Ozlem

    2016-01-01

    Introduction: Obesity has been suggested to lower the success of percutaneous nephrolithotomy (PCNL). However, the relationship between abdominal fat parameters, such as visceral and subcutaneous abdominal adipose tissue, and PCNL success remained unclear. In this study, we aimed to investigate the effect of abdominal fat parameters on PCNL success. Methods: A total of 150 patients who underwent PCNL were retrospectively enrolled in this study. Group 1 consisted of patients who had no residual stones or residual stone fragments <3 mm in diameter while group 2 included patients with residual stone fragments ≥3 mm. PCNL procedure was defined as successful if all stones were eliminated or if there were residual stone fragments <3 mm in diameter confirmed by non-contrast computed tomography (NCCT) performed postoperatively. Preoperative NCCT was used to determine abdominal fat parameters. Results: Group 1 consisted of 117 (78.0%) patients while group 2 included 33 (22.0%) patients. On univariate analysis, stone number, stone surface area (SSA), visceral fat area (VFA), abdominal circumference on computerized tomography (ACCT), and duration of procedure were found to be predictive factors affecting PCNL success. Logistic regression analysis revealed that ACCT and SSA were independent prognostic factors for PCNL success. Conclusions: PCNL success was not affected by VFA, subcutaneous fat area (SFA) and body mass index (BMI) in our series. However, ACCT and SSA had negative associations with PCNL success. We conclude that both ACCT and SSA can be used as tools for predicting PCNL outcomes. PMID:27330587

  16. Management of Postoperative Lymphoceles After Lymphadenectomy: Percutaneous Catheter Drainage With and Without Povidone-Iodine Sclerotherapy

    SciTech Connect

    Alago, William Deodhar, Ajita; Michell, Hans; Sofocleous, Constantinos T.; Covey, Anne M.; Solomon, Stephen B.; Getrajdman, George I.; Dalbagni, Guido; Brown, Karen T.

    2013-04-15

    To report our single-center experience in managing symptomatic lymphoceles after lymphadenectomy for genitourinary and gynecologic malignancy and to compare clinical outcomes of percutaneous catheter drainage (PCD) alone versus PCD with transcatheter povidone-iodine sclerotherapy (TPIS). The medical records of patients who presented for percutaneous drainage of pelvic lymphoceles from February 1999 to September 2007 were retrospectively reviewed. Catheters with prolonged outputs >50 cc/day were treated with TPIS. Technical success was defined as the ability to achieve complete resolution of the lymphocele. Clinical success was defined as resolution of the patient's symptoms that prompted the intervention. Sixty-four patients with 70 pelvic lymphoceles were treated. Forty-six patients (71.9 %) had PCD, and 18 patients (28.1 %) had multisession TPIS. The mean initial cavity size was 294.9 cc for those treated with TPIS and 228.2 cc for those treated with PCD alone (range 15-1,600) (p = 0.59). Mean duration of catheter drainage was 19 days (29 days with TPIS, 16 days with PCD, p = 0.001). Mean clinical follow-up was 22.6 months. Technical success was 74.3 % with PCD and 100 % with TPIS. Clinical success was 97 % with PCD and 100 % with TPIS. Postprocedural complications included pericatheter fluid leakage (n = 4), catheter dislodgement (n = 3), catheter occlusion (n = 9), and secondary infection of the collection (n = 4). PCD of symptomatic lymphoceles is an effective postoperative management technique. Initial cavity size is not an accurate predictor of the need for TPIS. When indicated, TPIS is safe and effective with catheter outputs >50 cc/day.

  17. Management strategies to reduce risk of postoperative infections

    PubMed Central

    Galor, Anat; Goldhardt, Raquel; Wellik, Sarah R.; Gregori, Ninel Z.; Flynn, Harry W.

    2013-01-01

    Postoperative infections, although rare, are still of great concern to the ophthalmologist. The incidence of post-cataract endophthalmitis is low, with a range of .28 per 1,000 to 2.99 per 1000. In addition to intraoperative considerations such as poor wound construction, vitreous loss, topical anesthesia, and prolonged surgical time, other risk factors include preoperative factors such as a diseased ocular surface and systemic immunosuppression. Potential methods of reducing risk of endophthalmitis after anterior segment surgery are discussed and available literature is summarized. PMID:24319649

  18. [Experimental studies of the prevention of postoperative adhesions].

    PubMed

    Schwarz, J; Donat, H

    1989-01-01

    Female wistar rats were used for the testing of different substances to prevent postoperative intraabdominal adhesions. It could be demonstrated that the best results were obtained by dextran 70 with a concentration of 10%. Good effects were seen also by contrykal (aprotinin) and hylase (hyaluronidase). By the combination of dextran 70 30% with contrykal the spread of adhesions was very low but the effect was not significant better than with dextran 70 10% alone. For the prevention of intraabdominal adhesions operative techniques with minimal lesions are important too of the peritoneal epithelium. PMID:2466384

  19. The effect of preoperative warming on patients' postoperative temperatures.

    PubMed

    Cooper, Shauna

    2006-05-01

    Many perioperative clinicians encounter difficulty in preventing hypothermia in surgical patients. One intervention to prevent perioperative hypothermia is the use of forced-air warming. Although forced-air warming is used most frequently in the intraoperative area, prewarming patients with forced-air warming systems before induction of anesthesia may be enough to prevent hypothermia throughout the surgical procedure, allowing patients to arrive in the postanesthesia care unit in a normothermic state. A review of the literature on preoperative forced-air warming is provided, and the effect of prewarming on postoperative patient temperatures is discussed. PMID:16722285

  20. Single dose oral ibuprofen for acute postoperative pain in adults

    PubMed Central

    Derry, Christopher J; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background This review updates a 1999 Cochrane review showing that ibuprofen at various doses was effective in postoperative pain in single dose studies designed to demonstrate analgesic efficacy. New studies have since been published. Ibuprofen is one of the most widely used non-steroidal anti-inflammatory (NSAID) analgesics both by prescription and as an over-the-counter medicine. Ibuprofen is used for acute and chronic painful conditions. Objectives To assess analgesic efficacy of ibuprofen in single oral doses for moderate and severe postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to May 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered ibuprofen (any formulation) in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk and number-needed-to-treat-to-benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. Main results Seventy-two studies compared ibuprofen and placebo (9186 participants). Studies were predominantly of high reporting quality, and the bulk of the information concerned ibuprofen 200 mg and 400 mg. For at least 50% pain relief compared with placebo the NNT for ibuprofen 200 mg (2690 participants) was 2.7 (2.5 to 3.0) and for ibuprofen 400 mg (6475 participants) it was 2.5 (2.4 to 2.6). The proportion with at least 50% pain relief was 46% with 200 mg and 54% with 400 mg. Remedication within 6 hours was less

  1. Hyperprolactinaemia: a cause of severe postoperative complication after reduction mammaplasty.

    PubMed

    Mestak, Ondrej; Mestak, Jan; Borsky, Jiri

    2014-12-01

    Galactorrhoea is a rare complication of wound healing after breast reduction and its association with necrosis of the areolar skin in women with no recent history of breast feeding has to our knowledge never been described. Galactorrhoea is common and there are many differential diagnoses. We report a case of a 46-year-old woman who had bilateral reductions of the breast and developed hyperprolactinaemia and galactorrhoea six weeks postoperatively. Subsequently she developed dry necrosis of both areolas. All radiographic and laboratory findings were within the reference ranges except for of prolactin. PMID:25399958

  2. Postoperative Complications: Looking Forward to a Safer Future.

    PubMed

    Tevis, Sarah E; Kennedy, Gregory D

    2016-09-01

    Colorectal surgery patients frequently suffer from postoperative complications. Patients with complications have been shown to be at higher risk for mortality, poor oncologic outcomes, additional complications, and worse quality of life. Complications are increasingly recognized as markers of quality of care with more use of risk-adjusted national surgical databases and increasing transparency in health care. Quality improvement work in colorectal surgery has identified methods to decrease complication rates and improve outcomes in this patient population. Future work will continue to identify best practices and standardized ways to measure quality of care. PMID:27582650

  3. Minimally Invasive Suturectomy and Postoperative Helmet Therapy : Advantages and Limitations

    PubMed Central

    Chong, Sangjoon; Wang, Kyu-Chang; Phi, Ji Hoon; Lee, Ji Yeoun

    2016-01-01

    Various operative techniques are available for the treatment of craniosynostosis. The patient's age at presentation is one of the most important factors in the determination of the surgical modality. Minimally invasive suturectomy and postoperative helmet therapy may be performed for relatively young infants, whose age is younger than 6 months. It relies upon the potential for rapid brain growth in this age group. Its minimal invasiveness is also advantageous. In this article, we review the advantages and limitations of minimally invasive suturectomy followed by helmet therapy for the treatment of craniosynostosis. PMID:27226853

  4. Pilonidal sinus surgery: could we predict postoperative complications?

    PubMed

    Milone, Marco; Di Minno, Matteo Nd; Bianco, Paolo; Coretti, Guido; Musella, Mario; Milone, Francesco

    2016-06-01

    Pilonidal sinus surgery could, as of now, be considered a surgery tailored more to the surgeon than to the patient. In an attempt to give to surgeons an objective instrument of decision, we have evaluated which variables could be considered predictive of postoperative complications after pilonidal sinus surgery. A prospective electronic database of all patients treated for sacrococcygeal pilonidal disease was analysed. Sex, age, obesity, smoking, recurrent disease, the presence of multiple orifices and the distance between the most lateral orifice and midline were recorded and correlated with the occurrence of postoperative complications (infection and recurrence); 1006 patients were evaluated. Excision with primary mid-line closure was performed on all the patients. Mean follow-up was 7·3 ± 3·6 years. A total of 158 patients with postoperative complications (infection and/or recurrence) were recorded during this period. A multivariate analysis showed that, after adjusting for major clinical and demographic characteristics, only a recurrent disease [odds ratio (OR): 3·41, 95% confidence interval (CI): 1·89-6·15, P < 0·001] and the distance of lateral orifice from midline (OR: 26·3, 95% CI: 12·2-56·7, P < 0·001) were independent predictors of overall postoperative complications. Focussing on the distance from midline, the receiver operative characteristic (ROC) analysis showed that the distance of lateral orifice from midline predicted 79·2% of complications and the Youden's test identified the best cut-off as 2·0 cm for this variable. An evidence-based tool for deciding on the type of surgical intervention could be developed and validated by further ad hoc prospective studies evaluating our results in comparison to other different types of surgical techniques. Our results support the use of these variables as an effective way to tailor pilonidal sinus surgery to the patient, so as to obtain the best results in patient care. PMID

  5. Ipsilateral Hemichorea-hemiballism in a Case of Postoperative Stroke

    PubMed Central

    Kannepalli, Narasinga Rao V. L.; Yadav, Ravi; Vazhayil, Vikas; Somanna, Sampath; Pal, Pramod Kumar

    2016-01-01

    Background Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on the same side of a brain lesion. Case report We describe a rare case of postoperative ipsilateral hemiballism in a patient who underwent pituitary adenoma resection and experienced a right internal cerebral artery territory infarct. We review the literature on hemichorea hemiballismus (HCHB) and explore various mechanisms for its occurrence. Discussion Only three cases of ipsilateral hemiballism have been described, and the exact pathophysiology remains unknown. A dominant left hemisphere with corpus callosal connections to the right basal ganglia is the most probable explanation for this unusual event. PMID:27127720

  6. Single dose oral diclofenac for acute postoperative pain in adults

    PubMed Central

    Derry, Philip; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

    2014-01-01

    Background Diclofenac is a non-steroidal anti-inflammatory drug (NSAID), available as a potassium salt (immediate-release) or sodium salt (delayed-release). This review updates an earlier review published in The Cochrane Database of Systematic Reviews (Issue 2, 2004) on ‘Single dose oral diclofenac for postoperative pain’. Objectives To assess single dose oral diclofenac for the treatment of acute postoperative pain. Search methods Cochrane CENTRAL, MEDLINE, EMBASE, Biological Abstracts, the Oxford Pain Relief Database, and reference lists of articles were searched; last search December 2008. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of single dose, oral diclofenac (sodium or potassium) for acute postoperative pain in adults. Data collection and analysis Two review authors independently assessed studies for inclusion and quality, and extracted data. The area under the pain relief versus time curve was used to derive the proportion of participants with at least 50% pain relief over 4 to 6 hours, using validated equations. Relative benefit (risk) and number needed to treat to benefit (NNT) were calculated. Information on adverse events, time to remedication, and participants needing additional analgesia was also collected. Main results Fifteen studies (eight additional studies) with 1512 participants more than doubled the information available at each dose. Overall 50% to 60% of participants experienced at least 50% pain relief over 4 to 6 hours at any dose with diclofenac, compared to 10 to 20% with placebo, giving NNTs of about 2.5 for doses of 25 mg to 100 mg (similar to earlier review); no dose response was demonstrated. At 50 mg and 100 mg, NNTs for diclofenac potassium (2.1 (1.8 to 2.4) and 1.9 (1.7 to 2.2)) were significantly lower (better) than for diclofenac sodium (6.7 (4.2 to 17) and 4.5 (3.2 to 7.7)). The median time to use of rescue medication was 2 hours for placebo, 4.3 hours for diclofenac 50 mg and 4.9 hours

  7. [Postoperative opacification of posterior chamber intraocular lenses - a review].

    PubMed

    Schmidbauer, J M; Werner, L; Apple, D J; Pandey, S K; Izak, A M; Trivedi, R H; Macky, T A; Auffarth, G U; Peng, Q; Arthur, S N; Escobar-Gomez, M; Ma, L; Vargas, L G

    2001-09-01

    Postoperative opacification of intraocular lenses (IOLs) is a very unpleasant complication for the ophthalmic surgeon and the patient. We report on our experiences with opacification of different foldable IOL designs and rigid poly (methyl methacrylate) (PMMA) posterior chamber lenses.1. Snowflake degeneration of PMMA IOLs: This condition is an unanticipated and surprising late postoperative finding 8 to 15 years after implantation. In our opinion, this complication is probably not related to the PMMA biomaterial itself, but rather it appears to represent a manufacturing problem that has affected a selected, albeit large number of lenses manufactured in the 1980s-mid 1990s.2. Degeneration of UV absorber material and calcium deposits within the optic of hydrophilic IOLs: Two years postoperatively degenerations of UV absorber material and calcium deposits within the optic of single piece hydrophilic acrylic lenses SC60B-OUV manufactured by MDR (Medical developmental research Inc. Clearwater FL, USA) can occur. Although the precise mechanism is not fully known, it was assumed that these opacifications are due to premature aging of the UV blocking agent incorporated in the lens biomaterial and calcification.3. Calcification on the surface of the Bausch & Lomb Hydroviewtrade mark IOLs: Twelve to 15 months postoperatively granular surface calcifications in Hydroviewtrade mark IOLs occured. The mechanism is not fully understood. According to Bausch and Lomb studies, part of the components of the packaging contained silicone, which may have come off the packaging onto the lens optic, where it then appears to be a catalyst for calcium precipitation. The manufacturer has correlated a change in packaging with the appearance of the opacification. The manufacturer now believes that this problem has been solved. However, final verification will require a careful 1 - 2 years clinical study.4. Glistenings in the hydrophobic acrylic AcrySoftrade mark IOLs: The time frame of

  8. Effect of magnesium sulfate nebulization on the incidence of postoperative sore throat

    PubMed Central

    Yadav, Monu; Chalumuru, Nitish; Gopinath, Ramachandran

    2016-01-01

    Background and Aims: Postoperative sore throat (POST) is a well-recognized complication after general anesthesia (GA). Numerous nonpharmacological and pharmacological measures have been used for attenuating POST with variable success. The present study was conducted to compare the efficiency of preoperative nebulization of normal saline and magnesium sulfate in reducing the incidence of POST following GA. Materials and Methods: Following institutional ethical committee approval and written informed consent, a prospective randomized double-blinded study was conducted in 100 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologist (ASA) status 1 or 2 undergoing elective surgery of approximately 2 h or more duration requiring tracheal intubation. Patients in Group A are nebulized with 3 ml of normal saline and the patients in Group B are nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulfate for 15 min, 5 min before induction of anesthesia. The incidence of POST at rest and on swallowing and any undue complaints at 0, 2, 4, and 24 h in the postoperative period are evaluated. Results: There is no significant difference in POST at rest during 0th, 2nd and 4th h between normal saline and MgSO4. Significant difference is seen at 24th h, where MgSO4 lessens POST. There is no significant difference in POST on swallowing during 0th and 2nd h between normal saline and MgSO4. Significant difference is seen at 4th h, where MgSO4 has been shown to lessen POST. Conclusions: MgSO4 significantly reduces the incidence of POST compared to normal saline. PMID:27275043

  9. Postoperative Chemotherapy Followed by Conformal Concomitant Chemoradiotherapy in High-Risk Gastric Cancer

    SciTech Connect

    Quero, Laurent; Bouchbika, Zineb; Kouto, Honorine; Baruch-Hennequin, Valerie; Gornet, Jean-Marc; Munoz, Nicolas; Cojean-Zelek, Isabelle; Houdart, Remi; Panis, Yves; Valleur, Patrice; Aparicio, Thomas; Maylin, Claude; Hennequin, Christophe

    2012-06-01

    Purpose: To analyze the efficacy, toxicity, and pattern of relapse after adjuvant cisplatin-based chemotherapy followed by three-dimensional irradiation and concomitant LV5FU2 chemotherapy (high-dose leucovorin and 5-fluorouracil bolus plus continuous infusion) in the treatment of completely resected high-risk gastric cancer. Methods and Materials: This was a retrospective analysis of 52 patients with high-risk gastric cancer initially treated by total/partial gastrectomy and lymphadenectomy between January 2002 and June 2007. Median age was 54 years (range, 36-75 years). Postoperative treatment consisted of 5-fluorouracil and cisplatin chemotherapy. Adjuvant chemotherapy was followed by three-dimensional conformal radiotherapy in the tumor bed and regional lymph nodes at 4500 cGy/25 fractions in association with concomitant chemotherapy. Concomitant chemotherapy consisted of a 2-h infusion of leucovorin (200 mg/m Superscript-Two ) followed by a bolus of 5-fluorouracil (400 mg/m Superscript-Two ) and then a 44-h continuous infusion of 5-fluorouracil (2400-3600 mg/m Superscript-Two ) given every 14 days, for three cycles (LV5FU2 protocol). Results: Five-year overall and disease-free survival were 50% and 48%, respectively. Distant metastases and peritoneal spread were the most frequent sites of relapse (37% each). After multivariate analysis, only pathologic nodal status was significantly associated with disease-free and overall survival. Acute toxicities were essentially gastrointestinal and hematologic. One myocardial infarction and one pulmonary embolism were also reported. Eighteen patients had a radiotherapy program interruption because of acute toxicity. All patients but 2 have completed radiotherapy. Conclusion: Postoperative cisplatin-based chemotherapy followed by conformal radiotherapy in association with concurrent 5-fluorouracil seemed to be feasible and resulted in successful locoregional control.

  10. Evaluating the Frequency of Postoperative Fever in Patients with Coronary Artery Bypass Surgey

    PubMed Central

    Mirmohammadsadeghi, Mohsen; Zohrenia, Hossein

    2011-01-01

    BACKGROUND Nowadays, coronary artery bypass graft (CABG) is a frequent surgery in treatment of coronary artery disease. According to high expense of this surgery and its important role in patients’ quality of life, high survival rate of patients and success of surgery are necessary. The aim of this study was the evaluation of fever incidence (febrile events) due to incidence of pneumonia, wound infection, bacteremia, urinary tract infection and inflammatory response without infection after CABG. METHODS In an intergrades descriptive-analytical study, 107 patients who underwent coronary artery bypass graft (CABG) were enrolled in the study. The patients then were examined by the febrile events and also their characteristics including age, sex, duration of surgery, underlying diseases, and frequency distribution of antibiotics consumptions in pre-surgical and postsurgical periods, and incidence of infectious syndromes. RESULTS Frequency distribution of febrile events after CABG was 29.9 percent. The most common administered antibiotic before the surgery was cephalothin (Keflin) and then, cefazolin. The most common administered antibiotic after the surgery was cephalothin (Keflin) and cephalexin (47.7%) and then, cephalothin-gentamicin-cephalexin (31.8%). The average age of patients without febrile syndrome was 60.53 years and in those with febrile syndrome was 59.31 years. In terms of gender, 74.8% of the patients were males. So that 32.5% of males and 22.2% of females had fever. The incidence time of fever in most cases was in the postoperative fourth day. In terms of underlying diseases, 13 percent of them had hypertension and hyperlipidemia, 14 percent had only hypertension, 11.2 percent had only hyperlipidemia and 6.5 percent had diabetes. CONCLUSION This study showed that the prevalence of fever in patients undergoing CABG was 29.9 percent and the most common cause of fever was sternal infections. There was a significant correlation between administered

  11. Percutaneous Transcatheter Ethanol Sclerotherapy and Catheter Drainage of Postoperative Pelvic Lymphoceles

    SciTech Connect

    Akhan, Okan Karcaaltincaba, Musturay; Ozmen, Mustafa N.; Akinci, Devrim; Karcaaltincaba, Deniz; Ayhan, Ali

    2007-04-15

    The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol scleortherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL). The mean catheterization duration was 11.8 days (1-60 days). The mean follow up time was 25.8 months (2-64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.

  12. The Effect of Levothyroxine Discontinuation Timing on Postoperative Hypothyroidism after Hemithyroidectomy for Papillary Thyroid Microcarcinoma

    PubMed Central

    Ha, Tae Kwun; Kim, Dong Wook; Park, Ha Kyoung; Baek, Jin Wook; Lee, Yoo Jin; Park, Young Mi; Kim, Do Hun; Jung, Soo Jin; Ahn, Ki Jung

    2016-01-01

    Objective. No previous studies regarding the appropriate timing of thyroid hormone discontinuation after hemithyroidectomy have been published. This study aimed to identify the appropriate timing for levothyroxine discontinuation after hemithyroidectomy among patients with papillary thyroid microcarcinoma (PTMC). Methods. This study retrospectively evaluated 304 patients who underwent ≥1 attempt to discontinue levothyroxine after hemithyroidectomy for treating PTMC between January 2008 and December 2013. Fifty-three patients were excluded because of preoperative hypothyroidism or hyperthyroidism, a history of thyroid hormone or antithyroid therapy, no available serological data, or a postoperative follow-up of <24 months. We evaluated the associations of successful levothyroxine discontinuation with patient age, sex, preoperative serological data, underlying thyroid gland histopathology, anteroposterior diameter of the residual thyroid gland, number of discontinuation attempts, and initial discontinuation timing. Results. Among the 251 included patients, 125 patients (49.8%) achieved successful levothyroxine discontinuation during the follow-up period after hemithyroidectomy. There was a significant difference in the outcomes for patients who underwent an initial discontinuation attempt at ≤3 months and ≥4 months after hemithyroidectomy (p < 0.001). There were significant differences in the discontinuation outcomes according to underlying thyroid histopathology (p = 0.001), preoperative thyroid-stimulating hormone levels (p < 0.001), and number of discontinuation attempts (p < 0.001). Conclusions. Among patients with PTMC, the initial levothyroxine discontinuation attempt is recommended at ≥4 months after hemithyroidectomy. PMID:27293432

  13. The Effect of Levothyroxine Discontinuation Timing on Postoperative Hypothyroidism after Hemithyroidectomy for Papillary Thyroid Microcarcinoma.

    PubMed

    Ha, Tae Kwun; Kim, Dong Wook; Park, Ha Kyoung; Baek, Jin Wook; Lee, Yoo Jin; Park, Young Mi; Kim, Do Hun; Jung, Soo Jin; Ahn, Ki Jung

    2016-01-01

    Objective. No previous studies regarding the appropriate timing of thyroid hormone discontinuation after hemithyroidectomy have been published. This study aimed to identify the appropriate timing for levothyroxine discontinuation after hemithyroidectomy among patients with papillary thyroid microcarcinoma (PTMC). Methods. This study retrospectively evaluated 304 patients who underwent ≥1 attempt to discontinue levothyroxine after hemithyroidectomy for treating PTMC between January 2008 and December 2013. Fifty-three patients were excluded because of preoperative hypothyroidism or hyperthyroidism, a history of thyroid hormone or antithyroid therapy, no available serological data, or a postoperative follow-up of <24 months. We evaluated the associations of successful levothyroxine discontinuation with patient age, sex, preoperative serological data, underlying thyroid gland histopathology, anteroposterior diameter of the residual thyroid gland, number of discontinuation attempts, and initial discontinuation timing. Results. Among the 251 included patients, 125 patients (49.8%) achieved successful levothyroxine discontinuation during the follow-up period after hemithyroidectomy. There was a significant difference in the outcomes for patients who underwent an initial discontinuation attempt at ≤3 months and ≥4 months after hemithyroidectomy (p < 0.001). There were significant differences in the discontinuation outcomes according to underlying thyroid histopathology (p = 0.001), preoperative thyroid-stimulating hormone levels (p < 0.001), and number of discontinuation attempts (p < 0.001). Conclusions. Among patients with PTMC, the initial levothyroxine discontinuation attempt is recommended at ≥4 months after hemithyroidectomy. PMID:27293432

  14. Bangladesh becomes "success story".

    PubMed

    1999-01-01

    The State Minister for Health and Family of Bangladesh, Dr. Mohammed Amanullah, highlighted some of the successes being achieved by his country in lowering fertility and improving the lives of the people since the 1994 International Conference on Population and Development. Some of these successes include practical measures to eliminate violence against women; introduction of a quota for women in public sector employment; and launching of the Health and Population Sector Program to provide a one-stop, full range of essential reproductive health, family planning and child health services through an integrated delivery mechanism. Moreover, the Minister informed the Forum participants that their success is attributable to many factors which include support from the government, from non-governmental organizations, civil society, mass media, religious and other community leaders, intersectoral collaboration, microcredit and income-generation activities. PMID:12295511

  15. [Post-operative bowel obstruction. Part 2: Mechanical post-operative small bowel obstruction by bands and adhesions].

    PubMed

    Duron, J J

    2003-12-01

    Small Bowel obstruction due to post-operative adhesions is a common problem in a general surgical practice. Any laparotomy initiates the lifelong risk of this complication. Mortality rates have improved dramatically in the last three decades. The basic evaluation and treatment of small bowel obstruction is well defined but many individual strategies may result from the variety of clinical presentations and from techniques and equipment available to a local surgical practice. Recent advances in surgical techniques and preventive strategies may improve overall results. Results will remain linked to the continuous aging of the populations of Western countries. PMID:14978440

  16. [Prevention and control of postoperative anastomotic leak after colorectal anastomosis].

    PubMed

    Zheng, Peng; Xu, Jianmin

    2016-04-25

    Anastomotic leak is a major complication after colorectal resection. Risk factors for anastomotic leak include patient and disease related factors, preoperative factors(e.g. use of neoadjuvant chemoradiation and mechanical bowel preparation), intraoperative factors(e.g. anastomotic techniques, performing of water injection test, preventive colostomy, and surgical procedures, etc; postoperative factors, such as postoperative medication use, etc. Early diagnosis of anastomotic fistula is crucial, which can be made by combining laboratory examination with imaging examination or take the prediction and diagnosis model as reference. Once diagnosed, anastomotic leak should be managed immediately according to individual status and severity of disease. As for intraperitoneal anastomosis, no matter whether the bowel lack of blood supply or not, original anastomosis should be removed and terminal loop ileumstomy should be created. As for extraperitoneal anastomosis(mainly low rectal anastomosis), adequate drainage and terminal loop ileumstomy can be considered when anastomosis is slightly cracked or invisible due to adhesion. When anastomosis is severely cracked or blood supply is too limited, however, we must disconnect the original anastomotic and create a proximal colostomy. PMID:27112466

  17. Modified Mandibulotomy Technique to Reduce Postoperative Complications: 5-Year Results

    PubMed Central

    Na, Hye-Young; Choi, Eun-Joo; Kim, Hyung Jun; Cha, In-Ho

    2013-01-01

    Purpose To review the 5-year outcomes of our modified mandibulotomy technique. Retrospective review of a tertiary level oral cancer center. Materials and Methods During a 5-year period, 30 patients who had a uniform surgical technique consisting of a lower lip-splitting, modified stair-step osteotomy with thin saw blade and osteotome after plate-precontouring and combination fixation with monocortical osteosynthesis (miniplate) and bicortical osteosynthesis (maxiplate and bicortical screws), with at least 14 months postoperative follow-up, were selected and reviewed retrospectively. Results There were 8 women and 22 men with an average age of 56.5 years. All the patients involved malignancies were squamous cell carcinoma. The main primary sites of the those who underwent a mandibulotomy were the tonsil, the base of tongue, the oral tongue, the retromolar pad area, and others. Others included buccal cheek, floor of mouth, and soft palate. 23 patients received postoperative radiation therapy, and among whom 8 patients also received chemotherapy. Total four (13%) mandibulotomy-related complications occurred, only two (6.7%) requiring additional operation under general anesthesia. Conclusion Our modified mandibulotomy meets the criteria for an ideal mandibulotomy technique relatively well because it requires no intermaxillary fixation, can precise preserve the occlusion in a precise way, allows early function, requires no secondary procedures, and has few complications. PMID:23918577

  18. Postoperative Delirium: Acute Change with Long-Term Implications

    PubMed Central

    Rudolph, James L.; Marcantonio, Edward R.

    2011-01-01

    Delirium is an acute change in cognition and attention, which may include alterations in consciousness and disorganized thinking. While delirium may affect any age group, it is most common in older patients, especially those with preexisting cognitive impairment. Patients with delirium after surgery recover more slowly than those without delirium and, as a result, have increased length of stay and hospital costs. The measured incidence of postoperative delirium varies with the type of surgery, the urgency of surgery, and the type and sensitivity of the delirium assessment. While generally considered a short-term condition, delirium can persist for months and is associated with poor cognitive and functional outcomes beyond the immediate postoperative period. In this article we will provide a guide to assess delirium risk preoperatively, and to prevent, diagnose, and treat this common and morbid condition. Care improvements such as identifying delirium risk preoperatively; training surgeons, anesthesiologists and nurses to screen for delirium; implementing delirium prevention programs; and developing standardized delirium treatment protocols may reduce the risk of delirium and its associated morbidity. PMID:21474660

  19. Key to Prevention of Bradycardia: Be Relax Postoperatively

    PubMed Central

    Chowdhury, Tumul; Schaller, Bernhard

    2016-01-01

    Abstract Hypotension and bradycardia are commonly observed after the spinal anesthesia and various mechanisms have been postulated for these hemodynamic changes. A middle-aged otherwise healthy male Caucasian patient developed several episodes of bradycardia postoperatively after the umbilical hernia repair under subarachnoid block (SAB) while trying to lean forward and move his legs. Episodes were aborted when patient was advised to relax in supine position. The common mechanism of bradycardia and hypotension under SAB is postulated as sympathetic blockade, decrease venous return, and parasympathetic over-dominance leading to a decrease in right arterial pressure and pressure in the great veins as they enter the right atrium. But over time, the parasympathetic inhibition is usually withdrawn first, leading to the risk of severe bradycardia that is probably favored by the reverse Trendelenburg position as described in our case. Postoperative severe hemodynamic changes can occur even under stable spinal anesthesia; however, can be prevented by vigilant monitoring and simple maneuver which includes maintenance of relax posture on the bed. PMID:27258501

  20. Battery of behavioral tests in mice to study postoperative delirium.

    PubMed

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  1. Managing the stiff elbow: operative, nonoperative, and postoperative techniques.

    PubMed

    Dávila, Sylvia A; Johnston-Jones, Karen

    2006-01-01

    Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture. PMID:16713873

  2. Influence of postoperative enteral nutrition on postsurgical infections.

    PubMed Central

    Beier-Holgersen, R; Boesby, S

    1996-01-01

    BACKGROUND: This study was undertaken to test the hypothesis that early enteral nutrition might reduce the incidence of serious complications after major abdominal surgery. METHODS: In a randomised double blind prospective trial 30 patients received Nutri-drink and 30 patients received placebo through a nasoduodenal feeding tube. On the day of operation the patients were given median 600 ml of either nutrition or placebo, 60 ml per hour. On the first postoperative day the patients received either 1000 ml (median) of nutrition or placebo, on day 2 1200 ml (median) nutrition, 1400 ml placebo, on day 3 1000 ml (median) nutrition, 1150 ml placebo, and on day 4 1000 ml (median) nutrition, 800 ml placebo. All patients were followed up for 30 days by the same investigator. RESULTS: The two groups were similar with regard to nutritional status and type of operation. The rate of postoperative infectious complications was significantly lower in the nutrition group, two of 30 compared with 14 of 30 in the placebo group (p = 0.0009). CONCLUSION: Early enteral nutrition given to patients after major abdominal surgery results in an important reduction in infectious complications. PMID:9038665

  3. The effects of early postoperative radiation on vascularized bone grafts

    SciTech Connect

    Evans, H.B.; Brown, S.; Hurst, L.N. )

    1991-06-01

    The effects of early postoperative radiation were assessed in free nonvascularized and free vascularized rib grafts in the canine model. The mandibles of one-half of the dogs were exposed to a cobalt 60 radiation dose of 4080 cGy over a 4-week period, starting 2 weeks postoperatively. The patency of vascularized grafts was confirmed with bone scintigraphy. Histological studies, including ultraviolet microscopy with trifluorochrome labeling, and histomorphometric analyses were performed. Osteocytes persist within the cortex of the vascularized nonradiated grafts to a much greater extent than in nonvascularized, nonradiated grafts. Cortical osteocytes do not persist in either vascularized or nonvascularized grafts subjected to radiation. New bone formation is significantly retarded in radiated grafts compared with nonradiated grafts. Periosteum and endosteum remained viable in the radiated vascularized grafts, producing both bone union and increased bone turnover, neither of which were evident to any significant extent in nonvascularized grafts. Bone union was achieved in vascularized and non-vascularized nonradiated bone. In the radiated group of dogs, union was only seen in the vascularized bone grafts.

  4. Comparison of postoperative pain: piezoelectric device versus microdrill.

    PubMed

    Crippa, Barbara; Salzano, Francesco Antonio; Mora, Renzo; Dellepiane, Massimo; Salami, Angelo; Guastini, Luca

    2011-09-01

    Piezosurgery® is a recently developed system for cutting bone with microvibrations. The objective of this study was to compare the severity of pain over the first 10 postoperative days in a group of 70 patients who underwent intact canal wall mastoidectomy, with the piezoelectric device, and to compare the results with traditional method by means of microdrill (70 patients). The subjective perception of pain was evaluated on a scale from 0 to 10, such that 0 represented no pain and 10 represented maximum pain; the severity was recorded as null when the score was 0; slight, when it was 1-4; moderate, when it was 5-7; or severe, when it was 8-10. Compared with microdrill, the patients that underwent surgery with the piezoelectric device showed a significant (P < 0.05) lower postoperative pain on day 1 (52 vs. 26 patients presented a slight pain, 12 vs. 37 presented a moderate pain, and 6 vs. 7 presented a severe pain) and day 3 (68 vs. 44 patients presented a slight pain, 2 vs. 23 presented a moderate pain, and 0 vs. 3 presented a severe pain). These results highlight as the piezoelectric device is a safe and minimally invasive tool. PMID:21327729

  5. Role of Interleukin-1β in Postoperative Cognitive Dysfunction

    PubMed Central

    Cibelli, Mario; Fidalgo, Antonio Rei; Terrando, Niccolò; Ma, Daqing; Monaco, Claudia; Feldmann, Marc; Takata, Masao; Lever, Isobel J.; Nanchahal, Jagdeep; Fanselow, Michael S.; Maze, Mervyn

    2016-01-01

    Objective Although postoperative cognitive dysfunction (POCD) often complicates recovery from major surgery, the pathogenic mechanisms remain unknown. We explored whether systemic inflammation, in response to surgical trauma, triggers hippocampal inflammation and subsequent memory impairment, in a mouse model of orthopedic surgery. Methods C57BL/6J, knock out (lacking interleukin [IL]-1 receptor, IL-1R−/−) and wild type mice underwent surgery of the tibia under general anesthesia. Separate cohorts of animals were tested for memory function with fear conditioning tests, or euthanized at different times to assess levels of systemic and hippocampal cytokines and microglial activation; the effects of interventions, designed to interrupt inflammation (specifically and nonspecifically), were also assessed. Results Surgery caused hippocampal-dependent memory impairment that was associated with increased plasma cytokines, as well as reactive microgliosis and IL-1β transcription and expression in the hippocampus. Nonspecific attenuation of innate immunity with minocycline prevented surgery-induced changes. Functional inhibition of IL-1β, both in mice pretreated with IL-1 receptor antagonist and in IL-1R−/− mice, mitigated the neuroinflammatory effects of surgery and memory dysfunction. Interpretation A peripheral surgery-induced innate immune response triggers an IL-1β-mediated inflammatory process in the hippocampus that underlies memory impairment. This may represent a viable target to interrupt the pathogenesis of postoperative cognitive dysfunction. PMID:20818791

  6. Gastric Decompression Decreases Postoperative Nausea and Vomiting in ENT Surgery

    PubMed Central

    Erkalp, Kerem; Kalekoglu Erkalp, Nuran; Sevdi, M. Salih; Korkut, A. Yasemin; Yeter, Hacer; Ege, Sertuğ Sinan; Alagol, Aysin

    2014-01-01

    There is a passive blood flow to the stomach during oral and nasal surgery. It may cause postoperative nausea and vomiting (PONV). We researched the relationship between gastric decompression (GD) and severity of PONV in ear, nose, and throat (ENT) surgery. 137 patients who have been into ENT surgery were included in the study. In Group I (n = 70), patients received GD after surgery before extubation; patients in Group II (n = 67) did not receive GD. In postoperative 2nd, 4th, 8th, and 12th hours, the number and ratio of patients demonstrating PONV were detected to be significantly more in Group II as compared to Group I. PONV was also significantly more severe in Group II as compared to Group I. In Group I, the PONV ratio in the 2nd hour was significantly more for those whose amounts of stomach content aspired were more than 10 mL as compared to those whose stomach content aspired was less than 10 mL. In the 4th, 8th, and 24th hours, there is no statistically significant difference between the stomach content aspired and PONV ratio. GD reduces the incidence and severity of PONV in ENT surgery. PMID:24803935

  7. 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

  8. Postoperative Pulmonary Dysfunction and Mechanical Ventilation in Cardiac Surgery

    PubMed Central

    Badenes, Rafael; Lozano, Angels; Belda, F. Javier

    2015-01-01

    Postoperative pulmonary dysfunction (PPD) is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC) and mechanical ventilation (VM). Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD) and pulmonary infections in surgical patients. In this way, the open lung approach (OLA), a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC) when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function. PMID:25705516

  9. Association of Preoperative Biliary Drainage with Postoperative Morbidity after Pancreaticoduodenectomy

    PubMed Central

    Liu, Chang; Lu, Jian-Wen; Du, Zhao-Qing; Liu, Xue-Min; Lv, Yi; Zhang, Xu-Feng

    2015-01-01

    Background. The advantages or disadvantages of preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) remain unclear. Methods. A prospectively maintained database was queried for 335 consecutive patients undergoing standard PD surgery between 2009 and 2013. Clinical data and postoperative complications of the 47 patients receiving PBD and 288 patients with early surgery were compared. A matching analysis was also performed between patients receiving or not receiving PBD (no-PBD). Results. The indication for PBD was severe obstructive jaundice (81%) and cholangitis (26%) at the time of PBD. 47 PBD patients had higher bilirubin level than 288 no-PBD patients preoperatively (363.2 μmol/L versus 136.0 μmol/L, p < 0.001). Although no significant difference of any complications could be observed between the two groups, positive intraoperative bile culture and wound infection seemed to be moderately increased in PBD compared to no-PBD patients (p = 0.084 and 0.183, resp.). In the matched-pair comparison, the incidence of wound infection was three times higher in PBD than no-PBD patients (14.9% versus 4.3%, p = 0.080). Conclusions. PBD seems to moderately increase the risk of postoperative wound and bile duct infection. Therefore, PBD should be selectively performed prior to PD. PMID:26798333

  10. Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels

    PubMed Central

    2011-01-01

    Background and purpose Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction. Accurate and reproducible methods to visualize and document bone tunnel placement are therefore important. We evaluated the reliability of standard radiographs, CT scans, and a 3-dimensional (3D) virtual reality (VR) approach in visualizing and measuring ACL reconstruction bone tunnel placement. Methods 50 consecutive patients who underwent single-bundle ACL reconstructions were evaluated postoperatively by standard radiographs, CT scans, and 3D VR images. Tibial and femoral tunnel positions were measured by 2 observers using the traditional methods of Amis, Aglietti, Hoser, Stäubli, and the method of Benereau for the VR approach. Results The tunnel was visualized in 50–82% of the standard radiographs and in 100% of the CT scans and 3D VR images. Using the intraclass correlation coefficient (ICC), the inter- and intraobserver agreement was between 0.39 and 0.83 for the standard femoral and tibial radiographs. CT scans showed an ICC range of 0.49–0.76 for the inter- and intraobserver agreement. The agreement in 3D VR was almost perfect, with an ICC of 0.83 for the femur and 0.95 for the tibia. Interpretation CT scans and 3D VR images are more reliable in assessing postoperative bone tunnel placement following ACL reconstruction than standard radiographs. PMID:21999625

  11. Reduced cerebral vasomotor reactivity as an indicator of postoperative confusion.

    PubMed

    Kessler, C; Junge, H M; Walker, M L; Busack, R; Albrecht, D M; von Ackeren, K

    1997-05-01

    Surgical intervention in elderly patients carries a high risk. A frequent problem with surgery in these patients is the occurrence of a temporary confusional state, which increases both the risk of postoperative complications and the need for intensive care. We hypothesised that, in part, temporary confusional state results from cerebral hypoxia occurring in response to blood pressure fluctuations during surgery. To assess whether disruption of autoregulation of cerebral blood vessels plays a role in temporary confusional state, we studied 31 patients over 55 years of age, using the Doppler-carbon dioxide test. We determined whether vasomotor reactivity could be used diagnostically to identify those patients most likely to experience temporary confusional state. Blood flow velocity in the middle cerebral artery was detected using Doppler ultrasound, and hypercapnia was induced by breathing carbon dioxide until an end-tidal concentration of 8.0% by volume was reached. Vasomotor reactivity was calculated on the basis of the changes in blood flow velocity in response to the increase in carbon dioxide. Temporary confusional state was assessed using the Syndrome Short Test (Syndrom-Kurztest). We found that resting blood flow velocity was inversely related to age (p < 0.05). In addition, there was a significant inverse correlation between vasomotor reactivity and temporary confusional state (p < 0.05). These data indicate that vasomotor reactivity, as measured by the Doppler-carbon dioxide test, is a reliable tool to identify patients at risk for postoperative psychological disturbances. PMID:9165961

  12. Postoperative physical therapy after coronary artery bypass surgery.

    PubMed

    Johnson, D; Kelm, C; To, T; Hurst, T; Naik, C; Gulka, I; Thomson, D; East, K; Osachoff, J; Mayers, I

    1995-09-01

    Coronary artery bypass surgery is frequently complicated by postoperative atelectasis. Although routinely prescribed, the efficacy of any specific chest physical therapy is not well established. We studied patients at a university center undergoing elective coronary artery bypass surgery. Based upon chest X-ray criteria at extubation, patients (n = 228) were classified as demonstrating greater or lesser degrees of atelectasis. Those with a lesser degree of atelectasis were randomized to receive either early mobilization or sustained maximal inflations (SMI). Those with greater a degree of atelectasis were separately randomized to receive either SMI or single-handed percussions (SSP). We found the extent of atelectasis at extubation did not predict the risk of developing pneumonia. Hospital stays and intensive care unit stays were similar regardless of treatment. Physical therapy costs were highest in the most labor-intensive therapy group (SSP). We conclude that postoperative respiratory dysfunction is common but does not commonly cause significant morbidity or prolong hospital stay. Adding SMI to patients with minimal atelectasis at extubation does not improve clinical outcomes. Similarly, adding SSP to patients with marked atelectasis does not improve outcomes over those obtained with SMI and early ambulation. PMID:7663809

  13. Preemptive Analgesia Does Not Reduce Pain or Improve Postoperative Functioning

    PubMed Central

    Grube, Jennifer O.; Damme-Sorenen, Jesse

    2004-01-01

    Objectives: To examine the effectiveness of preemptive analgesia in gynecologic laparoscopy patients. Methods: A double-blinded, randomized trial was performed from June 2000 to June 2001. Preoperatively, patients were randomly assigned to 0.25% bupivicaine or normal saline control. Following anesthetic induction, the study drug or a placebo was injected prior to the proposed incisions. Results: Of the 164 patients enrolled, 85 were randomized to the study group and 79 to the control. Age, surgery indication, and estimated blood loss did not vary significantly between groups. Overall mean pain score (± standard error of the mean) for study and control groups did not differ at 4 hours (3.2±0.3 vs 3.2±0.3) or at 24 hours (4.2±0.3 vs 4.2±0.3). Incisional pain scores also did not differ at 4 hours (3.0±0.3 vs 2.7±0.3) or at 24 hours (3.6±0.3 vs 3.6±0.3). Both groups were similar in activity limitation at 24 hours and oral narcotic consumption within 24 hours postoperatively. After stratifying surgery type for level of complexity, no difference was noted between groups. Multiple logistic regression analysis also noted no difference in outcomes. Conclusion: Preemptive analgesia in patients undergoing gynecologic laparoscopy does not reduce postoperative pain or decrease the time to return of normal activities. PMID:14974656

  14. Battery of behavioral tests in mice to study postoperative delirium

    PubMed Central

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R.; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  15. Student Success. May 2006

    ERIC Educational Resources Information Center

    Online Submission, 2006

    2006-01-01

    "Student Success" is EPI's occasional e-magazine dedicated to the discussion of retaining students in higher education. This is the second of three parts in the Institutional Strategies Series. The first article in the March issue outlined the barriers to student retention, both from the extant literature and also from interviews and surveys that…

  16. Determinants of project success

    NASA Technical Reports Server (NTRS)

    Murphy, D. C.; Baker, B. N.; Fisher, D.

    1974-01-01

    The interactions of numerous project characteristics, with particular reference to project performance, were studied. Determinants of success are identified along with the accompanying implications for client organization, parent organization, project organization, and future research. Variables are selected which are found to have the greatest impact on project outcome, and the methodology and analytic techniques to be employed in identification of those variables are discussed.

  17. Focus on Success

    ERIC Educational Resources Information Center

    Frey, Susan

    2011-01-01

    Successful middle schools do not happen by accident--they happen through leadership. Principals promote a shared vision that empowers school staffs to set high standards and continuously improve student achievement. And these middle grade educators also try to help their adolescent students see the connection between their work in school and their…

  18. Predictors of College Success.

    ERIC Educational Resources Information Center

    Hopper, Harold H.

    This study of prediction of college success was designed to use the high school GPA and other variables, both cognitive and non-cognitive. It attempted to locate factors that would predict grades in English, mathematics, and biology, as well as predict the over-all GPA. Seven hundred students were examined. In college English, 49% of the variance…

  19. Many Paths to Success

    ERIC Educational Resources Information Center

    Mero, Dianne

    2009-01-01

    A close look at the principals who make up the MetLife-NASSP Breakthrough Schools (BTS) Class of 2009 reveals a lot about desirable leadership traits. Each of the five middle level schools and the five high schools has achieved remarkable results while serving large numbers of economically challenged students. Behind each school's successes is a…

  20. ACT and College Success

    ERIC Educational Resources Information Center

    Bleyaert, Barbara

    2010-01-01

    What is the relationship between ACT scores and success in college? For decades, admissions policies in colleges and universities across the country have required applicants to submit scores from a college entrance exam, most typically the ACT (American College Testing) or SAT (Scholastic Aptitude Test). This requirement suggests that high school…

  1. Parent Outreach Success.

    ERIC Educational Resources Information Center

    Nitzberg, Joel; Sparrow, Judith

    2001-01-01

    Presents the Massachusetts Parent Involvement Project (MassPIP) comprising 59 local community coalitions of businesses, service organizations, school personnel, parents, and children. Describes steps coalitions follow in planning events and presents community success stories. The project developed a set of activities that parents can do at home…

  2. Postcards for Student Success.

    ERIC Educational Resources Information Center

    Budig, Jeanne E.

    Aware of the high correlation between class attendance and academic success, Vincennes University (VU) in Indiana implemented a "blue card" system to improve class attendance. The first week of class, students are asked to sign a blue card verifying their local address and allowing the release of academic information. Instructors begin class by…

  3. Celebrating Successful Students

    ERIC Educational Resources Information Center

    Squires, Dan; Case, Pauline

    2008-01-01

    The Machine Tool Program at Cowley College in Arkansas City, Kansas, is preparing students to become future leaders in the machining field, and the school recognizes the importance of sharing and celebrating those stories of success with the public to demonstrate the effectiveness of career and technical education (CTE) programs. Cowley College is…

  4. Pathways to School Success

    ERIC Educational Resources Information Center

    University of Pittsburgh Office of Child Development, 2012

    2012-01-01

    In 2006, the University of Pittsburgh Office of Child Development began implementing a multi-year school readiness project in several area schools. Evidence from both research and the field point to several key elements that foster school readiness and create pathways to school success for all children. This paper presents components of a…

  5. Characteristics of Successful Entrepreneurs.

    ERIC Educational Resources Information Center

    McClelland, David C.

    1987-01-01

    Comparison of characteristics of 12 average and 12 superior small business people in three developing nations (India, Malawi, and Ecuador) found proactive qualities such as initiative and assertiveness, achievement orientation, and commitment to others characteristic of successful entrepreneurs. Other expected qualities (self-confidence,…

  6. Strategies for success

    SciTech Connect

    Burr, M.T.

    1993-04-01

    Some 30 companies are developing a majority of the private power facilities worldwide. Attributes such as financial strength, a proven track record, experience in related markets, and a well developed business strategy are keys to success in this complex marketplace. Key executives from four of these companies were interviewed for their perspective in this industry.

  7. Enhancing Drug Court Success

    ERIC Educational Resources Information Center

    Deschenes, Elizabeth Piper; Ireland, Connie; Kleinpeter, Christine B.

    2009-01-01

    This study evaluates the impact of enhanced drug court services in a large county in Southern California. These enhanced services, including specialty counseling groups, educational/employment resources, and increased Residential Treatment (RT) beds, were designed to increase program retention and successful completion (graduation) of drug court.…

  8. FOCUS: Sustainable Mathematics Successes

    ERIC Educational Resources Information Center

    Mireles, Selina V.; Acee, Taylor W.; Gerber, Lindsey N.

    2014-01-01

    The FOCUS (Fundamentals of Conceptual Understanding and Success) Co-Requisite Model Intervention (FOCUS Intervention) for College Algebra was developed as part of the Developmental Education Demonstration Projects (DEDP) in Texas. The program was designed to use multiple services, courses, and best practices to support student completion of a…

  9. Success in a Hurry

    ERIC Educational Resources Information Center

    Martin, Harold L., Sr.

    2015-01-01

    Although a young program, the North Carolina A&T Honors Program illustrates how quickly and successfully honors can achieve its goals of providing a quality education to its high-achieving students, and how these students can benefit academically and personally from the experiences that honors provides for them. This article provides a brief…

  10. Five Keys to Success

    ERIC Educational Resources Information Center

    Peddy, Walter J.

    2009-01-01

    The first year as a principal is filled with self-doubt. As one already knows, there is no book or guide that can fully prepare someone for what the principal's position entails. All first-year principals have to learn by doing. In this article, the author discusses five keys to success that will guide and help first-year principals with the…

  11. Ensuring Students' Success

    ERIC Educational Resources Information Center

    Oblinger, James L.

    2006-01-01

    James L. Oblinger, Chancellor of North Carolina State University, argues that higher education must continually evolve new methods of teaching and learning to support students' lifelong skills and impending careers. Part of ensuring students' success lies in finding alternative learning models, such as the Student-Centered Activities for Large…

  12. Success Stories Profiles.

    ERIC Educational Resources Information Center

    Douthitt, Frieda; And Others

    This packet contains the stories of 20 successful alumni of Ohio's secondary vocational programs and postsecondary technical schools. They have been reproduced as loose-leaf camera-ready art. Suggested uses for these one-page biographies with accompanying photograph include the following: illustrations for use in speeches; reproduction of complete…

  13. The Cult of Success

    ERIC Educational Resources Information Center

    Senechal, Diana

    2012-01-01

    Success has meant wealth, virtue, excellence, wisdom, personal contentment, or any combination of these, but its definition has flattened over time, particularly in the past few decades. A combination of economic anxiety, aggressive advertising, ubiquitous ratings, and verbal vagueness has led to an emphasis on the external aspects of…

  14. Slump with Success

    ERIC Educational Resources Information Center

    White, Heather

    2008-01-01

    Glass slumping is one of those projects that gives students a feeling of success and accomplishment. Glass slumping looks difficult to produce, and it often leaves others wondering how it is created. Slumping glass can provide dramatic results. Slumping refers to glass that, when heated, softens and conforms to the shape of a mold. Elementary…

  15. Mindfulness and Student Success

    ERIC Educational Resources Information Center

    Leland, Matt

    2015-01-01

    Mindfulness has long been practiced in Eastern spiritual traditions for personal improvement, and educators and educational institutions have recently begun to explore its usefulness in schools. Mindfulness training can be valuable for helping students be more successful learners and more connected members of an educational community. To determine…

  16. Coping with Computing Success.

    ERIC Educational Resources Information Center

    Breslin, Richard D.

    Elements of computing success of Iona College, the challenges it currently faces, and the strategies conceived to cope with future computing needs are discussed. The college has mandated computer literacy for students and offers nine degrees in the computerized information system/management information system areas. Since planning is needed in…

  17. Successful School Composting.

    ERIC Educational Resources Information Center

    Mahar, Rhea Dawn

    2001-01-01

    School composting programs that have met the challenges inherent in long-term composting have several traits in common: a supportive educational program, schoolwide participation, and a consistent maintenance program. Examines the elements of success, offers examples of incorporating composting into the curriculum, and describes three methods of…

  18. Cultivating Models of Success

    ERIC Educational Resources Information Center

    Starace, Melissa D.

    2012-01-01

    Community colleges are often viewed as the gateway to higher education as well as institutions that can rapidly prepare students to enter the workforce. Yet, in spite of widespread acclaim for their effectiveness and success, community colleges have done very little to garner volunteer and financial support from their alumni. Admittedly, many…

  19. Secrets to success.

    PubMed

    Sorrel, Amy Lynn

    2014-02-01

    A new national study reveals what it takes for physician practices to stay financially viable. Several Texas practices, among those rated as "better performers," share their secrets to success. One of those secrets, a physician says, is "hiring good people and getting out of their way." PMID:24500918

  20. Linear Equations: Equivalence = Success

    ERIC Educational Resources Information Center

    Baratta, Wendy

    2011-01-01

    The ability to solve linear equations sets students up for success in many areas of mathematics and other disciplines requiring formula manipulations. There are many reasons why solving linear equations is a challenging skill for students to master. One major barrier for students is the inability to interpret the equals sign as anything other than…

  1. Writing for Successful Publication.

    ERIC Educational Resources Information Center

    Henson, Kenneth T.

    Arguing that becoming a successful author requires the ability to write simply, clearly, and forcefully, this book provides practical suggestion for clear and forceful professional writing. Chapters include: (1) "Why Write"; (2) "Finding Topics"; (3) "Getting Started"; (4) "About Style"; (5) "Organizing Articles"; (6) "Using Journals, Libraries…

  2. Building Successful Cleaning Processes.

    ERIC Educational Resources Information Center

    Walker, John P.

    2002-01-01

    Discusses how to build a successful cleaning process in order to most effectively maintain school facilities, explaining that the cleaning processes used plays a critical role in productivity. Focuses on: developing a standardized system; making sure that employees have the right tools for the work they perform; training employees; tracking and…

  3. Student Success. September 2006

    ERIC Educational Resources Information Center

    Online Submission, 2006

    2006-01-01

    "Student Success" is EPI's occasional e-magazine dedicated to the discussion of retaining students in higher education. This is the third of three parts in the Institutional Strategies Series. The first article in the March issue outlined the barriers to student retention, both from the extant literature and also from interviews and surveys…

  4. The Road to Success.

    ERIC Educational Resources Information Center

    Totten, Herman L.; Keys, Ronald L.

    1994-01-01

    Argues that management knowledge is not being successfully transferred through schools of library and information studies management courses. An analytical model of leadership should be implemented in the curriculum to emphasize creativity, risk-taking, innovation, and intuition. The model would include a discussion of these elements and their…

  5. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults

    PubMed Central

    Toms, Laurence; McQuay, Henry J; Derry, Sheena; Moore, R Andrew

    2014-01-01

    Background This is an updated version of the original Cochrane review published in Issue 1, 2004 - this original review had been split from a previous title on ‘Single dose paracetamol (acetaminophen) with and without codeine for postoperative pain’. The last version of this review concluded that paracetamol is an effective analgesic for postoperative pain, but additional trials have since been published. This review sought to evaluate the efficacy and safety of paracetamol using current data, and to compare the findings with other analgesics evaluated in the same way. Objectives To assess the efficacy of single dose oral paracetamol for the treatment of acute postoperative pain. Search methods We searched The Cochrane Library, MEDLINE, EMBASE, the Oxford Pain Relief Database and reference lists of articles to update an existing version of the review in July 2008. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of paracetamol for acute postoperative pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Area under the “pain relief versus time” curve was used to derive the proportion of participants with paracetamol or placebo experiencing at least 50% pain relief over four to six hours, using validated equations. Number-needed-to-treat-to-benefit (NNT) was calculated, with 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use, were sought as measures of duration of analgesia. Information on adverse events and withdrawals was also collected. Main results Fifty-one studies, with 5762 participants, were included: 3277 participants were treated with a single oral dose of paracetamol and 2425 with placebo. About half of participants treated with paracetamol at standard doses achieved at least 50% pain relief over four to six hours, compared with about 20% treated with placebo. NNTs for at

  6. Treatment Success in Cancer

    PubMed Central

    Djulbegovic, Benjamin; Kumar, Ambuj; Soares, Heloisa P.; Hozo, Iztok; Bepler, Gerold; Clarke, Mike; Bennett, Charles L.

    2009-01-01

    Background The evaluation of research output, such as estimation of the proportion of treatment successes, is of ethical, scientific, and public importance but has rarely been evaluated systematically. We assessed how often experimental cancer treatments that undergo testing in randomized clinical trials (RCTs) result in discovery of successful new interventions. Methods We extracted data from all completed (published and unpublished) phase 3 RCTs conducted by the National Cancer Institute cooperative groups since their inception in 1955. Therapeutic successes were determined by (1) assessing the proportion of statistically significant trials favoring new or standard treatments, (2) determining the proportion of the trials in which new treatments were considered superior to standard treatments according to the original researchers, and (3) quantitatively synthesizing data for main clinical outcomes (overall and event-free survival). Results Data from 624 trials (781 randomized comparisons) involving 216 451 patients were analyzed. In all, 30% of trials had statistically significant results, of which new interventions were superior to established treatments in 80% of trials. The original researchers judged that the risk-benefit profile favored new treatments in 41% of comparisons (316 of 766). Hazard ratios for overall and event-free survival, available for 614 comparisons, were 0.95 (99% confidence interval [CI], 0.93-0.98) and 0.90 (99% CI, 0.87- 0.93), respectively, slightly favoring new treatments. Breakthrough interventions were discovered in 15% of trials. Conclusions Approximately 25% to 50% of new cancer treatments that reach the stage of assessment in RCTs will prove successful. The pattern of successes has become more stable over time. The results are consistent with the hypothesis that the ethical principle of equipoise defines limits of discoverability in clinical research and ultimately drives therapeutic advances in clinical medicine. PMID:18362256

  7. Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility.

    PubMed Central

    Watters, J M; Kirkpatrick, S M; Norris, S B; Shamji, F M; Wells, G A

    1997-01-01

    OBJECTIVE: The authors set out to determine whether immediate enteral feeding minimizes early postoperative decreases in handgrip and respiratory muscle strength. SUMMARY BACKGROUND DATA: Muscle strength decreases considerably after major surgical procedures. Enteral feeding has been shown to restore strength rapidly in other clinical settings. METHODS: A randomized, controlled, nonblinded clinical trial was conducted in patients undergoing esophagectomy or pancreatoduodenectomy who received immediate postoperative enteral feeding via jejunostomy (fed, n = 13), or no enteral feeding during the first 6 postoperative days (unfed, n = 15). Handgrip strength, vital capacity, forced expiratory volume in one second (FEV1), and maximal inspiratory pressure (MIP) were measured before surgery and on postoperative days 2, 4, and 6. Fatigue and vigor were evaluated before surgery and on postoperative day 6. Mobility was assessed daily after surgery using a standardized descriptive scale. Postoperative urine biochemistry was evaluated in daily 24-hour collections. RESULTS: Postoperative vital capacity (p < 0.05) and FEV1 (p = 0.07) were consistently lower (18%-29%) in the fed group than in the unfed group, whereas grip strength and maximal inspiratory pressure were not significantly different. Postoperative mobility also was lower in the fed patients (p < 0.05) and tended to recover less rapidly (p = 0.07). Fatigue increased and vigor decreased after surgery (both p < or = 0.001), but changes were similar in the fed and unfed groups. Intensive care unit and postoperative hospital stay did not differ between groups. CONCLUSIONS: Immediate postoperative jejunal feeding was associated with impaired respiratory mechanics and postoperative mobility and did not influence the loss of muscle strength or the increase in fatigue, which occurred after major surgery. Immediate postoperative enteral feeding should not be routine in well-nourished patients at low risk of nutrition

  8. Protocols for treating the postoperative pain of fractures in Dutch hospitals

    PubMed Central

    Ossendorp, Rikkert; Forouzanfar, Tymour; Ashton-James, Claire E; Bloemers, Frank

    2013-01-01

    Introduction Every year, over 260,000 patients in the Netherlands are diagnosed with a traumatic fracture. Many patients are treated surgically and need postoperative treatment of pain. Research suggests postoperative pain is often under-treated, leaving a significant proportion of patients in moderate to severe postoperative pain. Specialized, evidence-based pain-management protocols offer patients the best possible pain management, and significantly reduce the risk of pain-related health complications. Objective Our objective was to review the range of postoperative pain protocols that are currently being used to treat postoperative fracture pain within the Netherlands, and investigate whether a specialized, evidence-based protocol for treating postoperative fracture pain exists within this sample. Methods A written request for the protocol currently being used for the treatment of postoperative pain following the surgical treatment of a fracture was sent to 101 Dutch hospital departments. The administration and dosage of pain medications used during postoperative pain management were then identified and summarized. Results Of the contacted hospitals, 57% sent in protocols; 45% of these were eligible for analysis. All of the departments sent a general or acute pain protocol rather than a specialized protocol for the treatment of postoperative pain associated with the surgical treatment of fractures. A total of 22 different analgesics were used for pain management in 135 different administration schemes. Paracetamol, diclofenac, and morphine were used in the majority of protocols. Medication was given via oral, rectal, intravenous, subcutaneous, intramuscular, and epidural routes, amongst others. Conclusion No specialized, evidence-based protocols for the treatment of postoperative fracture pain were found in this Dutch sample. A wide variety of medications, dosages, and administration schemes were used to manage postoperative pain following the surgical treatment

  9. The use of alvimopan for postoperative ileus in small and large bowel resections.

    PubMed

    Brady, Justin T; Dosokey, Eslam M G; Crawshaw, Benjamin P; Steele, Scott R; Delaney, Conor P

    2015-01-01

    Transient ileus is a normal physiologic process after surgery. When prolonged, it is an important contributor to postoperative complications, increased length of stay and increased healthcare costs. Efforts have been made to prevent and manage postoperative ileus; alvimopan is an oral, peripheral μ-opioid receptor antagonist, and the only currently US FDA-approved medication to accelerate the return of gastrointestinal function postoperatively. PMID:26488223

  10. Total pancreatectomy and islet autotransplantation for chronic pancreatitis: spectrum of postoperative CT findings.

    PubMed

    Haider, Maera; Makary, Martin A; Singh, Vikesh K; Hirose, Kenzo; Fishman, Elliot K; Zaheer, Atif

    2015-10-01

    Improved laboratory methods for preparing islets for autotransplantation and postoperative care for the apancreatic patient have led to a surge in centers performing total pancreatectomy with islet autotransplantation. Accordingly, imaging in this patient population is increasingly being performed. The purpose of this article is to review the expected normal postoperative findings unique to the procedure and common complications on dual phase CT in the immediate postoperative and long-term periods. PMID:26070749

  11. Small(pox) success?

    PubMed

    Birn, Anne-Emanuelle

    2011-02-01

    The 30th anniversary of the World Health Organization's (WHO) official certification of smallpox eradication was marked by a slew of events hailing the campaign's dramatic tale of technological and organizational triumph against an ancient scourge. Yet commemorations also serve as moments of critical reflection. This article questions the acclaim showered upon smallpox eradication as the single greatest public health success in history. It examines how and why smallpox eradication and WHO's concurrent social justice-oriented primary health care approach (following from the Declaration of Alma-Ata) became competing paradigms. It synthesizes critiques of eradication's shortcomings and debunks some of the myths surrounding the global eradication campaign as a public health priority and necessity, and as a Cold War victory of cooperation. The article concludes with thoughts on integrating technical and social-political aspects of health within the context of welfare states as the means to achieving widespread and enduring global public health success. PMID:21340334

  12. Single dose oral lumiracoxib for postoperative pain in adults

    PubMed Central

    Roy, Yvonne M; Derry, Sheena; Moore, R Andrew

    2014-01-01

    Background Lumiracoxib is a selective cyclooxygenase-2 (COX-2) inhibitor. COX-2 inhibitors were developed to avoid COX-1-related gastrointestinal (GI) problems while maintaining the analgesic and anti-inflammatory activity of traditional non-steriodal anti-inflammatory drugs (NSAIDs). Objectives To review the analgesic efficacy, duration of analgesia, and adverse effects of a single oral dose of lumiracoxib for moderate to severe postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, and EMBASE to February 2010. Selection criteria Single oral dose, randomised, double-blind, placebo-controlled trials of lumiracoxib for relief of established moderate to severe postoperative pain in adults. Data collection and analysis Studies were assessed for methodological quality and the data extracted by two review authors independently. Summed total pain relief over six hours (TOTPAR 6) was used to calculate the number of participants achieving at least 50% pain relief. These derived results were used to calculate, with 95% confidence intervals, the relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over six hours. Numbers of participants using rescue medication, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected. Main results In this updated review four studies met the inclusion criteria. In total 366 participants were treated with lumiracoxib 400 mg, 51 with lumiracoxib 100 mg, and 212 with placebo. Active comparators were naproxen 500 mg, rofecoxib 50 mg, celecoxib 200 mg, celecoxib 400 mg, and ibuprofen 400 mg. With lumiracoxib 400 mg 50% of participants had at least 50% pain relief over six hours, compared with 8% given placebo; RB 6.9 (95% CI 4.1 to 12), NNT 2.4 (2.1 to 2.8). Median time to onset of analgesia was shorter for lumiracoxib 400 mg (0.6 to 1.5 hours) than

  13. Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

    PubMed Central

    Kodra, Nertila; Shpata, Vjollca; Ohri, Ilir

    2016-01-01

    BACKGROUND: Incidence of postoperative pulmonary complications (PPC) in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system. AIM: The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures. MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors. RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients) and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p < 0.0001. PPC were identified as risk factors for mortality, OR: 21.84; 95% CI: 11.66-40.89; P < 0.0001. The multivariate regression analysis identified as being independently associated with an increased risk of PPC: age ≥ 65 years (OR 11.41; 95% CI: 4.84-26.91, p < 0.0001), duration of operation ≥ 2.5 hours (OR 8.38; 95% CI: 1.52-46.03, p = 0.01, history of previous pulmonary diseases (OR 11.12; 95% CI: 3.28-37.65, P = 0.0001) and ASA > 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01). CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit. PMID:27335597

  14. Probiotic use in preventing postoperative infection in liver transplant patients

    PubMed Central

    Chen, Jim; Wu, Jinshan; Chalson, Helen; Merigan, Lynn; Mitchell, Andrew

    2013-01-01

    Background Although liver transplantation has been widely practised, post-operative bacterial infection is still a frequent complication which contributed to an increased risk of fatality. There were studies on preoperative use of probiotics for liver transplant patients and acquired reduction in postoperative sepsis and wound infection, but the relevant clinical experience with pre- and probiotics is still limited. Objectives This study is to assess fibre and probiotic use aimed at preventing bacterial sepsis and wound complications in patients undergoing liver transplantation. Study methods There were a total of sixty-seven adult patients scheduled for liver transplantation were included in a public teaching hospital. From January to December 2011, 34 continuous patients following liver transplantation were put on fibre + probiotics. In retrospectively, from January to December 2010, 33 continuous patients were collected as a control group and they were only received fibre post operation. The incidence of bacterial infections was compared in patients receiving either fibre and lactobacillus or fibre only. Statistical analysis was performed using SPSS 15. The t test, fisher’s and chi- square test was used to compare discrete variables. Results In summary, in the analysis of 67 liver transplant recipients, 8.8% group A patients developed infections compared to 30.3% group B patients. The difference between groups A and B was statistically significant in both cases. In addition, the duration of antibiotic therapy was significantly shorter in the lactobacillus-group. Wound infection was the most frequent infections and enterococci the most frequently isolated bacteria. Fibre and lactobacilli were well tolerated in most cases. The operating time, amount of intra- and post-operatively transfused units of blood, fresh frozen plasma and albumin did not differ significantly between the groups. Conclusions Combined fibre and probiotics could lower the incidence of

  15. Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

    PubMed Central

    Shin, Young-Hee; Jeong, Hee-Joon

    2015-01-01

    Background Postoperative delirium is a frequent complication in elderly patients undergoing major abdominal surgery and is associated with a poor outcome. We compared postoperative delirium in elderly patients following laparoscopic gastrectomy (LG) versus open gastrectomy (OG). Methods In total, 130 patients aged ≥ 65 years with gastric cancer undergoing LG and OG were enrolled prospectively. Postoperative delirium and cognitive status were assessed daily using the Confusion Assessment Method (CAM) and Mini-Mental Status Examination (MMSE), respectively, for 3 days postoperatively. For CAM-positive patients, delirium severity was then assessed using the Delirium Index (DI). Results In total, 123 subjects (LG, n = 60; OG, n = 63) were included in the analysis. In both groups, the overall incidences of postoperative delirium were similar: 31.6% (19/60) in the LG group and 41.2% (26/63) in the OG group. When considering only those with delirium, the severity, expressed as the highest DI score, was similar between the groups. A decline in cognitive function (reduction in MMSE ≥ 2 points from baseline) during 3 days postoperatively was observed in 23 patients in the LG group (38.3%) and 27 patients in the OG group (42.9%) (P = 0.744). In both groups, postoperative cognitive decline was significantly associated with postoperative delirium (P < 0.001). Conclusions We found that, compared with traditional open gastrectomy, laparoscopic gastrectomy did not reduce either postoperative delirium or cognitive decline in elderly patients with gastric cancer. PMID:26257851

  16. Untangling Performance from Success

    NASA Astrophysics Data System (ADS)

    Yucesoy, Burcu; Barabasi, Albert-Laszlo

    Fame, popularity and celebrity status, frequently used tokens of success, are often loosely related to, or even divorced from professional performance. This dichotomy is partly rooted in the difficulty to distinguish performance, an individual measure that captures the actions of a performer, from success, a collective measure that captures a community's reactions to these actions. Yet, finding the relationship between the two measures is essential for all areas that aim to objectively reward excellence, from science to business. Here we quantify the relationship between performance and success by focusing on tennis, an individual sport where the two quantities can be independently measured. We show that a predictive model, relying only on a tennis player's performance in tournaments, can accurately predict an athlete's popularity, both during a player's active years and after retirement. Hence the model establishes a direct link between performance and momentary popularity. The agreement between the performance-driven and observed popularity suggests that in most areas of human achievement exceptional visibility may be rooted in detectable performance measures. This research was supported by Air Force Office of Scientific Research (AFOSR) under agreement FA9550-15-1-0077.

  17. [Prevention of postoperative surgical site infections : Between tradition and evidence].

    PubMed

    Scheithauer, S; Artelt, T; Bauer, M; Waeschle, R M

    2016-05-01

    Postoperative wound infections represent a relevant complication of invasive interventions. Current European prevalence data show that for participating hospitals from Germany (n = 132) surgical site infections represent the most commonly occurring nosocomial infection with 24.3 %. This corresponds to a point prevalence of 1.31 %. It is assumed that approximately 25-33 % of all infections acquired in hospital could be prevented if all possible precautions would be taken. Recent studies have indicated that this rate might be even higher for individual infection entities. Infection control measures can be divided into general measures, which are valid for prevention in many fields and for many infection entities and into specific precautions related to hospital-specific circumstances or specific infection entities. In this article the various hygiene measures and recommendations are presented with respect to the level of evidence. PMID:27146286

  18. Postoperative small bowel obstruction in infants and children.

    PubMed Central

    Festen, C

    1982-01-01

    In the Pediatric Surgical Department of The St Radboud Hospital, Nijmegen, The Netherlands, between January 1970 and December 1980, 1476 laparotomies were performed on neonates, infants, and children. In 33 of these patient the abdominal surgery was complicated by a postoperative small bowel obstruction (SBO), for which a second laparotomy had to be performed. In 80% of patients this SBO developed within three months of the prior operation. The risk of developing an adhesive SBO was greater when there was more than one prior peritoneal procedure, and when, during this prior procedure, there was already a peritonitis. There was no obvious relation with the nature of the original operation. In more than 70% of patients a single adhesion caused the obstruction, while in many of these cases there were already circulatory disturbances, even by early reintervention. The mortality was 6%. PMID:7125744

  19. POSTOP: Postbuckled open-stiffener optimum panels, user's manual

    NASA Technical Reports Server (NTRS)

    Biggers, S. B.; Dickson, J. N.

    1984-01-01

    The computer program POSTOP developed to serve as an aid in the analysis and sizing of stiffened composite panels that may be loaded in the postbuckling regime, is intended for the preliminary design of metal or composite panels with open-section stiffeners, subjected to multiple combined biaxial compression (or tension), shear and normal pressure load cases. Longitudinal compression, however, is assumed to be the dominant loading. Temperature, initial bow eccentricity and load eccentricity effects are included. The panel geometry is assumed to be repetitive over several bays in the longitudinal (stiffener) direction as well as in the transverse direction. Analytical routines are included to compute panel stiffnesses, strains, local and panel buckling loads, and skin/stiffener interface stresses. The resulting program is applicable to stiffened panels as commonly used in fuselage, wing, or empennage structures. The capabilities and limitations of the code are described. Instructions required to use the program and several example problems are included.

  20. Assessment of patient pain in the postoperative context.

    PubMed

    Manias, Elizabeth; Bucknall, Tracey; Botti, Mari

    2004-11-01

    Because of its subjective nature, the assessment of pain requires the use of comprehensive practices that accurately reflect a patient's experiences of pain. The purpose of this study was to determine how nurses make decisions in their assessment of patients' pain in the postoperative clinical setting. An observational design was chosen as the means of examining pain activities in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were selected. Each 2-hour observation period was examined 12 times thus resulting in 74 observations. In total, 316 pain activities were determined. Five themes relating to assessment were identified from the data analysis: simple questioning, use of a pain scale, complex assessment, the lack of pain assessment, and physical examination for pain. The study identified how nurses' prioritization of work demands created barriers in conducting timely and comprehensive pain assessment decisions. PMID:15466612

  1. Pre-, Intra- and Post-Operative Imaging of Cochlear Implants.

    PubMed

    Vogl, T J; Tawfik, A; Emam, A; Naguib, N N N; Nour-Eldin, A; Burck, I; Stöver, T

    2015-11-01

    The purpose of this review is to present essential imaging aspects in patients who are candidates for a possible cochlear implant as well as in postsurgical follow-up. Imaging plays a major role in providing information on preinterventional topography, variations and possible infections. Preoperative imaging using DVT, CT, MRI or CT and MRI together is essential for candidate selection, planning of surgical approach and exclusion of contraindications like the complete absence of the cochlea or cochlear nerve, or infection. Relative contraindications are variations of the cochlea and vestibulum. Intraoperative imaging can be performed by fluoroscopy, mobile radiography or DVT. Postoperative imaging is regularly performed by conventional X-ray, DVT, or CT. In summary, radiological imaging has its essential role in the pre- and post-interventional period for patients who are candidates for cochlear implants. PMID:26327670

  2. Quality of sleep in postoperative surgical oncologic patients.

    PubMed

    Barichello, Elizabeth; Sawada, Namie Okino; Sonobe, Helena Megumi; Zago, Márcia Maria Fontão

    2009-01-01

    This study aimed to evaluate surgical-oncologic patients' quality of sleep through the Pittsburgh Sleep Quality Index (PSQI) questionnaire. It is an exploratory study with transversal-observational design, in 46 postoperative head & neck and urology cancer patients. The PSQI questionnaire was used to evaluate the subjective quality of sleep and the occurrence of sleep disorders. Six PSQI components were statistically significant and 78.3% of the interviewees had impaired subjective quality of sleep. Among factors leading to sleep disorders we point out: taking too long to fall asleep; waking up in the middle of the night; getting up to go to the bathroom and napping during the day. This study is expected to sensitize the nursing team regarding the need to investigate quality of sleep and causes of its disorders in cancer survivors for an effective course of action. PMID:19820854

  3. Postoperative Submandibular Gland Swelling following Craniotomy under General Anesthesia

    PubMed Central

    Nakanishi, Haruka; Tono, Tetsuya; Ibusuki, Shoichiro

    2015-01-01

    Objective. Reporting of a rare case of postoperative submandibular gland swelling following craniotomy. Case Report. A 33-year-old male underwent resection for a brain tumor under general anesthesia. The tumor was resected via a retrosigmoid suboccipital approach and the patient was placed in a lateral position with his face down and turned to the right. Slight swelling of the right submandibular gland was observed just after the surgery. Seven hours after surgery, edematous change around the submandibular gland worsened and he required emergent reintubation due to airway compromise. The cause of submandibular gland swelling seemed to be an obstruction of the salivary duct due to surgical positioning. Conclusion. Once submandibular swelling and edematous change around the submandibular gland occur, they can worsen and compromise the air way within several hours after operation. Adequate precaution must be taken for any predisposing skull-base surgery that requires strong cervical rotation and flexion. PMID:26697254

  4. Fournier's Gangrene as a Postoperative Complication of Inguinal Hernia Repair

    PubMed Central

    Dinc, Tolga; Kayilioglu, Selami Ilgaz; Sozen, Isa; Yildiz, Baris Dogu; Coskun, Faruk

    2014-01-01

    Fournier's gangrene is the necrotizing fasciitis of perianal, genitourinary, and perineal regions. Herein, we present a case of scrotal Fournier's gangrene as a postoperative complication of inguinal hernia repair. A 51-year-old male with giant indirect hernia is presented. Patient underwent inguinal hernia repair, and after an unproblematic recovery period, he was discharged. He applied to our outpatient clinic on the fifth day with swollen and painful scrotum and it turned out to be Fournier's gangrene. Polypropylene mesh was not infected. Patient recovered and was discharged after repeated debridements. Basic principles in treatment of Fournier's gangrene are comprised of initial resuscitation, broad-spectrum antibiotics therapy, and early aggressive debridement. In the management of presented case, aggressive debridement was made right after diagnosis and broad-spectrum antibiotics were given to the hemodynamically stable patient. In these circumstances, the important question is whether we could prevent occurrence of Fournier's gangrene. PMID:25506030

  5. Delayed aortic rupture resulting from postoperative superficial sternal wound infection

    PubMed Central

    Kim, Su Wan; Chang, Jee Won

    2016-01-01

    While deep sternal wound infection (DSWI) after cardiac surgery is a significant contributor to patient morbidity and mortality, superficial sternal wound infection (SSWI) mostly has a benign course. We report a mortality case of aortic rupture resulting from SSWI after cardiac surgery. A 50-year-old male underwent an aortic valve replacement (AVR). Three months after the valve operation, he presented with severe dyspnea, which had never before been observed, and chest computed tomography revealed an ascending aortic rupture with large hematoma compressing the main pulmonary artery. We performed an emergent operation for aortic rupture that possibly originated from the SSWI. Postoperatively, the patient died of hypovolemic shock due to recurrent aortic rupture despite efforts to resuscitate him. PMID:27499988

  6. Postoperative adjuvant radiotherapy for patients with gastric adenocarcinoma.

    PubMed

    Lim, Do Hoon

    2012-12-01

    In gastric adenocarcinoma, high rates of loco-regional recurrences have been reported even after complete resection, and various studies have been tried to find the role of postoperative adjuvant therapy. Among them, Intergroup 0116 trial was a landmark trial, and demonstrated the definite survival benefit in adjuvant chemoradiotherapy, compared with surgery alone. However, the INT 0116 trial had major limitation for global acceptance of the INT 0116 regimen as an adjuvant treatment modality because of the limited lymph node dissection. Lately, several randomized studies that were performed to patients with D2-dissected gastric cancer were published. This review summarizes the data about patterns of failure after surgical resection and the earlier prospective studies, including INT 0116 study. Author will introduce the latest studies, including ARTIST trial and discuss whether external beam radiotherapy should be applied to patients receiving extended lymph node dissection and adjuvant chemotherapy. PMID:23346491

  7. [Optimal Postoperative Pain Management After Tonsillectomy: An Unsolved Problem].

    PubMed

    Guntinas-Lichius, O; Geißler, K; Preußler, N-P; Meißner, W

    2016-01-01

    Tonsillectomy is one of the most painful surgical procedures. Unfortunately, it is not unusual that the patient hear statement like: "There is no way around" or "You receive already enough pain killers". Asking the anesthetist or the otorhinolaryngologist, one may get to hear: "Pain after tonsillectomy is not a real problem. We have a reliable pain management protocol". In contradiction, many clinical studies are showing that many patients have persistent and even severe pain after tonsillectomy despite postoperative pain therapy. Considering the results of many controlled clinical trials analyzing manifold varieties of pain management regimes it becomes obvious that there is no standard pain therapy after tonsillectomy with reliable proof of sufficient pain suppression. This review wants to give an overview on the current status of clinical research on pain measurement methods and pain management after tonsillectomy. PMID:26756653

  8. Postoperative cystoid macular oedema in a patient on fingolimod.

    PubMed

    Gaskin, Jennifer Chen-Chia Fan; Coote, Michael

    2015-01-01

    We describe the first case of fingolimod-associated bilateral cystoid macular oedema (CMO) following uncomplicated cataract surgery. A 57-year-old woman has been on fingolimod for the past 2 years for the treatment of relapsing-remitting multiple sclerosis. She underwent uneventful consecutive cataract surgery 2 weeks apart. Three weeks following the second cataract operation, she reported gradual-onset blurred vision bilaterally. Examination revealed mildly reduced visual acuity and bilateral CMO. Treatment with topical corticosteroids and non-steroidal anti-inflammatory eye drops, as well as cessation of fingolimod in collaboration with the neurologist, resulted in complete resolution of the CMO. Patients on fingolimod are likely to be at increased risk of developing postoperative CMO. PMID:25969500

  9. The role of epidural anesthesia and analgesia in postoperative outcome.

    PubMed

    Grass, J A

    2000-06-01

    There is increasing evidence to support the hypothesis that epidural anesthesia and analgesia (EAA) can improve surgical outcome by reducing postoperative morbidity and hastening recovery. Likely benefits include decreased incidence of cardiac complications in high-risk patients; lower incidence of pulmonary complications, specifically pneumonia, atelectasis, and hypoxemia in patients at risk for pulmonary complications; lower incidence of vascular graft occlusion after lower extremity revascularization; lower incidence of DVT and pulmonary embolus; suppression of the neuroendocrine stress response; and earlier return of gastrointestinal function. Nonetheless, large multicenter prospective randomized studies are required to more definitively assess the impact of EAA on morbidity and mortality, ICU time, length of hospitalization, and cost of healthcare. PMID:10935017

  10. Major postoperative complications and survival for colon cancer elderly patients

    PubMed Central

    2012-01-01

    Background Increased life expectancy has led to elevating the mean age of the patients at the time of diagnosis of colon cancer and subsequent treatment. Differences in complication rates and outcome between elderly and younger patients have been investigated. Methods We retrospectively analysed a database containing the information of patients who underwent surgery for stage I-III colorectal cancer from January 2004 to January 2012 at our institution and compared demographic, cancer-related, and outcomes data of 235 elderly patients with 211 patients ≤65 years old. Results Intraoperative complications did not differ between young and old patients whereas some differences have been found in postoperative and late complications: elderly patients suffered more by ileus (P = 0.024), peritonitis or septic shock (P = 0.017), pelvic abscess (P = 0.028), wound infection (P = 0.031), and incisional/port herniation (P = 0.012) compared with younger patients. Moreover, elderly patients suffered by systemic complications such as cardiovascular (4.7% vs. 1.4%, P = 0.049), renal (4.7% vs. 0.5%, P = 0.006), and respiratory (10.6% vs. 5.2%, P = 0.036). The multivariate analysis assessing the odds of having a complication revealed that older age (Odd Ratio [OR] 2.75, 95% Confidential Interval [CI]: 1.67-4.52) and open surgery (OR 1.63, 95% CI: 1.01-2.62) are significantly and independently associated with having a complication. Conclusions In our series, elderly patients have presented a slight higher incidence of comorbidities that may affect the incidence rates of postoperative complications. These results have implications in increasing the hospital stay as well as a higher rate of death. PMID:23173563

  11. Improved nephrostomy tube can reduce percutaneous nephrolithotomy postoperative bleeding

    PubMed Central

    He, Xiangfei; Xie, Donghua; Du, Chengtian; Zhu, Wenbin; Li, Wenzhi; Wang, Kai; Li, Yang; Lu, Hua; Guo, Fengfu

    2015-01-01

    Renal hemorrhage is one of the most common and worrisome complications of post-percutaneous nephrolithotomy (PCNL). This study aimed at evaluating the safety, effectiveness of utilization of the absorbable hemostatic gauze cover renal tract for hemorrhage of post-PCNL. The prospective study including 188 patients with upper urinary tract calculi was carried out in the department of Urology at Linyi People’s Hospital from November 2011 to September 2013. All patients underwent PCNL procedures and they were divided into two groups randomly before the procedure. Group A (n=91) was indwelled a 16F catheter as nephrostomy tube at the end of the surgery, Group B (n=97) was indwelled a 14F catheter covered with absorbable hemostatic gauze for hemostasis. Blood loss was estimated based on the mass of hemoglobin in the draining liquid and urine during postoperative duration by HiCN method. The average blood loss was 25.76±23.99 g for Group A, and 14.25±6.87 g for Group B, respectively, with statistical difference by comparison (P<0.05). The delta hemoglobin was 16.24±10.98 mmol/L for Group A, and 10.71±5.57 mmol/L for Group B, respectively, also with statistical difference by comparison (P<0.05). Nephrostomy channel applications of absorbable hemostatic gauze after PCNL can significantly reduce postoperative bleeding. Utilizing the absorbable hemostatic gauze for post-PCNL hemorrhage is safe, effective and feasible. PMID:26064336

  12. Attacking Postoperative Metastases using Perioperative Oncolytic Viruses and Viral Vaccines

    PubMed Central

    Tai, Lee-Hwa; Auer, Rebecca

    2014-01-01

    Surgical resection of solid primary malignancies is a mainstay of therapy for cancer patients. Despite being the most effective treatment for these tumors, cancer surgery has been associated with impaired metastatic clearance due to immunosuppression. In preclinical surgery models and human cancer patients, we and others have demonstrated a profound suppression of both natural killer (NK) and T cell function in the postoperative period and this plays a major role in the enhanced development of metastases following surgery. Oncolytic viruses (OV) were originally designed to selectively infect and replicate in tumors, with the primary objective of directly lysing cancer cells. It is becoming increasingly clear, however, that OV infection results in a profound inflammatory reaction within the tumor, initiating innate and adaptive immune responses against it that is critical for its therapeutic benefit. This anti-tumor immunity appears to be mediated predominantly by NK and cytotoxic T cells. In preclinical models, we found that preoperative OV prevents postoperative NK cell dysfunction and attenuates tumor dissemination. Due to theoretical safety concerns of administering live virus prior to surgery in cancer patients, we characterized safe, attenuated versions of OV, and viral vaccines that could stimulate NK cells and reduce metastases when administered in the perioperative period. In cancer patients, we observed that in vivo infusion with oncolytic vaccinia virus and ex vivo stimulation with viral vaccines promote NK cell activation. These preclinical studies provide a novel and clinically relevant setting for OV therapy. Our challenge is to identify safe and promising OV therapies that will activate NK and T cells in the perioperative period preventing the establishment of micrometastatic disease in cancer patients. PMID:25161958

  13. Optimized multisite ventricular pacing in postoperative single-ventricle patients.

    PubMed

    Havalad, Vinod; Cabreriza, Santos E; Cheung, Eva W; Aponte-Patel, Linda; Wang, Alice; Cheng, Bin; Wang, Daniel Y; Silver, Eric; Bacha, Emile A; Spotnitz, Henry M

    2014-10-01

    Ventricular dyssynchrony is associated with morbidity and mortality after palliation of a single ventricle. The authors hypothesized that resynchronization with optimized temporary multisite pacing postoperatively would be safe, feasible, and effective. Pacing was assessed in the intensive care unit within the first 24 h after surgery. Two unipolar atrial pacing leads and four bipolar ventricular pacing leads were placed at standardized sites intraoperatively. Pacing was optimized to maximize mean arterial pressure. The protocol tested 11 combinations of the 4 different ventricular lead sites, 6 atrioventricular delays (50-150 ms), and 14 intraventricular delays. Optimal pacing settings were thus determined and ultimately compared in four configurations: bipolar, unipolar, single-site atrioventricular pacing, and intrinsic rhythm. Each patient was his or her own control, and all pacing comparisons were implemented in random sequence. Single-ventricle palliation was performed for 17 children ages 0-21 years. Pacing increased mean arterial pressure (MAP) versus intrinsic rhythm, with the following configurations: bipolar multisite pacing increased MAP by 2.2 % (67.7 ± 2.4 to 69.2 ± 2.4 mmHg; p = 0.013) and unipolar multisite pacing increased MAP by 2.8 % (67.7 ± 2.4 to 69.6 ± 2.7 mmHg; p = 0.002). Atrioventricular single-site pacing increased MAP by 2.1 % (67.7 ± 2.4 to 69.1 ± 2.5 mmHg: p = 0.02, insignificant difference under Bonferroni correction). The echocardiographic fractional area change in nine patients increased significantly only with unipolar pacing (32 ± 3.1 to 36 ± 4.2 %; p = 0.02). No study-related adverse events occurred. Multisite pacing optimization is safe and feasible in the early postoperative period after single-ventricle palliation, with improvements in mean arterial pressure and fractional area shortening. Further study to evaluate clinical benefits is required. PMID:24827078

  14. Postoperative Speech Outcomes and Complications in Submucous Cleft Palate Patients

    PubMed Central

    Park, Tae Seo; Nam, Su Bong; Kang, Kyung Dong; Sung, Ji Yoon

    2016-01-01

    Background The postoperative speech outcomes of submucous cleft palate (SMCP) surgery are known to be poorer than those of other types of cleft palate. We attempted to objectively characterize the postoperative complications and speech outcomes of the surgical treatment of SMCP through a comparison with the outcomes of incomplete cleft palate (ICP). Methods This study included 53 SMCP patients and 285 ICP patients who underwent surgical repair from 1998 to 2015. The average age of the patients at the time of surgery was 3.9±1.9 years for the SMCP patients and 1.3±0.9 years for the ICP patients. A retrospective analysis was performed of the complications, the frequency of subsequent surgical correction for velopharyngeal dysfunction (VPD), and speech outcomes. Results In both the SMCP and ICP patients, no cases of respiratory difficulty, bleeding, or wound disruption were noted. Delayed wound healing and fistula occurred in 18.9% and 5.7% of the SMCP patients and in 14% and 3.2% of the ICP patients, respectively. However, no statistically significant difference in either delayed wound healing or fistula occurrence was observed between the two groups. The rate of surgical correction for VPD in the SMCP group was higher than in the ICP group. In the subset of 26 SMCP patients and 62 ICP patients who underwent speech evaluation, the median speech score value was 58.8 in the SMCP group and 66 in the ICP group, which was a statistically significant difference. Conclusions SMCP and ICP were found to have similar complication rates, but SMCP had significantly worse speech outcomes. PMID:27218023

  15. Effects of MIAVS on Early Postoperative ELWI and Respiratory Mechanics

    PubMed Central

    Li, Wei; Xue, Qian; Liu, Kai; Hong, Jiang; Xu, Jibin; Wu, Lihui; Ji, Guangyu; Wang, Zhinong; Zhang, Yufeng

    2016-01-01

    Background The effects of minimally invasive aortic valve surgery (MIAVS) on the early postoperative extravascular lung water index (ELWI) and respiratory mechanics have rarely been studied. Material/Methods A total of 90 patients were divided into 3 groups: a conventional full sternotomy (CS) group (n=30), an upper ministernotomy (US) group (n=30), and a right anterior thoracotomy (RT) group (n=30). Hemodynamic and respiratory mechanics parameters were recorded at perioperative time points, including before skin incision (T(−1)); at sternum closing (T0); and 4 h (T4), 8 h (T8), 12 h (T12), and 24 h (T24) after the operation. The ventilator support time, ICU length of stay, and postoperative hospitalization time, as well as the thoracic drainage volume and blood transfusion volume, were recorded. Results The ELWI and pulmonary vascular permeability index (PVPI) increased at T4, and the values were significantly lower in the US group than in the RT group and CS group (P<0.05). At T8, the ELWI and PVPI in the US group and RT group were significantly lower than in the CS group. At T12, there were no significant differences among the 3 groups. In addition, at T4 static lung compliance decreased, plateau airway pressure increased, and airway resistance changed non-significantly. There were no significant differences between the US group and the RT group, but both groups showed better results than the CS group did. Conclusions The ELWI and PVPI may transiently increase after aortic valve surgery with cardiopulmonary bypass. Compared with the 12 h required to recover from a conventional sternotomy operation, it may only take 8 h to recover from MIAVS. PMID:27036392

  16. Movement, Function, Pain, and Postoperative Edema in Axillary Web Syndrome

    PubMed Central

    Blaes, Anne H.; Haddad, Tuffia C.; Hunter, David W.; Hirsch, Alan T.; Ludewig, Paula M.

    2015-01-01

    Background Axillary web syndrome (AWS) is a condition that may develop following breast cancer surgery and that presents as a palpable axillary cord of tissue. Objective The purposes of this study were: (1) to determine the clinical characteristics of AWS related to movement, function, pain, and postoperative edema and (2) to define the incidence of and risk factors for AWS within the first 3 months following breast cancer surgery. Design This was a prospective cohort study with a repeated-measures design. Methods Women who underwent breast cancer surgery with sentinel node biopsy or axillary lymph node dissection (N=36) were assessed for AWS, shoulder range of motion, function, pain, and postoperative edema (using girth measurements, bioimpedance, and tissue dielectric constant) at 2, 4, and 12 weeks. Demographic characteristics were used for risk analysis. Results Seventeen women (47.2%) developed AWS, and AWS persisted in 10 participants (27.8%) at 12 weeks. Abduction range of motion was significantly lower in the AWS group compared with the non-AWS group at 2 and 4 weeks. There were no differences between groups in measurements of function, pain, or edema at any time point. Trunk edema measured by dielectric constant was present in both groups, with an incidence of 55%. Multivariate analysis determined lower body mass index as being significantly associated with AWS (odds ratio=0.86; 95% confidence interval=0.74, 1.00). Limitations Limitations included a short follow-up time and a small sample size. Conclusion Axillary web syndrome is prevalent following breast/axilla surgery for early-stage breast cancer and may persist beyond 12 weeks. The early consequences include movement restriction, but the long-term effects of persistent AWS cords are yet unknown. Low body mass index is considered a risk factor for AWS. PMID:25977305

  17. Avoiding Opioids and Their Harmful Side Effects in the Postoperative Patient: Exogenous Opioids, Endogenous Endorphins, Wellness, Mood, and Their Relation to Postoperative Pain.

    PubMed

    Stephan, Bradley C; Parsa, Fereydoun D

    2016-03-01

    Prescribed opioids are routinely used for many postoperative patients. However, these medications have daunting adverse effects on the body's innate pain management system - the action of the beta-endorphins. The prescribed opioids not only severely impair the function of the mu-opioid receptors, but also inhibit the release of beta-endorphin. This is unfortunate, because beta-endorphin appears to be a much more potent agonist of the mu-opioid receptor than opioids. In addition, beta-endorphin indirectly elevates dopamine, a neurotransmitter related to feelings of euphoria. Therefore, by prescribing opioids, practitioners may inadvertently prolong and increase the overall intensity of the postoperative patients' pain as well as herald anhedonia. This article highlights the relationships between prescribed (exogenous) opioids, beta-endorphins, mu-opioid receptors, wellness, mood, and postoperative pain. The role of patient education, opioid alternatives, and additional recommendations regarding pain control in the postoperative patient are also discussed. PMID:27011886

  18. Avoiding Opioids and Their Harmful Side Effects in the Postoperative Patient: Exogenous Opioids, Endogenous Endorphins, Wellness, Mood, and Their Relation to Postoperative Pain

    PubMed Central

    Parsa, Fereydoun D

    2016-01-01

    Prescribed opioids are routinely used for many postoperative patients. However, these medications have daunting adverse effects on the body's innate pain management system - the action of the beta-endorphins. The prescribed opioids not only severely impair the function of the mu-opioid receptors, but also inhibit the release of beta-endorphin. This is unfortunate, because beta-endorphin appears to be a much more potent agonist of the mu-opioid receptor than opioids. In addition, beta-endorphin indirectly elevates dopamine, a neurotransmitter related to feelings of euphoria. Therefore, by prescribing opioids, practitioners may inadvertently prolong and increase the overall intensity of the postoperative patients' pain as well as herald anhedonia. This article highlights the relationships between prescribed (exogenous) opioids, beta-endorphins, mu-opioid receptors, wellness, mood, and postoperative pain. The role of patient education, opioid alternatives, and additional recommendations regarding pain control in the postoperative patient are also discussed. PMID:27011886

  19. Loss in mechanical contact of cementless acetabular prostheses due to post-operative weight bearing: a biomechanical model.

    PubMed

    Bellini, Chiara Maria; Galbusera, Fabio; Ceroni, Roberto Giacometti; Raimondi, Manuela Teresa

    2007-03-01

    The primary stability of cementless acetabular components is a prerequisite for their clinical success. The target of the present study was to analyse possible effects of post-operative joint loading on the initial mechanical stability of a press-fitted acetabular prosthesis. For this purpose, a three-dimensional finite element model of the pelvic bone with acetabular reconstruction was set-up. The analysis included two steps: (1) simulation of the prosthesis press-fit implantation and (2) simulation of the instant of peak resultant hip loading during the one-legged stance. The difference between the contact pressures at the bone/implant interface, at the end of the second step and those at the end of the first step was calculated and assumed as an index of variation in mechanical contact due to post-operative weight bearing. The results show that, due to hip loading, contact pressures given by press-fit increase in the postero-superior acetabular region but decrease in the antero-inferior acetabular region. The calculated area in which the contact pressures decrease extend to about 30% of the total contact surface. These results imply that post-operative joint loading significantly reduces the mechanical stability given by press-fit. The decrease in contact pressures at the bone/implant interface may result in a lack of osteointegration, possibly hindering the implant secondary stability. It may also create a route for wear debris, possibly favouring periprosthetic osteolysis, which may lead to further loss in contact and clinical failure of the implant due to loosening. PMID:16569508

  20. Local anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a randomized trial.

    PubMed

    Sanchez, Barry; Waxman, Kenneth; Tatevossian, Raymond; Gamberdella, Marla; Read, Bruce

    2004-11-01

    Pain after an open inguinal hernia repair may be significant. In fact, some surgeons feel that the pain after open repair justifies a laparoscopic approach. The purpose of this study was to determine if the use of local anesthetic infusion pumps would reduce postoperative pain after open inguinal hernia repair. We performed a prospective, double-blind randomized study of 45 open plug and patch inguinal hernia repairs. Patients were randomized to receive either 0.25 per cent bupivicaine or saline solution via an elastomeric infusion pump (ON-Q) for 48 hours, at 2 cc/h. The catheters were placed in the subcutaneous tissue and removed on postoperative day 3. Both groups were prescribed hydrocodone to use in the postoperative period at the prescribed dosage as needed for pain. Interviews were conducted on postoperative days 3 and 7, and patient's questionnaires, including pain scores, amount of pain medicine used, and any complications, were collected accordingly. During the first 5 postoperative days, postoperative pain was assessed using a visual analog scale. Twenty-three repairs were randomized to the bupivicaine group and 22 repairs randomized to the placebo group. In the bupivicaine group, there was a significant decrease in postoperative pain on postoperative days 2 through 5 with P values <0.05. This significant difference continued through postoperative day 5, 2 days after the infusion pumps were removed. Patients who had bupivicaine instilled in their infusion pump had statistically significant lower subjective pain scores on postoperative days 2 through 5. This significant difference continued even after the infusion pumps were removed. Local anesthetic infusion pumps significantly decreased the amount of early postoperative pain. Pain relief persisted for 2 days after catheter and pump removal. PMID:15586515

  1. Successful product realization strategies

    NASA Astrophysics Data System (ADS)

    Peeples, John; Boulton, William R.

    1995-02-01

    Product realization is the process of defining, designing, developing, and delivering products to the market. While the main thrust of this JTEC panel was to conduct a complete investigation of the state of Japanese low-cost electronic packaging technologies, it is very difficult to totally separate the development of technology and products from the product realization process. Japan's electronics firms adhere to a product realization strategy based on a strong customer focus, a consistent commitment to excellence in design, and a cost-effective approach to technology commercialization. The Japanese product-pull strategy has been a successful driver and influencing factor in every aspect of the product development cycle.

  2. Successful product realization strategies

    NASA Technical Reports Server (NTRS)

    Peeples, John; Boulton, William R.

    1995-01-01

    Product realization is the process of defining, designing, developing, and delivering products to the market. While the main thrust of this JTEC panel was to conduct a complete investigation of the state of Japanese low-cost electronic packaging technologies, it is very difficult to totally separate the development of technology and products from the product realization process. Japan's electronics firms adhere to a product realization strategy based on a strong customer focus, a consistent commitment to excellence in design, and a cost-effective approach to technology commercialization. The Japanese product-pull strategy has been a successful driver and influencing factor in every aspect of the product development cycle.

  3. The Success-Breeds-Success Phenomenon and Bibliometric Processes.

    ERIC Educational Resources Information Center

    Tague, Jean

    1981-01-01

    Describes success-breeds-success phenomenon by single and multiple-urn models, and shows that these models lead to a negative binomial distribution for the total number of successes and to a Zipf-Mandelbrot law for the number of sources contributing a specified number of successes. Ten references are cited. (FM)

  4. A Case Report of Idiopathic Systemic Capillary Leak Syndrome That Occurred During the Postoperative Period of Abdominoperineal Resection for Colorectal Cancer

    PubMed Central

    Ozawa, Tsuyoshi; Yamaguchi, Hironori; Kiyomatsu, Tomomichi; Saito, Shinsuke; Ishihara, Soichiro; Sunami, Eiji; Kitayama, Joji; Watanabe, Toshiaki

    2015-01-01

    A 57-year-old woman without any past medical history underwent abdominoperineal resection for rectal cancer in our department. On postoperative day 15, the patient complained of sudden abdominal pain, and high fever was noted in addition to the appearance of erythema around the stoma. The diagnosis of phlegmon was made, and antibiotic infusion was started. However, a few days later, the patient developed hypovolemic shock with hypoalbuminemia and hemoconcentration. Fasciotomy was performed to exclude the necrotizing fasciitis, though all cultures were negative. Upon exclusion of the differential diagnoses, idiopathic systemic capillary leak syndrome (ISCLS) was diagnosed. She was successfully treated with massive fluid infusion under ventilation and continuous hemodiafiltration. Here, we report the first case of ISCLS that occurred during the postoperative period of colorectal surgery. PMID:25594640

  5. Achieving success with the silicone expander for overacting superior obliques.

    PubMed Central

    Pollard, Z F; Greenberg, M

    1999-01-01

    PURPOSE: To report the results of and complications with silicone expander surgery for the overacting superior oblique. METHODS: A total of 26 patients with bilateral overaction of the superior oblique and A-pattern strabismus and 5 patients with unilateral overacting superior oblique secondary to inferior oblique palsy were treated with a 7 mm silicone expander. Care was taken not to enter the sub-Tenon's space. RESULTS: The group that underwent bilateral superior oblique surgery had an average preoperative pattern of 37.42 diopters (D) and an average correction of 35.37 D. Three patients had a severe unilateral postoperative inflammatory incident that was successfully treated with oral and topical corticosteroids. One of these patient developed Brown's syndrome. Another patient, who had no postoperative inflammatory incident, also developed Brown's syndrome. In these 4 patients, the sub-Tenon's space was inadvertently entered during surgery. CONCLUSION: The silicone expander surgery has a very high success rate in treating the A-pattern associated with the bilateral overacting superior oblique. This procedure also works well for the unilateral superior oblique that overacts owing to an inferior oblique palsy. No cyclotorsion symptoms occurred after this surgery. However, 4 patients had complications because the sub-Tenon's space was exposed during surgery. With this procedure, there is a learning curve to obtain the skill not to enter the sub-Tenon's space. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 PMID:10703132

  6. [The postoperative care and treatment in esophageal cancer (4). Postoperative follow up-(recurrence, nutritional management and after-care of IC)].

    PubMed

    Ide, H; Nakamura, H; Ohota, M; Tanigawa, K; Kobayashi, A; Yoshida, K; Hayashi, K; Nakamura, T; Eguchi, R

    1996-06-01

    The points of the postoperative care in radical operation of esophageal cancer are followings. 1) Postoperative nutritional management: In the reconstruction using gastric tube, we make Witzel's gastrostomy in antrum of regardless of the reconstructive routes and transfer to enteral tube-feeding to assist the oral food-taking amount. These management is not only attributing to assist early return to working but also effective to prevent the loss of postoperative physical strength in older patients. 2) Postoperative adjuvant therapy: The esophageal cancer is the diseases that react chemo- and radio-therapy, so most of advanced cases were treated with adjuvant therapy. Nowadays, it is essential for patients to explain the real diagnosis, treatment regimen, then to agree to the informed concent. After informed, the tender mental consult during treatment and outpatient service is required for mental burden. 3) Postoperative follow-up: The recognition of postoperative QOL, early detection of recurrence are mostly emphasized during 2 years after operation. The occurrence of secondary cancer (gastric cancer, cervico-pharyngeal cancer, colorectal cancer etc.) are seen in even 5-10 years after operation. Then the long-term periodical examination and life care are needed. PMID:8774815

  7. Teaching a Machine to Feel Postoperative Pain: Combining High-Dimensional Clinical Data with Machine Learning Algorithms to Forecast Acute Postoperative Pain

    PubMed Central

    Tighe, Patrick J.; Harle, Christopher A.; Hurley, Robert W.; Aytug, Haldun; Boezaart, Andre P.; Fillingim, Roger B.

    2015-01-01

    Background Given their ability to process highly dimensional datasets with hundreds of variables, machine learning algorithms may offer one solution to the vexing challenge of predicting postoperative pain. Methods Here, we report on the application of machine learning algorithms to predict postoperative pain outcomes in a retrospective cohort of 8071 surgical patients using 796 clinical variables. Five algorithms were compared in terms of their ability to forecast moderate to severe postoperative pain: Least Absolute Shrinkage and Selection Operator (LASSO), gradient-boosted decision tree, support vector machine, neural network, and k-nearest neighbor, with logistic regression included for baseline comparison. Results In forecasting moderate to severe postoperative pain for postoperative day (POD) 1, the LASSO algorithm, using all 796 variables, had the highest accuracy with an area under the receiver-operating curve (ROC) of 0.704. Next, the gradient-boosted decision tree had an ROC of 0.665 and the k-nearest neighbor algorithm had an ROC of 0.643. For POD 3, the LASSO algorithm, using all variables, again had the highest accuracy, with an ROC of 0.727. Logistic regression had a lower ROC of 0.5 for predicting pain outcomes on POD 1 and 3. Conclusions Machine learning algorithms, when combined with complex and heterogeneous data from electronic medical record systems, can forecast acute postoperative pain outcomes with accuracies similar to methods that rely only on variables specifically collected for pain outcome prediction. PMID:26031220

  8. Special needle over cannula for postoperative analgesia in geriatric lower extremity joint arthroplasty

    PubMed Central

    Yu, Bin; Zou, Tianxiao; He, Miao; Xie, Shuqi; Zhang, Yuwen; Jin, Guangyu; Ruan, Lei; Zhang, Xiaoqing

    2015-01-01

    Objective: To investigate superiorities of a special needle-over-cannula adopting different location methods for continuous femoral nerve block (CFNB) for geriatric lower extremity joint arthroplasty. Methods: 60 elderly patients intending to receive scheduled knee or hip replacement surgery were recruited and divided into 3 groups randomly. Group 1 (n=20) adopted fascial pop for continuous femoral nerve block and postoperative analgesia with indwelling cannula. Group 2 (n=20) adopted location guided by B ultrasound, and Group 3 (n=20) adopted fascial pop combined with B ultrasound. Results: There was significant difference in the performing time of cannula indwelling on average between each two groups (P<0.01). There was no significant difference among three groups about visual analogue scale (VAS) score, Ramsay sedation score (RSS), incidence of nausea and vomit, or patient’s satisfaction at 6, 12, 24 and 48 h. Infection at the puncture site, toxic reaction of local anesthetics and respiratory depression were absent during the cannula indwelling. All the patients did not receive any other analgesic, and the indwelling time of external cannula was 45.3 hours on average. There was only one patient in group 2 who felt mild pains in front of the thigh after removing the indwelling cannula. No stolidity or other abnormal symptom was found among the remaining patients. Conclusions: Shorter indwelling cannula time and higher success rate of single attempt placement suggest that fascial pop combined ultrasound guidance is worth for clinical recommendation. PMID:26064292

  9. Postoperative hospital course of patients with history of severe psychiatric illness.

    PubMed

    Solomon, S; McCartney, J R; Saravay, S M; Katz, E

    1987-09-01

    The postoperative hospital course of 54 patients with a past history of psychiatric illness was studied through chart review. Both chronic schizophrenics and chronic depressives tolerated surgical procedures well, without any unusual difficulties or exacerbation of psychiatric illness. They represented no management problems. Patients with acute, severe upset in the preoperative period (regardless of diagnosis) presented most of the management problems postoperatively. PMID:3678811

  10. Intraoperative cerebral high intensity transient signals and postoperative cognitive function: a systematic review

    PubMed Central

    Martin, Kristin K; Wigginton, Jeremy B.; Babikian, Viken L; Pochay, Val E.; Crittenden, Michael D.; Rudolph, James L.

    2009-01-01

    Summary Microemboli during surgery have been hypothesized to cause postoperative cognitive changes. The purpose of this article was to systematically review the available literature related to intraoperative microemboli, measured with transcranial Doppler ultrasound and postoperative cognitive function. The literature remains largely undecided on the role of microemboli and cognitive impairment after surgery, because most studies underpowered to show a relationship. PMID:18723157

  11. The Importance of Pre and Postoperative Physical Activity Counseling in Bariatric Surgery

    PubMed Central

    King, Wendy C; Bond, Dale S

    2012-01-01

    There is increasing evidence that physical activity (PA) can enhance weight loss and other outcomes after bariatric surgery. However, most preoperative patients are insufficiently active, and without support, fail to make substantial increases in their PA postoperatively. This review provides the rationale for PA counseling in bariatric surgery and describes how to appropriately tailor strategies to pre- and postoperative patients. PMID:22710705

  12. The role of nitric oxide synthase in post-operative hyperglycaemia.

    PubMed

    Qader, Ss

    2008-01-01

    Post-operative hyperglycaemia is important with regard to outcomes of surgical operations. It affects post-operative morbidity, length of hospital stay, and mortality. Poor peri-operative blood glucose control leads to a higher risk of post-operative complication. Insulin resistance as a cause of post-operative hyperglycaemia has been blamed for some time. Nitric Oxide (NO) is produced by nitric oxide synthase (NOS) isoenzymes. Inducible nitric oxide synthase (iNOS) is not a normal cellular constitute. It is expressed by cytokines and non-cytokines e.g. fasting, trauma, intravenous glucose, and lipid infusion, which are encountered in surgical operations. Review of current published data on postoperative hyperglycaemia was completed. Our studies and others were explored for the possible role of NO in this scenario. Induction and expression of iNOS enzyme in pancreatic islet cells is included in the chaotic postoperative blood glucose control. The high concentrations of iNOS derived NO are toxic to pancreatic β-cells and may inhibit insulin secretion postoperatively. Hence, current peri-operative management is questionable regarding post-operative hyperglycaemia and necessitates development of a new strategy. PMID:21516149

  13. Comparative study between paracetamol and two different doses of pregabalin on postoperative pain in laparoscopic cholecystectomy

    PubMed Central

    Esmat, Ibrahim M.; Farag, Hanan M.

    2015-01-01

    Background: Postoperative pain is the primary reason for prolonged hospital stay after laparoscopic cholecystectomy. This study compared the effect of a single oral preoperative administration of paracetamol (1 g) with 2 different doses of pregabalin (150 or 300 mg) for attenuating postoperative pain and analgesic consumption. Materials and Methods: Seventy-five patients, aged 18-60 years, American Society of Anesthesiologists’ physical status I and II undergoing elective laparoscopic cholecystectomy were included in this randomized controlled study. Patients were divided into three groups, 25 each to receive either oral paracetamol 1 g (group I, control group) or pregabalin 150 (group II) or 300 mg (group III), 2 h before surgery. Postoperative pain was evaluated based on visual analog scale over a period of 6 h and 1st time for rescue analgesia. Postoperative sedation, hemodynamic changes, serum cortisol level, and side effects were also evaluated. Results: There was a significant decrease in mean heart rate, mean systolic blood pressure, sedation score, pain score, and delayed the first request for analgesics postoperatively in group (II) and group (III) compared to group (I) 2 h postoperatively. There was no significant difference in group (III) compared to group (II) postoperatively. The incidence of postoperative side effects was more in group (III). Conclusion: The single oral preoperative dose administration of pregabalin had significant opioid-sparing effect in the first 6 h after surgery, whereas side effects were more common with administration of pregabalin 300 mg. PMID:26543452

  14. A case of adolescent giant parathyroid adenoma presenting multiple osteolytic fractures and postoperative hungry bone syndrome

    PubMed Central

    Ebina, Kosuke; Miyoshi, Yuji; Izumi, Shinji; Hashimoto, Jun; Naka, Norifumi; Tsukamoto, Yasunori; Kashii, Masafumi; Kaito, Takashi; Yoshikawa, Hideki

    2015-01-01

    Key Clinical Message Primary hyperparathyroidism (PHPT) and postoperative hungry bone syndrome are very rare conditions in adolescents, and may be frequently misdiagnosed as a metastatic bone tumor. However, delay in diagnosis may lead to a fatal preoperative hypercalcemia and postoperative hypocalcemia. PHPT is a differential diagnosis of adolescent hypercalcemia and osteolytic fractures. PMID:26509019

  15. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair

    PubMed Central

    Venkatraman, Rajagopalan; Abhinaya, Ranganathan Jothi; Sakthivel, Ayyanar; Sivarajan, Govindarajan

    2016-01-01

    Background and aim Transversus abdominis plane block (TAP block) is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. Materials and methods Sixty patients scheduled for elective inguinal hernia repair were selected for the study. At the end of the surgical procedure, they were randomly divided into two groups. Ultrasound-guided TAP block was performed with 20 mL of ropivacaine 0.2% (group A) or normal saline (group B). Visual analog scale (VAS) scores were used to assess pain. Paracetamol was given if VAS > 3 and tramadol was used when VAS > 6. Patients were monitored for VAS scores and total analgesic consumption for the 24-hour period. Results The TAP block with ropivacaine (group A) reduced VAS scores at 4, 6, and 12 hours. There was no distinction in VAS scores at 0, 2, and 24 hours between the two groups. The duration of analgesia for TAP block with ropivacaine lasted for 390 minutes. Total analgesics consumption was also significantly reduced in group A than group B. No complication was reported to TAP block in both the groups. Conclusion The ultrasound-guided TAP block provides good postoperative analgesia, reduces analgesic requirements, and provides good VAS scores with fewer complications following inguinal hernia surgery. PMID:26848274

  16. Postoperative discal cyst: An unusual complication after microendoscopic discectomy in teenagers.

    PubMed

    Jha, Subash C; Tonogai, Ichiro; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Goda, Yuichiro; Abe, Mitsunobu; Nagamachi, Akihiro; Fukuta, Shoji; Sairyo, Koichi

    2016-02-01

    Various complications after microendoscopic discectomy (MED) are well known, but postoperative discal cyst is a unique and relatively unknown complication. Here, we report on two teenage patients who presented with postoperative discal cyst after MED for herniated nucleus pulposus (HNP), which resolved after conservative treatment. The patients were diagnosed with HNP at L4-5 and L5-S1 based on MRI and then treated by MED. Postoperative discal cyst was diagnosed on MRI after recurrence of symptoms. Both patients were managed conservatively. T2-weighted MRI demonstrated hyperintense collections adjacent to the operated intervertebral disc level, which were communicating with the corresponding disc annulus. Because the clinical symptoms were relatively mild, the patients were managed conservatively; both made a complete clinical recovery with radiological evidence of improvement. Postoperative discal cyst is a relatively unknown complication after MED for HNP. Surgeons should be aware of this postoperative complication when operating on young individuals with HNP. PMID:26781537

  17. CLINICAL ASPECTS OF ACUTE POST-OPERATIVE PAIN MANAGEMENT & ITS ASSESSMENT

    PubMed Central

    Gupta, Anuj; Kaur, Kirtipal; Sharma, Sheeshpal; Goyal, Shubham; Arora, Saahil; Murthy, R.S.R

    2010-01-01

    Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system. PMID:22247838

  18. Jordanian nurses' roles in the management of postoperative pain in the postanesthesia care unit.

    PubMed

    al-Hassan, M; Alkhalil, M S; al Ma'aitah, R

    1999-12-01

    One of the most important patient care issues for nurses is pain because of its significant impact on patients' well-being. Therefore, the main purpose of this exploratory study was to describe the role of Jordanian nurses in the management of postoperative pain in the PACU. A convenience sample of 42 postoperative patients was included in this study. Forty-two nurse-patient encounters involving 20 different nurses were observed during data collection. Findings from this study indicated that nurses in Jordan pay little attention to the area of assessment and management of postoperative pain. Cultural issues were discussed in light of the perception of pain and management of postoperative pain among Jordanian patients. Recommendations related to nursing practice, education, and research were developed to improve the quality of nursing care provided to postoperative patients in Jordan. PMID:10839078

  19. Nursing postoperative visit as a quality indicator for surgical patient care.

    PubMed

    Silva, R; Martins, M M; Jardim, H G

    2016-06-01

    The postoperative visit as a quality indicator for surgical patient care, demands some consideration from perioperative nurses. We evaluated the nursing perioperative interventions on postoperative visits, and adjusted them to the needs of the patients with postoperative pain. Our study indicated that 73% of patients visited didn't have postoperative pain whereas 27% had pain. The pain is aggravated when the patient is mobilised, one of the most common signs and symptoms being gastrointestinal changes. Pharmacological and non-pharmacological measures were used in pain management. The results showed that the percentage of patients with postoperative visits needs to be improved. We aim to have high quality perioperative nursing interventions which raise levels of patient satisfaction. PMID:27498440

  20. Bench-to-bedside review: Routine postoperative use of the nasogastric tube – utility or futility?

    PubMed Central

    Tanguy, Michèle; Seguin, Philippe; Mallédant, Yannick

    2007-01-01

    This article provides a summary of current information on rational postoperative use of the nasogastric tube, based on a review of literature related to postoperative gastrointestinal discomfort and management with the nasogastric tube. Routine gastric decompression after major surgery neither hastens the return of bowel function nor diminishes the incidence of postoperative nausea and vomiting. The multimodal postoperative rehabilitation programme is a modern and more efficient approach. Omission of nasogastric tube decompression does not increase the incidence of anastomotic leakage or wound dehiscence. Conversely, early enteral feeding is feasible and safe, favours local immunity and gut integrity, and improves nutritional status. With the objective to feeding, nasogastric tube could be used in selected patients. To conclude, use of the nasogastric tube to prevent or limit postoperative gastrointestinal discomfort must be challenged. In contrast to gastric decompression, early gastric feeding must be considered within the new concept of fast track surgery. PMID:17214909

  1. Postoperative analgesia following total hip replacement: a comparison of intrathecal morphine and diamorphine.

    PubMed Central

    Fogarty, D J; Milligan, K R

    1995-01-01

    Sixty patients undergoing elective total hip replacement under spinal anaesthesia were randomly assigned to receive either intrathecal (IT) diamorphine 0.75 mg (n = 30) or IT morphine 1.0 mg (n = 30). Postoperative pain scores, analgesic requirements and side effects were assessed by a blinded observer. Postoperative pain scores were broadly similar and satisfactory for both groups but the amount of additional IV morphine required to achieve this was significantly reduced in the morphine compared with the diamorphine group (P < 0.05). Twelve of the morphine group required no postoperative analgesics compared with four in the diamorphine group (P < 0.02). There were no differences between the groups in the incidence of side effects such as emesis and pruritus. No significant postoperative respiratory depression was noted. In the doses used intrathecal morphine provided superior postoperative analgesia to that of intrathecal diamorphine. PMID:7769597

  2. Prediction of Post-Operative Liver Dysfunction by Serum Markers of Liver Fibrosis in Hepatocellular Carcinoma

    PubMed Central

    Shen, Yinghao; Shi, Guoming; Huang, Cheng; Zhu, Xiaodong; Chen, Si; Sun, Huichuan; Zhou, Jian; Fan, Jia

    2015-01-01

    Aim To investigate the role of biomarkers in predicting postoperative liver dysfunction in patients with hepatocellular carcinoma (HCC). Methods A total of 200 patients operated from July 2009 to June 2010 at Zhongshan Hospital, Fudan University for pathologically confirmed HCC were retrospectively analyzed for clinical data, HBD DNA level and serum biochemical markers for liver fibrosis. The patients were followed up to observersation end point. Correlation of the monitored parameters with postoperative liver dysfunction and patient survival was statistically analyzed. Results Preoperative hepatitis B virus (HBV) DNA level, serum prealbumin (PA) hyaluronic acid (HA), and laminin (LN) levels correlated with postoperative liver dysfunction. A predictive model was generated using these 4 parameters and validated in 89 HCC patients with sensitivity and specificity of 0.625 and 0.912, respectively. However, no correlation was identified between postoperative liver function and overall survival. Conclusion Liver fibrosis markers could be preoperatively used in predicting postoperative liver dysfunction in HCC patients. PMID:26501145

  3. Successfully reforming orthopaedic outpatients.

    PubMed

    Schoch, Peter A; Adair, Lisa

    2012-05-01

    Since 2005, Barwon Health has successfully reformed its orthopaedic outpatient service to address the following issues: increasing number of referrals, inefficient referral management and triage, long waiting times for non-urgent appointments, high 'Did Not Attend' (DNA) rates and poor utilisation of conservative therapies before referral to surgeon. Numerous strategies have been implemented including: waiting list audits, triage guidelines, physiotherapy-led clinics, a DNA policy, an orthopaedic lead nurse role and a patient-focussed booking system. There has been a 66% reduction in the number of patients waiting for their first appointment; an 87% reduction in the waiting time from referral to first appointment; a 10% reduction in new patient DNAs; and more efficient referral management and communication processes. Patients are now seen in clinically appropriate time frames and offered earlier access to a wider range of conservative treatments. PMID:22624648

  4. Partnering for success.

    PubMed

    Gookin, L B

    1996-01-01

    Almost every health care journal or newsletter I pick up has at least one article about the changes occurring in the health care delivery system. The changes for providers in all settings are enormous as we downsize, rightsize, merge, or simply change to meet the demands of managed care. The bottom line is that hospitals are shrinking and health care is moving into the outpatient and community environment. Those of us who are providers in any of these settings must respond rapidly to the changes, which are having a profound impact on the practice of nursing today that will continue into the future. Are nursing educators prepared to respond as quickly as providers to the environmental changes, and are they prepared to make the necessary curriculum changes to prepare students for their future profession? It seems more critical than ever for providers and educators to partner to successfully meet the current and future demands of the nursing profession. PMID:9157919

  5. Fluoridation: strategies for success.

    PubMed

    Isman, R

    1981-07-01

    Of 19 referenda on community water fluoridation held in the first six months of 1980, 17 were defeated. Among the postulated reasons are a growing distrust of government and the health establishment. The public remains largely ignorant of the purpose and benefits of fluoridation. The emotionalism surrounding the issue has made it difficult to generate public support outside of the health professions. Opponents have also learned to fight fluoridation with increasingly sophisticated techniques. Some of the strategies used in recent successful campaigns in Oakland, California, and Portland, Oregon are described; recommendations that can be applied to communities considering fluoridation include careful wording of ballot measures so they are unequivocally clear and simple; timing ballot measures with elections likely to draw the largest voter turnout; broadening the base of political and financial support; using a figurehead if possible; and making maximum use of the media. PMID:7246838

  6. Predicting scheduling success

    NASA Technical Reports Server (NTRS)

    Messing, Fredric

    1993-01-01

    This paper provides an analytical formulation to predict scheduling success for a class of problems frequently referred to as activity scheduling. Space Network communications scheduling is an example of activity scheduling. The principal assumption is that the activity start times are randomly distributed over the available time in the time line. The formulation makes it possible to estimate how much of the demand can be scheduled as a function of the demand, number of resources, activity duration, and activity flexibility. The paper includes computed results for a variety of resource and demand conditions. The results demonstrate that even with highly flexible activities, it is difficult to schedule demand greater than 60 percent of resources without the use of optimization and conflict resolution capabilities in the scheduling system.

  7. A metric for success

    NASA Astrophysics Data System (ADS)

    Carver, Gary P.

    1994-05-01

    The federal agencies are working with industry to ease adoption of the metric system. The goal is to help U.S. industry compete more successfully in the global marketplace, increase exports, and create new jobs. The strategy is to use federal procurement, financial assistance, and other business-related activities to encourage voluntary conversion. Based upon the positive experiences of firms and industries that have converted, federal agencies have concluded that metric use will yield long-term benefits that are beyond any one-time costs or inconveniences. It may be time for additional steps to move the Nation out of its dual-system comfort zone and continue to progress toward metrication. This report includes 'Metric Highlights in U.S. History'.

  8. NEWS: Successfully communicating physics

    NASA Astrophysics Data System (ADS)

    2000-11-01

    Congratulations to winners of the Institute of Physics' Public Awareness of Physics awards. Among this year's recipients is a team from the physics department at the University of York. Professor Jim Matthew with Sarah Thompson, Peter Main and Mat Hill have been performing a dialogue `Is Science Chaotic' for over ten years, performing on over 50 occasions to a wide variety of audiences. The current performance features Sarah as a young experimentalist debating, arguing and joking with an older `sceptic' (Jim Matthew) over the ability of science to make predictions. What makes the presentation so successful and popular? Sarah's view is that `Our audiences like the jokes, the arguing and the demonstrations: it's different and it's amusing.' But there has to be some good science behind the show: `you can tell from the questions that people are disturbed by the range of science affected by chaos', she adds.

  9. Iridium: failures & successes

    NASA Astrophysics Data System (ADS)

    Christensen, CarissaBryce; Beard, Suzette

    2001-03-01

    This paper will provide an overview of the Iridium business venture in terms of the challenges faced, the successes achieved, and the causes of the ultimate failure of the venture — bankruptcy and system de-orbit. The paper will address technical, business, and policy issues. The intent of the paper is to provide a balanced and accurate overview of the Iridium experience, to aid future decision-making by policy makers, the business community, and technical experts. Key topics will include the history of the program, the objectives and decision-making of Motorola, the market research and analysis conducted, partnering strategies and their impact, consumer equipment availability, and technical issues — target performance, performance achieved, technical accomplishments, and expected and unexpected technical challenges. The paper will use as sources trade media and business articles on the Iridium program, technical papers and conference presentations, Wall Street analyst's reports, and, where possible, interviews with participants and close observers.

  10. Safety of undiluted intracameral moxifloxacin without postoperative topical antibiotics in cataract surgery.

    PubMed

    Zhou, Andrew Xingyu; Messenger, Wyatt Boyer; Sargent, Steven; Ambati, Balamurali Krishna

    2016-08-01

    The objective of this study is to evaluate the safety of undiluted 0.5 % intracameral moxifloxacin for postoperative endophthalmitis prophylaxis in cataract surgery patients without the use of additional postoperative topical antibiotics. All phacoemulsification cataract surgeries performed by a single surgeon (B.A.) at the John A. Moran Eye Center from June 2012 to May 2015 were reviewed retrospectively. From June 2012 to April 2014, patients were given topical 0.5 % moxifloxacin postoperatively. From May 2014 to May 2015, all patients were given moxifloxacin intracamerally with no antibiotics postoperatively. The follow-up period was 1 month after surgery. Preoperative visual acuity and postoperative visual acuity, corneal edema, and anterior chamber reaction were recorded and compared between the two groups. 384 cataract surgeries were performed during the study period. None of the 384 eyes in the study developed endophthalmitis. Of those 384 eyes, 222 were included in the study for analysis based on the inclusion and exclusion criteria. 131 were part of the topical antibiotic group and 91 were part of the intracameral group. The differences in uncorrected visual acuity at 1 day postoperatively (p = 0.595) and best corrected visual acuity at 1 month postoperatively (p = 0.099) were not statistically significant. Differences in corneal edema (p = 0.370) and anterior chamber reaction (p = 0.069) at 1 day postoperatively and corneal edema (p = 0.512) and anterior chamber reaction (p = 0.512) at 1 month postoperatively were also not statistically significant. Undiluted 0.5 % moxifloxacin can be safely injected intracamerally following cataract surgery without additional postoperative antibiotic prophylaxis to prevent endophthalmitis without adverse effects on patient outcomes. PMID:26577588

  11. Optimal Dose of Prophylactic Dexmedetomidine for Preventing Postoperative Shivering

    PubMed Central

    Kim, Yong-Shin; Kim, Yong-Il; Seo, Kwon-Hui; Kang, Hye-Rim

    2013-01-01

    Objective The aim of this study was to investigate the optimum dosage of dexmedetomidine for prevention of postanesthetic shivering. Methods One-hundred thirty two ASA physical status I-II patients scheduled for elective laparoscopic total hysterectomy were enrolled in this randomised, placebo-controlled study. Patients were randomly allocated to receive dexmedetomidine in four groups: group S (0.9% normal saline), group D0.5 (dexmedetomidine 0.5 µg/kg), group D0.75 (dexmedetomidine 0.75 µg/kg), group D1.0 (dexmedetomidine 1.0 µg/kg). Time to extubation and tympanic temperature during and after operation were measured. Shivering was graded (0-3 scale) upon patients arrival to the PACU and every ten minutes thereafter up to forty minutes. Sedation and first rescue analgesic time at the PACU were evaluated. Results The incidence of shivering was significantly lower in group D0.75 and D1.0 than in group S (P < 0.05). There were significantly fewer patients with a shivering score of 2 or 3 in groups D0.75 and D1.0 than in group S (P < 0.05, P < 0.001). Extubation time was shorter in group S than in groups D0.75 and D1.0 (P < 0.05). Tympanic temperature at 40 minutes postoperatively in the recovery room was higher in group S than in the other dexmedetomidine groups (P < 0.05) Fewer patients required rescue analgesia in groups D0.75 and D1.0 than in group S (P < 0.001), and the time to rescue analgesia was longer in group D1.0 than in group S (P < 0.001). Modified Observer's Assessment of Alertness/Sedation (MOAA/S) at arrival in the PACU was lower in all dexmedetomidine groups than in group S (P < 0.05). Conclusions Our results suggest that dexmedetomidine 0.75 or 1.0 µg/kg provides effective prophylaxis against postoperative shivering as well as an analgesic effect. Though potential for intraoperative requirement for atropine, sedation in the immediate recovery period and delayed extubation time with dexmedetomidine was noted, there were no major clinical impacts

  12. 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

  13. Predictors of Delayed Postoperative Respiratory Depression Assessed From Naloxone Administration

    PubMed Central

    Weingarten, Toby N.; Herasevich, Vitaly; McGlinch, Maria C.; Beatty, Nicole C.; Christensen, Erin D.; Hannifan, Susan K.; Koenig, Amy E.; Klanke, Justin; Zhu, Xun; Gali, Bhargavi; Schroeder, Darrell R.; Sprung, Juraj

    2015-01-01

    Background To identify patient and procedural characteristics associated with postoperative respiratory depression or sedation that required naloxone intervention. Methods We identified patients who received naloxone to reverse opioid-induced respiratory depression or sedation within 48 hours after discharge from anesthetic care (transfer from the post anesthesia care unit, or transfer from the operating room to postoperative areas) between July 1, 2008 and June 30, 2010. Patients were matched to two controls based on age, sex, and exact type of procedure performed during the same year. A chart review was performed to identify patient, anesthetic and surgical factors that may be associated with risk for intervention requiring naloxone. In addition, we identified all patients who developed adverse respiratory events [hypoventilation, apnea, oxyhemoglobin desaturation, pain/sedation mismatch] during Phase I anesthesia recovery. We performed conditional logistic regression taking into account the 1:2 matched set case-control study design to assess patient and procedural characteristics associated with naloxone use. Results We identified 134 naloxone administrations, 58% within 12 hours of discharge from anesthesia care, with incidence of 1.6 per 1,000 (95% CI 1.3 – 1.9) anesthetics. Presence of obstructive sleep apnea (odds ratio = 2.45, 95%CI 1.27-4.66, P = 0.008), and diagnosis of adverse respiratory event in postanesthesia recovery room (odds ratio = 5.11, 95%CI 2.32-11.27, P < 0.001) were associated with increased risk for requiring naloxone to treat respiratory depression or sedation following discharge from anesthesia care. Following discharge from anesthesia care, patients administered naloxone used a greater median dose of opioids (10 [interquartile range 0, 47.1] vs. 5 [0, 24.8] intravenous morphine equivalents, P = 0.020) and more medications with sedating side effects (N = 41 [31%] vs. 24 [9%], P<0.001). Conclusion Obstructive sleep apnea and adverse

  14. Overcome barriers to career success

    SciTech Connect

    Raudsepp, E.

    1983-04-01

    A test is given to determine if an engineer suffers from one of the three barriers to technical success: fear of success, fear of failure, or perfectionism. As in most such tests, the middle way is best. Successful engineers know that perfection cannot be attained, that they don't have time to worry about failure or success, and that by aiming and perservering in doing things well, success can be achieved.

  15. The knowledge and attitudes of nonanesthesia nurses regarding postoperative epidural analgesia.

    PubMed

    Sandie, C L; Heindel, L J

    1999-10-01

    The provision of epidural analgesia for postoperative pain control offers many patient benefits and has become commonplace on many nursing units. Since nurses are responsible for the day-to-day management of patients receiving epidural analgesia, their knowledge, attitudes, and practices regarding this technique are pivotal to its success. Therefore, the purpose of the present descriptive study was to examine the knowledge base, attitudes, and clinical practice of registered nurses (N = 85) regarding postoperative epidural analgesia as managed by an acute pain service (APS). Information was obtained from a survey distributed via a convenience sample to all nurses working on 6 units in a large military teaching facility. We developed the "Epidural Knowledge and Attitude Survey" using the nursing literature on epidural analgesia. The survey consisted of a demographics section, true/false (T/F) questions, multiple choice (M/C) questions, an attitude section, and a comment section. These sections addressed the nurses' knowledge, attitudes, and practices in regard to epidural pharmacology, management, and adverse effects, as well as their general satisfaction with the APS of their facility. Data were analyzed statistically using means, standard deviations, percentages, forward step-wise linear regression, the Fisher-Irwin (exact) test, the chi 2 test, and analysis of variance with Bonferroni multiple comparisons. A P value of < .05 was considered statistically significant. Results of the study demonstrated that the respondents attained a 78% overall correct score on T/F questions and 38% on M/C questions. The attitude section illustrated that 73% of nurses had "positive" attitudes toward epidural analgesia. Correct management of patients receiving epidural analgesia was being practiced by 77% of nurses. The satisfaction with the APS at this facility was 32% "very satisfied" and 62% "somewhat satisfied." The demographic characteristics that best predicted a higher score

  16. Postoperative pain relief using intermittent intrapleural analgesia following thoracoscopic anterior correction for progressive adolescent idiopathic scoliosis

    PubMed Central

    2013-01-01

    Background Thoracoscopic anterior scoliosis instrumentation is a safe and viable surgical option for corrective fusion of progressive adolescent idiopathic scoliosis (AIS) and has been performed at our centre on 205 patients since 2000. However, there is a paucity of literature reporting on or examining optimum methods of analgesia following this type of surgery. A retrospective study was designed to present the authors’ technique for delivering intermittent local anaesthetic boluses via an intrapleural catheter following thoracoscopic scoliosis surgery; report the pain levels that may be expected and any adverse effects associated with the use of intrapleural analgesia, as part of a combined postoperative analgesia regime. Methods Records for 32 patients who underwent thoracoscopic anterior correction for AIS were reviewed. All patients received an intrapleural catheter inserted during surgery, in addition to patient-controlled opiate analgesia and oral analgesia. After surgery, patients received a bolus of 0.25% bupivacaine every four hours via the intrapleural catheter. Patient’s perceptions of their pain control was measured using the visual analogue pain scale scores which were recorded before and after local anaesthetic administration and the quantity and time of day that any other analgesia was taken, were also recorded. Results 28 female and four male patients (mean age 14.5 ± 1.5 years) had a total of 230 boluses of local anaesthetic administered in the 96 hour period following surgery. Pain scores significantly decreased following the administration of a bolus (p < 0.0001), with the mean pain score decreasing from 3.66 to 1.83. The quantity of opiates via patient-controlled analgesia after surgery decreased steadily between successive 24 hours intervals after an initial increase in the second 24 hour period when patients were mobilised. One intrapleural catheter required early removal due to leakage; there were no other associated

  17. Effect of body mass index on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing percutaneous nephrolithotomy

    PubMed Central

    Shohab, Durre; Ayub, Ramsha; Alam, Muhammad Umar; Butt, Amna; Sheikh, Sanam; Assad, Salman; Akhter, Saeed

    2015-01-01

    Objective To compare the effect of body mass index (BMI) on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing percutaneous nephrolithotomy (PCNL) by comparing three BMI groups. Material and methods This is a retrospective analysis of 129 patients who underwent PCNL from January 2010 to August 2013. All the patients underwent PCNL by a standard technique. The patients were divided into three groups: patients having a BMI ≤24 kg/m2 were included in the normal group, those having a BMI of 24.1–30.0 kg/m2 were included in the overweight group, and those having a BMI >30 kg/m2 were included in the obese group. Three groups were compared for operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement. Results A total of 129 patients including 44 females and 85 males were included with a mean age of 45.00±1.44 years. The mean age in the normal group was 43.29±1.69 years, 47.08±1.29 years in the overweight group, and 43.61±1.25 years in the obese group. The mean stone size in the normal group was 25.46±8.92 mm, 28.01±8.40 mm in the overweight group, and 26.84±7.41 mm in the obese group. Our results showed no statistically significant difference with respect to mean operative time, mean hospital stay, and stone clearance in the normal, obese, and overweight patients undergoing PCNL. Postoperative complications and analgesia requirement were also similar in all the three groups. Conclusion There was no effect of BMI on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing PCNL. PCNL is a safe and effective procedure for the removal of renal stones in obese patients. PMID:26623145

  18. [The metabolism of panthenol in patients with postoperative intestinal atony].

    PubMed

    Sachs, M; Asskali, F; Lanaras, C; Förster, H; Bockhorn, H

    1990-12-01

    The aim of this study was the examination of the metabolism and mechanism of action of D-pantothenyl alcohol in patients with postoperative intestinal atony. Seven metabolically healthy patients were examined on the 4th day following colorectal surgery, before bowel activity had started. Increased urinary excretion of the vitamin pantothenic acid was noted following the intravenous application of 2 gm of D-pantothenyl alcohol. Ten to 30% of the administered dose D-pantothenyl alcohol is excreted in the urine as pantothenic acid within 24 h. Simultaneously, the urinary excretion of beta-alanine, a pantothenic acid component, is increased. D-pantothenyl alcohol was metabolized to pantothenic acid in all the patients examined. Pantothenic acid is a component of coenzyme A, a key substance in the intermediary pathway of metabolism. Coenzyme A plays a role in the synthesis of acetylcholine from choline (a co-enzyme of cholinacetylase). Peristalsis induced by D-pantothenyl alcohol may be due to the increased synthesis of coenzyme A and acetylcholine in the autonomic nerve plexus of the intestinal tract. PMID:2080639

  19. Validation of sensor for postoperative positioning with intraocular gas

    PubMed Central

    Brodie, Frank L; Woo, Kelly Y; Balakrishna, Ashwin; Choo, Hyuck; Grubbs, Robert H

    2016-01-01

    Purpose Surgical repair of retinal attachment or macular hole frequently requires intraocular gas. This necessitates specific postoperative positioning to improve outcomes and avoid complications. However, patients struggle with correct positioning. We have developed a novel sensor to detect the position of the gas bubble in the eye and provide feedback to patients in real time. In this paper, we determine the specificity and sensitivity of our sensor in vitro using a model eye. Methods We assessed the reliability of our sensor to detect when a gas bubble has deviated off a model retinal break in a model eye. Various bubble sizes representing the intraocular kinetics of sulfur hexafluoride gas and varying degrees of deviation from the correct position were tested using the sensor attached to a mannequin head with a model eye. Results We recorded 36 data points. The sensor acted appropriately in 33 (91.7%) of them. The sensor triggered the alarm every time the bubble deviated off the break (n=15, sensitivity =100%). However, it triggered the alarm (falsely) 3/21 times when the bubble was correctly positioned over the retinal break (specificity =86%). Conclusion Our device shows excellent sensitivity (100%) and specificity (86%) in detecting whether intraocular gas is tamponading a retinal break in a model eye. PMID:27307698

  20. Risk Factors for Postoperative Retention After Hemorrhoidectomy: A Cohort Study.

    PubMed

    Qi-Ming, Xue; Jue-Ying, Xiang; Ben-Hui, Chen; Jing, Wu; Ning, Li

    2015-01-01

    The objective of this study was to identify the risk factors for urinary retention after hemorrhoidectomy. With the approval of West China Hospital of Sichuan University Ethics Board, data were abstracted from 961 charts of patients who underwent hemorrhoidectomy from January 1, 2009, to June 30, 2011. The outcome was urinary retention in the first 24 hours after surgery. Risk factors were identified using multivariable logistic regression, and they were expressed as odds ratios or 95% confidence intervals. The overall urinary retention rate was 14.8% (n = 142). Significant risk factors associated with postoperative urinary retention included female gender, anesthesia methods, severity of hemorrhoid, a large amount of intravenous fluid administered perioperatively, and length of hospital stay. Logistic regression analysis revealed that female gender (odds ratio, 2.607; p < .01), sacral anesthesia (odds ratio, 2.481; p = .02), more than 3 hemorrhoids resected (odds ratio, 2.658; p < .01), hemorrhoids having 4 degrees of severity (odds ratio, 3.101; p < .01), intravenous fluids > 700 ml (odds ratio, 1.597; p = .02), and length of stay more than 7 days (odds ratio, 1.852; p < .01) were significant predictors of urinary retention post-hemorrhoidectomy. PMID:25974011