Intraoperative and early postoperative complications of manual sutureless cataract extraction.

PubMed

Iqbal, Yasir; Zia, Sohail; Baig Mirza, Aneeq Ullah

2014-04-01

To determine the intraoperative and early postoperative complications of manual sutureless cataract extraction. Case series. Redo Eye Hospital, Rawalpindi, Pakistan, from January 2009 to December 2010. Three hundred patients of cataract through purposive non-probability sampling were selected. The patients underwent manual sutureless cataract surgery (MSCS) by single experienced surgeon and intraoperative complications were documented. The surgical technique was modified to deal with any intraoperative complications accordingly. Patients were examined on the first postoperative day and on the first postoperative week for any postoperative complications. The data was entered in Statistical Package for Social Sciences (SPSS) version 13.0 and the results were calculated in frequencies. Among the 300 cases, 81.3% surgeries went uneventful whereas 18.6% had some complication. The common intraoperative complications were superior button-hole formation in 5%; posterior capsular rent in 5% and premature entry with iris prolapse in 3% cases. Postoperatively, the commonly encountered complications were striate keratopathy in 9.6% and hyphema 9%. At first week follow-up, 4% had striate keratopathy and 0.6% had hyphema. Striate keratopathy resolved with topical medication on subsequent follow-up. A total of 9 cases (3%) underwent second surgery: 2 cases for lens matter wash, 2 cases for hyphema and 5 cases needed suturing of wound for shallow anterior chamber due to wound leak. Superior button-hole formation, posterior capsular rent and premature entry were the common intraoperative complications of MSCS whereas the common early postoperative complications were striate keratopathy and hyphema.

Early and late postoperative seizure outcome in 97 patients with supratentorial meningioma and preoperative seizures: a retrospective study.

PubMed

Zheng, Zhe; Chen, Peng; Fu, Weiming; Zhu, Junming; Zhang, Hong; Shi, Jian; Zhang, Jianmin

2013-08-01

We identified factors associated with early and late postoperative seizure control in patients with supratentorial meningioma plus preoperative seizures. In this retrospective study, univariate analysis and multivariate logistic regression analysis compared 24 clinical variables according to the occurrence of early (≤1 week) or late (>1 week) postoperative seizures. Sixty-two of 97 patients (63.9 %) were seizure free for the entire postoperative follow-up period (29.5 ± 11.8 months), while 13 patients (13.4 %) still had frequent seizures at the end of follow-up. Fourteen of 97 patients (14.4 %) experienced early postoperative seizures, and emergence of new postoperative neurological deficits was the only significant risk factor (odds ratio = 7.377). Thirty-three patients (34.0 %) experienced late postoperative seizures at some time during follow-up, including 12 of 14 patients with early postoperative seizures. Associated risk factors for late postoperative seizures included tumor progression (odds ratio = 7.012) and new permanent postoperative neurological deficits (odds ratio = 4.327). Occurrence of postoperative seizures in patients with supratentorial meningioma and preoperative seizure was associated with new postoperative neurological deficits. Reduced cerebral or vascular injury during surgery may lead to fewer postoperative neurological deficits and better seizure outcome.

Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy.

PubMed

Garrahy, Aoife; Murphy, Matthew S; Sheahan, Patrick

2016-04-01

Postoperative hypocalcemia is a common complication of thyroidectomy. Magnesium is known to modulate serum calcium levels and hypomagnesemia may impede correction of hypocalcemia. The purpose of this study was to investigate whether hypomagnesemia after thyroidectomy has any impact on early hypocalcemia and/or permanent hypoparathyroidism. We conducted a retrospective review of prospectively maintained databases. Inclusion criteria were total or completion total thyroidectomy with postoperative magnesium levels available. The incidence of postoperative hypocalcemia was correlated with postoperative hypomagnesemia and other risk factors. Two hundred one cases were included. Twenty-six patients (13%) developed postoperative hypomagnesemia. Hypomagnesemia (p = .002), cancer diagnosis (p = .01), central neck dissection (p = .02), and inadvertent parathyroid resection (p = .02) were significantly associated with hypocalcemia. On multivariate analysis, only hypomagnesemia (p = .005) remained significant. Hypomagnesemia was also a significant predictor of permanent hypoparathyroidism (p = .0004). Hypomagnesemia is significantly associated with early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Magnesium levels should be closely monitored in patients with postthyroidectomy hypocalcemia. © 2015 Wiley Periodicals, Inc.

Clinical multifactorial analysis of early postoperative seizures in elderly patients following meningioma resection

PubMed Central

ZHANG, BO; WANG, DAN; GUO, YUNBAO; YU, JINLU

2015-01-01

The aim of the present study was to identify the major factors correlated with early postoperative seizures in elderly patients who had undergone a meningioma resection, and subsequently, to develop a logistic regression equation for assessing the seizures risk. Fourteen factors possibly correlated with early postoperative seizures in a cohort of 209 elderly patients who had undergone meningioma resection, as analyzed by multifactorial stepwise logistic regression. Phenobarbital sodium (0.1 g, intramuscularly) was administered to all 209 patients 30 min prior to undergoing surgery. All the patients had no previous history of seizures. The correlation of the 14 clinical factors (gender, tumor site, dyskinesia, peritumoral brain edema (PTBE), tumor diameter, pre- and postoperative prophylaxes, surgery time, tumor adhesion, circumscription, blood supply, intraoperative transfusion, original site of the tumor and dysphasia) was assessed in association with the risk for post-operative seizures. Tumor diameter, postoperative prophylactic antiepileptic drug (PPAD) administration, PTBE and tumor site were entered as risk factors into a mathematical regression model. The odds ratio (OR) of the tumor diameter was >1, and PPAD administration showed an OR >1, relative to a non-prophylactic group. A logistic regression equation was obtained and the sensitivity, specificity and misdiagnosis rates were 91.4, 74.3 and 25.7%, respectively. Tumor diameter, PPAD administration, PTBE and tumor site were closely correlated with early postoperative seizures; PTBE and PPAD administration were risk and protective factors, respectively. PMID:26137257

Value of Early Postoperative Computed Tomography Assessment in Ankle Fractures Defining Joint Congruity and Criticizing the Need for Early Revision Surgery.

PubMed

Palmanovich, Ezequiel; Brin, Yaron S; Kish, Benny; Nyska, Meir; Hetsroni, Iftach

2016-01-01

Previous investigators have questioned the reliability of plain radiographs in assessing the accuracy of ankle fracture reduction when these were compared with the computed tomography (CT) evaluation in the preoperative setting, in particular, in fractures with syndesmosis injuries or trimalleolar fragments. The role of CT assessment, however, has not been investigated in the early postoperative setting. In the early postoperative setting, reduction still relies most commonly on fluoroscopy and plain radiographs alone. In the present study, we hypothesized that early postoperative CT assessment of ankle fractures with syndesmosic injuries and posterior malleolar fragments can add valuable information about the joint congruity compared with plain radiographs alone and that this information could affect the decisions regarding the need for early revision surgery. A total of 352 consecutive operated ankle fractures were reviewed. Of these, 68 (19%) underwent early postoperative CT assessment and were studied further to identify the causes that prompted revision surgery. Of the 68 cases, despite acceptable reduction found on the plain radiographs, 20 (29%) underwent early (within 1 week) revision surgery after studying the CT scans, which revealed malreduction of the syndesmosis, malreduction of the posterior lip fragment, and intra-articular fragments. We concluded that in ankle fractures involving disruptions of the syndesmosis or posterior malleolar fragments, early postoperative CT assessment could be justified, because it will reveal malreduction and prompt early revision intervention for a substantial proportion of these patients. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Utility of Early Post-operative High Resolution Volumetric MR Imaging after Transsphenoidal Pituitary Tumor Surgery

PubMed Central

Patel, Kunal S.; Kazam, Jacob; Tsiouris, Apostolos J.; Anand, Vijay K.; Schwartz, Theodore H.

2014-01-01

Objective Controversy exists over the utility of early post-operative magnetic resonance imaging (MRI) after transsphenoidal pituitary surgery for macroadenomas. We investigate whether valuable information can be derived from current higher resolution scans. Methods Volumetric MRI scans were obtained in the early (<10 days) and late (>30 days) post-operative periods in a series of patients undergoing transsphenoidal pituitary surgery. The volume of the residual tumor, resection cavity, and corresponding visual field tests were recorded at each time point. Statistical analyses of changes in tumor volume and cavity size were calculated using the late MRI as the gold standard. Results 40 patients met the inclusion criteria. Pre-operative tumor volume averaged 8.8 cm3. Early postoperative assessment of average residual tumor volume (1.18 cm3) was quite accurate and did not differ statistically from late post-operative volume (1.23 cm3, p=.64), indicating the utility of early scans to measure residual tumor. Early scans were 100% sensitive and 91% specific for predicting ≥ 98% resection (p<.001, Fisher’s exact test). The average percent decrease in cavity volume from pre-operative MRI (tumor volume) to early post-operative imaging was 45% with decreases in all but 3 patients. There was no correlation between the size of the early cavity and the visual outcome. Conclusions Early high resolution volumetric MRI is valuable in determining the presence or absence of residual tumor. Cavity volume almost always decreases after surgery and a lack of decrease should alert the surgeon to possible persistent compression of the optic apparatus that may warrant re-operation. PMID:25045791

Mobility one week after a hip fracture - can it be predicted?

PubMed

Fitzgerald, Michelle; Blake, Catherine; Askin, David; Quinlan, John; Coughlan, Tara; Cunningham, Caitriona

2018-05-01

Better patient outcomes and more efficient healthcare could be achieved by predicting post hip fracture function at an early stage. This study aimed to identify independent predictors of mobility outcome one week post hip fracture surgery. All hip fracture inpatients (n=77) were included in this 6 month prospective observational cohort study. Predictor variables were obtained on the first postoperative day and included premorbid function using the New Mobility Score (NMS). Mobility outcome measures one week postoperatively included the Cumulated Ambulatory Score (CAS). Data were analysed with SPSS using binary multiple logistic regression analysis RESULTS: Patients who fell outdoors (OR 3.848; 95% CI, 1.053-14.061), had no delay to surgery (OR 5.472; 95% CI, 1.073-27.907) and had high pre-fracture function (OR3.366; 95% CI, 1.042-10.879) were predicted to achieve independent mobility (CAS = 6) one week postoperatively. Fall location, time to surgery and baseline function predict independent mobility one week after hip fracture, and can be used for early rehabilitation stratification. The NMS and CAS are recommended as standardised hip fracture clinical measures. Orthogeriatric and physiotherapy service initiatives may improve early functional outcome. Copyright © 2017. Published by Elsevier Ltd.

Effects of oral preoperative carbohydrate on early postoperative outcome after thyroidectomy.

PubMed

Lauwick, S M; Kaba, A; Maweja, S; Hamoir, E E; Joris, Jean L

2009-01-01

Preoperative carbohydrate (CHO) reduces perioperative insulin resistance and improves preoperative patient comfort. We tested the hypotheses that preoperative CHO reduces the risk of postoperative nausea and vomiting (PONV) and improves early postoperative patient comfort. Two hundred women scheduled for thyroidectomy were randomly allocated to drink 50 g CHO in 400 ml of water or 0.5 g aspartam in 100 ml of water 2 h before surgery. The incidence and the severity of PONV, pain scores, and analgesic consumption were recorded postoperatively. Intensity of thirst, hunger, anxiety, fatigue were recorded on 100-mm visual analog scales just before the induction of anesthesia, 2, 6, and 24 h postoperatively. The incidence and severity of PONV were similar in both groups. Patients from the CHO group reported significantly less thirst (P = 0.007), hunger (P = 0.04), and fatigue (P = 0.01) than patients from the control group. Postoperative pain scores did not differ significantly between both groups (P = 0.34). However patients from the CHO group requested less acetaminophen during the first 24 postoperative h: 3 g vs. 2 g (median, P = 0.002). Oral carbohydrate before thyroidectomy improves pre- and postoperative patient comfort, as well as postoperative analgesia, but has no effect on the PONV.

Hypocalcaemia following total thyroidectomy: early post-operative parathyroid hormone assay as a risk stratification and management tool.

PubMed

Islam, S; Al Maqbali, T; Howe, D; Campbell, J

2014-03-01

To develop a practical, efficient and predictive algorithm to manage potential or actual post-operative hypocalcaemia after complete thyroidectomy, using a single post-operative parathyroid hormone assay. This paper reports a prospective study of 59 patients who underwent total or completion thyroidectomy over a period of 24 months. Parathyroid hormone levels were checked post-operatively on the day of surgery, and all patients were evaluated for hypocalcaemia both clinically and biochemically with serial corrected calcium measurements. No patient with an early post-operative parathyroid hormone level of 23 ng/l or more (i.e. approximately twice the lower limit of the normal range) developed hypocalcaemia. All the patients who initially had post-operative hypocalcaemia but had an early parathyroid hormone level of 8 ng/l or more (i.e. approximately two-thirds of the lower limit of the normal range) had complete resolution of their hypocalcaemia within three months. Early post-operative parathyroid hormone measurement can reliably predict patients at risk of post-thyroidectomy hypocalcaemia, and predict those patients expected to recover from temporary hypocalcaemia. A suggested post-operative management algorithm is presented.

Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery.

PubMed

Henriksen, M G; Hessov, I; Dela, F; Hansen, H Vind; Haraldsted, V; Rodt, S A

2003-02-01

Surgery is succeeded by long-lasting state of relative peripheral insulin resistance, which is reduced by giving glucose infusion or oral carbohydrate-rich drinks immediate before operating instead of fasting. The aim of the present study was to investigate whether oral carbohydrate or carbohydrate with peptide drinks preoperatively instead of fasting would improve postoperative voluntary muscle strength, nutritional intake and ambulation, decrease postoperative fatigue, anxiety and discomfort, and reduce the endocrine response to surgery. Forty-eight patients were included and randomized into three groups to receive 2 x 400 ml of carbohydrate-rich drinks or to fast overnight and allowed only water. Voluntary grip and quadriceps strength, body composition, pulmonary function, VAS-score of eight parameters of wellbeing, muscle biopsies and insulin, glucagon, IGF-1 and free fatty acids were measured before and after the operation. The basic postoperative regimen for all groups were immediate oral nutrition and early enforced mobilization. Significant postoperative decrease in glycogen synthase activity in the muscle biopsies was reduced in the intervention groups, and in combination, the intervention groups had a less reduced quadriceps strength after one week (-10% vs. -16%, NS) and one month (-5% vs. -13%, P < 0.05). Minor changes in the endocrine response to surgery were found without differences between the groups, and there were no differences between the groups in ambulation time, nutritional intake or subjective measures of wellbeing. Copyright Acta Anaesthesiologica Scandinavica 47 (2003)

Early postoperative statin therapy is associated with a lower incidence of acute kidney injury following cardiac surgery

PubMed Central

Billings, Frederic T.; Pretorius, Mias; Siew, Edward D.; Yu, Chang; Brown, Nancy J.

2010-01-01

Objective To test the hypothesis that perioperative statin use reduces acute kidney injury (AKI) following cardiac surgery Design Retrospective analysis of prospectively collected data from an ongoing clinical trial Setting Quaternary-care university hospital Participants Three hundred twenty-four elective adult cardiac surgery patients Interventions None Measurements and Main Results We assessed the association of preoperative statin use, early postoperative statin use, and acute statin withdrawal with the incidence of AKI. Early postoperative statin use was defined as statin treatment within the first postoperative day. Statin withdrawal was defined as discontinuation of preoperative statin treatment prior to surgery until at least postoperative day 2. Logistic regression and propensity score modeling were used to control for AKI risk factors. Sixty-eight of 324 patients (21.0%) developed AKI. AKI patients stayed in the hospital longer (P=0.03) and were more likely to develop pneumonia (P=0.002) or die (P=0.001). Higher body mass index (P=0.003), higher central venous pressure (P=0.03), and statin withdrawal (27.4 vs. 14.7%, P=0.046) were associated with a higher incidence of AKI, while early postoperative statin use was protective (12.5 vs. 23.8%, P=0.03). Preoperative statin use did not affect risk of AKI. In multivariate logistic regression, age (P=0.03), male gender (P=0.02), body mass index (P<0.001), and early postoperative statin use (OR 0.32, 95% CI 0.14–0.72, P=0.006) independently predicted AKI. Propensity score-adjusted risk assessment confirmed the association between early postoperative statin use and reduced AKI (OR 0.30, 95% CI 0.13–0.70, P=0.005). Conclusions Early postoperative statin use is associated with a lower incidence of AKI among both chronic statin users and statin-naïve cardiac surgery patients. PMID:20599398

Early versus delayed post-operative bathing or showering to prevent wound complications.

PubMed

Toon, Clare D; Sinha, Sidhartha; Davidson, Brian R; Gurusamy, Kurinchi Selvan

2015-07-23

Many people undergo surgical operations during their life-time, which result in surgical wounds. After an operation the incision is closed using stiches, staples, steri-strips or an adhesive glue. Usually, towards the end of the surgical procedure and before the patient leaves the operating theatre, the surgeon covers the closed surgical wound using gauze and adhesive tape or an adhesive tape containing a pad (a wound dressing) that covers the surgical wound. There is currently no guidance about when the wound can be made wet by post-operative bathing or showering. Early bathing may encourage early mobilisation of the patient, which is good after most types of operation. Avoiding post-operative bathing or showering for two to three days may result in accumulation of sweat and dirt on the body. Conversely, early washing of the surgical wound may have an adverse effect on healing, for example by irritating or macerating the wound, and disturbing the healing environment. To compare the benefits (such as potential improvements to quality of life) and harms (potentially increased wound-related morbidity) of early post-operative bathing or showering (i.e. within 48 hours after surgery, the period during which epithelialisation of the wound occurs) compared with delayed post-operative bathing or showering (i.e. no bathing or showering for over 48 hours after surgery) in patients with closed surgical wounds. We searched The Cochrane Wounds Group Specialised Register (30th June 2015); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); The Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; EBSCO CINAHL; the metaRegister of Controlled Trials (mRCT) and the International Clinical Trials Registry Platform (ICTRP). We considered all randomised trials conducted in patients who had undergone any surgical procedure and had surgical closure of

Early versus delayed post-operative bathing or showering to prevent wound complications.

PubMed

Toon, Clare D; Sinha, Sidhartha; Davidson, Brian R; Gurusamy, Kurinchi Selvan

2013-10-12

Many people undergo surgical operations during their life-time, which result in surgical wounds. After an operation the incision is closed using stiches, staples, steri-strips or an adhesive glue. Usually, towards the end of the surgical procedure and before the patient leaves the operating theatre, the surgeon covers the closed surgical wound using gauze and adhesive tape or an adhesive tape containing a pad (a wound dressing) that covers the surgical wound. There is currently no guidance about when the wound can be made wet by post-operative bathing or showering. Early bathing may encourage early mobilisation of the patient, which is good after most types of operation. Avoiding post-operative bathing or showering for two to three days may result in accumulation of sweat and dirt on the body. Conversely, early washing of the surgical wound may have an adverse effect on healing, for example by irritating or macerating the wound, and disturbing the healing environment. To compare the benefits (such as potential improvements to quality of life) and harms (potentially increased wound-related morbidity) of early post-operative bathing or showering (i.e. within 48 hours after surgery, the period during which epithelialisation of the wound occurs) compared with delayed post-operative bathing or showering (i.e. no bathing or showering for over 48 hours after surgery) in patients with closed surgical wounds. We searched The Cochrane Wounds Group Specialised Register;The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); The Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; EBSCO CINAHL; the metaRegister of Controlled Trials (mRCT) and the International Clinical Trials Registry Platform (ICTRP). We considered all randomised trials conducted in patients who had undergone any surgical procedure and had surgical closure of their wounds

[Circulating miR-152 helps early prediction of postoperative biochemical recurrence of prostate cancer].

PubMed

Chen, Jun-Feng; Liao, Yu-Feng; Ma, Jian-Bo; Mao, Qi-Feng; Jia, Guang-Cheng; Dong, Xue-Jun

2017-07-01

To investigate the value of circulating miR-152 in the early prediction of postoperative biochemical recurrence of prostate cancer. Sixty-six cases of prostate cancer were included in this study, 35 with and 31 without biochemical recurrence within two years postoperatively, and another 31 healthy individuals were enrolled as normal controls. The relative expression levels of circulating miR-152 in the serum of the subjects were detected by qRT-PCR, its value in the early diagnosis of postoperative biochemical recurrence of prostate cancer was assessed by ROC curve analysis, and the correlation of its expression level with the clinicopathological parameters of the patients were analyzed. The expression of circulating miR-152 was significantly lower in the serum of the prostate cancer patients than in the normal controls (t = －5.212, P = 0.001), and so was it in the patients with than in those without postoperative biochemical recurrence (t = －5.727, P = 0.001). The ROC curve for the value of miR-152 in the early prediction of postoperative biochemical recurrence of prostate cancer showed the area under the curve (AUC) to be 0.906 (95% CI: 0.809－0.964), with a sensitivity of 91.4% and a specificity of 80.6%. The expression level of miR-152 was correlated with the Gleason score, clinical stage of prostate cancer, biochemical recurrence, and bone metastasis (P <0.05), decreasing with increased Gleason scores and elevated clinical stage of the malignancy. No correlation, however, was found between the miR-152 expression and the patients' age or preoperative PSA level (P >0.05). The expression level of circulating miR-152 is significantly reduced in prostate cancer patients with biochemical recurrence after prostatectomy and could be a biomarker in the early prediction of postoperative biochemical recurrence of the malignancy.

Potential superiority of periarticular injection in analgesic effect and early mobilization ability over femoral nerve block following total knee arthroplasty.

PubMed

Fu, Huichao; Wang, Jiaxing; Zhang, Wen; Cheng, Tao; Zhang, Xianlong

2017-01-01

Pain management after total knee arthroplasty (TKA) should permit early knee mobilization with minimal pain. Periarticular injection (PAI) with local anaesthetics has been recently discussed as a protocol of pain control. The purpose of this review of the literature was to evaluate the efficacy of PAI in comparison with femoral nerve block (FNB). A literature search was performed in PubMed, EMBASE, the OVID database and the Cochrane Library databases. Risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included narcotic consumption, pain score, early mobilization ability, length of stay and adverse effects or events. Research identified 918 articles, of which six with a total of 284 knees, met the inclusion criteria and were eligible for the current study. Conflicting evidence was found in terms of narcotic consumption on the postoperative day 1 and early mobilization ability. Total narcotic consumption, pain score in the first 2 days after surgery, length of stay and adverse effects or events showed no difference between two groups. Lower pain score on the day of surgery was detected after PAI. When compared to continuous FNB, patients in PAI group showed a tendency to achieving better ability of early mobilization. In consideration of its relatively simple practice and its potential in analgesic effects or early mobilization ability, PAI had superiority to FNB in the management of pain control after TKA. Before PAI could be widely used in clinical practice after TKAs, further investigations would be necessary to confirm or refute our observed results and to unify the protocol of PAI. I.

Prediction of early postoperative infections in pediatric liver transplantation by logistic regression

NASA Astrophysics Data System (ADS)

Uzunova, Yordanka; Prodanova, Krasimira; Spassov, Lubomir

2016-12-01

Orthotopic liver transplantation (OLT) is the only curative treatment for end-stage liver disease. Early diagnosis and treatment of infections after OLT are usually associated with improved outcomes. This study's objective is to identify reliable factors that can predict postoperative infectious morbidity. 27 children were included in the analysis. They underwent liver transplantation in our department. The correlation between two parameters (the level of blood glucose at 5th postoperative day and the duration of the anhepatic phase) and postoperative infections was analyzed, using univariate analysis. In this analysis, an independent predictive factor was derived which adequately identifies patients at risk of infectious complications after a liver transplantation.

Periarticular local anesthesia does not improve pain or mobility after THA.

PubMed

Dobie, I; Bennett, D; Spence, D J; Murray, J M; Beverland, D E

2012-07-01

Periarticular infiltration of local anesthetic, NSAIDs, and adrenaline have been reported to reduce postoperative pain, improve mobility, and reduce hospital stay for patients having THAs, but available studies have not determined whether local anesthetic infiltration alone achieves similar improvements. We therefore asked whether periarticular injection of a local anesthetic during THA reduced postoperative pain and opioid requirements and improved postoperative mobility. We randomized 96 patients to either treatment (n = 50) or control groups (n = 46). Before wound closure, the treatment group received local infiltration of 160 mL of levobupivacaine with adrenaline. The control group received no local infiltration. We assessed postoperative morphine consumption and pain during the 24 hours after surgery. Mobilization was assessed 24 hours postoperatively with supine-to-sit and sit-to-stand transfers, timed 10-m walk test, and timed stair ascent and descent. Patients and assessing physiotherapists were blind to study status. We observed no differences in postoperative morphine consumption, time to ascend and descend stairs, or ability to transfer between treatment and control groups. The treatment group reported more pain 7 to 12 hours postoperatively, but there were no differences in pain scores between groups at all other postoperative intervals. The treatment group showed increased postoperative walking speed greater than 6 m, but not greater than 10 m, compared with the control group. Periarticular infiltration of local anesthetic during THA did not reduce postoperative pain or length of hospital stay and did not improve early postoperative mobilization.

Mobile Learning and Early Age Mathematics

ERIC Educational Resources Information Center

Peled, Shir; Schocken, Shimon

2014-01-01

The ability to develop engaging simulations and constructive learning experiences using mobile devices is unprecedented, presenting a disruption in educational practices of historical proportions. In this paper we describe some of the unique virtues that mobile learning hold for early age mathematics education. In particular, we describe how…

Low fat-containing elemental formula is effective for postoperative recovery and potentially useful for preventing chyle leak during postoperative early enteral nutrition after esophagectomy.

PubMed

Moro, Kazuki; Koyama, Yu; Kosugi, Shin-Ichi; Ishikawa, Takashi; Ichikawa, Hiroshi; Hanyu, Takaaki; Miura, Kohei; Nagahashi, Masayuki; Nakajima, Masato; Tatsuda, Kumiko; Tsuchida, Junko; Toshikawa, Chie; Ikarashi, Mayuko; Shimada, Yoshifumi; Sakata, Jun; Kobayashi, Takashi; Kameyama, Hitoshi; Wakai, Toshifumi

2016-12-01

Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery. A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak. Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P < 0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P < 0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F. Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak. Copyright © 2016 The Authors. Published

Evaluation of a Progressive Mobility Protocol in Postoperative Cardiothoracic Surgical Patients.

PubMed

Floyd, Shawn; Craig, Sarah W; Topley, Darla; Tullmann, Dorothy

2016-01-01

Cardiothoracic surgical patients are at high risk for complications related to immobility, such as increased intensive care and hospital length of stay, intensive care unit readmission, pressure ulcer development, and deep vein thrombosis/pulmonary embolus. A progressive mobility protocol was started in the thoracic cardiovascular intensive care unit in a rural academic medical center. The purpose of the progressive mobility protocol was to increase mobilization of postoperative patients and decrease complications related to immobility in this unique patient population. A matched-pairs design was used to compare a randomly selected sample of the preintervention group (n = 30) to a matched postintervention group (n = 30). The analysis compared outcomes including intensive care unit and hospital length of stay, intensive care unit readmission occurrence, pressure ulcer prevalence, and deep vein thrombosis/pulmonary embolism prevalence between the 2 groups. Although this comparison does not achieve statistical significance (P < .05) for any of the outcomes measured, it does show clinical significance in a reduction in hospital length of stay, intensive care unit days, in intensive care unit readmission rate, and a decline in pressure ulcer prevalence, which is the overall goal of progressive mobility. This study has implications for nursing, hospital administration, and therapy services with regard to staffing and cost savings related to fewer complications of immobility. Future studies with a larger sample size and other populations are warranted.

Role of gastrografin challenge in early postoperative small bowel obstruction.

PubMed

Khasawneh, Mohammad A; Ugarte, Maria L Martinez; Srvantstian, Boris; Dozois, Eric J; Bannon, Michael P; Zielinski, Martin D

2014-02-01

Early small bowel obstruction following abdominal surgery presents a diagnostic and therapeutic challenge. Abdominal imaging using Gastrografin has been shown to have diagnostic and therapeutic properties when used in the setting of small bowel obstruction outside the early postoperative period (>6 weeks). We hypothesize that a GG challenge will reduce need for re-exploration. Patients with early small bowel obstruction who underwent a Gastrografin challenge between 2010 and 2012 were case controlled, based on age ±5 years, sex, and operative approach to an equal number of patients that did not receive the challenge. One hundred sixteen patients received a Gastrografin challenge. There were 87 males in each group with an average age of 62 years. A laparoscopic approach in the index operation was done equally between groups (18 vs. 18 %). There was no difference between groups in operative re-exploration rates (14 vs. 10 %); however, hospital duration of stay was greater in patients who received Gastrografin challenge (17 vs. 13 days). Two in hospital deaths occurred, one in each group, both of infectious complications. Use of the Gastrografin challenge in the immediate postoperative period appeared to be safe. There was no difference, however, in the rate of re-exploration between groups.

Early postoperative evaluation of groins after laparoscopic total extraperitoneal repair of inguinal hernias.

PubMed

Shpitz, Baruch; Kuriansky, Josef; Werener, Miriam; Osadchi, Alexandra; Tiomkin, Vitaly; Bugayev, Nikolay; Klein, Ehud

2004-12-01

Minimally invasive laparoscopic total extraperitoneal (LTEP) repair of bilateral and/or recurrent groin hernias has been popularized as one of the procedures of choice in the past decade. The early postoperative course is uneventful in most cases. A few patients, however, will develop temporary postoperative groin swelling. The aim of our study was to evaluate clinical and sonographic findings in the groin during the early postoperative period following LTEP. One hundred and five consecutive patients with primary bilateral (n = 90), recurrent unilateral (n = 12), and primary unilateral (n =3) groin hernias operated on during an 18-month period underwent clinical and sonographic examination two to three weeks after LTEP. On clinical examination, a localized groin swelling was found in 21 patients (20%). The most frequent sonographic findings were localized groin collections compatible with seroma or hematoma, found in 35 patients (33%). Hypoechoic diffuse tissue swelling around the mesh, lipomas, and residual hernias was found in four patients each (4%). None of the patients with hypoecoic mass had any clinical manifestations postoperatively. Extraperitoneal close suction drains were left for 8-12 hours in 46 patients. The average volume of fluid drained was 62 mL (range, 30-200 mL). There was no correlation between the use of suction drains and the frequency of fluid collections detected on sonography. Cord lipoma was detected postoperatively in four patients and was excised in one using an open anterior approach. Residual or recurrent hernia was detected postoperatively on sonography in four patients, but only one developed a symptomatic and clinically detectable hernia during eight months of follow-up. Overall, postoperative ultrasonographic findings following LTEP repair were found in 37% of patients. Clinical and sonographic findings such as localized fluid collections compatible with seroma or hematoma are common following LTEP. Postoperative suction drains

Novel approach to repair of acute achilles tendon rupture: early recovery without postoperative fixation or orthosis.

PubMed

Yotsumoto, Tadahiko; Miyamoto, Wataru; Uchio, Yuji

2010-02-01

Immobilization or orthosis is required after conventional Achilles tendon surgery. Hypothesis This new Achilles tendon repair approach enables early rehabilitation without any postoperative immobilization or orthosis. Case series; Level of evidence, 4. Twenty consecutive patients (14 men and 6 women; mean age, 43.4 years; range, 16-70 years) who had acute subcutaneous Achilles tendon rupture were treated by the new method, with an average follow-up of 2.9 years (range, 2-4.8 years). Among them, 15 injuries were sports-related and 5 were work-related. The authors applied a side-locking loop technique of their own design for the core suture, using braided polyblend suture thread, with peripheral cross-stitches added. The patients started active and passive ankle mobilization from the next day, partial weightbearing walking from 1 week, full-load walking from 4 weeks, and double-legged heel raises from 6 weeks after surgery. The range of motion recovery equal to the intact side averaged 3.2 weeks. Double-legged heel raises and 20 continuous single-legged heel raise exercises were possible at an average of 6.3 weeks and 9.9 weeks, respectively. T2-weighted magnetic resonance signal intensity recovered to equal that of the intact portion of the same tendon at 12 weeks. The patients resumed sports activities or heavy labor at an average of 14.4 weeks. The Achilles tendon rupture score averaged 98.3 at 24 weeks. There were no complications. This new Achilles tendon repair approach enables early mobilization exercise without costly specialized orthosis or immobilization and allows an early return to normal life and sports activities, reducing the physical and economic burden on patients.

Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

PubMed Central

Brigatto, Patrícia; Carbinatto, Jéssica C.; Costa, Carolina M.; Montebelo, Maria I. L.; Rasera-Júnior, Irineu; Pazzianotto-Forti, Eli M.

2014-01-01

Objective: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preoperatively assessed by spirometry and cirtometry and reevaluated on the 1st postoperative day. After preoperative evaluation, the subjects were randomized and allocated into groups: EPAP Group (n=20), IPPB Group (n=20) and BIPAP Group (n=20), then received the corresponding intervention: positive expiratory pressure (EPAP), inspiratory positive pressure breathing (IPPB) or bilevel inspiratory positive airway pressure (BIPAP), in 6 sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period and on the 1st postoperative day, in addition to conventional physical therapy. Results: There was a significant postoperative reduction in spirometric variables (p<0.05), regardless of the technique used, with no significant difference among the techniques (p>0.05). Thoracic mobility was preserved only in group BIPAP (p>0.05), but no significant difference was found in the comparison among groups (p>0.05). Conclusion: The application of positive pressure does not seem to be effective in restoring lung function after bariatric surgery, but the use of bilevel positive pressure can preserve thoracic mobility, although this technique was not superior to the other techniques. PMID:25590448

Early rise in postoperative creatinine for identification of acute kidney injury after cardiac surgery.

PubMed

Karkouti, Keyvan; Rao, Vivek; Chan, Christopher T; Wijeysundera, Duminda N

2017-08-01

Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Treatment strategies are unlikely to prove efficacious unless patients are identified and treated soon after the onset of injury. In this observational study, we determined and validated the ability of an early rise in postoperative serum creatinine to identify patients who suffer AKI during cardiac surgery. The relationship between an early rise in creatinine (immediate postoperative / preoperative creatinine) and AKI (> 50% increase in creatinine by postoperative calendar days 1or 2) was determined by logistic regression modelling. Existing databases were used for model development (n = 4,820; one institution) and validation (n = 6,553; 12 institutions). Acute kidney injury occurred in 9.1% (n = 437) and 9.8% (n = 645) of patients in the development and validation sets, respectively. An early rise in creatinine was related to AKI (P < 0.001), with an area under the receiver operating characteristic curve of 0.78 (95% confidence interval [CI], 0.75 to 0.80) in the development set and 0.77 (95% CI, 0.75 to 0.79) in the validation set. Using a threshold ratio of > 1.30 (n = 127), the sensitivity, specificity, positive, and negative predictive values for AKI in the development set were 20% (95% CI, 16 to 24), 99% (95% CI, 99 to 99), 68% (95% CI, 59 to 76), and 93% (95% CI, 92 to 93), respectively. In patients undergoing cardiac surgery with cardiopulmonary bypass, an early rise in postoperative creatinine is a useful marker for the early identification of AKI patients. This could allow inclusion of such patients in clinical trials of promising therapeutic strategies that need to be initiated soon after the onset of injury.

Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer.

PubMed

Li, B; Liu, H Y; Guo, S H; Sun, P; Gong, F M; Jia, B Q

2015-06-29

The impact of early enteral nutrition (EEN) on clinical outcomes of gastric cancer patients was investigated. Three hundred pa-tients undergoing gastric cancer surgery from July 2010 to May 2014 were randomly divided into experimental and control groups (n = 150/group). Experimental group patients received enteral nutrition in water during the early postoperative period. Control group patients received conventional perioperative treatment. Patients' clinical outcomes, post-operative immune function, and nutritional statuses were compared, which revealed that the postoperative fever duration (80.2 ± 6.0 vs 88.1 ± 8.1 h, P < 0.05), anal exhaust time (78.8 ± 9.3 vs 85.3 ± 8.4 h, P < 0.05), and length of hospitalization (7.73 ± 2.13 vs 9.77 ± 1.76 days, P < 0.01) differed significantly. Treatment costs in thousands of dol-lars were 31.24 ± 3.21 for the experimental group and 35.61 ± 2.32 for the control group; this difference was statistically significant (P < 0.01). The incidence of postoperative complications did not significantly differ between the experimental and control groups [14.0% (21/150) vs 17.3% (26/150), P > 0.05]. At postoperative days 3 and 7, the CD3(+), CD4(+), natural killer cell, albumin, and prealbumin levels and CD4(+)/CD8(+) ra-tio were significantly higher in the experimental group than the control group (all P < 0.05). CD8(+) cell counts were significantly lower in the experimental group than the control group (P < 0.05). Postsurgical oral EEN can improve nutritional status and immune function and promote early recovery of intestinal function in patients with gastric cancer.

[Algorithms for early mobilization in intensive care units].

PubMed

Nydahl, P; Dubb, R; Filipovic, S; Hermes, C; Jüttner, F; Kaltwasser, A; Klarmann, S; Mende, H; Nessizius, S; Rottensteiner, C

2017-03-01

Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.

Impact of Major Pulmonary Resections on Right Ventricular Function: Early Postoperative Changes.

PubMed

Elrakhawy, Hany M; Alassal, Mohamed A; Shaalan, Ayman M; Awad, Ahmed A; Sayed, Sameh; Saffan, Mohammad M

2018-01-15

Right ventricular (RV) dysfunction after pulmonary resection in the early postoperative period is documented by reduced RV ejection fraction and increased RV end-diastolic volume index. Supraventricular arrhythmia, particularly atrial fibrillation, is common after pulmonary resection. RV assessment can be done by non-invasive methods and/or invasive approaches such as right cardiac catheterization. Incorporation of a rapid response thermistor to pulmonary artery catheter permits continuous measurements of cardiac output, right ventricular ejection fraction, and right ventricular end-diastolic volume. It can also be used for right atrial and right ventricular pacing, and for measuring right-sided pressures, including pulmonary capillary wedge pressure. This study included 178 patients who underwent major pulmonary resections, 36 who underwent pneumonectomy assigned as group (I) and 142 who underwent lobectomy assigned as group (II). The study was conducted at the cardiothoracic surgery department of Benha University hospital in Egypt; patients enrolled were operated on from February 2012 to February 2016. A rapid response thermistor pulmonary artery catheter was inserted via the right internal jugular vein. Preoperatively the following was recorded: central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, right ventricular ejection fraction and volumes. The same parameters were collected in fixed time intervals after 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours postoperatively. For group (I): There were no statistically significant changes between the preoperative and postoperative records in the central venous pressure and mean arterial pressure; there were no statistically significant changes in the preoperative and 12, 24, and 48 hour postoperative records for cardiac index; 3 and 6 hours postoperative showed significant changes. There were statistically significant changes between the preoperative and

Prediction of Late Postoperative Hemorrhage after Whipple Procedure Using Computed Tomography Performed During Early Postoperative Period.

PubMed

Han, Ga Jin; Kim, Suk; Lee, Nam Kyung; Kim, Chang Won; Seo, Hyeong Il; Kim, Hyun Sung; Kim, Tae Un

2018-01-01

Postpancreatectomy hemorrhage (PPH) is an uncommon but serious complication of Whipple surgery. To evaluate the radiologic features associated with late PPH at the first postoperative follow up CT, before bleeding. To evaluate the radiological features associated with late PPH at the first follow-up CT, two radiologists retrospectively reviewed the initial postoperative follow-up CT images of 151 patients, who had undergone Whipple surgery. Twenty patients showed PPH due to vascular problem or anastomotic ulcer. The research compared CT and clinical findings of 20 patients with late PPH and 131 patients without late PPH, including presence of suggestive feature of pancreatic fistula (presence of air at fluid along pancreaticojejunostomy [PJ]), abscess (fluid collection with an enhancing rim or gas), fluid along hepaticojejunostomy or PJ, the density of ascites, and the size of visible gastroduodenal artery (GDA) stump. CT findings including pancreatic fistula, abscess, and large GDA stump were associated with PPH on univariate analysis ( p ≤ 0.009). On multivariate analysis, radiological features suggestive of a pancreatic fistula, abscess, and a GDA stump > 4.45 mm were associated with PPH ( p ≤ 0.031). Early postoperative CT findings including GDA stump size larger than 4.45 mm, fluid collection with an enhancing rim or gas, and air at fluid along PJ, could predict late PPH.

Beneficial effects of dexmedetomidine on early postoperative cognitive dysfunction in pediatric patients with tonsillectomy.

PubMed

Han, Chuanlai; Fu, Rong; Lei, Weifu

2018-07-01

According to clinical investigations, early postoperative cognitive dysfunction is the most common adverse event in pediatric patients after tonsillectomy. A previous study has indicated that dexmedetomidine (DEX) is an efficient drug for the treatment of postoperative cognitive dysfunction. However, the efficacy of DEX in alleviating early postoperative cognitive dysfunction in pediatric patients following tonsillectomy has remained elusive, which was therefore assessed in the present study. A total of 186 children presenting with cognitive dysfunction subsequent to tonsillectomy were recruited to analyze the efficacy of DEX. Patients were randomly divided into two groups and received intravenous treatment with DEX (n=112) or placebo (n=74). Duration of treatment, dose-limiting toxicities (DLT) and maximum tolerated dose (MTD) of DEX were evaluated in a preliminary experiment. The improvement of postoperative cognitive function in children with tonsillectomy was analyzed with a Mini-Mental State Examination (MMSE) following treatment with DEX. A 40-item quality of life (MONEX-40) questionnaire was used to assess the efficacy of DEX. The plasma levels of interleukin (IL)-6, IL-1, tumor necrosis factor (TNF)-α, superoxide dismutase (SOD), neuron-specific enolase (NSE), C-reactive protein (CRP), cortisol and melatonin were also analyzed. The preliminary experiment determined that the DLT was 10 mg/kg and the MTD was 15 mg/kg. In the major clinical trial, it was revealed that MMSE scores in the DEX treatment group were markedly improved, indicating that DEX had a beneficial effect in pediatric patients with early postoperative cognitive dysfunction after tonsillectomy. In addition, IL-1and TNF-α were downregulated, while IL-6 and SOD were upregulated in patients with cognitive dysfunction after treatment with DEX compared with those in the placebo group. Furthermore, DEX treatment markedly decreased the serum levels of CRP, NSE cortisol and melatonin, which are

Early mobilization reduces the atelectasis and pleural effusion in patients undergoing coronary artery bypass graft surgery: A randomized clinical trial.

PubMed

Moradian, Seyed Tayeb; Najafloo, Mohammad; Mahmoudi, Hosein; Ghiasi, Mohammad Saeid

2017-09-01

Atelectasis and pleural effusion are common after coronary artery bypass graft surgery (CABG). Longer stay in the bed is one of the most important contributing factors in pulmonary complications. Some studies confirm the benefits of early mobilization (EM) in critically ill patients, but the efficacy of EM on pulmonary complications after CABG is not clear. This study was designed to examine the effect of EM on the incidence of atelectasis and pleural effusion in patients undergoing CABG. In a single-blinded randomized clinical trial, 100 patients who were undergoing coronary artery bypass graft surgery were randomly assigned into two groups each consisted of 50 patients. Patients in the experimental group were enrolled in a mobilization protocol consisting of the mobilization from the bed in the first 3 days after surgery in the morning and evening. Patients in the control group were mobilized from bed in third postoperation day, according to the hospital routine. Arterial blood gases, pleural effusion, and atelectasis were compared between groups. Atelectasis and pleural effusion was reduced in experimental group. The partial pressure of oxygen in arterial blood in third postoperative day and the percentage of arterial oxygen saturation in the fourth postoperative day were higher in the intervention group (P value < .05). EM from bed could be an effective intervention in reducing atelectasis and pleural effusion in patients undergoing CABG. Copyright © 2017 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.

Early postoperative healing following buccal single flap approach to access intraosseous periodontal defects.

PubMed

Farina, Roberto; Simonelli, Anna; Rizzi, Alessandro; Pramstraller, Mattia; Cucchi, Alessandro; Trombelli, Leonardo

2013-07-01

This study aims to evaluate the early postoperative healing of papillary incision wounds and its association with (1) patient/site-related factors and technical (surgical) aspects as well as with (2) 6-month clinical outcomes following buccal single flap approach (SFA) in the treatment of intraosseous periodontal defects. Forty-three intraosseous defects in 35 patients were accessed with a buccal SFA alone or in combination with a reconstructive technology (graft, enamel matrix derivative (EMD), graft + EMD, or graft + membrane). Postoperative healing was evaluated at 2 weeks using the Early Wound-Healing Index (EHI). EHI ranged from score 1 (i.e., complete flap closure and optimal healing) to score 4 (i.e., loss of primary closure and partial tissue necrosis). SFA resulted in a complete wound closure at 2 weeks in the great majority of sites. A significantly more frequent presence of interdental contact point and interdental soft tissue crater, and narrower base of the interdental papilla were observed at sites with either EHI > 1 or EHI = 4 compared to sites with EHI = 1. No association between EHI and the 6-month clinical outcomes was observed. At 2 weeks, buccal SFA may result in highly predictable complete flap closure. Site-specific characteristics may influence the early postoperative healing of the papillary incision following SFA procedure. Two-week soft tissue healing, however, was not associated with the 6-month clinical outcomes.

Rectus sheath catheter infusions for post-operative pain management.

PubMed

Layzell, Mandy

2014-06-24

Managing pain following major abdominal surgery remains a challenge. Traditionally, patient-controlled analgesia (PCA) or epidural analgesia have been used, which have improved post-operative pain and the patient experience, but have presented some problems in recovery. PCA can cause adverse effects, including sedation, nausea, vomiting, and prolonged gastric ileus. While epidurals do have some advantages over PCA, there are risks involved related to catheter insertion and adverse effects, such as hypotension and motor blocks which limit mobility. This article examines rectus sheath catheter infusions, a relatively new and alternative technique to epidural analgesia, and presents some early audit data related to pain scores, analgesic use and mobility.

[Effect of early postoperative use of ACEI/ARB or diuretics on the incidence of acute kidney injury after cardiac surgery in elderly patients].

PubMed

Hu, Peng-hua; Chen, Yuan-han; Liang, Xin-ling; Li, Rui-zhao; Li, Zhi-lian; Jiang, Fen; Shi, Wei

2013-07-01

To explore the influence of early postoperative use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) or diuretics on acute kidney injury (AKI) after cardiac surgery in elderly patients. Data from elderly patients (age≥60 years old) who underwent cardiac surgery with extracorporeal circulation in Guangdong General Hospital between January 2007 and December 2010 were analyzed in this retrospective research. The primary endpoint was AKI as diagnosed according to the serum creatinine criteria of RIFLE (risk, injury, failure, loss, end stage renal disease). The baseline serum creatinine was defined as the latest serum creatinine level before cardiac surgery. Multivariate analysis by logistic regression was used to obtain the independent risk factors for AKI. Among 618 elderly patients, 76 (12.3%) patients received ACEI/ARB during early postoperative period, 491 (79.4%) patients were given diuretics during early postoperative period, and postoperative AKI occurred in 394 (63.8%) patients. The incidence of AKI was 46.1% in patients who received early postoperative ACEI/ARB, and 66.2% in patients who did not (P<0.001). Patients who received diuretics postoperatively were less likely to suffer from AKI compared with patients who did not (57.0% vs. 89.8%, P<0.001). After adjustment of other potential factors of postoperative AKI, logistic regression analysis showed that early postoperative use of ACEI/ARB [odds ratio (OR)=0.131, 95% confidence interval (95%CI) 0.033-0.517, P=0.004], and early postoperative use of diuretics (OR=0.149, 95%CI 0.076-0.291, P<0.001) independently predicted the occurrence of AKI. Early postoperative use of ACEI/ARB or diuretics is associated with a lower incidence of AKI after cardiac surgery with extracorporeal circulation in elderly patients.

Interference of postoperative pain on women's daily life after early discharge from cardiac surgery.

PubMed

Leegaard, Marit; Rustøen, Tone; Fagermoen, May Solveig

2010-06-01

Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory-Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important. (c) 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Early mobilization in the critical care unit: A review of adult and pediatric literature.

PubMed

Cameron, Saoirse; Ball, Ian; Cepinskas, Gediminas; Choong, Karen; Doherty, Timothy J; Ellis, Christopher G; Martin, Claudio M; Mele, Tina S; Sharpe, Michael; Shoemaker, J Kevin; Fraser, Douglas D

2015-08-01

Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. Pediatric ICU data are limited, but recent studies also suggest that early mobilization is achievable without increasing patient risk. In this review, we provide a current and comprehensive appraisal of ICU mobilization techniques in both adult and pediatric critically ill patients. Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations. Copyright © 2015 Elsevier Inc. All rights reserved.

Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery.

PubMed

Mokart, D; Merlin, M; Sannini, A; Brun, J P; Delpero, J R; Houvenaeghel, G; Moutardier, V; Blache, J L

2005-06-01

Patients who undergo major surgery for cancer are at high risk of postoperative sepsis. Early markers of septic complications would be useful for diagnosis and therapeutic management in patients with postoperative sepsis. The aim of this study was to investigate the association between early (first postoperative day) changes in interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) serum concentrations and the occurrence of subsequent septic complications after major surgery. Serial blood samples were collected from 50 consecutive patients for determination of IL-6, PCT and CRP serum levels. Blood samples were obtained on the morning of surgery and on the morning of the first postoperative day. Sixteen patients developed septic complications during the first five postoperative days (group 1), and 34 patients developed no septic complications (group 2). On day 1, PCT and IL-6 levels were significantly higher in group 1 (P-values of 0.003 and 0.006, respectively) but CRP levels were similar. An IL-6 cut-off point set at 310 pg ml(-1) yielded a sensitivity of 90% and a specificity of 58% to differentiate group 1 patients from group 2 patients. When associated with the occurrence of SIRS on day 1 these values reached 100% and 79%, respectively. A PCT cut-off point set at 1.1 ng ml(-1) yielded a sensitivity of 81% and a specificity of 72%. When associated with the occurrence of SIRS on day 1, these values reached 100% and 86%, respectively. PCT and IL-6 appear to be early markers of subsequent postoperative sepsis in patients undergoing major surgery for cancer. These findings could allow identification of postoperative septic complications.

Can preoperative and postoperative CA19-9 levels predict survival and early recurrence in patients with resectable hilar cholangiocarcinoma?

PubMed

Wang, Jun-Ke; Hu, Hai-Jie; Shrestha, Anuj; Ma, Wen-Jie; Yang, Qin; Liu, Fei; Cheng, Nan-Sheng; Li, Fu-Yu

2017-07-11

To investigate the predictive values of preoperative and postoperative serum CA19-9 levels on survival and other prognostic factors including early recurrence in patients with resectable hilar cholangiocarcinoma. In univariate analysis, increased preoperative and postoperative CA19-9 levels in the light of different cut-off points (37, 100, 150, 200, 400, 1000 U/ml) were significantly associated with poor survival outcomes, of which the cut-off point of 150 U/ml showed the strongest predictive value (both P < 0.001). Preoperative to postoperative increase in CA19-9 level was also correlated with poor survival outcome (P < 0.001). In multivariate analysis, preoperative CA19-9 level > 150 U/ml was significantly associated with lymph node metastasis (OR = 3.471, 95% CI 1.216-9.905; P = 0.020) and early recurrence (OR = 8.280, 95% CI 2.391-28.674; P = 0.001). Meanwhile, postoperative CA19-9 level > 150 U/ml was also correlated with early recurrence (OR = 4.006, 95% CI 1.107-14.459; P = 0.034). Ninety-eight patients who had undergone curative surgery for hilar cholangiocarcinoma between 1995 and 2014 in our institution were selected for the study. The correlations of preoperative and postoperative serum CA19-9 levels on the basis of different cut-off points with survival and various tumor factors were retrospectively analyzed with univariate and multivariate methods. In patients with resectable hilar cholangiocarcinoma, serum CA19-9 predict survival and early recurrence. Patients with increased preoperative and postoperative CA19-9 levels have poor survival outcomes and higher tendency of early recurrence.

Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition.

PubMed

Holte, K; Kehlet, H

2002-06-01

Surgical injury leads to an endocrine-metabolic and inflammatory response with protein catabolism, increased cardiovascular demands, impaired pulmonary function and paralytic ileus, the most important release mechanisms being afferent neural stimuli and inflammatory mediators. Epidural local anaesthetic blockade of afferent stimuli reduces endocrine metabolic responses, and improve postoperative catabolism. Furthermore, dynamic pain relief is achieved with improved pulmonary function and a pronounced reduction of postoperative ileus, thereby providing optimal conditions for improved mobilization and oral nutrition, and preservation of body composition and muscle function. Studies integrating continuous epidural local anaesthetics with enforced early nutrition and mobilization uniformly suggest an improved recovery, decreased hospital stay and convalescence. Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity.

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.

Early water intake restriction to prevent inappropriate antidiuretic hormone secretion following transsphenoidal surgery: low BMI predicts postoperative SIADH.

PubMed

Matsuyama, Junko; Ikeda, Hidetoshi; Sato, Shunsuke; Yamamoto, Koh; Ohashi, Genichiro; Watanabe, Kazuo

2014-12-01

The goals of this study were to assess the incidence of and risk factors for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients following transsphenoidal surgery (TSS), and to validate the effectiveness of early prophylactic restriction of water intake. Retrospective analysis was performed for 207 patients who had undergone TSS, including 156 patients not placed on early prophylactic water restriction. Sixty-four patients received treatment for SIADH. We compared the incidence of SIADH between patients with and without early water intake restriction, and analyzed various risk factors for SIADH using statistical analyses. BMI was significantly lower for patients with SIADH than for those patients without SIADH. Statistical analysis revealed that the threshold BMI predicting SIADH was 26. Serum sodium levels on postoperative days 5-10 and daily urine volumes on postoperative days 5-10 were significantly lower in patients with SIADH than in those without SIADH. Postoperative body weight loss on days 6, 8, 10, and 11 was significantly higher in patients with SIADH. The incidence of SIADH after starting prophylactic water intake restriction (14%) was significantly lower than the rate before early water restriction (38%; P<0.05). SIADH is relatively common after TSS, and serum sodium concentrations and daily urine volumes should be carefully monitored. Patients with low preoperative BMI should be closely observed, as this represented a significant preoperative risk factor for SIADH. Early prophylactic water intake restriction appears effective at preventing postoperative SIADH. © 2014 European Society of Endocrinology.

Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy.

PubMed

Frask, Agata; Orłowski, Michał; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Gajewski, Krzysztof; Michalik, Maciej

2017-06-01

Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. To develop and implement certain standards for early detection of complications. The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1 st and 2 nd postoperative day (POD). Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2 nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1 st and 2 nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2 nd POD compared to the remainder. The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG.

Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy

PubMed Central

Frask, Agata; Orłowski, Michał; Lech, Paweł; Gajewski, Krzysztof; Michalik, Maciej

2017-01-01

Introduction Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. Aim To develop and implement certain standards for early detection of complications. Material and methods The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1st and 2nd postoperative day (POD). Results Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1st and 2nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2nd POD compared to the remainder. Conclusions The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG. PMID:28694902

Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit.

PubMed

Doiron, Katherine A; Hoffmann, Tammy C; Beller, Elaine M

2018-03-27

.38, low quality evidence). There is low quality evidence that early mobilization may have little or no effect on physical function measured by the Short Physical Performance Battery score at ICU discharge from one study of 184 participants (mean 1.6 in the intervention group versus 1.9 in usual care, MD -0.30, 95% CI -1.10 to 0.50), or at hospital discharge (MD 0, 95% CI -1.00 to 0.90). The fourth study, which examined postoperative cardiac surgery patients did not measure physical function as an outcome.Adverse effects were reported across the four studies but we could not combine the data. Our certainty in the risk of adverse events with either mobilization strategy is low due to the low rate of events. One study reported that in the intervention group one out of 49 participants (2%) experienced oxygen desaturation less than 80% and one of 49 (2%) had accidental dislodgement of the radial catheter. This study also found cessation of therapy due to participant instability occurred in 19 of 498 (4%) of the intervention sessions. In another study five of 101 (5%) participants in the intervention group and five of 109 (4.6%) participants in the control group had postoperative pulmonary complications deemed to be unrelated to intervention. A third study found one of 150 participants in the intervention group had an episode of asymptomatic bradycardia, but completed the exercise session. The fourth study reported no adverse events. There is insufficient evidence on the effect of early mobilization of critically ill people in the ICU on physical function or performance, adverse events, muscle strength and health-related quality of life at this time. The four studies awaiting classification, and the three ongoing studies may alter the conclusions of the review once these results are available. We assessed that there is currently low-quality evidence for the effect of early mobilization of critically ill adults in the ICU due to small sample sizes, lack of blinding of

Preoperative determinant of early postoperative renal function following radical cystectomy and intestinal urinary diversion.

PubMed

Gondo, Tatsuo; Ohno, Yoshio; Nakashima, Jun; Hashimoto, Takeshi; Nakagami, Yoshihiro; Tachibana, Masaaki

2017-02-01

To identify preoperative factors correlated with postoperative early renal function in patients who had undergone radical cystectomy (RC) and intestinal urinary diversion. We retrospectively identified 201 consecutive bladder cancer patients without distant metastasis who had undergone RC at our institution between 2003 and 2012. The estimated glomerular filtration rate (eGFR) was calculated using the modified Chronic Kidney Disease Epidemiology equation before RC and 3 months following RC. Univariate and stepwise multiple linear regression analyses were applied to estimate postoperative renal function and to identify significant preoperative predictors of postoperative renal function. Patients who had undergone intestinal urinary diversion and were available for the collection of follow-up data (n = 164) were eligible for the present study. Median preoperative and postoperative eGFRs were 69.7 (interquartile range [IQR] 56.3-78.0) and 70.7 (IQR 57.3-78.1), respectively. In univariate analyses, age, preoperative proteinuria, thickness of abdominal subcutaneous fat tissue (TSF), preoperative serum creatinine level, preoperative eGFR, and urinary diversion type were significantly associated with postoperative eGFR. In a stepwise multiple linear regression analysis, preoperative eGFR, age, and TSF were significant factors for predicting postoperative eGFR (p < 0.001, p = 0.02, and p = 0.046, respectively). The estimated postoperative eGFRs correlated well with the actual postoperative eGFRs (r = 0.65, p < 0.001). Preoperative eGFR, age, and TSF were independent preoperative factors for determining postoperative renal function in patients who had undergone RC and intestinal urinary diversion. These results may be used for patient counseling before surgery, including the planning of perioperative chemotherapy administration.

Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol.

PubMed

Cuff, Derek J; Pupello, Derek R

2012-11-01

This study evaluated patient outcomes and rotator cuff healing after arthroscopic rotator cuff repair using a postoperative physical therapy protocol with early passive motion compared with a delayed protocol that limited early passive motion. The study enrolled 68 patients (average age, 63.2 years) who met inclusion criteria. All patients had a full-thickness crescent-shaped tear of the supraspinatus that was repaired using a transosseous equivalent suture-bridge technique along with subacromial decompression. In the early group, 33 patients were randomized to passive elevation and rotation that began at postoperative day 2. In the delayed group, 35 patients began the same protocol at 6 weeks. Patients were monitored clinically for a minimum of 12 months, and rotator cuff healing was assessed using ultrasound imaging. Both groups had similar improvements in preoperative to postoperative American Shoulder and Elbow Surgeons scores (early group: 43.9 to 91.9, P < .0001; delayed group: 41.0 to 92.8, P < .0001) and Simple Shoulder Test scores (early group: 5.5 to 11.1, P < .0001; delayed group: 5.1 to 11.1, P < .0001). There were no significant differences in patient satisfaction, rotator cuff healing, or range of motion between the early and delayed groups. Patients in the early group and delayed group both demonstrated very similar outcomes and range of motion at 1 year. There was a slightly higher rotator cuff healing rate in the delayed passive range of motion group compared with the early passive range of motion group (91% vs 85%). Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Peripheral and spinal activation of cannabinoid receptors by joint mobilization alleviates postoperative pain in mice.

PubMed

Martins, D F; Mazzardo-Martins, L; Cidral-Filho, F J; Gadotti, V M; Santos, A R S

2013-01-01

The present study was undertaken to investigate the relative contribution of cannabinoid receptors (CBRs) subtypes and to analyze cannabimimetic mechanisms involved in the inhibition of anandamide (AEA) and 2-arachidonoyl glycerol degradation on the antihyperalgesic effect of ankle joint mobilization (AJM). Mice (25-35g) were subjected to plantar incision (PI) and 24h after surgery animals received the following treatments, AJM for 9min, AEA (10mg/kg, intraperitoneal [i.p.]), WIN 55,212-2 (1.5mg/kg, i.p.), URB937 (0.01-1mg/kg, i.p.; a fatty acid amide hydrolase [FAAH] inhibitor) or JZL184 (0.016-16mg/kg, i.p.; a monoacylglycerol lipase [MAGL] inhibitor). Withdrawal frequency to mechanical stimuli was assessed 24h after PI and at different time intervals after treatments. Receptor specificity was investigated using selective CB1R (AM281) and CB2R (AM630) antagonists. In addition, the effect of the FAAH and MAGL inhibitors on the antihyperalgesic action of AJM was investigated. AJM, AEA, WIN 55,212-2, URB937 and JZL184 decreased mechanical hyperalgesia induced by PI. The antihyperalgesic effect of AJM was reversed by pretreatment with AM281 given by intraperitoneal and intrathecal routes, but not intraplantarly. Additionally, intraperitoneal and intraplantar, but not intrathecal administration of AM630 blocked AJM-induced antihyperalgesia. Interestingly, in mice pretreated with FAAH or the MAGL inhibitor the antihyperalgesic effect of AJM was significantly longer. This article presents data addressing the CBR mechanisms underlying the antihyperalgesic activity of joint mobilization as well as of the endocannabinoid catabolic enzyme inhibitors in the mouse postoperative pain model. Joint mobilization and these enzymes offer potential targets to treat postoperative pain. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

Early Transthoracic Echocardiography after Cardiac Surgery Predicts Postoperative Atrial Fibrillation.

PubMed

Lacalzada, Juan; Jiménez, Juan José; Iribarren, José Luis; de la Rosa, Alejandro; Martín-Cabeza, Marta; Izquierdo, María Manuela; Marí-López, Belén; García-González, Martín Jesús; Jorge-Pérez, Pablo; Barragán, Antonio; Laynez, Ignacio

2016-09-01

Postoperative atrial fibrillation (POAF) is frequent after cardiac surgery. We aimed to establish a predictive model of POAF based on postoperative transthoracic echocardiography (TTE) findings. This study included 147 patients (aged 67 ± 11 years; 109 men) undergoing coronary artery bypass grafting and/or aortic valve replacement. TTE and Doppler tissue imaging were performed on intensive care unit arrival after surgery. All patients were continuously monitored during hospitalization. The end point was the appearance of POAF. POAF appeared in 37 patients (25.2%). These patients were older (69 ± 16 vs. 65 ± 12 years; P < 0.001) and had increased long axis of the left atrium (LA) dimension (5.4 ± 1 vs. 4.8 ± 0.9 cm, P = 0.02), lower early diastolic velocity of the mitral annulus (e') (6.9 ± 2.1 vs. 8 ± 1.8 cm/sec; P < 0.01), and higher early diastolic pulsed Doppler mitral ratio (E)/e' (E/e') (17.4 ± 6.8 vs. 13.8 ± 6; P = 0.01). Left ventricle diastolic dysfunction grade (DFG) of 2 or 3 relative to grade 0 was significant: odds ratio (OR) 22.5, 95% confidence interval (CI) 4.52-57.2; P < 0.001, and OR: 23.6, 95% CI: 3.57-60.1; P = 0.001), respectively. On multivariate analysis, the independent predictors of POAF were age (OR: 1.10, 95% CI: 1.01-1.18; P < 0.05), long-axis LA dimension (OR: 6.24, 95% CI: 1.97-8.23; P = 0.0017), DFG-2 (OR: 4.1, 95% CI: 1.57-15.81; P < 0.001), and DFG-3 (OR: 8.3, 95% CI: 4.11-25.37; P < 0.001). Apart from age, the simple determination by postoperative TTE of long-axis LA dimension and DFG after cardiac surgery proved to be powerful independent predictors of POAF and may be useful for risk stratification of these patients. © 2016, Wiley Periodicals, Inc.

Robot-assisted laparoscopic prostatectomy is not associated with early postoperative radiation therapy.

PubMed

Chino, Junzo; Schroeck, Florian R; Sun, Leon; Lee, W Robert; Albala, David M; Moul, Judd W; Koontz, Bridget F

2009-11-01

To compare open radical prostatectomy (RP) and robot-assisted laparoscopic prostatectomy (RALP), and to determine whether RALP is associated with a higher risk of features that determine recommendations for postoperative radiation therapy (RT). Patients undergoing RP from 2003 to 2007 were stratified into two groups: open RP and RALP. Preoperative (PSA level, T stage and Gleason score), pathological factors (T stage, Gleason score, extracapsular extension [ECE] and the status of surgical margins and seminal vesicle invasion [SVI]) and early treatment with RT or referral for RT within 6 months were compared between the groups. Multivariate analysis was used to control for selection bias in the RALP group. In all, 904 patients were identified; 368 underwent RALP and 536 underwent open RP (retropubic or perineal). Patients undergoing open RP had a higher pathological stage with ECE present in 24.8% vs 19.3% in RALP (P = 0.05) and SVI in 10.3% vs 3.8% (P < 0.001). In the RALP vs open RP group, there were positive surgical margins in 31.5% vs 31.9% (P = 0.9) and there were postoperative PSA levels of (3) 0.2 ng/mL in 5.7% vs 6.3% (P = 0.7), respectively. On multivariate analysis to control for selection bias, RALP was not associated with indication for RT (odds ratio (OR) 1.10, P = 0.55), or referral for RT (OR 1.04, P = 0.86). RALP was not associated with an increase in either indication or referral for early postoperative RT.

Preoperative Recipient Parameters Allow Early Estimation of Postoperative Outcome and Intraoperative Transfusion Requirements in Liver Transplantation.

PubMed

Schumacher, Carsten; Eismann, Hendrik; Sieg, Lion; Friedrich, Lars; Scheinichen, Dirk; Vondran, Florian W R; Johanning, Kai

2018-01-01

Liver transplantation is a complex intervention, and early anticipation of personnel and logistic requirements is of great importance. Early identification of high-risk patients could prove useful. We therefore evaluated prognostic values of recipient parameters commonly available in the early preoperative stage regarding postoperative 30- and 90-day outcomes and intraoperative transfusion requirements in liver transplantation. All adult patients undergoing first liver transplantation at Hannover Medical School between January 2005 and December 2010 were included in this retrospective study. Demographic, clinical, and laboratory data as well as clinical courses were recorded. Prognostic values regarding 30- and 90-day outcomes were evaluated by uni- and multivariate statistical tests. Identified risk parameters were used to calculate risk scores. There were 426 patients (40.4% female) included with a mean age of 48.6 (11.9) years. Absolute 30-day mortality rate was 9.9%, and absolute 90-day mortality rate was 13.4%. Preoperative leukocyte count >5200/μL, platelet count <91 000/μL, and creatinine values ≥77 μmol/L were relevant risk factors for both observation periods ( P < .05, respectively). A score based on these factors significantly differentiated between groups of varying postoperative outcomes and intraoperative transfusion requirements ( P < .05, respectively). A score based on preoperative creatinine, leukocyte, and platelet values allowed early estimation of postoperative 30- and 90-day outcomes and intraoperative transfusion requirements in liver transplantation. Results might help to improve timely logistic and personal strategies.

Fatigue and pain limit independent mobility and physiotherapy after hip fracture surgery.

PubMed

Münter, Kristine H; Clemmesen, Christopher G; Foss, Nicolai B; Palm, Henrik; Kristensen, Morten T

2018-07-01

The patient's ability to complete their planned physiotherapy session after hip fracture surgery has been proposed as an independent predictor for achieving basic mobility independency upon hospital discharge. However, knowledge of factors limiting mobility is sparse. We therefore examined patient reported factors limiting ability to complete planned physiotherapy sessions as well as limitations for not achieving independency in basic mobility early after hip fracture surgery. A total of 204 consecutive patients with a hip fracture (mean (SD) age of 80 (9.9) years, 47 patients were admitted from a nursing home) were treated in accordance with a multimodal program. The Cumulated Ambulation Score was used to evaluate the patient's independency in three basic mobility activities: getting in and out of bed, sit-to-stand-to-sit from a chair and indoor walking. Pre-defined limitations; pain, motor blockade, dizziness, fatigue, nausea, acute cognitive dysfunction and "other limitations", for not achieving a full Cumulated Ambulation Score or inability to complete planned physiotherapy sessions were noted by the physiotherapist on each of the three first postoperative days. This period was chosen, because of its importance on how well the patients had regained their pre-fracture functional level. Fatigue and hip fracture-related pain were the most frequent reasons for patients not achieving an independent basic mobility level (> 85%) or not fully completing their planned physiotherapy (> 42%) on all three days. At hospital discharge (median day 10), only 54% of the patients had regained their pre-fracture basic mobility level. Based on the patient's perception, fatigue and pain are the most frequent limitations in not achieving independent basic mobility and not completing physiotherapy after hip fracture surgery. This raises questions whether multimodal peri-operative programs can be further optimized to enhance the early recovery of these frail patients. Implications

[Usefulness of upper gastrointestinal series to detect leaks in the early postoperative period of bariatric surgery].

PubMed

Medina, Francisco J; Miranda-Merchak, Andrés; Martínez, Alonso; Sánchez, Felipe; Bravo, Sebastián; Contreras, Juan Eduardo; Alliende, Isabel; Canals, Andrea

2016-04-01

Postoperative leaks are the most undesirable complication of bariatric surgery and upper gastrointestinal (GI) series are routinely ordered to rule them out. Despite the published literature recommending against its routine use, it is still being customarily used in Chile. To examine the usefulness of routine upper GI series using water-soluble iodinated contrast media for the detection of early postoperative leaks in patients undergoing bariatric surgery. A cohort of 328 patients subjected to bariatric surgery was followed from October 2012 to October 2013. Most of them underwent sleeve gastrectomy. Upper GI series on the first postoperative day were ordered to 308 (94%) patients. Postoperative leaks were observed in two patients, with an incidence of 0.6%. The sensitivity for upper GI series detection of leak was 0% and the negative predictive value was 99%. Routine upper GI series after bariatric surgery is not useful for the diagnosis of postoperative leak, given the low incidence of this complication and the low sensitivity of the technique.

Postoperative respiratory muscle dysfunction: pathophysiology and preventive strategies.

PubMed

Sasaki, Nobuo; Meyer, Matthew J; Eikermann, Matthias

2013-04-01

Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups. These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.

Risk factors for early post-operative neurological deterioration in dogs undergoing a cervical dorsal laminectomy or hemilaminectomy: 100 cases (2002-2014).

PubMed

Taylor-Brown, F E; Cardy, T J A; Liebel, F X; Garosi, L; Kenny, P J; Volk, H A; De Decker, S

2015-12-01

Early post-operative neurological deterioration is a well-known complication following dorsal cervical laminectomies and hemilaminectomies in dogs. This study aimed to evaluate potential risk factors for early post-operative neurological deterioration following these surgical procedures. Medical records of 100 dogs that had undergone a cervical dorsal laminectomy or hemilaminectomy between 2002 and 2014 were assessed retrospectively. Assessed variables included signalment, bodyweight, duration of clinical signs, neurological status before surgery, diagnosis, surgical site, type and extent of surgery and duration of procedure. Outcome measures were neurological status immediately following surgery and duration of hospitalisation. Univariate statistical analysis was performed to identify variables to be included in a multivariate model. Diagnoses included osseous associated cervical spondylomyelopathy (OACSM; n = 41), acute intervertebral disk extrusion (IVDE; 31), meningioma (11), spinal arachnoid diverticulum (10) and vertebral arch anomalies (7). Overall 54% (95% CI 45.25-64.75) of dogs were neurologically worse 48 h post-operatively. Multivariate statistical analysis identified four factors significantly related to early post-operative neurological outcome. Diagnoses of OACSM or meningioma were considered the strongest variables to predict early post-operative neurological deterioration, followed by higher (more severely affected) neurological grade before surgery and longer surgery time. This information can aid in the management of expectations of clinical staff and owners with dogs undergoing these surgical procedures. Copyright © 2015 Elsevier Ltd. All rights reserved.

Utility of routine postoperative visit after appendectomy and cholecystectomy with evaluation of mobile technology access in an urban safety net population.

PubMed

Chen, Diane W; Davis, Rachel W; Balentine, Courtney J; Scott, Aaron R; Gao, Yue; Tapia, Nicole M; Berger, David H; Suliburk, James W

2014-08-01

The value of routine postoperative visits after general surgery remains unclear. The objective of this study was to evaluate the utility of routine postoperative visits after appendectomy and cholecystectomy and to determine access to mobile technology as an alternative platform for follow-up. Retrospective review of 219 appendectomies and 200 cholecystectomies performed at a safety net hospital. One patient underwent both surgeries. Patient demographics, duration of clinic visit, and need for additional imaging, tests or readmissions were recorded. Access to mobile technology was surveyed by a validated questionnaire. Of 418 patients, 84% percent completed a postoperative visit. At follow-up, 58 patients (14%) required 70 interventions, including staple removal (16, 23%), suture removal (4, 6%), drain removal (8, 11%), additional follow-up (20, 28%), medication action (16, 21%), additional imaging (3, 4%), and readmission (1, 1%). Occupational paperwork (62) and nonsurgical clinic referrals (28) were also performed. Average check-in to check-out time was 100 ± 54 min per patient. One intervention was performed for every 7.8 h of time in the clinic. Additionally, 88% of the surveyed population reported access to cell phone technology, and 69% of patients <40 y had smartphone access. Routine in-person follow-up after surgery consumes significant time and resources for patients and healthcare systems but has little impact on patient care. Most of the work done in the clinic is administrative and could be completed using mobile technology, which is pervasive in our population. Copyright © 2014 Elsevier Inc. All rights reserved.

Preoperative Gabapentin Decreases Anxiety and Improves Early Functional Recovery From Knee Surgery

PubMed Central

Ménigaux, Christophe; Adam, Frédéric; Guignard, Bruno; Sessler, Daniel I.; Chauvin, Marcel

2005-01-01

Gabapentin has antihyperalgesic and anxiolytic properties. We thus tested the hypothesis that premedication with gabapentin would decrease preoperative anxiety and improve postoperative analgesia and early postoperative knee mobilization in patients undergoing arthroscopic anterior cruciate ligament repair under general anesthesia. Forty patients were randomly assigned to receive 1200 mg oral gabapentin or placebo 1-2 h before surgery; anesthesia was standardized. Patients received morphine, 0.1 mg/kg, 30 min before the end of surgery and postoperatively via a patient-controlled pump. Pain scores and morphine consumption were recorded over 48 hours. Degrees of active and passive knee flexion and extension were recorded during physiotherapy on days 1 and 2. Preoperative anxiety scores were less in the Gabapentin than Control group (visual analog [VAS] score of 28 ± 16 mm versus 66 ± 15 mm; P < 0.001). The Gabapentin group required less morphine than the Control group (29 ± 22 mg versus 69 ± 40 mg; P < 0.001). VAS pain scores at rest and after mobilization were significantly reduced in the Gabapentin group. First and maximal passive and active knee flexions at 24 and 48 hours were significantly more extensive in the Gabapentin than in the Control group. In conclusion, premedication with 1200 mg gabapentin improved preoperative anxiolysis, postoperative analgesia, and early knee mobilization after arthroscopic anterior cruciate ligament repair. PMID:15845693

Left atrial volume index as a predictor for persistent left ventricular dysfunction after aortic valve surgery in patients with chronic aortic regurgitation: the role of early postoperative echocardiography.

PubMed

Cho, In-Jeong; Chang, Hyuk-Jae; Hong, Geu-Ru; Heo, Ran; Sung, Ji Min; Lee, Sang-Eun; Chang, Byung-Chul; Shim, Chi Young; Ha, Jong-Won; Chung, Namsik

2015-06-01

This study aimed to explore whether echocardiographic measurements during the early postoperative period can predict persistent left ventricular systolic dysfunction (LVSD) after aortic valve surgery in patients with chronic aortic regurgitation (AR). We prospectively recruited 54 patients (59 ± 12 years) with isolated chronic severe AR who subsequently underwent aortic valve surgery. Standard transthoracic echocardiography was performed before the operation, during the early postoperative period (≤2 weeks), and then 1 year after the surgery. Twelve patients with preoperative LVSD demonstrated LVSD at early after the surgery. Of the 42 patients without LVSD at preoperative echocardiography, 15 patients (36%) developed early postoperative LVSD after surgical correction. All 27 patients without LVSD at early postoperative echocardiography maintained LV function at 1 year after surgery. In the other 27 patients with postoperative LVSD, 17 patients recovered from LVSD and 10 patients did not at 1 year after surgery. Multiple logistic analysis demonstrated that postoperative left atrial volume index (LAVI) was the only independent predictor for persistent LVSD at 1 year after surgery in patients with postoperative LVSD (OR 1.180, 95% CI, 1.003-1.390, P = 0.046). The optimal LAVI cutoff value (>34.9 mL/m(2) ) had a sensitivity of 80% and a specificity of 88% for the prediction of persistent LVSD. Prevalence of early postoperative LVSD was relatively high, even in the patients without LVSD at preoperative echocardiography. Postoperative LAVI could be useful to predict persistent LVSD after aortic valve surgery in patients with early postoperative LVSD. © 2014, Wiley Periodicals, Inc.

Very Early Colorectal Anastomotic Leakage within 5 Post-operative Days: a More Severe Subtype Needs Relaparatomy

PubMed Central

Li, Yi-Wei; Lian, Peng; Huang, Ben; Zheng, Hong-Tu; Wang, Ming-He; Gu, Wei-Lie; Li, Xin-Xiang; Xu, Ye; Cai, San-Jun

2017-01-01

Early anastomotic leakage (AL), usually defined as leakage within 30 post-operative days, represents a severe entity. However, mounting evidence has indicated that majorities of leakage occur within one week after surgery, making late AL rarity. Here we analyzed 101 consecutive colorectal AL, all of which occurred within 30 post-operative days, during Jan 2013 and Dec 2015 in cancer hospital of Fudan University. AL occurring within 5 post-operative days was defined as very early AL (vE-AL). We evaluated risk factors of vE-AL compared with non-vEAL and correlated with post-leakage peritonitis and need of relaparatomy. We found that AL occurred at median time of 7 days after surgery. 23 cases were vE-AL. Reconstruction of post-peritoneum for mid-low rectal carcinoma significantly reduced incidence of vE-AL compared with non-vE-AL (p = 0.042). Patients with vE-AL was associated with presence of peritonitis (p = 0.031), the latter significantly correlated with increased re-operation rate (p = 6.8E-13). Besides, patients with vE-AL trended to correlate with increased re-operation rate after leakage (p = 0.088). In concludsion, vE-AL occurring within 5 post-operative days represents a severe subtype associated with general peritonitis and need of relaparatomy. PMID:28084305

Inefficacy of Kinesio-Taping(®) on early postoperative pain after ACL reconstruction: Prospective comparative study.

PubMed

Laborie, M; Klouche, S; Herman, S; Gerometta, A; Lefevre, N; Bohu, Y

2015-12-01

Kinesio-Taping(®) (K-Tape) is used in sports traumatology with the aim of reducing pain and improving blood and lymph circulation. The main objective of the present study was to assess the efficacy of K-Tape on early postoperative pain after anterior cruciate ligament (ACL) reconstruction. The study hypothesis was that K-Tape significantly decreases pain. A prospective non-randomized comparative study was conducted in 2013-2014 and included all patients who underwent primary ACL reconstruction by hamstring graft. Analgesia was standardized. Two groups, "K-Tape" and "controls", were formed according to the days on which the study physiotherapist was present. The K-Tape compression/decompression assembly was applied immediately postoperatively and maintained for 3days. Patients filled out online questionnaires. The main assessment criterion was mean postoperative pain (D0-D3) on a 0-to-10 scale. Secondary criteria were analgesia intake on the three WHO levels, awakening during the night of D0 due to pain, signs of postoperative discomfort, and patient satisfaction. Sixty patients (30 per group) were included, 57 of whom could be assessed: 28 K-Tape, 29 controls; 44 male, 13 female; mean age, 30.9±8.9 years. At inclusion, the two groups were comparable. There was no significant difference in mean (D0-D3) knee pain intensity: 3.8±2.2 for K-Tape, and 3.9±2 for controls (P=0.93). Analysis of variance (ANOVA) found no significant intergroup difference in evolution of pain (P=0.34). There were no other significant differences on the other assessment criteria. K-Tape showed no efficacy on early postoperative pain following ACL reconstruction. III; prospective non-randomized comparative study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Importance of Early Postoperative Body Temperature Management for Treatment of Subarachnoid Hemorrhage.

PubMed

Suehiro, Eiichi; Sadahiro, Hirokazu; Goto, Hisaharu; Oku, Takayuki; Oka, Fumiaki; Fujiyama, Yuichi; Shirao, Satoshi; Yoneda, Hiroshi; Koizumi, Hiroyasu; Ishihara, Hideyuki; Suzuki, Michiyasu

2016-06-01

The importance of acute-phase brain temperature management is widely accepted for prevention of exacerbation of brain damage by a high body temperature. In this study, we investigated the influence of body temperature in the early postoperative period on the outcomes of 62 patients with subarachnoid hemorrhage who were admitted to our department. Body temperature was measured from day 4 to day 14 after onset. The patients were divided into those treated with surgical clipping (clip group) and coil embolization (coil group), those graded I-III (mild) and IV-V (severe) based on the Hunt & Hess classification on admission, those with and without development of delayed cerebral ischemia (DCI), and those with favorable and poor outcomes. Body temperatures throughout the hospital stay were compared in each group. There was no significant difference in body temperature between the clip and coil groups or between the mild and severe groups, but body temperature was significantly higher in patients with DCI compared to those without DCI, and in patients with a poor outcome compared to those with a favorable outcome. Fever in the early postoperative period of subarachnoid hemorrhage is associated with development of DCI and a poor outcome. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Does evidence really matter? Professionals’ opinions on the practice of early mobilization after stroke

PubMed Central

Sjöholm, Anna; Skarin, Monica; Linden, Thomas; Bernhardt, Julie

2011-01-01

Introduction: Early mobilization after stroke may be important for a good outcome and it is currently recommended in a range of international guidelines. The evidence base, however, is limited and clear definitions of what constitutes early mobilization are lacking. Aims: To explore stroke care professionals’ opinions about (1) when after stroke, first mobilization should take place, (2) whether early mobilization may affect patients’ final outcome, and (3) what level of evidence they require to be convinced that early mobilization is beneficial. Methods: A nine-item questionnaire was used to interview stroke care professionals during a conference in Sydney, Australia. Results: Among 202 professionals interviewed, 40% were in favor of mobilizing both ischemic and hemorrhagic stroke patients within 24 hours of stroke onset. There was no clear agreement about the optimal time point beyond 24 hours. Most professionals thought that patients’ final motor outcome (76%), cognitive outcome (57%), and risk of depression (75%) depends on being mobilized early. Only 19% required a large randomized controlled trial or a systematic review to be convinced of benefit. Conclusion: The spread in opinion reflects the absence of clear guidelines and knowledge in this important area of stroke recovery and rehabilitation, which suggests further research is required. PMID:22096341

Impressions of Early Mobilization of Critically Ill Children-Clinician, Patient, and Family Perspectives.

PubMed

Zheng, Katina; Sarti, Aimee; Boles, Sama; Cameron, Saoirse; Carlisi, Robert; Clark, Heather; Khawaji, Adeeb; Awladthani, Saif; Al-Harbi, Samah; Choong, Karen

2018-04-11

To understand patient, family caregiver, and clinician impressions of early mobilization, the perceived barriers and facilitators to its implementation, and the use of in-bed cycling as a method of mobilization. A qualitative study, conducted as part of the Early Exercise in Critically ill Youth and Children, a preliminary Evaluation (wEECYCLE) Pilot randomized controlled trial. McMaster Children's Hospital PICU, Hamilton, ON, Canada. Clinicians (i.e., physicians, nurses, and physiotherapists), family caregivers, and capable patients age greater than or equal to 8 years old who were enrolled in a clinical trial of early mobilization in critically ill children (wEECYCLE). Semistructured, face-to-face interviews using a customized interview guide for clinicians, caregivers, and patients respectively, conducted after exposure to the early mobilization intervention. Thirty-seven participants were interviewed (19 family caregivers, four patients, and 14 clinicians). Family caregivers and clinicians described similar interrelated themes representing barriers to mobilization, namely low prioritization of mobilization by the medical team, safety concerns, the lack of physiotherapy resources, and low patient motivation. Key facilitators were family trust in the healthcare team, team engagement, an a priori belief that physical activity is important, and participation in research. Increased familiarity and specific features such as the virtual reality component and ability to execute passive and or active mobilization helped to engage critically ill children in in-bed cycling. Clinicians, patients, and families were highly supportive of mobilization in critically ill children; however, concerns were identified with respect to how and when to execute this practice. Understanding key stakeholder perspectives enables the development of strategies to facilitate the implementation of early mobilization and in-bed cycling, not just in the context of a clinical trial but also

Extended Release Liposomal Bupivacaine Injection (Exparel) for Early Postoperative Pain Control Following Palatoplasty.

PubMed

Day, Kristopher M; Nair, Narayanan M; Sargent, Larry A

2018-05-14

Liposomal bupivacaine (LB) is a long-acting local anesthetic reported to decrease postoperative pain in adults. The authors demonstrate the safe use of LB in pediatric patients with improved pain control following palatoplasty. Retrospective patient series of all single-surgeon palatoplasty patients treated at a tertiary craniofacial center from August 2014 to December 2015 were included. All patients received 1.3% LB intraoperatively as greater palatal nerve and surgical field blocks in 2-flap V-Y pushback palatoplasty. Postoperative oral intake, opioids administered, duration of hospitalization, and FLACC (face, legs, activity, cry, consolability) pain scores were measured. Twenty-seven patients (16 males and 11 females, average age of 10.8 months, weight 8.8 kg) received 2.9 ± 0.9 mL (2.6 ± 1.9 mg/kg) 1.3% LB. Average FLACC scores were 2.4 ± 2.2/10 in the postanesthesia care unit and 3.8 ± 1.8/10 while inpatients. Oral intake was first tolerated 10.3 ± 11.5 hours postoperatively and tolerated 496.4 ± 354.2 mL orally in the first 24 hours postoperatively. Patients received 8.5 ± 8.4 mg hydrocodone equivalents (0.46 ± 0.45 mg/kg per d hydrocodone equivalents) and were discharged 2.1 ± 1.3 days postoperatively. Opioid-related adverse events included emesis in 7.4% and pruritis in 3.7% of patients. The LB may be used safely in pediatric patients. Intraoperative injection of LB during palatoplasty can yield low postoperative opioid use and an early and adequate volume of oral intake over an average hospital stay. Further cost-efficacy studies of LB are needed to assess its value in pediatric plastic surgery.

The effectiveness of Kinesio Taping® after total knee replacement in early postoperative rehabilitation period. A randomized controlled trial.

PubMed

Donec, V; Kriščiūnas, A

2014-08-01

The number of total knee replacements performed each year is increasing. Among the main impediments to functional recovery after these surgeries include postoperative edema, pain, lower limb muscle strength deficits, all of which point to a need to identify safe, effective postoperative rehabilitation modalities. The aim of this paper was to evaluate the effectiveness of Kinesio Taping® (KT) method in reducing postoperative pain, edema, and improved knee range of motion recovery after total knee replacement (TKR) operation in early postoperative rehabilitation period. Randomized clinical trial. Inpatient rehabilitation facility. Ninety-four patients, who underwent primary TKR surgery. Using simple randomization, participants were divided into KT group and control group. Both groups received same rehabilitation program and procedures after surgery, except KT group also received KT applications throughout all rehabilitation period. Postoperative pain, edema, restoration of the operated knee flexion and extension were evaluated. The chosen level of significance was P<0.05; in evaluation power of the test β ≤ 0.2. Groups were homogenous to sex, age, BMI, comorbidities, preoperative knee flexion/extension impairment, preoperative pain intensity, anaesthesia, prosthesis implanted (P>0.05). In both groups postoperative pain decreased significantly during rehabilitation period, however less pain was found in KT group from the second postoperative week till the end of inpatient rehabilitation (28th postoperative day) (P<0.05; β ≤ 0.2). Postoperative edema was less intense and subsided more quickly in KT group as well (P<0.05; β ≤ 0.2). No difference was found in improvement of knee flexion (P>0.05). Operated knee extension was found better in KT group then in control at the end of in-patient rehabilitation (P<0.05; β ≤ 0.2). KT was well tolerated by patients. KT technique appeared to be beneficial for reducing postoperative pain, edema, improving knee extension

[Effects of Early Enteral Immunonutrition on Postoperative Immune Function and Rehabilitation of Patients with Gastric Cancer and Nutritional Risk].

PubMed

Peng, Chang-Bing; Li, Wen-Zhong; Xu, Rui; Zhuang, Wen

2017-05-01

To investigate the effects of early enteral immunonutrition on postoperative immune function and rehabilitation of gastric cancer patients with nutritional risk. New hospitalized patients with gastric cancer were evaluated the nutrient status based on NRS 2002. The patients who scored between 3 to 5 points were randomized into two groups(30 cases for each group), and those in experimental group were given 7-d early postoperative enteral immune nutrition, those in control group were given normal nutrition. The immune indexes (CD3 + , CD4 + , CD8 + and CD4 + /CD8 + ) and nutritional indexes(transferrin, pre-albumin, albumin) were measured before operation and at the 3 rd and 7 th day postoperatively. In addition, the first flatus time, gastrointestinal adverse reactions and complications, length of hospital stays were compared between the two groups. The level of CD4 + /CD8 + and transferrin, pre-albumin, albumin in experimental group were significantly higher than those in control group at the third and seventh day postoperatively ( P <0.05).Compared with the control group, the experimental group had shorter first flatus time after surgery, which were (63.5±7.3) h vs. (72.8±8.6 ) h respectively ( P <0.05).There were no statistically difference on pneumonia, anastomosis leakage, severe abdominal distension, inflammatory bowel obstruction and total postoperative hospitalization time between the two groups ( P >0.05). Early enteral immunonutrition can effectively promote the recovery of nutritional status and immune function in gastric cancer patients with nutrition risk.

Association Between Early Postoperative Acetaminophen Exposure and Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery.

PubMed

Van Driest, Sara L; Jooste, Edmund H; Shi, Yaping; Choi, Leena; Darghosian, Leon; Hill, Kevin D; Smith, Andrew H; Kannankeril, Prince J; Roden, Dan M; Ware, Lorraine B

2018-05-14

Acute kidney injury (AKI) is a common and serious complication for pediatric cardiac surgery patients associated with increased morbidity, mortality, and length of stay. Current strategies focus on risk reduction and early identification because there are no known preventive or therapeutic agents. Cardiac surgery and cardiopulmonary bypass lyse erythrocytes, releasing free hemoglobin and contributing to oxidative injury. Acetaminophen may prevent AKI by reducing the oxidation state of free hemoglobin. To test the hypothesis that early postoperative acetaminophen exposure is associated with reduced risk of AKI in pediatric patients undergoing cardiac surgery. In this retrospective cohort study, the setting was 2 tertiary referral children's hospitals. The primary and validation cohorts included children older than 28 days admitted for cardiac surgery between July 1, 2008, and June 1, 2016. Exclusion criteria were postoperative extracorporeal membrane oxygenation and inadequate serum creatinine measurements to determine AKI status. Acetaminophen exposure in the first 48 postoperative hours. Acute kidney injury based on Kidney Disease: Improving Global Outcomes serum creatinine criteria (increase by ≥0.3 mg/dL from baseline or at least 1.5-fold more than the baseline [to convert to micromoles per liter, multiply by 88.4]) in the first postoperative week. The primary cohort (n = 666) had a median age of 6.5 (interquartile range [IQR], 3.9-44.7) months, and 341 (51.2%) had AKI. In unadjusted analyses, those with AKI had lower median acetaminophen doses than those without AKI (47 [IQR, 16-88] vs 78 [IQR, 43-104] mg/kg, P < .001). In logistic regression analysis adjusting for age, cardiopulmonary bypass time, red blood cell distribution width, postoperative hypotension, nephrotoxin exposure, and Risk Adjustment for Congenital Heart Surgery score, acetaminophen exposure was protective against postoperative AKI (odds ratio, 0.86 [95% CI, 0.82-0.90] per each

Spinal fusion for scoliosis in Rett syndrome with an emphasis on early postoperative complications.

PubMed

Gabos, Peter G; Inan, Muharrem; Thacker, Mihir; Borkhu, Buttugs

2012-01-15

Retrospective case-control study. To examine the postoperative complications of posterior spinal fusion in a population of patients with Rett syndrome (RS). Scoliosis is a common feature of RS, a progressive neurologic disorder affecting almost exclusively females. Despite this, there is little published information regarding the surgical treatment of scoliosis in this disorder. Sixteen consecutive female patients with RS treated by posterior spinal fusion and unit rod instrumentation for progressive scoliosis between 1995 and 2003 were evaluated. Only patients with a minimum of 2-year follow-up were included. Preoperative medical conditions and postoperative complications were recorded. As a control group, we randomly selected 32 spastic quadriplegic patients who underwent the identical procedure during the same time period, selected from our database and matched according to age, level of neurologic impairment, and medical complexity. There was a high rate of early medical complications in the RS patients, with 28 major and 37 minor complications. Only 1 patient did not have a major medical complication, and every patient had at least 1 minor gastrointestinal and/or respiratory complication. Major respiratory complications occurred in 10 patients (63%) and comprised 61% of all major complications. Major gastrointestinal complications occurred in 6 patients (37%) and comprised 21% of all major complications. Other major complications included disseminated intravascular coagulopathy (1 patient), subacute bacterial endocarditis (1 patient), sacral decubiti requiring surgical debridement (2 patients), and extensive bilateral heterotopic ossification of the hips (1 patient). There were no cases of instrumentation failure, pseudarthrosis, deep infection, or need for rod revision. Postoperative complication scores were similar to those in patients with spastic quadriplegic pattern cerebral palsy. Spinal fusion for scoliosis in RS can give a satisfactory technical result

Early weight-bearing after periacetabular osteotomy leads to a high incidence of postoperative pelvic fractures.

PubMed

Ito, Hiroshi; Tanino, Hiromasa; Sato, Tatsuya; Nishida, Yasuhiro; Matsuno, Takeo

2014-07-11

It has not been shown whether accelerated rehabilitation following periacetabular osteotomy (PAO) is effective for early recovery. The purpose of this retrospective study was to compare complication rates in patients with standard and accelerated rehabilitation protocols who underwent PAO. Between January 2002 and August 2011, patients with a lateral center-edge (CE) angle of < 20°, showing good joint congruency with the hip in abduction, pre- or early stage of osteoarthritis, and age younger than 60 years were included in this study. We evaluated 156 hips in 138 patients, with a mean age at the time of surgery of 30 years. Full weight-bearing with two crutches started 2 months postoperatively in 73 patients (80 hips) with the standard rehabilitation protocol. In 65 patients (76 hips) with the accelerated rehabilitation protocol, postoperative strengthening of the hip, thigh and core musculature was begun on the day of surgery as tolerated. The exercise program included active hip range of motion, and gentle isometric hamstring and quadriceps muscle sets; these exercises were performed for 30 minutes in the morning and 30 minutes in the afternoon with a physical therapist every weekday for 6 weeks. Full weight-bearing with two axillary crutches started on the day of surgery as tolerated. Complications were evaluated for 2 years. The clinical results at the time of follow-up were similar in the two groups. The average periods between the osteotomy and full-weight-bearing walking without support were 4.2 months and 6.9 months in patients with the accelerated and standard rehabilitation protocols (P < 0.001), indicating that the accelerated rehabilitation protocol could achieve earlier recovery of patients. However, postoperative fractures of the ischial ramus and posterior column of the pelvis were more frequently found in patients with the accelerated rehabilitation protocol (8/76) than in those with the standard rehabilitation protocol (1/80) (P = 0

Early postoperative endophthalmitis after pars plana Ahmed valve placement with persistent extraocular infection.

PubMed

Park, Susanna S; Rabowsky, Jeffrey

2007-01-01

This article presents a case of early postoperative endophthalmitis that occurred after vitrectomy and Ahmed Glaucoma Valve (New World Medical, Inc., Rancho Cucamonga, CA) placement and was treated with intravitreal antibiotics. Intravenous vancomycin was started after aqueous culture grew methicillin-resistant Staphylococcus aureus. The endophthalmitis improved, but new purulent discharge around the peritomy was noted 10 days after presentation, requiring removal of the valve.

Assessment of early post-operative pain following septorhinoplasty.

PubMed

Szychta, P; Antoszewski, B

2010-11-01

To evaluate pain incidence and intensity in patients undergoing septorhinoplasty, and to assess analgesic treatment effectiveness, in the first 7 days after surgery. Prospective outcomes analysis using visual analogue scale assessment of pain intensity in the first 7 post-operative days. Fifty-seven patients were enrolled in the study, 29 women and 28 men, aged 18 to 51 years. All were treated for post-traumatic deformity of the external nose and/or nasal septum, with either septorhinoplasty or septoplasty. In the first 3 days after septorhinoplasty, patients' mean visual analogue scale pain score exceeded the range denoting 'analgesic success', and showed considerable exacerbation in the evening. Patients' pain decreased to a mean score of 15.4 one hour after administration of a nonsteroidal anti-inflammatory drug (metamizole). Analgesia is recommended for all patients in the first 3 days after septorhinoplasty, especially in the early evening.

[Role of the small intestinal decompression tube and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction].

PubMed

Li, Wei; Li, Zhixia; An, Dali; Liu, Jing; Zhang, Xiaohu

2014-03-01

To evaluate the role of the small intestinal decompression tube (SIDT) and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction (EPISBO). Twelve patients presented EPISBO after abdominal surgery in our department from April 2011 to July 2012. Initially, nasogastric tube decompression and other conventional conservative treatment were administrated. After 14 days, obstruction symptom improvement was not obvious, then the SIDT was used. At the same time, Gastrografin was injected into the small bowel through the SIDT in order to demonstrate the site of obstruction of small bowel and its efficacy. In 11 patients after this management, obstruction symptoms disappeared, bowel function recovered within 3 weeks, and oral feeding occurred gradually. Another patient did not pass flatus after 4 weeks and was reoperated. After postoperative follow-up of 6 months, no case relapsed with intestinal obstruction. For severe and long course of early postoperative inflammatory intestinal obstruction, intestinal decompression tube plus Gastrografin is safe and effective, and can avoid unnecessary reoperation.

Early weight-bearing after periacetabular osteotomy leads to a high incidence of postoperative pelvic fractures

PubMed Central

2014-01-01

Background It has not been shown whether accelerated rehabilitation following periacetabular osteotomy (PAO) is effective for early recovery. The purpose of this retrospective study was to compare complication rates in patients with standard and accelerated rehabilitation protocols who underwent PAO. Methods Between January 2002 and August 2011, patients with a lateral center-edge (CE) angle of < 20°, showing good joint congruency with the hip in abduction, pre- or early stage of osteoarthritis, and age younger than 60 years were included in this study. We evaluated 156 hips in 138 patients, with a mean age at the time of surgery of 30 years. Full weight-bearing with two crutches started 2 months postoperatively in 73 patients (80 hips) with the standard rehabilitation protocol. In 65 patients (76 hips) with the accelerated rehabilitation protocol, postoperative strengthening of the hip, thigh and core musculature was begun on the day of surgery as tolerated. The exercise program included active hip range of motion, and gentle isometric hamstring and quadriceps muscle sets; these exercises were performed for 30 minutes in the morning and 30 minutes in the afternoon with a physical therapist every weekday for 6 weeks. Full weight-bearing with two axillary crutches started on the day of surgery as tolerated. Complications were evaluated for 2 years. Results The clinical results at the time of follow-up were similar in the two groups. The average periods between the osteotomy and full-weight-bearing walking without support were 4.2 months and 6.9 months in patients with the accelerated and standard rehabilitation protocols (P < 0.001), indicating that the accelerated rehabilitation protocol could achieve earlier recovery of patients. However, postoperative fractures of the ischial ramus and posterior column of the pelvis were more frequently found in patients with the accelerated rehabilitation protocol (8/76) than in those with the standard

Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession.

PubMed

Garzon-Serrano, Jaime; Ryan, Cheryl; Waak, Karen; Hirschberg, Ronald; Tully, Susan; Bittner, Edward A; Chipman, Daniel W; Schmidt, Ulrich; Kasotakis, Georgios; Benjamin, John; Zafonte, Ross; Eikermann, Matthias

2011-04-01

To evaluate whether the level of mobilization achieved and the barriers for progressing to the next mobilization level differ between nurses and physical therapists. Prospective, observational study. Twenty-bed surgical intensive care unit (SICU) of the Massachusetts General Hospital. Sixty-three critically ill patients. Physical therapists and nurses performed 179 mobilization therapies with 63 patients. Mobilization was defined as the process of enhancing mobility in the SICU, including bed mobility, edge of bed activities, transfers out of bed to a chair, and gait training; the mobilization level was measured on the SICU optimal mobilization scale, a 5-point (0-4) numerical rating scale. Patients' level of mobilization achieved by physical therapists was significantly higher compared with that achieved by nurses (2.3 ± 1.2 mean ± SD versus 1.2 ± 1.2, respectively P < .0001). Different barriers for mobilization were identified by physical therapists and nurses: hemodynamic instability (26% versus 12%, P = .03) and renal replacement therapy (12% versus 1%, P = .03) were barriers rated higher by nurses, whereas neurologic impairment was rated higher by physical therapists providers (18% versus 38%, P = .002). No mobilization-associated adverse events were observed in this study. This study showed that physical therapists mobilize their critically ill patients to higher levels compared with nurses. Nurse and physical therapists identify different barriers for mobilization. Routine involvement of physical therapists in directing mobilization treatment may promote early mobilization of critically ill patients. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Postoperative Delirium in Severely Burned Patients Undergoing Early Escharotomy: Incidence, Risk Factors, and Outcomes.

PubMed

Guo, Zhenggang; Liu, Jiabin; Li, Jia; Wang, Xiaoyan; Guo, Hui; Ma, Panpan; Su, Xiaojun; Li, Ping

The aim of this study is to investigate the incidence, related risk factors, and outcomes of postoperative delirium (POD) in severely burned patients undergoing early escharotomy. This study included 385 severely burned patients (injured <1 week; TBSA, 31-50% or 11-20%; American Society of Anesthesiologists physical status, II-IV) aged 18 to 65 years, who underwent early escharotomy between October 2014 and December 2015, and were selected by cluster sampling. The authors excluded patients with preoperative delirium or diagnosed dementia, depression, or cognitive dysfunction. Preoperative, perioperative, intraoperative, and postoperative information, such as demographic characteristics, vital signs, and health history were collected. The Confusion Assessment Method was used once daily for 5 days after surgery to identify POD. Stepwise binary logistic regression analysis was used to identify the risk factors for POD, t-tests, and χ tests were performed to compare the outcomes of patients with and without the condition. Fifty-six (14.55%) of the patients in the sample were diagnosed with POD. Stepwise binary logistic regression showed that the significant risk factors for POD in severely burned patients undergoing early escharotomy were advanced age (>50 years old), a history of alcohol consumption (>3/week), high American Society of Anesthesiologists classification (III or IV), time between injury and surgery (>2 days), number of previous escharotomies (>2), combined intravenous and inhalation anesthesia, no bispectral index applied, long duration surgery (>180 min), and intraoperative hypotension (mean arterial pressure < 55 mm Hg). On the basis of the different odds ratios, the authors established a weighted model. When the score of a patient's weighted odds ratios is more than 6, the incidence of POD increased significantly (P < .05). When the score of a patient's weighted odds ratios is more than 6, the incidence of POD increased significantly (P < .05

Do postoperative platelet-rich plasma injections accelerate early tendon healing and functional recovery after arthroscopic supraspinatus repair? A randomized controlled trial.

PubMed

Wang, Allan; McCann, Philip; Colliver, Jess; Koh, Eamon; Ackland, Timothy; Joss, Brendan; Zheng, Minghao; Breidahl, Bill

2015-06-01

Tendon-bone healing after rotator cuff repair directly correlates with a successful outcome. Biological therapies that elevate local growth-factor concentrations may potentiate healing after surgery. To ascertain whether postoperative and repeated application of platelet-rich plasma (PRP) to the tendon repair site improves early tendon healing and enhances early functional recovery after double-row arthroscopic supraspinatus repair. Randomized controlled trial; Level of evidence, 1. A total of 60 patients underwent arthroscopic double-row supraspinatus tendon repair. After randomization, half the patients received 2 ultrasound-guided injections of PRP to the repair site at postoperative days 7 and 14. Early structural healing was assessed with MRI at 16 weeks, and cuff appearances were graded according to the Sugaya classification. Functional scores were recorded with the Oxford Shoulder Score; Quick Disability of the Arm, Shoulder and Hand; visual analog scale for pain; and Short Form-12 quality-of-life score both preoperatively and at postoperative weeks 6, 12, and 16; isokinetic strength and active range of motion were measured at 16 weeks. PRP treatment did not improve early functional recovery, range of motion, or strength or influence pain scores at any time point after arthroscopic supraspinatus repair. There was no difference in structural integrity of the supraspinatus repair on MRI between the PRP group (0% full-thickness retear; 23% partial tear; 77% intact) and the control group (7% full-thickness retear; 23% partial tear; 70% intact) at 16 weeks postoperatively (P = .35). After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery. © 2015 The Author(s).

Clinical Features of Early and Late Postoperative Hypothyroidism After Lobectomy.

PubMed

Park, Suyeon; Jeon, Min Ji; Song, Eyun; Oh, Hye-Seon; Kim, Mijin; Kwon, Hyemi; Kim, Tae Yong; Hong, Suck Joon; Shong, Young Kee; Kim, Won Bae; Sung, Tae-Yon; Kim, Won Gu

2017-04-01

Lobectomy is preferred in thyroid cancer to decrease surgical complications and avoid lifelong thyroid-hormone replacement. However, postoperative hypothyroidism, requiring thyroid-hormone replacement, may occur. We aimed to identify the incidence and risk factors of postoperative hypothyroidism to develop a surveillance strategy after lobectomy for papillary thyroid microcarcinoma (PTMC). This historical cohort study involved 335 patients with PTMC treated by lobectomy. Postoperative thyroid functions were measured regularly, and patients were prescribed levothyroxine according to specific criteria. Patients not satisfying hormone-replacement criteria were closely followed up. Postoperative hypothyroidism occurred in 215 patients (64.2%) including 5 (1.5%) with overt hypothyroidism and 210 (62.7%) with subclinical hypothyroidism. Forty patients (11.9%) were required thyroid hormone replacement. One hundred nineteen patients (33.5%) experienced temporary hypothyroidism and spontaneously recovered to euthyroid state. High preoperative thyroid-stimulating hormone (TSH) was the most important factor predicting postoperative hypothyroidism and failure of recover from hypothyroidism (odds ratio [OR], 2.82 and 1.77; 95% confidence interval [CI], 2.07 to 3.95 and 1.22 to 2.63; P < 0.001 and 0.002, respectively). Of the 215 patients eventually developing postoperative hypothyroidism, 70 (32.6%) developed hypothyroidism after the first postoperative year. Postoperative 1-year TSH levels were able to differentiate patients developing late hypothyroidism or euthyroidism (OR, 2.29; 95% CI, 1.68 to 3.26; P < 0.001). Preoperative and postoperative TSH levels might be predictive for patients who develop postlobectomy hypothyroidism and identify those requiring long-term surveillance for hypothyroidism. Additionally, mild postoperative hypothyroidism cases should be followed up without immediate levothyroxine replacement with the expectation of spontaneous recovery. Copyright �

Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: A prospective randomized study.

PubMed

Arer, Ilker Murat; Kus, Murat; Akkapulu, Nezih; Aytac, Huseyin Ozgur; Yabanoglu, Hakan; Caliskan, Kenan; Tarim, Mehmet Akin

2017-02-01

Postoperative hypocalcemia is the most common complication after total thyroidectomy. Postoperative parathyroid hormone (PTH) measurement is one of the methods to detect or prevent postoperative hypocalcemia. Prophylactic oral calcium supplementation is another method to prevent early postoperative hypocalcemia. The aim of this study is to detect the accurate timing of PTH and evaluate efficacy of routine oral calcium supplementation for postoperative hypocalcemia. A total of 106 patients were performed total thyroidectomy. Rotuine oral calcium supplementation was given to group 1 and no treatment to group 2 according to randomization. Serum calcium and PTH level of patients in group 2 at postoperative 6, 12 and 24 h and patients in both groups at postoperative day 7 were evaluated. Patients were compared according to age, sex, operation findings, serum calcium and PTH levels and symptomatic hypocalcemia. Half of the patients (50%) were in group 1. Most of the patients were female (83%). The most common etiology of thyroid disease was multinodular goiter (64.1%). Oral calcium supplementation was given to 18 (33.9%) patients in group 2. Symptomatic hypocalcemia for group 1 and 2 was found to be 1.9 and 33.9% respectively (p < 0.05). No statistical difference can be observed regarding the timing of serum biomarkers. Serum PTH levels at postoperative 12 and 24 h can predict early post-thyroidectomy hypocalcemia. Prophylactic oral calcium supplementation therapy can prevent early post-thyroidectomy hypocalcemia with advantages of being cost effective and safe. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

C-reactive protein level as a possible predictor for early postoperative ileus following elective surgery for colorectal cancer.

PubMed

Fujii, Takaaki; Sutoh, Toshinaga; Kigure, Wakako; Morita, Hiroki; Katoh, Toshihide; Yajima, Reina; Tsutsumi, Soichi; Asao, Takayuki; Kuwano, Hiroyuki

2015-01-01

Inflammatory reactions are par- tially responsible for postoperative ileus (POI). Serum C-reactive protein (CRP) is an acknowledged marker of inflammation. In this study the CRP response with respect to POI in elective colorectal surgery was exam- ined to define the role of serum CRP as an early predic- tor of POI. Three hundred eighty-three patients who underwent elective colorectal resection were identified for inclusion in this study. We defined early POI as that occurring within 30 days following the surgery. Thirty-five patients with POI were com- pared to a subgroup of 348 patients with an unevent- ful postoperative course, and the correlation between postoperative serum CRP levels and POI in colorectal surgery was investigated. In the univariate analysis, length of operation, surgical blood loss, and serum CRP were factors significantly associated with POI following colorectal surgery; however, these fac- tors lost their significance on multivariate analysis. Our results suggest that an increase in CRP levels alone is not a predictor for POI following surgery for colorectal surgery. Although inflammatory responses are known to contribute to the ileus, ad- ditional study is required to identify risk factors that would be more useful for prediction of POI.

Early postoperative and late metabolic morbidity after pancreatic resections: An old and new challenge for surgeons - A review.

PubMed

Beger, Hans G; Mayer, Benjamin

2018-02-16

The metrics for measuring early postoperative morbidity after resection of pancreatic neoplastic tumors are overall morbidity, severe surgery-related morbidity, frequency of reoperation and reintervention, in-hospital, 30-day and 90-day mortality and length of hospital stay. Thirty-day readmission after discharge is additionally an indispensable criterion to assess quality of surgery. The metrics for surgery-associated long-term results after pancreatic resections are survival times, new onset of diabetes (DM), impaired glucose tolerance, exocrine pancreatic insufficiency, body mass index and GI motility dysfunctions. Following pancreaticoduodenectomy (PD) performed on pancreatic normo-glycemic patients for malignant and benign tumors, 4-30% develop postoperative new onset of diabetes. Long-term persistence of diabetes mellitus is observed after surgery for benign tumors in 14% and in 15.5% of patients after cancer resection. Pancreatic exocrine insufficiency after PD is observed in the early postoperative period in 23-80% of patients. Persistence of exocrine dysfunctions exists in 25% and 49% of patients. Following left-sided pancreatic resection, new onset DM is observed in 14% of cases; an exocrine insufficiency persisting in the long-term outcome is observed in 16-28% of patients. Copyright © 2018 Elsevier Inc. All rights reserved.

Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma.

PubMed

Rong, S S; Feng, M Y; Wang, N; Meng, H; Thomas, R; Fan, S; Wang, R; Wang, X; Tang, X; Liang, Y B

2013-03-01

To evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome. A total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (<10 mm Hg), B (≥10 and <15 mm Hg), C (≥15 and <20 mm Hg), and D (≥20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher's exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome. The mean age was 62.5±7.9 years and 41.21% (n=68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P=0.047, P=0.033, P=0.008, and P<0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP <15 mm Hg (Fisher's exact P=0.001) and <20 mm Hg (P=0.039) without medication. Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOP<15 mm Hg without medication and failure after surgery, respectively. The IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.

Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery.

PubMed

Rao, Raghavendra M; Nagendra, H R; Raghuram, Nagarathna; Vinay, C; Chandrashekara, S; Gopinath, K S; Srinath, B S

2008-01-01

Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal (P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. The results suggest possible benefits of yoga in reducing postoperative complications in

[Post-operative infections after cosmetic tourism].

PubMed

Holst-Albrechtsen, Sine; Sørensen, Lene Birk; Juel, Jacob

2018-06-11

Cosmetic tourism is defined as patient mobility across borders, typically constituted by patients seeking cosmetic surgery at lower costs abroad. The most common procedures are abdominoplasty, fat grafting and breast augmentation. Very little is known about the complication rates after cosmetic tourism, and there is a paucity of evidence in all aspects of cosmetic tourism. In this review, we focus on post-operative complications i.e. post-operative infections, in particular with rare microorganisms such as mycobacteria.

Serum proteomics of early postoperative cognitive dysfunction in elderly patients.

PubMed

Zhang, Qing; Li, Shi-Zhong; Feng, Chun-Sheng; Qu, Xiang-Dong; Wang, Hui; Zhang, Xue-Na; Liu, Yang; Wang, Yun; Wu, An-Shi; Yue, Yun

2012-07-01

Studies on postoperative cognitive dysfunction (POCD) have attracted extensive attention and achieved significant progress. However, the diagnosis of POCD is not very satisfactory as no specific biomarkers have been classified. The aim of the present study was to evaluate differences in serum protein composition between POCD and Non-POCD patients, identify potential biomarkers associated with early POCD, and study the mechanism underlying POCD. Sixty-eight elderly patients (age ≥ 65 years) received isoflurane inhalation anesthesia for arthroplasty surgeries. One day before and seven days after the surgery, these patients were subjected to a neuropsychological test and venous blood sample collection. Postoperative cognitive dysfunction was determined using Z test scores. Based on the results, the patients were divided into POCD and non-POCD groups. Twenty-five randomly chosen blood samples obtained seven days after the surgery from each group were analyzed on a Bruker ultraFlex(TM) time of flight (TOF)/TOF mass spectrophotometer. The resulting peptide fingerprints were compared with those from the pre-surgery samples to identify differences in serum protein composition. The model designed to distinguish between a non-POCD group and a POCD group were established and validated. Three proteins with the most significant changes were selected for further characterization. Thirty-three cases were diagnosed as POCD. Using the Clinprotools software, 58 polypeptides were found to display differential expression (P < 0.05). Using a support vector algorithm method, seven differential peaks were isolated to establish a diagnostic model to distinguish POCD patients from normal individuals. The prediction rate and recognition rate were 96.89% and 100%, respectively. Validation of this model showed that the accuracy rates were 100% and 85% using samples from the POCD and non-POCD groups, respectively. Protein analysis also led to the identification of fibrinopeptide A (FPA) as a

Early Post-Operative Outcomes and Blood Product Utilization in Adult Cardiac Surgery- The Post Aprotinin Era

PubMed Central

DeSantis, Stacia; Toole, J. Matthew; Kratz, John M.; Uber, Walter E.; Wheat, Margaret J.; Stroud, Martha R.; Ikonomidis, John S.; Spinale, Francis G.

2011-01-01

Background Aprotinin was a commonly utilized pharmacological agent for homeostasis in cardiac surgery but was discontinued resulting in the extensive use of lysine analogues. This study tested the hypothesis that early post-operative adverse events and blood product utilization would affected in this post-aprotinin era. Methods/Results Adult patients (n=781) undergoing coronary artery bypass (CABG), valve replacement, or both from November 1, 2005-October 31, 2008 at a single institution were included. Multiple logistic regression modeling and propensity scoring were performed on 29 pre-operative and intra-operative variables in patients receiving aprotinin (n=325) or lysine analogues (n=456). The propensity adjusted relative risk (RR;95% confidence interval;CI) for the intra-operative use of packed red blood cells (RR:0.75;CI:0.57–0.99), fresh frozen plasma (RR:0.37;0.21–0.64), and cryoprecipitate (RR:0.06;CI:0.02–0.22) were lower in the aprotinin versus lysine analogue group (all p<0.05). The risk for mortality (RR:0.53;CI:0.16–1.79) and neurological events (RR:0.87;CI:0.35–2.18) remained similar between groups, whereas a trend for reduced risk for renal dysfunction was observed in the aprotinin group. Conclusions In the post-aprotinin era with the exclusive use of lysine analogues, the relative risk of early post-operative outcomes such as mortality and renal dysfunction have not improved, but the risk for the intra-operative use of blood products has increased. Thus, improvements in early post-operative outcomes have not been realized with the discontinued use of aprotinin, but rather increased blood product utilization has occurred with the attendant costs and risks inherent with this strategy. PMID:21911820

Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden.

PubMed

Westerdahl, Elisabeth; Möller, Margareta

2010-08-25

Limited published data are available on how patients are mobilized and exercised during the postoperative hospital stay following cardiac surgery. The aim of this survey was to determine current practice of physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. A prospective survey was carried out among physiotherapists treating adult cardiac surgery patients. A total population sample was identified and postal questionnaires were sent to the 33 physiotherapists currently working at the departments of thoracic surgery in Sweden. In total, 29 physiotherapists (response rate 88%) from eight hospitals completed the survey. The majority (90%) of the physiotherapists offered preoperative information. The main rationale of physiotherapy treatment after cardiac surgery was to prevent and treat postoperative complications, improve pulmonary function and promote physical activity. In general, one to three treatment sessions were given by a physiotherapist on postoperative day 1 and one to two treatment sessions were given during postoperative days 2 and 3. During weekends, physiotherapy was given to a lesser degree (59% on Saturdays and 31% on Sundays to patients on postoperative day 1). No physiotherapy treatment was given in the evenings. The routine use of early mobilization and shoulder range of motion exercises was common during the first postoperative days, but the choice of exercises and duration of treatment varied. Patients were reminded to adhere to sternal precautions. There were great variations of instructions to the patients concerning weight bearing and exercises involving the sternotomy. All respondents considered physiotherapy necessary after cardiac surgery, but only half of them considered the physiotherapy treatment offered as optimal. The results of this survey show that there are small variations in physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. However, the frequency and

Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden

PubMed Central

2010-01-01

Background Limited published data are available on how patients are mobilized and exercised during the postoperative hospital stay following cardiac surgery. The aim of this survey was to determine current practice of physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. Methods A prospective survey was carried out among physiotherapists treating adult cardiac surgery patients. A total population sample was identified and postal questionnaires were sent to the 33 physiotherapists currently working at the departments of thoracic surgery in Sweden. In total, 29 physiotherapists (response rate 88%) from eight hospitals completed the survey. Results The majority (90%) of the physiotherapists offered preoperative information. The main rationale of physiotherapy treatment after cardiac surgery was to prevent and treat postoperative complications, improve pulmonary function and promote physical activity. In general, one to three treatment sessions were given by a physiotherapist on postoperative day 1 and one to two treatment sessions were given during postoperative days 2 and 3. During weekends, physiotherapy was given to a lesser degree (59% on Saturdays and 31% on Sundays to patients on postoperative day 1). No physiotherapy treatment was given in the evenings. The routine use of early mobilization and shoulder range of motion exercises was common during the first postoperative days, but the choice of exercises and duration of treatment varied. Patients were reminded to adhere to sternal precautions. There were great variations of instructions to the patients concerning weight bearing and exercises involving the sternotomy. All respondents considered physiotherapy necessary after cardiac surgery, but only half of them considered the physiotherapy treatment offered as optimal. Conclusions The results of this survey show that there are small variations in physiotherapy-supervised mobilization and exercise following cardiac surgery in

The postoperative clinical outcomes and safety of early enteral nutrition in operated gastric cancer patients.

PubMed

Li, Bing; Liu, Hong-Yi; Guo, Shao-Hua; Sun, Peng; Gong, Fang-Ming; Jia, Bao-Qing

2015-01-01

This study investigated the impact of early enteral nutrition (EEN) on the clinical outcomes of gastric cancer patients after radical gastrectomy. Four hundred gastric cancer patients undergoing radical gastrectomy of any extend with D2 nodal dissection were randomly divided into an experimental and a control group with 200 cases in each group. Patients in the control group received postoperative parenteral nutrition (PN), while patients in the experimental group received postoperative EEN. After treatment, the clinical outcomes, postoperative immune function, and nutritional status of the two groups were evaluated. The postoperative fever time, intestinal function recovery time, anal exhaust time, and the length of hospital stay for patients in the experimental group were significantly shorter than those of the control group. We did not find significant differences in anastomotic leak, postoperative ileus and regurgitation between the two groups. The activities of multiple immune cell types, including CD3⁺, CD4⁺, CD4⁺/CD8⁺, and natural killer (NK) cells, were significantly lower in both groups on postoperative day 1 when compared with the preoperative levels (p<0.05). The level of CD8⁺ was not significantly different between the two groups (p>0.05). After treatment, levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺, and NK cells in the experimental group patients were 35.6 ± 4.2, 42.2 ± 3.0, 1.7 ± 0.3, and 27.3 ± 5.3%, respectively, on postoperative day 7, which were similar to the preoperative levels. The immune cell levels from the control group patients remained significantly lower when compared with preoperative values; in addition, these values were also significantly lower when compared with the EEN patients (p<0.05) CONCLUSION: For gastric cancer patients undergoing radical gastrectomy, the clinical outcome, immune function and nutritional status after EEN were significantly improved. These data suggest the widespread use of EEN in clinical practice.

[Therapeutic approach to postoperative anemia].

PubMed

Bisbe Vives, E; Moltó, L

2015-06-01

Postoperative anemia is a common finding in patients who undergo major surgery, and it can affect early rehabilitation and the return to daily activities. Allogeneic blood transfusion is still the most widely used method for restoring hemoglobin levels rapidly and effectively. However, the potential risks of transfusions have led to the review of this practice and to a search for alternative measures for treating postoperative anemia. The early administration of intravenous iron appears to improve the evolution of postoperative hemoglobin levels and reduce allogeneic transfusions, especially in patients with significant iron deficiency or anemia. What is not clear is whether this treatment heavily influences rehabilitation and quality of life. There is a lack of well-designed, sufficiently large, randomized prospective studies to determine whether postoperative or perioperative intravenous iron treatment, with or without recombinant erythropoietin, has a role in the recovery from postoperative anemia, in reducing transfusions and morbidity rates and in improving exercise capacity and quality of life. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study.

PubMed

Clark, Diane E; Lowman, John D; Griffin, Russell L; Matthews, Helen M; Reiff, Donald A

2013-02-01

Bed rest and immobility in patients on mechanical ventilation or in an intensive care unit (ICU) have detrimental effects. Studies in medical ICUs show that early mobilization is safe, does not increase costs, and can be associated with decreased ICU and hospital lengths of stay (LOS). The purpose of this study was to assess the effects of an early mobilization protocol on complication rates, ventilator days, and ICU and hospital LOS for patients admitted to a trauma and burn ICU (TBICU). This was a retrospective cohort study of an interdisciplinary quality-improvement program. Pre- and post-early mobility program patient data from the trauma registry for 2,176 patients admitted to the TBICU between May 2008 and April 2010 were compared. No adverse events were reported related to the early mobility program. After adjusting for age and injury severity, there was a decrease in airway, pulmonary, and vascular complications (including pneumonia and deep vein thrombosis) post-early mobility program. Ventilator days and TBICU and hospital lengths of stay were not significantly decreased. Using a historical control group, there was no way to account for other changes in patient care that may have occurred between the 2 periods that could have affected patient outcomes. The dose of physical activity both before and after the early mobility program were not specifically assessed. Early mobilization of patients in a TBICU was safe and effective. Medical, nursing, and physical therapy staff, as well as hospital administrators, have embraced the new culture of early mobilization in the ICU.

Influence of pre- or intraoperational use of tramadol (preemptive or preventive analgesia) on tramadol requirement in the early postoperative period.

PubMed

Wordliczek, Jerzy; Banach, Marcin; Garlicki, Jarosław; Jakowicka-Wordliczek, Joanna; Dobrogowski, Jan

2002-01-01

The aim of this study was to assess the influence of iv tramadol on opioid requirement in the early postoperative period. The subjects were 90 patients scheduled for colon surgery (hemicolectomy) who received general anesthesia using the (N2O/O2) isoflurane technique. Thirty patients (group I) were administered 100 mg of tramadol iv before induction of general anesthesia (preemptive analgesia). Group II (30 patients) was administered 100 mg of tramadol iv immediately after peritoneal closure (preventive analgesia) and control group (30 patients) received 100 mg of tramadol iv immediately after operation. Following the operation, all patients were administered tramadol in the PCA-iv mode in order to treat postoperative pain. In the postoperative period, the following parameters were measured: pain intensity (using VAS), total consumption of tramadol, time until the first PCA activation, and frequency of side effects (drowsiness, nausea, vomiting). In patients of groups I and II who had received preemptive or preventive analgesia, a significantly lower total consumption of tramadol, as compared with control group, was observed in the early postoperative period. However, the time until the first PCA activation was significantly shorter in group I as compared to the other two groups. No significant differences between the groups were found regarding pain intensity and frequency of side effects.

Influence of muscle strength on early mobility in critically ill adult patients: Systematic literature review.

PubMed

Roberson, Audrey R; Starkweather, Angela; Grossman, Catherine; Acevedo, Edmund; Salyer, Jeanne

Muscle strength may be one indicator of readiness to mobilize that can be used to guide decisions regarding early mobility efforts and to progressively advance mobilization. To provide a synthesis of current measures of muscle strength in the assessment of early mobilization in critically ill adult patients who are receiving MV therapy. Research studies conducted between 2000-2015 were identified using PubMed, CINHAL, MEDLINE, and the Cochrane Database of Systematic Reviews databases using the search terms "muscle strength", "intensive care", "mechanical ventilation" and "muscle weakness". Nine articles used manual muscle testing, the Medical Research Council scale and/or hand-held dynamometer to provide objective measures for assessing muscle strength in the critically ill adult patient population. Further research is needed to examine the application of standardized measures of muscle strength for guiding decisions regarding early and progressive advancement of mobility goals in adult ICU patients on MV. Copyright © 2017 Elsevier Inc. All rights reserved.

Advances in the mechanisms and early warning indicators of the postoperative cognitive dysfunction after the extracorporeal circulation.

PubMed

Liu, Chao; Han, Jian-ge

2015-02-01

The high incidence of postoperative cognitive dysfunction (POCD) after extracorporeal circulation has seriously affected the prognosis and quality of life. Its mechanism may involve the inflammatory response and oxidative stress,the excessive phosphorylation of tau protein, the decreased blood volume and oxygen in the cerebral cortex. Appropriate early warning indicators of POCD after the extracorporeal circulation should be chosen to facilitate the cross validation of the results obtained different technical approaches and thus promote the early diagnosis and treatment of POCD.

Early mobilization of critically ill adults: a survey of knowledge, perceptions and practices of Canadian physicians and physiotherapists

PubMed Central

Koo, Karen K.Y.; Choong, Karen; Cook, Deborah J.; Herridge, Margaret; Newman, Anastasia; Lo, Vincent; Guyatt, Gordon; Priestap, Fran; Campbell, Eileen; Burns, Karen E.A.; Lamontagne, FranÇois; Meade, Maureen O.

2016-01-01

Background: The promotion of early mobilization following critical illness is tempered by national reports of patient and institutional barriers to this approach. We carried out a survey to assess current knowledge, perceptions and practices of Canadian physicians and physiotherapists with respect to acquired weakness and early mobilization in adults in the intensive care unit (ICU). Methods: We conducted a cross-sectional, self-administered postal survey among critical care physicians and physiotherapists in all 46 academic ICUs in Canada in 2011-2012. To identify all physicians and physiotherapists working in the ICUs, we contacted division heads and senior physiotherapists by telephone or email. We designed, tested and administered a questionnaire with the following domains: knowledge of ICU-acquired weakness and early mobilization; personal views of, perceived barriers to and adequacy of technical skills for early mobilization; assessments for initiation of early mobilization and permissible activity levels by patient physiologic characteristics, diagnoses and therapies; staffing issues; and sedation practices. Results: The overall response rate was 71.3% (311/436); it was 64.2% (194/302) among physicians and 87.3% (117/134) among physiotherapists. A total of 214 respondents (68.8%) underestimated the incidence of ICU-acquired weakness in the general medical-surgical ICU population, and 186 (59.8%) stated they had insufficient knowledge or skills to mobilize patients receiving mechanical ventilation. Excessive sedation, medical instability, limited staffing, safety concerns, insufficient guidelines and insufficient equipment were common perceived barriers to early mobilization. Interpretation: Physicians and physiotherapists in the ICU underestimated the incidence of ICU-acquired weakness and felt inadequately trained to mobilize patients receiving mechanical ventilation. We identified multiple modifiable barriers to early mobilization at the institutional

[Characteristics of postoperative peritonitis].

PubMed

Lock, J F; Eckmann, C; Germer, C-T

2016-01-01

Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.

Early Postoperative Measures Predict 1- and 2-Year Outcomes After Unilateral Total Knee Arthroplasty: Importance of Contralateral Limb Strength

PubMed Central

Snyder-Mackler, Lynn

2010-01-01

Background Total knee arthroplasty (TKA) has been shown to be an effective surgical intervention for people with end-stage knee osteoarthritis. However, recovery of function is variable, and not all people have successful outcomes. Objective The aim of this study was to discern which early postoperative functional measures could predict functional ability at 1 year and 2 years after surgery. Design and Methods One hundred fifty-five people who underwent unilateral TKA participated in the prospective longitudinal study. Functional evaluations were performed at the initial outpatient physical therapy appointment and at 1 and 2 years after surgery. Evaluations consisted of measurements of height, weight, quadriceps muscle strength (force-generating capacity), and knee range of motion; the Timed “Up & Go” Test (TUG); the stair-climbing task (SCT); and the Knee Outcome Survey (KOS) questionnaire. The ability to predict 1- and 2-year outcomes on the basis of early postoperative measures was analyzed with a hierarchical regression. Differences in functional scores were evaluated with a repeated-measures analysis of variance. Results The TUG, SCT, and KOS scores at 1 and 2 years showed significant improvements over the scores at the initial evaluation (P<.001). A weaker quadriceps muscle in the limb that did not undergo surgery (“nonoperated limb”) was related to poorer 1- and 2-year outcomes even after the influence of the other early postoperative measures was accounted for in the regression. Older participants with higher body masses also had poorer outcomes at 1 and 2 years. Postoperative measures were better predictors of TUG and SCT times than of KOS scores. Conclusions Rehabilitation regimens after TKA should include exercises to improve the strength of the nonoperated limb as well as to treat the deficits imposed by the surgery. Emphasis on treating age-related impairments and reducing body mass also might improve long-term outcomes. PMID:19959653

The 2013 Frank Stinchfield Award: Diagnosis of infection in the early postoperative period after total hip arthroplasty.

PubMed

Yi, Paul H; Cross, Michael B; Moric, Mario; Sporer, Scott M; Berger, Richard A; Della Valle, Craig J

2014-02-01

Diagnosis of periprosthetic joint infection (PJI) can be difficult in the early postoperative period after total hip arthroplasty (THA) because normal cues from the physical examination often are unreliable, and serological markers commonly used for diagnosis are elevated from the recent surgery. The purposes of this study were to determine the optimal cutoff values for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial fluid white blood cell (WBC) count, and differential for diagnosing PJI in the early postoperative period after primary THA. We reviewed 6033 consecutive primary THAs and identified 73 patients (1.2%) who underwent reoperation for any reason within the first 6 weeks postoperatively. Thirty-six of these patients were infected according to modified Musculoskeletal Infection Society criteria. Mean values for the diagnostic tests were compared between groups and receiver operating characteristic curves generated along with an area under the curve (AUC) to determine test performance and optimal cutoff values to diagnose infection. The best test for the diagnosis of PJI was the synovial fluid WBC count (AUC = 98%; optimal cutoff value 12,800 cells/μL) followed by the CRP (AUC = 93%; optimal cutoff value 93 mg/L), and synovial fluid differential (AUC = 91%; optimal cutoff value 89% PMN). The mean ESR (infected = 69 mm/hr, not infected = 46 mm/hr), CRP (infected = 192 mg/L, not infected = 30 mg/L), synovial fluid WBC count (infected = 84,954 cells/μL, not infected = 2391 cells/μL), and differential (infected = 91% polymorphonuclear cells [PMN], not infected = 63% PMN) all were significantly higher in the infected group. Optimal cutoff values for the diagnosis of PJI in the acute postoperative period were higher than those traditionally used for the diagnosis of chronic PJI. The serum CRP is an excellent screening test, whereas the synovial fluid WBC count is more specific.

Postoperative Nutritional Effects of Early Enteral Feeding Compared with Total Parental Nutrition in Pancreaticoduodectomy Patients: A Prosepective, Randomized Study

PubMed Central

Park, Joon Seong; Chung, Hye-Kyung; Hwang, Ho Kyoung; Kim, Jae Keun

2012-01-01

The benefits of early enteral feeding (EEN) have been demonstrated in gastrointestinal surgery. But, the impact of EEN has not been elucidated yet. We assessed the postoperative nutritional status of patients who had undergone pancreaticoduodenectomy (PD) according to the postoperative nutritional method and compared the clinical outcomes of two methods. A prospective randomized trial was undertaken following PD. Patients were randomly divided into two groups; the EEN group received the postoperative enteral feed and the control group received the postoperative total parenteral nutrition (TPN) management. Thirty-eight patients were included in our analyses. The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than in TPN group. Prealbumin and transferrin were significantly reduced on post-operative day (POD) 7 and were slowly recovered until POD 90 in the TPN group than in the EEN group. EEN group rapidly recovered weight after POD 21 whereas it was gradually decreased in TPN group until POD 90. EEN after PD is associated with preservation of weight compared with TPN and impact on recovery of digestive function after PD. PMID:22379336

Early postoperative changes in cerebral oxygen metabolism following neonatal cardiac surgery: Effects of surgical duration

PubMed Central

Buckley, Erin M.; Lynch, Jennifer M.; Goff, Donna A.; Schwab, Peter J.; Baker, Wesley B.; Durduran, Turgut; Busch, David R.; Nicolson, Susan C.; Montenegro, Lisa M.; Naim, Maryam Y.; Xiao, Rui; Spray, Thomas L.; Yodh, A. G.; Gaynor, J. William; Licht, Daniel J.

2013-01-01

Objective The early postoperative period following neonatal cardiac surgery is a time of increased risk for brain injury, yet the mechanisms underlying this risk are unknown. To understand these risks more completely, we quantified changes in postoperative cerebral metabolic rate of oxygen (CMRO2), oxygen extraction fraction (OEF), and cerebral blood flow (CBF) compared with preoperative levels by using noninvasive optical modalities. Methods Diffuse optical spectroscopy and diffuse correlation spectroscopy were used concurrently to derive cerebral blood flow and oxygen utilization postoperatively for 12 hours. Relative changes in CMRO2, OEF, and CBF were quantified with reference to preoperative data. A mixed-effect model was used to investigate the influence of total support time and deep hypothermic circulatory arrest duration on relative changes in CMRO2, OEF, and CBF. Results Relative changes in CMRO2, OEF, and CBF were assessed in 36 patients, 21 with single-ventricle defects and 15 with 2-ventricle defects. Among patients with single-ventricle lesions, deep hypothermic circulatory arrest duration did not affect relative changes in CMRO2, CBF, or OEF (P > .05). Among 2-ventricle patients, total support time was not a significant predictor of relative changes in CMRO2 or CBF (P > .05), although longer total support time was associated significantly with greater increases in relative change of postoperative OEF (P = .008). Conclusions Noninvasive diffuse optical techniques were used to quantify postoperative relative changes in CMRO2, CBF, and OEF for the first time in this observational pilot study. Pilot data suggest that surgical duration does not account for observed variability in the relative change in CMRO2, and that more comprehensive clinical studies using the new technology are feasible and warranted to elucidate these issues further. PMID:23111021

Postoperative hypocalcemia: assessment timing.

PubMed

Sperlongano, Pasquale; Sperlongano, Simona; Foroni, Fabrizio; De Lucia, Francesco Paolo; Pezzulo, Carmine; Manfredi, Celeste; Esposito, Emanuela; Sperlongano, Rossella

2014-01-01

180 total thyroidectomy case studies performed by the same operator in the years 2006-2010, all done with sutureless technique (Ligasure precise(®)). The monitoring of patients involved a dose of serum calcium on the 1st, 2nd, 3rd and seventh post-operative, before the ambulatory monitoring of the patient. Treatment of post-operative thyroidectomy also includes the administration from the first day of post-surgery, of 2 g/day of calcium (calcium lactate gluconate 2940 mg, calcium carbonate 300 mg). Hypocalcemia was observed in 27 cases (15%) of which 23/180 (12.8%) were transitional and 4/180 (2.2%) were permanent. The average postoperative hospitalization was 2.5 days with a minimum of 30 h. The peak of hypocalcemia was of 11 patients on the first postoperative day (40.7%) in 6 patients on the second postoperative day (22.2%), in 8 patients on the third postoperative day (29.6%), in 1 patient on the fourth postoperative day (3.7%) and in another one on the fifth postoperative day (3.7%). The second postoperative day is crucial for the determination of early discharge (24-30 h). When the surgeon identifies and manages to preserve at least 3 parathyroid glands during surgery, the risk of hypocalcemia together with evaluations of serum calcium on the first and second post-operative day, eliminates the hypocalcemic risk. Copyright © 2014 Surgical Associates Ltd. All rights reserved.

EARLY POSTOPERATIVE COMPLICATIONS IN ROUX-EN-Y GASTRIC BYPASS

PubMed Central

STOLL, Aluisio; ROSIN, Leandro; DIAS, Mariana Fernandes; MARQUIOTTI, Bruna; GUGELMIN, Giovana; STOLL, Gabriela Fanezzi

2016-01-01

ABSTRACT Background: Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim: To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method: Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results: The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion: In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death. PMID:27683781

Independence and mobility after infrainguinal lower limb bypass surgery for critical limb ischemia.

PubMed

Ambler, Graeme K; Dapaah, Andrew; Al Zuhir, Naail; Hayes, Paul D; Gohel, Manjit S; Boyle, Jonathan R; Varty, Kevin; Coughlin, Patrick A

2014-04-01

Critical limb ischemia (CLI) is a common condition associated with high levels of morbidity and mortality. Most work to date has focused on surgeon-oriented outcomes such as patency, but there is increasing interest in patient-oriented outcomes such as mobility and independence. This study was conducted to determine the effect of infrainguinal lower limb bypass surgery (LLBS) on postoperative mobility in a United Kingdom tertiary vascular surgery unit and to investigate causes and consequences of poor postoperative mobility. We collected data on all patients undergoing LLBS for CLI at our institution during a 3-year period and analyzed potential factors that correlated with poor postoperative mobility. During the study period, 93 index LLBS procedures were performed for patients with CLI. Median length of stay was 11 days (interquartile range, 11 days). The 12-month rates of graft patency, major amputation, and mortality were 75%, 9%, and 6%, respectively. Rates of dependence increased fourfold during the first postoperative year, from 5% preoperatively to 21% at 12 months. Predictors of poor postoperative mobility were female sex (P = .04) and poor postoperative mobility (P < .001), initially and at the 12-month follow-up. Patients with poor postoperative mobility had significantly prolonged hospital length of stay (15 vs 8 days; P < .001). Patients undergoing LLBS for CLI suffer significantly impaired postoperative mobility, and this is associated with prolonged hospital stay, irrespective of successful revascularization. Further work is needed to better predict patients who will benefit from revascularization and in whom a nonoperative strategy is optimal. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Early mobilization: Why, what for and how?

PubMed

Miranda Rocha, A R; Martinez, B P; Maldaner da Silva, V Z; Forgiarini Junior, L A

2017-10-01

Early mobilization strategies in the intensive care unit may result in the prevention and reduction of polyneuromyopathy in the critical patient, improved quality of life, shortened ICU and hospital stay, and lesser mortality during hospitalization. However, it is well known that factors such as the protocol used, the population included in the studies, the timing of the strategy, the severity of the patients and different barriers directly influence the outcomes. This study examines the main protocols described in the literature and their associated results. The main techniques used were kinesitherapy, transfer and locomotion training, as well as neuromuscular electrical stimulation and cycle ergometry. Although two trials and a meta-analysis found no positive results with mobilization, programs that focus on specific populations, such as patients with weakness due to immobility and with preserved neuromuscular excitability can derive more positive effects from such treatment. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Single-injection femoral nerve block. Effects on the independence level in functional activities in the early postoperative period in patients with total knee arthroplasty.

PubMed

Tugay, Nazan; Saricaoglu, Fatma; Satilmis, Tulin; Alpar, Ulku; Akarcali, Inci; Citaker, Seyit; Tugay, Umut; Atilla, Bulent; Tokgozoglu, Mazhar

2006-07-01

To investigate the efficacy of single injection femoral nerve block (FNB) on the independence level in functional activities in the early postoperative period in patients with total knee arthroplasty (TKA). We conducted this prospective, randomized, blinded trial in the Department of Orthopedics and Traumatology, Hacettepe University Hospital Ankara, Turkey, between June 2003 and April 2004. Twenty-three patients scheduled for elective TKA were randomly divided into 3 groups. Group I received preemptive single injection FNB, group II received postoperative single injection FNB, and group III served as a control group. Intravenous morphine patient controlled analgesia (PCA) was used following surgery in all groups. Morphine dose and pain score defined by the visual analog scale (VAS) were recorded postoperatively at the 15th minute, 30th minute, 1st, 4th, 6th, 12th, 24th, and 48th hours. A standard rehabilitation protocol was applied for all patients. The independence level in functional activities was assessed during the first 2 postoperative days and at discharge with the Iowa Level of Assistance Scale (ILAS) and the Iowa Ambulation Speed Scale (IASS). Physical therapists that enrolled in the study were blinded to the groups. Pain scores were significantly different between the groups (p<0.05). The preemptive and postoperative FNB group`s VAS scores were both significantly lower than the control group (p<0.05). However, there was no significant difference in VAS scores between preemptive and postoperative FNB groups (p>0.05). There was no statistically significant difference between the groups in any of the functional scores in the first 2 postoperative days, and at discharge (p>0.05). Single injection FNB provided effective analgesia in patients undergoing TKA. However, the independence level in functional activities in the early postoperative period was not influenced by the analgesia method.

Diet and mobility in Early Medieval Bavaria: a study of carbon and nitrogen stable isotopes.

PubMed

Hakenbeck, Susanne; McManus, Ellen; Geisler, Hans; Grupe, Gisela; O'Connell, Tamsin

2010-10-01

This study investigates patterns of mobility in Early Medieval Bavaria through a combined study of diet and associated burial practice. Carbon and nitrogen isotope ratios were analyzed in human bone samples from the Late Roman cemetery of Klettham and from the Early Medieval cemeteries of Altenerding and Straubing-Bajuwarenstrasse. For dietary comparison, samples of faunal bone from one Late Roman and three Early Medieval settlement sites were also analyzed. The results indicate that the average diet was in keeping with a landlocked environment and fairly limited availability of freshwater or marine resources. The diet appears not to have changed significantly from the Late Roman to the Early Medieval period. However, in the population of Altenerding, there were significant differences in the diet of men and women, supporting a hypothesis of greater mobility among women. Furthermore, the isotopic evidence from dietary outliers is supported by "foreign" grave goods and practices, such as artificial skull modification. These results reveal the potential of carbon and nitrogen isotope analysis for questions regarding migration and mobility. © 2010 Wiley-Liss, Inc.

Intramuscular Local Anesthetic Infiltration at Closure for Postoperative Analgesia in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.

PubMed

Perera, Andrea P; Chari, Aswin; Kostusiak, Milosz; Khan, Akbar Ali; Luoma, Astri Mv; Casey, Adrian T H

2017-07-15

Systematic Review and Meta-Analysis OBJECTIVE.: To identify whether intramuscular local anesthetic infiltration prior to wound closure was effective in reducing postoperative pain and facilitating early discharge following lumbar spine surgery. Local anesthetic infiltration prior to wound closure may form part of the multimodal strategy for postoperative analgesia, facilitating early mobilization and discharge. Although there are a number of small studies investigating its utility, a quantitative meta-analysis of the data has never been performed. This review was conducted according the PRISMA statement and was registered with the PROSPERO database. Only randomized controlled trials were eligible for inclusion. Key outcomes of interest included time to first analgesic demand, total postoperative opiate usage in the first 24 hours, visual analogue score (VAS) at 1, 12 and 24 hours and postoperative length of stay. Eleven publications fulfilled the inclusion criteria. A total of 438 patients were include; 212 in the control group and 226 in the intervention group. Local anesthetic infiltration resulted in a prolonged time to first analgesic demand (mean difference (MD) 65.88 minutes, 95% confidence interval (95% CI) 23.70 to 108.06, P.0.002) as well as a significantly reduced postoperative opiate demand (M.D. -9.71 mg, 95% CI -15.07, -4.34, p = 0.0004). There was a small but statistically significant reduction in postoperative visual analogue score (VAS) at 1 hour (M.D. -0.87 95%CI -1.55, -0.20, p = 0.01), but no significant reduction at 12 or 24 hours (p = 0.93 and 0.85 respectively). This systematic review and meta-analysis provides evidence that postoperative intramuscular local anaesthetic infiltration reduces postoperative analgesic requirements and the time to first analgesic demands for patients undergoing lumbar spine surgery. Key research priorities include optimization of the choice and strength of local anaesthetic agent and health

Early laparoscopic management of acute postoperative hemorrhage after initial laparoscopic surgery.

PubMed

Gong, Edward M; Zorn, Kevin C; Gofrit, Ofer N; Lucioni, Alvaro; Orvieto, Marcelo A; Zagaja, Gregory P; Shalhav, Arieh L

2007-08-01

The use of laparoscopic surgery has been well established for the management of abdominal emergencies. However, the value of this technique for postoperative hemorrhage in urology has not been characterized. We present our favorable experience with laparoscopic exploration after urologic surgery and suggest guidelines for laparoscopic management of post-laparoscopy bleeding. Three patients who developed hemorrhage shortly after laparoscopic urologic surgery and were managed by laparoscopic exploration were identified from a series of 910 laparoscopic urologic procedures performed at our institution from October 2002 to June 2006. Three patients, who were hemodynamically stable (two after robot-assisted laparoscopic prostatectomy, one after laparoscopic radical nephrectomy), required prompt surgical exploration for postoperative hemorrhage not stabilized by blood transfusion (mean 2.7 units) at a mean of 19.4 hours after initial surgery. Clots were evacuated with a 10-mm suction-irrigator. Two patients were found to have abdominal-wall arterial bleeding and were managed with suture ligation. The third patient demonstrated diffuse bleeding from the prostatic bed, which was controlled with Surgicel and FloSeal. Bleeding was efficiently controlled in all patients, and none required post-exploration transfusion. The mean post-exploration hospital stay was 2.3 days. Significant hemorrhage after urologic laparoscopy is a rare event. We found laparoscopic exploration to be an excellent way to diagnose and correct such hemorrhage in certain patients. Early diagnosis with clinical and hematologic studies, a lowered threshold for surgical exploration, and specific operative equipment may decrease patient morbidity and the need for open surgical exploration.

Effect of pre-emptive analgesia by continuous femoral nerve block on early postoperative cognitive function following total knee arthroplasty in elderly patients

PubMed Central

Deng, Li-Qin; Hou, Lei-Na; Song, Feng-Xiang; Zhu, Han-Yue; Zhao, Hai-Ying; Chen, Gang; Li, Jing-Jing

2017-01-01

To the best of our knowledge, the effect of pre-emptively blocking pain transmission on acute postoperative cognitive dysfunction (POCD) has not yet been assessed. Therefore, the present study aimed to investigate the effect of pre-emptive analgesia via a continuous femoral nerve block (CFNB) on postoperative pain and early cognitive function following total knee arthroplasty (TKA) surgery in elderly patients. CFNB was performed prior to TKA surgery in the pre-emptive analgesia group (n=30) and following TKA surgery in the control group (n=30). POCD was defined as a two-point reduction in the postoperative score compared with the preoperative score in the mini-mental state examination. The visual analog scale (VAS) was used to evaluate the intensity of pain at rest and during exercise. The intraoperative dose of remifentanil in the pre-emptive analgesia group was significantly lower than in the control group (P<0.01). In the preemptive analgesia group, VAS scores at three days post-surgery were lower than those in the control group (P<0.01). The incidence of POCD on the third postoperative day was slightly lower in the pre-emptive analgesia group compared with the control group. In conclusion, the results demonstrate that pre-emptive analgesia by CFNB may promote the recovery of early cognitive function following TKA in elderly patients. PMID:28413514

Effect of pre-emptive analgesia by continuous femoral nerve block on early postoperative cognitive function following total knee arthroplasty in elderly patients.

PubMed

Deng, Li-Qin; Hou, Lei-Na; Song, Feng-Xiang; Zhu, Han-Yue; Zhao, Hai-Ying; Chen, Gang; Li, Jing-Jing

2017-04-01

To the best of our knowledge, the effect of pre-emptively blocking pain transmission on acute postoperative cognitive dysfunction (POCD) has not yet been assessed. Therefore, the present study aimed to investigate the effect of pre-emptive analgesia via a continuous femoral nerve block (CFNB) on postoperative pain and early cognitive function following total knee arthroplasty (TKA) surgery in elderly patients. CFNB was performed prior to TKA surgery in the pre-emptive analgesia group (n=30) and following TKA surgery in the control group (n=30). POCD was defined as a two-point reduction in the postoperative score compared with the preoperative score in the mini-mental state examination. The visual analog scale (VAS) was used to evaluate the intensity of pain at rest and during exercise. The intraoperative dose of remifentanil in the pre-emptive analgesia group was significantly lower than in the control group (P<0.01). In the preemptive analgesia group, VAS scores at three days post-surgery were lower than those in the control group (P<0.01). The incidence of POCD on the third postoperative day was slightly lower in the pre-emptive analgesia group compared with the control group. In conclusion, the results demonstrate that pre-emptive analgesia by CFNB may promote the recovery of early cognitive function following TKA in elderly patients.

Development of the multiple sclerosis (MS) early mobility impairment questionnaire (EMIQ).

PubMed

Ziemssen, Tjalf; Phillips, Glenn; Shah, Ruchit; Mathias, Adam; Foley, Catherine; Coon, Cheryl; Sen, Rohini; Lee, Andrew; Agarwal, Sonalee

2016-10-01

The Early Mobility Impairment Questionnaire (EMIQ) was developed to facilitate early identification of mobility impairments in multiple sclerosis (MS) patients. We describe the initial development of the EMIQ with a focus on the psychometric evaluation of the questionnaire using classical and item response theory methods. The initial 20-item EMIQ was constructed by clinical specialists and qualitatively tested among people with MS and physicians via cognitive interviews. Data from an observational study was used to make additional updates to the instrument based on exploratory factor analysis (EFA) and item response theory (IRT) analysis, and psychometric analyses were performed to evaluate the reliability and validity of the final instrument's scores and screening properties (i.e., sensitivity and specificity). Based on qualitative interview analyses, a revised 15-item EMIQ was included in the observational study. EFA, IRT and item-to-item correlation analyses revealed redundant items which were removed leading to the final nine-item EMIQ. The nine-item EMIQ performed well with respect to: test-retest reliability (ICC = 0.858); internal consistency (α = 0.893); convergent validity; and known-groups methods for construct validity. A cut-point of 41 on the 0-to-100 scale resulted in sufficient sensitivity and specificity statistics for viably identifying patients with mobility impairment. The EMIQ is a content valid and psychometrically sound instrument for capturing MS patients' experience with mobility impairments in a clinical practice setting. Additional research is suggested to further confirm the EMIQ's screening properties over time.

Fungal infections in children in the early postoperative period after cardiac surgery for congenital heart disease: a single-centre experience.

PubMed

Jaworski, Radoslaw; Haponiuk, Ireneusz; Irga-Jaworska, Ninela; Chojnicki, Maciej; Steffens, Mariusz; Paczkowski, Konrad; Zielinski, Jacek

2016-09-01

Postoperative infections are still an important problem in cardiac surgery, especially in the paediatric population, and may influence the final outcome of congenital heart disease treatment. Postoperative infections with fungi are uncommon. The aetiology is poorly understood, and the proper diagnosis and treatment is unclear. In this single-centre study, the frequency of invasive fungal disease in children who underwent surgical management of congenital heart diseases was determined along with the risk factors for infection, treatment options and outcomes. All consecutive paediatric patients (<18 years of age) who underwent cardiac surgery for congenital heart disease between September 2008 and December 2015 in a paediatric cardiac centre in Poland were identified. Those who developed invasive fungal disease in the early postoperative period (30 days) were identified. Of the 1540 cardiosurgical procedures for congenital heart disease, 6 were complicated by fungal infection (0.39%). One patient had a high probability of fungal infection, but the diagnosis was unproved. Nevertheless, the patient was successfully treated with antifungal treatment. Five had proven invasive fungal disease. Of these, 3 were diagnosed with candidaemia. All had undergone cardiopulmonary bypass. Of the remaining 2 patients, 1 was a preterm newborn with complete atrioventricular septal defect who developed rib fungal invasion. The remaining patient had pulmonary atresia with ventricular septal defect and developed Fournier's gangrene after surgery. None of the patients died due to infection in the early postoperative period. However, the child with rib fungal invasion died 39 days after surgery as a result of multiorgan failure. Fungal infections in paediatric patients after cardiac surgery may markedly influence morbidity and mortality. Fungal infection prophylaxis in this specific group of children may reduce morbidity, whereas early empirical treatment followed by a targeted approach may

[Postoperative management of patients with BMI > 40 kg / m2].

PubMed

Kaffarnik, M; Utzolino, S

2009-02-01

Bariatric surgery, especially in the morbidly obese, can be associated with serious postoperative problems. Apart from surgical complications requiring reoperation, pre-existing disease can worsen during the postoperative period. Bariatric patients require particular therapeutic approaches such as adapted fluid and pain management, management of obstructive sleep apnoea-hypopnea, early ambulation and measures for preventing pressure ulcers. Another challenging issue is the early identification and management of postoperative intraabdominal sepsis (IAS) before the onset of organ dysfunction. Early and frequent ambulation is thought to reduce risk of pressure ulcers, deep vein thrombosis, resedation, pain, pneumonia and atelectasis. To prevent spine injury of health care workers it is necessary to provide appropriate support with special beds, lifting and transfer devices.

Incidence, predictors and early post-operative course of diabetes insipidus in paediatric craniopharygioma: a comparison with adults.

PubMed

Pratheesh, Ravindran; Swallow, Diane Margaret A; Rajaratnam, Simon; Jacob, K S; Chacko, Geeta; Joseph, Mathew; Chacko, Ari G

2013-06-01

This study aims to determine the incidence, predictors, early post-operative course of diabetes insipidus (DI) in paediatric craniopharyngiomas(CP) and compare the findings with adults. Retrospective analysis of clinical, biochemical, radiological and operative data for 102 consecutive CP surgeries (45 paediatric and 57 adult cases) was done. Bivariate and multivariate analyses were done to determine the predictors of DI. The incidence of the triphasic response and electrolyte abnormalities in the first post-operative week was compared between children and adults. Children had larger tumours and higher incidence of cystic tumours and hydrocephalus. Preoperative DI was close to 15 % in both the age groups. Radical/subtotal excision was achieved in 58 % of children and 53 % of adults. The incidence of post-operative DI was 80 % and 63 % in children and adults, respectively. Children had significantly higher incidence of permanent DI (55.6 %). Radical excision in children (p = 0.000); previous tumour surgery (p = 0.014) and new onset hypopituitarism (p = 0.019) in adults were associated with permanent DI. The triphasic response (23 %), wide intra-day serum sodium fluctuations and hyponatraemia were more common in children. Post-operative DI is a frequent and significant cause of morbidity in children undergoing surgery for CP. Children have a higher incidence of permanent DI. Radical excision is a predictor of permanent DI in children, whereas previous tumour excision and new onset hypopituitarism were predictors of permanent DI among adults. The management of post-operative DI is more difficult in children and the treating physician needs to be alert to detect the triphasic response.

Extending the benefits of early mobility to critically ill patients undergoing continuous renal replacement therapy: the Michigan experience.

PubMed

Talley, Cheryl L; Wonnacott, Robert O; Schuette, Janice K; Jamieson, Jill; Heung, Michael

2013-01-01

Evidence to support improved outcomes with early ambulation is strong in medical literature. Yet, critically ill continuous renal replacement therapy (CRRT) patients remain tethered to their beds by devices delivering supportive therapy. The University of Michigan Adult CRRT Committee identified this deficiency and sought to change it. There was no guidance in the literature to support mobilizing this population; therefore, we reviewed literature from devices with similar technological profiles. Revision of our institutional mobility protocol for the CRRT population included a simple safety acronym, ASK. The acronym addresses appropriate candidacy; secured, appropriate access; and potential device and patient complications as a memorable aid to help nursing staff determine whether their CRRT patients are candidates for early mobility. After implementing our CRRT mobility standard, a preliminary study of 109 CRRT patients and a review of incident reports related to CRRT demonstrated no significant adverse patient events or falls and no access complications related to mobility. This deliberate intervention allows CRRT patients to safely engage in mobility activities to improve this population's outcomes. A simple mobility protocol and safety acronym partnered with strong clinical leadership has permitted the University of Michigan to add CRRT patients to the body of early mobility literature.

Does the obesity paradox apply to early postoperative complications after hip surgery? A retrospective chart review.

PubMed

Shaparin, Naum; Widyn, James; Nair, Singh; Kho, Irene; Geller, David; Delphin, Ellise

2016-08-01

There is evidence that very obese patients (body mass index [BMI] >40 kg/m(2)) undergoing hip replacement have longer average hospital stays, as well as higher rates of complications and readmission compared with patients with normal BMI. However, there are sparse data describing how overweight and obese patients fare in the period immediately after hip replacement surgery compared with patients with low or normal BMI. In this study, we sought to explore the association of BMI with the rate of early postoperative complications in patients undergoing total hip arthroplasty. A proprietary hospital software program, Clinical Looking Glass was used to query the Montefiore Medical Center database and create a list of patients with International Classification of Diseases, Ninth Revision code 81.51 (hip replacement) from the period of January 1, 2010, through December 31, 2012. The medical records of patients with length of stay 5 or more days were reviewed to evaluate the reason for the extended stay. The primary outcome studied was the association between BMI and occurrence of early complications in patients who had undergone total hip replacement surgery. Logistic regression was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of BMI and early postoperative complications. Of the 802 patients undergoing hip replacement surgery within our time frame, 142 patient medical records were reviewed due to their length of stay of ≥5 days. Overall complication rate in the analyzed patients demonstrated a J-curve distribution pattern, with the highest morbidity being 23.5% in the underweight group, the second highest in the normal-weight group (17.3%), and decreasing to nadir in the overweight (8.0%) and obese class I (10.0%) and then higher again in classes II (14.3%) and III (16.7%). Adjusted ORs demonstrated the same J distribution pattern similar to the pattern observed in the univariate analysis. Of the variables studied

[Analgesic effect of TES therapy in the early postoperative period in patients who underwent tonsillectomy].

PubMed

Semënov, F V; Kade, A Kh; Banashek-Meshchiarkova, T V; Vartanian, M S

2013-01-01

The objective of the present work was to study peculiarities of the analgesic action of therapeutic electrical stimulation (TES therapy) in the early postoperative period in the patients who underwent tonsillectomy. A total of 60 patients admitted for this surgery to the specialized otorhinolaryngological department were available for observation. They were divided into two groups depending on the pain relief strategy. The patients of the study group (n=30) underwent courses of transcranial electrical stimulation on a daily basis (from the onset of hospitalization) in addition to the administration of a standard analgetic. The standard dose of tramadol (2.0 ml) was given to the patients of the control group (n=30) who complained of strong pain. The results of the objective and subjective estimations indicate that the degree of pharyngeal pain in the patients treated with TES therapy and the standard analgetic was significantly different. The patients receiving TES therapy could sooner resume their habitual diet and required smaller amounts of the analgetic which makes this modality a cost-effective supplement to the standard postoperative treatment.

Meta-analysis: effect of preoperative infliximab use on early postoperative complications in patients with ulcerative colitis undergoing abdominal surgery.

PubMed

Yang, Z; Wu, Q; Wang, F; Wu, K; Fan, D

2012-11-01

Infliximab is widely used in severe and refractory ulcerative colitis (UC). The results of clinical studies are inconsistent on whether preoperative infliximab use increases early postoperative complications in UC patients. To determine the clinical safety and efficacy of preoperative infliximab treatment in UC patients with regard to short-term outcomes following abdominal surgery. PubMed, Embase databases were searched for controlled observational studies comparing postsurgical morbidity in UC patients receiving infliximab preoperatively with those not on infliximab. The primary endpoint was total complication rate. Secondary endpoints included the rate of infectious and non-infectious complications. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) as summary measures. A total of 13 studies involving 2933 patients were included in our meta-analysis. There was no significant association between infliximab therapy preoperatively and total (OR = 1.09, 95% CI: 0.87-1.37, P = 0.47), infectious (OR = 1.10, 95% CI: 0.51-2.38, P = 0.81) and non-infectious (OR = 1.10, 95% CI: 0.76-1.59, P = 0.61) postoperative complications respectively. Infliximab might be a protective factor against infection for the use within 12 weeks prior to surgery (OR = 0.43, 95% CI: 0.22-0.83, P = 0.01). No publication bias was found. Preoperative infliximab use does not increase the risk of early postoperative complications in patients with ulcerative colitis undergoing abdominal surgery. © 2012 Blackwell Publishing Ltd.

Systematic Occlusion of Shunts: Control of Early Postoperative IOP and Hypotony-related Complications Following Glaucoma Shunt Surgery.

PubMed

Sharkawi, Eamon; Artes, Paul H; Oleszczuk, Justyna D; Bela, Cyrielle; Achache, Farid; Barton, Keith; Bergin, Ciara

2016-01-01

Evaluation of a protocol of total intraluminal occlusion of Baerveldt shunts and its effects on early postoperative intraocular pressure (IOP) control and hypotony-related complications. This was a noncomparative, prospective, and interventional study. Glaucoma patients were recruited to undergo Baerveldt shunt surgery. A total of 116 eyes of 112 patients were enrolled. During shunt implantation, aqueous outflow was restricted using an intraluminal occluding stent inserted through the entire tube length, with and without external ligation, to halt aqueous flow. Postoperatively, eyes underwent ligature laser suture lysis and partial or complete stent removals, at predetermined time intervals. Loss of postoperative IOP control was categorized as transient or persistent hypotony (IOP≤5 mm Hg) or hypertony (IOP>21 mm Hg). Patients were followed up for 1 year. Preoperatively median IOP was 23 mm Hg (mean 26 mm Hg, SD 12 mm Hg), median number of glaucoma medications was 3.0 (mean 3.0, SD 1.2). During year 1, laser suture lysis was performed in 30 eyes (26%) and stent removal in 93 eyes (80%) (23 partial; 70 complete). There was 1 case of transient hypotony, no cases of persistent hypotony, 10 of transient hypertony, and 3 of persistent hypertony. Nine eyes had IOP≤5 mm Hg at ≥1 time points and hypotony-related complications occurred in 8 eyes (7%). At 1 year, median IOP was 12 mm Hg (mean 13 mm Hg, SD 4 mm Hg) with a median of 1.0 glaucoma medications (mean 1.1, SD 1.3). The cumulative probability of failure during the first 12 months follow-up was 6% (n=7). Overall postoperative complications occurred in 11 eyes (9%). The surgical and postoperative protocol resulted in controlled, step-wise reductions of IOP with low rates of hypotony and related complications.

The impact of music on postoperative pain and anxiety following cesarean section.

PubMed

Reza, Nikandish; Ali, Sahmedini Mohammad; Saeed, Khademi; Abul-Qasim, Avand; Reza, Tabatabaee Hamid

2007-10-01

The relief of post-cesarean delivery pain is important. Good pain relief improves mobility and reduces the risk of thromboembolic disease, which may have been increased during pregnancy. Pain may impair the mother's ability to optimally care for her infant in the immediate postpartum period and may adversely affect early interactions between mother and infant. It is necessary, therefore that pain relief be safe and effective and results in no adverse neonatal effects during breast-feeding. Music may be considered as a potential method of post cesarean pain therapy due to its noninvasiveness and lack of side effects. In this study we evaluated the effect of intraoperative music under general anesthesia for reducing the postoperative morphine requirements after cesarean section. In a double blind placebo-controlled trial, 100 women (ASA I) scheduled for elective cesarean section under general anesthesia, were randomly allocated into two groups of fifty. After standardization of anesthesia, patients in the music group were exposed to a compact disk of Spanish guitar after induction of anesthesia up to the time of wound dressing. In the control group patients were exposed to white music. Post operative pain and anxiety were evaluated by visual analog scale (VAS) up to six hours after discharge from PACU. Morphine was given intravenously for reducing pain to VAS < or = 3 postoperatively. There was not statistically significant difference in VAS for pain between two groups up to six hours postoperatively (P>0.05). In addition, morphine requirements were not different between two groups at different time intervals up to six hours postoperatively (P>0.05). There were not statistically significant difference between two groups regarding postoperative anxiety score and vomiting frequency (P>0.05). As per conditions of this study, intraoperative Spanish music was not effective in reducing postoperative pain after cesarean section. In addition postoperative morphine

Structural and biomechanical characteristics after early mobilization in an Achilles tendon rupture model: operative versus nonoperative treatment.

PubMed

Krapf, Daniel; Kaipel, Martin; Majewski, Martin

2012-09-01

Acute Achilles tendon ruptures are common sports injuries; however, treatment remains a clinical challenge. Studies show a superior effect of early mobilization and full weight bearing on tendon healing and clinical outcome; however, few data exist on structural and biomechanical characteristics in the early healing phase. This study investigated the histological and biomechanical characteristics of early mobilization and full weight bearing in an Achilles tendon rupture model. Eighty rats underwent dissection of a hindpaw Achilles tendon; 40 rats were treated conservatively and 40 underwent open repair of the transected Achilles tendon by suturing. Early mobilization and full weight bearing were allowed in both groups. At 1, 2, 4, and 8 weeks after tenotomy, tensile strength, stiffness, thickness, tissue characteristics (histological analysis), and length were determined. Dissected Achilles tendons healed in all animals during full weight-bearing early mobilization. One and 2 weeks after tenotomy, rats in the operative group showed increased tensile strength and stiffness compared with the nonoperative group. Repair-site diameters were increased at 1, 2, and 8 weeks after tenotomy. Tendon length was decreased in the operative group throughout observation, whereas the nonoperative group showed increased structural characteristics on the cellular level and a more homogeneous collagen distribution. Surgical treatment of dissected rat Achilles tendons showed superior biomechanical characteristics within the first 2 weeks. Conservative treatment resulted in superior histological findings but significant lengthening of the tendon in the early healing phase (weeks 1-8). Copyright 2012, SLACK Incorporated.

Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy: a randomized, placebo-controlled trial.

PubMed

Hristovska, Ana-Marija; Kristensen, Billy B; Rasmussen, Marianne A; Rasmussen, Yvonne H; Elving, Lisbeth B; Nielsen, Christian V; Kehlet, Henrik

2014-03-01

To assess the effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy, and describe the technique in detail. A randomized, double-blind, placebo-controlled study following the CONSORT criteria. A university hospital. Thirty-seven patients undergoing vaginal hysterectomy. Patients received high-volume (50 mL) ropivacaine 0.50% (n = 20) or saline (n = 17) infiltration using a systematic technique ensuring uniform delivery to all tissues incised, handled or instrumented during the procedure. Pain, nausea, vomiting and opioid requirements were assessed for 32 h as well as time spent in the post-anesthesia care unit and time to first mobilization. Pain at rest was significantly reduced after one, four and eight hours in the ropivacaine group (p ≤ 0.001-0.01). Pain during coughing was significantly reduced after one and four hours (p ≤ 0.001 and p ≤ 0.003), and pain during movement was significantly reduced after four hours (p ≤ 0.02). Opioid requirements and time spent in the post-anesthesia care unit were significantly reduced in the ropivacaine group (p < 0.001 and p < 0.001, respectively), as well as the time to first mobilization (p < 0.001). Intra-operative systematic local infiltration analgesia reduces postoperative pain in patients undergoing vaginal hysterectomy, facilities mobilization and improves early recovery. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Mobility scores as a predictor of length of stay in general surgery: a prospective cohort study.

PubMed

Carroll, Georgia M; Hampton, Jacob; Carroll, Rosemary; Smith, Stephen R

2018-05-22

Post-operative length of stay (LOS) is an increasingly important clinical indicator in general surgery. Despite this, no tool has been validated to predict LOS or readiness for discharge in general surgical patients. The de Morton Mobility Index (DEMMI) is a functional mobility assessment tool that has been validated in rehabilitation patient populations. In this prospective cohort study, we aimed to identify if trends in DEMMI scores were associated with discharge within 1 week and overall LOS in general surgical patients. A total of 161 patients who underwent elective gastrointestinal resections were included. DEMMI scores were performed preoperatively, on days 1, 2, 3 and 30 post-operative. Statistical analysis was performed to identify any association between DEMMI scores and discharge within 1 week and LOS. Functional recovery (measured by achieving 80% of baseline DEMMI score by post-operative day 1) was significantly associated with discharge within 1 week. Presence of a stoma was associated with longer LOS. The area under the receiver operating characteristic curve using functional recovery on post-operative day 1 as a predictor of discharge within 1 week is 0.772. The DEMMI score is a fast, easy and useful tool to, on post-operative day 1, predict discharge within 1 week. The utility of this is to act as an anticipatory trigger for more proactive and efficient discharge planning in the early post-operative period, and there is potential to use the DEMMI as a comparator in clinical trials to assess functional recovery. © 2018 Royal Australasian College of Surgeons.

Renal excretion of ingested gastrografin: clinical relevance in early postoperative treatment of patients who have undergone gastric surgery.

PubMed

Sohn, Kyung-Myung; Lee, Sung-Yong; Kwon, Oh-Han

2002-05-01

We performed this study to evaluate the clinical relevance of renal excretion of ingested Gastrografin (methylglucamine diatrizoate) revealed on CT in the early treatment of patients who have undergone gastric surgery. Unenhanced abdominal CT was performed before and then 1 hr to 1 hr 30 min after Gastrografin ingestion in 30 patients 7 days after gastric surgery and in 19 healthy adults who served as the control group. CT scans were reviewed for the opacification of the renal collecting system or urinary bladder after Gastrografin ingestion, a finding that represents renal excretion of the ingested contrast medium. In the control group, four (21 %) of the 19 healthy adults showed renal excretion of ingested Gastrografin visualized as opacification of the urinary tract on CT scans obtained 1 hr to 1 hr 30 min after ingestion of the substance. Renal excretion of the ingested Gastrografin was seen in 19 (63%) of the 30 patients, a significantly larger percentage than in the control group (z score, p < 0.01). No patient showed either radiologic or clinical evidence of leakage from the anastomotic site. Renal excretion of ingested Gastrografin is frequently visualized on CT in patients without anastomotic leakage during the early postoperative period after gastric surgery, and this phenomenon is not rare, even in healthy adults. Therefore, renal excretion seen on CT should not be regarded as a sign of anastomotic leakage in early postoperative patients.

Thyroidectomy: post-operative care and common complications.

PubMed

Furtado, L

Any surgical procedure involves risks. Thyroid surgery can cause potentially fatal complications during the early post-operative phase. It is essential that nurses have the knowledge and skills to detect early signs and symptoms of potential complications and take appropriate action. Early detection and rapid response are key to maintaining patient safety and minimising harm.

The Impact of Early Powered Mobility on Parental Stress, Negative Emotions, and Family Social Interactions

ERIC Educational Resources Information Center

Tefft, Donita; Guerette, Paula; Furumasu, Jan

2011-01-01

Powered mobility has been found to have positive effects on young children with severe physical disabilities, but the impact on the family has been less well documented. We evaluated the impact of early powered mobility on parental stress, negative emotions, perceived social interactions, and parental satisfaction with wheelchair characteristics…

Cerebral oximetry during infant cardiac surgery: evaluation and relationship to early postoperative outcome.

PubMed

Kussman, Barry D; Wypij, David; DiNardo, James A; Newburger, Jane W; Mayer, John E; del Nido, Pedro J; Bacha, Emile A; Pigula, Frank; McGrath, Ellen; Laussen, Peter C

2009-04-01

We examined changes in cerebral oxygen saturation during infant heart surgery and its relationship to anatomic diagnosis and early outcome. Regional cerebral oxygen saturation (rSO(2)) was measured by near-infrared spectroscopy in 104 infants undergoing biventricular repair without aortic arch obstruction as part of a randomized trial of hemodilution to a hematocrit of 25% vs 35%. Before cardiopulmonary bypass (CPB), infants with tetralogy of Fallot had higher rSO(2) values compared to those with D-transposition of the great arteries (D-TGA) or ventricular septal defect (P < 0.001). During CPB cooling, low flow, and at the termination of CPB, D-TGA subjects had the highest rSO(2) values (P < 0.001). There were no significant associations between intraoperative rSO(2) and early postoperative outcomes after adjustment for diagnosis. In 39 D-TGA subjects with > or =5 min of deep hypothermic circulatory arrest (DHCA), there was no correlation between the rSO(2) (91% +/- 6%) or hematocrit (29.2% +/- 5.5%) at the onset of arrest and the rate of decline in rSO(2) during arrest. Intraoperative rSO(2) varies according to anatomic diagnosis but accounts for very little of the variance in early outcome. As measured by frontal near-infrared spectroscopy, higher levels of hematocrit and current perfusion techniques appear to provide an adequate oxygen reservoir prior to relatively short periods of DHCA.

Toward Shorter Hospitalization After Endoscopic Transsphenoidal Pituitary Surgery: Day-by-Day Analysis of Early Postoperative Complications and Interventions.

PubMed

Shimanskaya, Viktoria E; Wagenmakers, Margreet A E M; Bartels, Ronald H M A; Boogaarts, Hieronymus D; Grotenhuis, J André; Hermus, Ad R M M; van de Ven, Annenienke C; van Lindert, Erik J

2018-03-01

It is unclear which patients have the greatest risk of developing complications in the first days after endoscopic transsphenoidal pituitary surgery (ETS) and how long patients should stay hospitalized after surgery. The objective of this study is to identify which patients are at risk for early postoperative medical and surgical reinterventions to optimize the length of hospitalization. The medical records of 146 patients who underwent ETS for a pituitary adenoma between January 2013 and July 2016 were reviewed retrospectively. Data were collected on baseline patient-related characteristics, characteristics of the pituitary adenoma, perioperative complications and interventions, and postoperative outcomes. Patients who underwent additional interventions on days 2, 3, and 4 after ETS were identified as cases, and patients who did not have any interventions after day 1 postoperatively were identified as controls. Diabetes mellitus (odds ratio [OR], 4.279; 95% confidence interval [CI], 1.149-15.933; P = 0.03), incomplete adenoma resection (OR, 2.840; 95% CI, 1.228-6.568; P = 0.02) and increased morning sodium concentration on day 2 after surgery (OR, 5.211; 95% CI, 2.158-12.579; P <0.001) were associated with reinterventions. Patients without interventions on day 1 or 2 had only an 18.6% chance of a reintervention (OR, 0.201; 95% CI, 0.095-0.424). Patients with diabetes mellitus, incomplete adenoma resection, and increased morning sodium concentration on day 2 after surgery have an increased chance on reinterventions. In addition, patients without any interventions on day 1 and 2 are at low risk for later reinterventions. These patients could be suitable candidates for early hospital discharge. Copyright © 2018 Elsevier Inc. All rights reserved.

Effect of Unshaven Hair with Absorbable Sutures and Early Postoperative Shampoo on Cranial Surgery Site Infection.

PubMed

Oh, Won-Oak; Yeom, Insun; Kim, Dong-Seok; Park, Eun-Kyung; Shim, Kyu-Won

2018-01-01

Cranial surgical site infection is a significant cause of morbidity and mortality in hospitals. Preoperative hair shaving for cranial neurosurgical procedures is performed traditionally in an attempt to protect patients against complications from infections at cranial surgical sites. However, preoperative shaving of surgical incision sites using traditional surgical blades without properly washing the head after surgery can cause infections at surgical sites. Therefore, a rapid protocol in which the scalp remains unshaven and absorbable sutures are used for scalp closure with early postoperative shampooing is examined in this study. A retrospective comparative study was conducted from January 2008 to December 2012. A total of 2,641 patients who underwent unshaven cranial surgery with absorbable sutures for scalp closure were enrolled in this study. Data of 1,882 patients who underwent surgery with the traditional protocol from January 2005 to December 2007 were also analyzed for comparison. Of 2,641 patients who underwent cranial surgery with the rapid protocol, all but 2 (0.07%) patients experienced satisfactory wound healing. Of 1,882 patients who underwent cranial surgery with the traditional protocol, 3 patients (0.15%) had infections. Each infection occurred at the superficial incisional surgical site. Unshaven cranial surgery using absorbable sutures for scalp closure with early postoperative shampooing is safe and effective in the cranial neurosurgery setting. This protocol has a positive psychological effect. It can help patients accept neurosurgical procedures and improve their self-image after the operation. © 2017 S. Karger AG, Basel.

Effects of combination of whey protein intake and rehabilitation on muscle strength and daily movements in patients with hip fracture in the early postoperative period.

PubMed

Niitsu, Masaya; Ichinose, Daisuke; Hirooka, Taku; Mitsutomi, Kazuhiko; Morimoto, Yoshitaka; Sarukawa, Junichiro; Nishikino, Shoichi; Yamauchi, Katsuya; Yamazaki, Kaoru

2016-08-01

Elderly patients can be at risk of protein catabolism and malnutrition in the early postoperative period. Whey protein includes most essential amino acids and stimulates the synthesis of muscle protein. The purpose of this study was to investigate the effect of resistance training in combination with whey protein intake in the early postoperative period. We randomized patients to a whey protein group or a control group. The former group received 32.2 g of whey protein pre- and post-rehabilitation in the early postoperative period for two weeks. Outcomes were knee extension strength on either side by Biodex 4.0, and the ability of transfer, walking, toilet use and stair use by the Barthel Index (BI). We performed initial and final assessments in the second and tenth rehabilitation sessions. A total of 38 patients were recruited: 20 in the whey protein group and 18 in the control group. Participants in the whey protein group showed significantly greater improvement in knee extension strength in the operated limb compared with the control group (F = 6.11, P = 0.02). The non-operated limb also showed a similar tendency (F = 3.51, P = 0.07). The abilities of transfer, walking and toilet use showed greater improvements in the whey protein group than in the control group by BI (P < 0.05). The combination of whey protein intake and rehabilitation for two weeks in the early postoperative period has a beneficial effect on knee extension strength in both lower limbs and BI (transfer, walking and toilet use) scores in patients with hip fracture. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Air Travel Safety in Postoperative Breast Cancer Patients: A Systematic Review.

PubMed

Co, Michael; Ng, Judy; Kwong, Ava

2018-05-17

Air travel has long been a dilemma in post-breast cancer surgery patients. Anecdotal reports have described adverse outcomes on surgical wound, implants, and lymphedema during air travel. This review aims to evaluate the best evidence from the literature concerning the air travel safety in breast cancer patients. A comprehensive review was performed of the Medline, Embase, CINAHL, and Cochrane databases using a predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by 2 researchers. We reviewed the best evidence on air travel safety in postoperative breast cancer patients. Evidence was limited in the current literature to suggest adverse effects on postoperative mastectomy wounds and drains by high-altitude travel. Similarly, adverse effects on breast implants were limited to case reports and ex vivo experiments. A systematic review of 12 studies concluded that air travel is not associated with upper limb lymphedema after breast cancer surgery. Deep-vein thrombosis (DVT) is a known complication after air travel; in addition, malignancy itself is a known risk factor for DVT. Evidence of safety to continue tamoxifen during the period of air travel is lacking in the literature. Evidence to support the use of systemic DVT prophylaxis in general postoperative breast cancer patients is also limited. Best evidence from a large retrospective study suggested that mechanical antiembolism devices and early mobilization are the only measures required. Air travel is generally safe in patients after breast cancer surgery. Copyright © 2018. Published by Elsevier Inc.

[Accelerated postoperative recovery after colorectal surgery].

PubMed

Alfonsi, P; Schaack, E

2007-01-01

Accelerated recovery programs are clinical pathways which outline the stages, and streamline the means, and techniques aiming toward the desired end a rapid return of the patient to his pre-operative physical and psychological status. Recovery from colo-rectal surgery may be slowed by the patient's general health, surgical stress, post-surgical pain, and post-operative ileus. Both surgeons and anesthesiologists participate throughout the peri-operative period in a clinical pathway aimed at minimizing these delaying factors. Key elements of this pathway include avoidance of pre-operative colonic cleansing, early enteral feeding, and effective post-operative pain management permitting early ambulation (usually via thoracic epidural anesthesia). Pre-operative information and motivation of the patient is also a key to the success of this accelerated recovery program. Studies of such programs have shown decreased duration of post-operative ileus and hospital stay without an increase in complications or re-admissions. The elements of the clinical pathway must be regularly re-evaluated and updated according to local experience and published data.

Removal of restrictions following primary THA with posterolateral approach does not increase the risk of early dislocation.

PubMed

Gromov, Kirill; Troelsen, Anders; Otte, Kristian Stahl; Ørsnes, Thue; Ladelund, Steen; Husted, Henrik

2015-01-01

Patient education and mobilization restrictions are often used in an attempt to reduce the risk of dislocation following primary THA. To date, there have been no studies investigating the safety of removal of mobilization restrictions following THA performed using a posterolateral approach. In this retrospective non-inferiority study, we investigated the rate of early dislocation following primary THA in an unselected patient cohort before and after removal of postoperative mobilization restrictions. From the Danish National Health Registry, we identified patients with early dislocation in 2 consecutive and unselected cohorts of patients who received primary THA at our institution from 2004 through 2008 (n = 946) and from 2010 through 2014 (n = 1,329). Patients in the first cohort were mobilized with functional restrictions following primary THA whereas patients in the second cohort were allowed unrestricted mobilization. Risk of early dislocation (within 90 days) was compared in the 2 groups and odds ratio (OR)-adjusted for possible confounders-was calculated. Reasons for early dislocation in the 2 groups were identified. When we adjusted for potential confounders, we found no increased risk of early dislocation within 90 days in patients who were mobilized without restrictions. Risk of dislocation within 90 days was lower (3.4% vs 2.8%), risk of dislocation within 30 days was lower (2.1% vs 2.0%), and risk of multiple dislocations (1.8% vs 1.1%) was lower in patients who were mobilized without restrictions, but not statistically significantly so. Increasing age was an independent risk factor for dislocation. Removal of mobilization restrictions from the mobilization protocol following primary THA performed with a posterolateral approach did not lead to an increased risk of dislocation within 90 days.

Early Mobilization in Ischemic Stroke: A Pilot Randomized Trial of Safety and Feasibility in a Public Hospital in Brazil

PubMed Central

Poletto, Simone Rosa; Rebello, Letícia Costa; Valença, Maria Júlia Monteiro; Rossato, Daniele; Almeida, Andrea Garcia; Brondani, Rosane; Chaves, Márcia Lorena Fagundes; Nasi, Luiz Antônio; Martins, Sheila Cristina Ouriques

2015-01-01

Background The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant

Occlusive ligature and standardized fenestration of a Baerveldt tube with and without antimetabolites for early postoperative intraocular pressure control.

PubMed

Trible, J R; Brown, D B

1998-12-01

To determine the effectiveness of a surgical modification for a nonvalved aqueous tube shunt in controlling intraocular pressure (IOP) in the early postoperative period. The effect of antimetabolite use on IOP also was studied. A retrospective study of consecutive patients who underwent modified Baerveldt 350-mm2 implant with varied, nonrandomized, exposure to antimetabolites. Fifty-one eyes of 46 patients with uncontrolled glaucoma were examined. Identical surgical modification of a Baerveldt 350-mm2 tube was performed in all cases and consisted of placement of an occlusive 7-0 polyglactin suture just anterior to the plate followed by a through-and-through penetration of the tube just anterior to the occlusive ligature with a standardized 15 degrees blade. Seventeen eyes were not exposed to antimetabolite, while 2 groups of 17 eyes had 3 minutes' episcleral exposure to either 5-fluorouracil 50 mg/ml or mitomycin C 0.4 mg/ml at the location corresponding to the fenestration. The Tenon's layer and conjunctiva were not exposed because of concerns regarding conjunctival erosion over the device. Intraocular pressure and number of antiglaucoma medications required were analyzed. For the group, mean IOP before surgery and on postoperative days 1, 4, 10, 21, 42, 63, 84, and 112 was (in millimeters of mercury) 34.6, 20.1, 17.0, 17.2, 22.0, 17.3, 18.7, 17.4, and 15.6, respectively. There was an elevation of IOP at day 21 relative to fibrotic blockage of the fenestration before suture autolysis. This was temporized with antiglaucoma medication until suture autolysis occurred or treated with laser suture lysis (8 eyes). On day 1, hypotony occurred in 3 (6%) eyes whereas IOP greater than 30 mmHg was observed in 13 (26%) eyes. By day 10, the frequency had decreased to one (2.1 %) eye and three (6.4%) eyes, respectively. The use of antimetabolites did not result in lower IOP or less medication needed for any group at any interval (analysis of variance). This modification of a

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ucar, Adem, E-mail: ucaradem@yahoo.com; Yahyayev, Aghakishi, E-mail: aghakishi@yahoo.com; Bakkaloglu, Huseyin, E-mail: drhuseyin@yahoo.com

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.

Ultrasound-guided bilateral rectus sheath block reduces early postoperative pain after laparoscopic gynecologic surgery: a randomized study.

PubMed

Cho, Sooyoung; Kim, Youn Jin; Jeong, Kyungah; Moon, Hye-Sung

2018-04-01

Rectus sheath block (RSB) is an anterior abdominal wall block that reduces postoperative pain associated with midline incisions. This study aims to investigate the effect of ultrasound-guided bilateral RSB (US-BRSB) on postoperative pain and analgesic consumption in patients undergoing laparoscopic gynecologic surgery. Sixty patients who underwent laparoscopic gynecologic surgery were allocated to RSB (n = 30) or control (n = 30) group. A bilateral US-BRSB procedure (30 ml of 0.25% ropivacaine) was performed after induction of general anesthesia in the RSB group. The control group proceeded the surgery without sham block. All patients received fentanyl-based intravenous patient-controlled analgesia and rescue analgesics upon demand. Pain was scored by a blinded observer using a verbal numerical rating scale (VNRS) at rest while coughing at 0, 1, 6, 12, 24, and 48 h after postanesthesia care unit (PACU) admission. The primary outcome was the total number of rescue analgesics used in the 48-h postoperative period. At 0 h, VNRS were lower in the RSB group than in the control, both at rest (median VNRS 4.5 vs. 5, p = 0.02) and while coughing (median VNRS 6 vs. 7, p = 0.004). At 6 h, VNRS scores were lower in the RSB group than in the control while coughing (median VNRS 3 vs. 5, p = 0.01). Fentanyl use as rescue analgesics in the PACU was significantly lower in the RSB group than in the control (27.7 ± 32.1 vs. 53.3 ± 33.7 µg, respectively; p = 0.004). At 48 h postoperatively, the total number of rescue analgesics administered were significantly fewer in the RSB group than in the control (2.5 ± 2.5 vs. 3.9 ± 2.6, respectively; p = 0.04). US-BRSB reduces the immediate postoperative pain and opioid consumption during the early postoperative period. CLINICALTRIALS. NCT02476799, https://clinicaltrials.gov/ct2/show/NCT02476799 .

Psychological factors as predictors of early postoperative pain after open nephrectomy

PubMed Central

Mimic, Ana; Bantel, Carsten; Jovicic, Jelena; Mimic, Branko; Kisic-Tepavcevic, Darija; Durutovic, Otas; Ladjevic, Nebojsa

2018-01-01

Purpose There is an increasing interest in the identification of predictors for individual responses to analgesics and surgical pain. In this study, we aimed to determine psychological factors that might contribute to this response. We hence investigated patients undergoing a standardized surgical intervention (open nephrectomy). Patients and methods Between May 2014 and April 2015, we conducted a prospective observational cohort study. The following psychological tests were administered preoperatively: Mini-Mental State Examination, Amsterdam Preoperative Anxiety and Information Scale (APAIS), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Pain Catastrophizing Scale. The primary outcome, postoperative pain intensity (11-point numerical rating scale, [NRS]), was assessed in the “immediate early” (first 8 hours), “early” (12 and 24 hours), and “late early” periods (48 and 72 hours). Results A total of 196 patients were assessed, and 150 were finally included in the study. NRS scores improved from 4.9 (95% confidence interval [CI]: 4.7–5.1) in the “immediate early” to 3.1 (95% CI: 2.9–3.3) in the “early” and 2.3 (95% CI: 2.1–2.5) in the “late early” postoperative period. Most (87%) patients received intravenous opioids, while 13% received analgesics epidurally. Repeated measures analysis of variance indicated better pain management with epidural analgesia in the first two postoperative periods (F=15.01, p<0.00). Postoperative pain correlated strongly with analgesic strategy and preoperative psychological assessment. Multiple linear regression analysis showed “expected pain” was the only predictor in the “immediate early” phase, and “anxiety” was most important in the “early” postoperative period. In the “late early” phase, catastrophizing was the predominant predictor, alongside “preoperative analgesic usage” and “APAIS anxiety”. Conclusion After open nephrectomy, epidural analgesia

Two-Way Social Media Messaging in Postoperative Cataract Surgical Patients: Prospective Interventional Study

PubMed Central

Sanguansak, Thuss; Morley, Michael G; Thinkhamrop, Kavin; Thuanman, Jaruwan; Agarwal, Isha

2017-01-01

Background Social media offers a new way to provide education, reminders, and support for patients with a variety of health conditions. Most of these interventions use one-way, provider-patient communication. Incorporating social media tools to improve postoperative (postop) education and follow-up care has only been used in limited situations. Objective The aim of this study was to determine the feasibility and efficacy of two-way social media messaging to deliver reminders and educational information about postop care to cataract patients. Methods A total of 98 patients undergoing their first eye cataract surgery were divided into two groups: a no message group receiving usual pre- and postop care and a message group receiving usual care plus messages in a mobile social media format with standardized content and timing. Each patient in the message group received nine messages about hand and face hygiene, medication and postop visit adherence, and links to patient education videos about postop care. Patients could respond to messages as desired. Main outcome measures included medication adherence, postop visit adherence, clinical outcomes, and patients’ subjective assessments of two-way messaging. The number, types, content, and timing of responses by patients to messages were recorded. Results Medication adherence was better in the message group at postop day 7, with high adherence in 47 patients (96%, 47/49) versus 36 patients (73%, 36/49) in the no message group (P=.004), but no statistically significant differences in medication adherence between the groups were noted at preop and postop day 30. Visit adherence was higher at postop day 30 in the message group (100%, 49/49) versus the no message group (88%, 43/49; P=.03) but was 100% (49/49) in both groups at postop day 1 and 7. Final visual outcomes were similar between groups. A total of 441 standardized messages were sent to the message group. Out of 270 responses generated, 188 (70%) were simple

Radiological factors affecting post-operative global coronal balance in Lenke 5 C scoliosis.

PubMed

Shetty, Ajoy Prasad; Suresh, Subramani; Aiyer, Siddharth N; Kanna, Rishi; Rajasekaran, Shanmuganathan

2017-12-01

Lenke 5 C curves are frequently associated with clinically and radiological coronal imbalance. Appropriate selection of proximal and distal levels of fusion is essential to ensure good coronal balance (CB). We aimed to evaluate radiological factors associated with (I) global CB in the early post-operative period; (II) late decompensation of CB; and (III) favourable spontaneous correction of CB on long term follow up. Twenty-three Lenke type 5C scoliosis cases treated with selective posterior lumbar instrumentation were retrospectively evaluated. Pre-operative, early post-operative and late post-operative (>2 years) whole length radiographs were analysed. Cobb's angle, lumbar lordosis, coronal imbalance, lower instrumented vertebra (LIV) tilt and translation and upper instrumented vertebra (UIV) tilt and translation were measured. The proximal and distal fusion levels were noted and correlated with post-operative CB. There were 21 females and 2 males with a mean follow up of 36 months. The mean pre-operative cobb angle was 55°±13.26°, which corrected to 14.7°±8.84° and was maintained on follow up. Eight patients had early post-operative coronal imbalance with spontaneous resolution seen in six cases on long term follow-up. At final follow-up, four cases had coronal imbalance (persistent imbalance since early post-operative period =2; late decompensation =2). In cases with early imbalance 5/8 cases had a pre-operative LIV tilt of ≥25°. All four patients with coronal imbalance at final follow-up had pre-operative LIV tilt ≥25°. Radiographic parameters which correlated with post-operative coronal imbalance were pre-operative LIV tilt (r=0.64, P=0.001), pre-operative LIV translation (r=0.696, P<0.001), pre-operative UIV translation (r=0.44, P=0.030), post-operative LIV tilt (r=0.804, P<0.001), and post-operative UIV tilt (r=0.62, P=0.001). In Lenke 5C scoliosis, a pre-operative LIV tilt ≥25° significantly correlates with post-operative global coronal

Radiological factors affecting post-operative global coronal balance in Lenke 5 C scoliosis

PubMed Central

Suresh, Subramani; Aiyer, Siddharth N.; Kanna, Rishi; Rajasekaran, Shanmuganathan

2017-01-01

Background Lenke 5 C curves are frequently associated with clinically and radiological coronal imbalance. Appropriate selection of proximal and distal levels of fusion is essential to ensure good coronal balance (CB). We aimed to evaluate radiological factors associated with (I) global CB in the early post-operative period; (II) late decompensation of CB; and (III) favourable spontaneous correction of CB on long term follow up. Methods Twenty-three Lenke type 5C scoliosis cases treated with selective posterior lumbar instrumentation were retrospectively evaluated. Pre-operative, early post-operative and late post-operative (>2 years) whole length radiographs were analysed. Cobb’s angle, lumbar lordosis, coronal imbalance, lower instrumented vertebra (LIV) tilt and translation and upper instrumented vertebra (UIV) tilt and translation were measured. The proximal and distal fusion levels were noted and correlated with post-operative CB. Results There were 21 females and 2 males with a mean follow up of 36 months. The mean pre-operative cobb angle was 55°±13.26°, which corrected to 14.7°±8.84° and was maintained on follow up. Eight patients had early post-operative coronal imbalance with spontaneous resolution seen in six cases on long term follow-up. At final follow-up, four cases had coronal imbalance (persistent imbalance since early post-operative period =2; late decompensation =2). In cases with early imbalance 5/8 cases had a pre-operative LIV tilt of ≥25°. All four patients with coronal imbalance at final follow-up had pre-operative LIV tilt ≥25°. Radiographic parameters which correlated with post-operative coronal imbalance were pre-operative LIV tilt (r=0.64, P=0.001), pre-operative LIV translation (r=0.696, P<0.001), pre-operative UIV translation (r=0.44, P=0.030), post-operative LIV tilt (r=0.804, P<0.001), and post-operative UIV tilt (r=0.62, P=0.001). Conclusions In Lenke 5C scoliosis, a pre-operative LIV tilt ≥25° significantly

Delayed early passive motion is harmless to shoulder rotator cuff healing in a rabbit model.

PubMed

Zhang, Shurong; Li, Hong; Tao, Hongyue; Li, Hongyun; Cho, Samson; Hua, Yinghui; Chen, Jiwu; Chen, Shiyi; Li, Yunxia

2013-08-01

Postoperative passive motion is the most widely accepted rehabilitation protocol after rotator cuff repair; however, a rotator cuff retear remains a frequent surgical complication. Clinical outcomes indicate that early passive motion is harmless to rotator cuff healing, but no laboratory evidence supports this proposition. (1) Immediate postoperative immobilization improves rotator cuff healing in rabbits. (2) Early passive motion after short-term immobilization does not harm rotator cuff healing in rabbits. Controlled laboratory study. An injury to the supraspinatus tendon was created and repaired in 90 New Zealand White rabbits, after which they were randomly separated into 3 groups: (1) nonimmobilization (NI; n = 30), (2) continuous immobilization (IM; n = 30), and (3) immobilization with early passive motion (IP; n = 30). At 3, 6, and 12 weeks postoperatively, 5 rabbits from each group were sacrificed for histological evaluation, biomechanical testing, and magnetic resonance imaging. The histological study demonstrated better postoperative healing in the IM and IP groups, with clusters of chondrocytes accumulated at the tendon-bone junction. Magnetic resonance imaging illustrated that the tendon-bone junction was intact in the IM and IP groups. The magnetic resonance quantification analysis showed that the signal-to-noise quotient (SNQ) of the NI group was not significantly higher than that of the immobilization groups at 3 weeks (P = .232) or 6 weeks (P = .117), but it was significantly different at 12 weeks (NI vs IM, P = .006; NI vs IP, P = .009). At 12 weeks, the failure load was significantly higher in the IM and IP groups than in the NI group (NI vs IM, P = .002; NI vs IP, P = .002), but no difference was found between the IM and IP groups (P = .599). Immediate postoperative immobilization led to better tendon-bone healing than immediate postoperative mobilization, and under immobilization, early passive motion was harmless to tendon-bone healing in this

The Effect of Mobile App Home Monitoring on Number of In-Person Visits Following Ambulatory Surgery: Protocol for a Randomized Controlled Trial

PubMed Central

Coyte, Peter C; Bhatia, R Sacha; Semple, John L

2015-01-01

Background Women’s College Hospital, Toronto, Canada, offers specialized ambulatory surgical procedures. Patients often travel great distances to undergo surgery. Most patients receiving ambulatory surgery have a low rate of postoperative events necessitating clinic visits. However, regular follow-up is still considered important in the early postoperative phase. Increasingly, telemedicine is used to overcome the distance patients must travel to receive specialized care. Telemedicine data suggest that mobile monitoring and follow-up care is valued by patients and can reduce costs to society. Women’s College Hospital has used a mobile app (QoC Health Inc) to complement in-person postoperative follow-up care for breast reconstruction patients. Preliminary studies suggest that mobile app follow-up care is feasible, can avert in-person follow-up care, and is cost-effective from a societal and health care system perspective. Objective We hope to expand the use of mobile app follow-up care through its formal assessment in a randomized controlled trial. In postoperative ambulatory surgery patients at Women’s College Hospital (WCH), can we avert in-person follow-up care through the use of mobile app follow-up care compared to conventional, in-person follow-up care in the first 30 days after surgery. Methods This will be a pragmatic, single-center, open, controlled, 2-arm parallel-group superiority randomized trial comparing mobile app and in-person follow-up care over the first month following surgery. The patient population will comprise all postoperative ambulatory surgery patients at WCH undergoing breast reconstruction. The intervention consists of a postoperative mobile app follow-up care using the quality of recovery-9 (QoR9) and a pain visual analog scale (VAS), surgery-specific questions, and surgical site photos submitted daily for the first 2 weeks and weekly for the following 2 weeks. The primary outcome is the total number of physician visits related to

Physiological Effects of Early Incremental Mobilization of a Patient with Acute Intracerebral and Intraventricular Hemorrhage Requiring Dual External Ventricular Drainage.

PubMed

Kumble, Sowmya; Zink, Elizabeth K; Burch, Mackenzie; Deluzio, Sandra; Stevens, Robert D; Bahouth, Mona N

2017-08-01

Recent trials have challenged the notion that very early mobility benefits patients with acute stroke. It is unclear how cerebral autoregulatory impairments, prevalent in this population, could be affected by mobilization. The safety of mobilizing patients who have external ventricular drainage (EVD) devices for cerebrospinal fluid diversion and intracranial pressure (ICP) monitoring is another concern due to risk of device dislodgment and potential elevation in ICP. We report hemodynamic and ICP responses during progressive, device-assisted mobility interventions performed in a critically ill patient with intracerebral hemorrhage (ICH) requiring two EVDs. A 55-year-old man was admitted to the Neuroscience Critical Care Unit with an acute thalamic ICH and complex intraventricular hemorrhage requiring placement of two EVDs. Progressive mobilization was achieved using mobility technology devices. Range of motion exercises were performed initially, progressing to supine cycle ergometry followed by incremental verticalization using a tilt table. Physiological parameters were recorded before and after the interventions. All mobility interventions were completed without any adverse event or clinically detectable change in the patient's neurological state. Physiological parameters including hemodynamic variables and ICP remained within prescribed goals throughout. Progressive, device-assisted early mobilization was feasible and safe in this critically ill patient with hemorrhagic stroke when titrated by an interdisciplinary team of skilled healthcare professionals. Studies are needed to gain insight into the hemodynamic and neurophysiological responses associated with early mobility in acute stroke to identify subsets of patients who are most likely to benefit from this intervention.

Early melanoma diagnosis with mobile imaging.

PubMed

Do, Thanh-Toan; Zhou, Yiren; Zheng, Haitian; Cheung, Ngai-Man; Koh, Dawn

2014-01-01

We research a mobile imaging system for early diagnosis of melanoma. Different from previous work, we focus on smartphone-captured images, and propose a detection system that runs entirely on the smartphone. Smartphone-captured images taken under loosely-controlled conditions introduce new challenges for melanoma detection, while processing performed on the smartphone is subject to computation and memory constraints. To address these challenges, we propose to localize the skin lesion by combining fast skin detection and fusion of two fast segmentation results. We propose new features to capture color variation and border irregularity which are useful for smartphone-captured images. We also propose a new feature selection criterion to select a small set of good features used in the final lightweight system. Our evaluation confirms the effectiveness of proposed algorithms and features. In addition, we present our system prototype which computes selected visual features from a user-captured skin lesion image, and analyzes them to estimate the likelihood of malignance, all on an off-the-shelf smartphone.

Post-operative complications in elderly onset inflammatory bowel disease: a population-based study.

PubMed

Sacleux, S-C; Sarter, H; Fumery, M; Charpentier, C; Guillon-Dellac, N; Coevoet, H; Pariente, B; Peyrin-Biroulet, L; Gower-Rousseau, C; Savoye, G

2018-06-01

IBD diagnosed after the age of 60 is increasing. Data on post-operative complications in elderly onset IBD are scarce. To describe the incidence of and factors associated with post-operative complications in elderly onset IBD, diagnosed after the age of 60. Using EPIMAD Cohort (1988-2006), among 841 incident IBD patients, 139 (17%) underwent intestinal surgery, including 100 Crohn's disease (CD) and 39 ulcerative colitis (UC). After a median post-operative follow-up of 6 years (2-10), 50 (36%) patients experienced at least 1 complication with a total of 69. During the first 30 post-operative days, the mortality rate was 4%. Thirty-two early complications (<30 days) were observed in 23 patients (17%), with 15 infectious, without significant difference between CD and UC. More than half early post-operative complications (n = 19, 59%) were severe (>grade 2) without significant difference between CD and UC (P = 0.28). Thirty-seven long-term adverse effects of surgical therapy (≥30 days) were observed in 33 patients (24%). Multivariate analysis found (1) acute severe colitis (OR = 7.84 [2.15-28.52]) and emergency surgery (OR = 4.46 [1.75-11.36]) were associated with early post-operative complications, and (2) Female gender (HR = 2.10 [1.01-4.37]) and delay before surgery >3 months (HR = 2.09 [1.01-4.31]) with long-term adverse effects of surgical therapy. One-third of elderly IBD patients experienced at least 1 post-operative complication. Half of the early complications were severe, and infectious. Emergency surgery was the key driver for post-operative complication. © 2018 John Wiley & Sons Ltd.

Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study.

PubMed

Hodgson, Carol; Bellomo, Rinaldo; Berney, Susan; Bailey, Michael; Buhr, Heidi; Denehy, Linda; Harrold, Megan; Higgins, Alisa; Presneill, Jeff; Saxena, Manoj; Skinner, Elizabeth; Young, Paul; Webb, Steven

2015-02-26

The aim of this study was to investigate current mobilization practice, strength at ICU discharge and functional recovery at 6 months among mechanically ventilated ICU patients. This was a prospective, multi-centre, cohort study conducted in twelve ICUs in Australia and New Zealand. Patients were previously functionally independent and expected to be ventilated for >48 hours. We measured mobilization during invasive ventilation, sedation depth using the Richmond Agitation and Sedation Scale (RASS), co-interventions, duration of mechanical ventilation, ICU-acquired weakness (ICUAW) at ICU discharge, mortality at day 90, and 6-month functional recovery including return to work. We studied 192 patients (mean age 58.1 ± 15.8 years; mean Acute Physiology and Chronic Health Evaluation (APACHE) (IQR) II score, 18.0 (14 to 24)). Mortality at day 90 was 26.6% (51/192). Over 1,351 study days, we collected information during 1,288 planned early mobilization episodes in patients on mechanical ventilation for the first 14 days or until extubation (whichever occurred first). We recorded the highest level of early mobilization. Despite the presence of dedicated physical therapy staff, no mobilization occurred in 1,079 (84%) of these episodes. Where mobilization occurred, the maximum levels of mobilization were exercises in bed (N = 94, 7%), standing at the bed side (N = 11, 0.9%) or walking (N = 26, 2%). On day three, all patients who were mobilized were mechanically ventilated via an endotracheal tube (N = 10), whereas by day five 50% of the patients mobilized were mechanically ventilated via a tracheostomy tube (N = 18). Early mobilization of patients receiving mechanical ventilation was uncommon. More than 50% of patients discharged from the ICU had developed ICU-acquired weakness, which was associated with death between ICU discharge and day-90. ClinicalTrials.gov NCT01674608. Registered 14 August 2012.

Earthquake Early Warning Beta Users: Java, Modeling, and Mobile Apps

NASA Astrophysics Data System (ADS)

Strauss, J. A.; Vinci, M.; Steele, W. P.; Allen, R. M.; Hellweg, M.

2014-12-01

Earthquake Early Warning (EEW) is a system that can provide a few to tens of seconds warning prior to ground shaking at a user's location. The goal and purpose of such a system is to reduce, or minimize, the damage, costs, and casualties resulting from an earthquake. A demonstration earthquake early warning system (ShakeAlert) is undergoing testing in the United States by the UC Berkeley Seismological Laboratory, Caltech, ETH Zurich, University of Washington, the USGS, and beta users in California and the Pacific Northwest. The beta users receive earthquake information very rapidly in real-time and are providing feedback on their experiences of performance and potential uses within their organization. Beta user interactions allow the ShakeAlert team to discern: which alert delivery options are most effective, what changes would make the UserDisplay more useful in a pre-disaster situation, and most importantly, what actions users plan to take for various scenarios. Actions could include: personal safety approaches, such as drop cover, and hold on; automated processes and procedures, such as opening elevator or fire stations doors; or situational awareness. Users are beginning to determine which policy and technological changes may need to be enacted, and funding requirements to implement their automated controls. The use of models and mobile apps are beginning to augment the basic Java desktop applet. Modeling allows beta users to test their early warning responses against various scenarios without having to wait for a real event. Mobile apps are also changing the possible response landscape, providing other avenues for people to receive information. All of these combine to improve business continuity and resiliency.

Acute postoperative obstruction of extracardiac conduit due to separation of thin fibrous peel.

PubMed

Agarwal, K C; Edwards, W D; Puga, F J; Mair, D D

1982-03-01

Late postoperative obstruction of extracardiac conduits may occur in some patients and may result from one of several mechanisms. Severe intraoperative or early postoperative obstruction of such conduits is very rare. Herein we describe a case of acute, severe, early postoperative obstruction of an extracardiac conduit; this followed partial excision and replacement of a Hancock conduit in which late postoperative calcific valvular stenosis had occurred. Unexpectedly elevated right ventricular pressure should suggest the possibility of acute conduit obstruction. In cases with partial conduit replacement, the remaining segment should be carefully inspected for the presence of a peel; if a peel is present, it should be removed from the conduit even if it is considered thin and nonobstructive.

Two-Way Social Media Messaging in Postoperative Cataract Surgical Patients: Prospective Interventional Study.

PubMed

Sanguansak, Thuss; Morley, Katharine E; Morley, Michael G; Thinkhamrop, Kavin; Thuanman, Jaruwan; Agarwal, Isha

2017-12-19

Social media offers a new way to provide education, reminders, and support for patients with a variety of health conditions. Most of these interventions use one-way, provider-patient communication. Incorporating social media tools to improve postoperative (postop) education and follow-up care has only been used in limited situations. The aim of this study was to determine the feasibility and efficacy of two-way social media messaging to deliver reminders and educational information about postop care to cataract patients. A total of 98 patients undergoing their first eye cataract surgery were divided into two groups: a no message group receiving usual pre- and postop care and a message group receiving usual care plus messages in a mobile social media format with standardized content and timing. Each patient in the message group received nine messages about hand and face hygiene, medication and postop visit adherence, and links to patient education videos about postop care. Patients could respond to messages as desired. Main outcome measures included medication adherence, postop visit adherence, clinical outcomes, and patients' subjective assessments of two-way messaging. The number, types, content, and timing of responses by patients to messages were recorded. Medication adherence was better in the message group at postop day 7, with high adherence in 47 patients (96%, 47/49) versus 36 patients (73%, 36/49) in the no message group (P=.004), but no statistically significant differences in medication adherence between the groups were noted at preop and postop day 30. Visit adherence was higher at postop day 30 in the message group (100%, 49/49) versus the no message group (88%, 43/49; P=.03) but was 100% (49/49) in both groups at postop day 1 and 7. Final visual outcomes were similar between groups. A total of 441 standardized messages were sent to the message group. Out of 270 responses generated, 188 (70%) were simple acknowledgments or "thank you," and 82 (30

Are the same tapes really the same? Ultrasound study of laser-cut and mechanically cut TVT-O post-operative behavior.

PubMed

Rusavy, Zdenek; Masata, Jaromir; Svabik, Kamil; Hubka, Petr; Zvara, Karel; Martan, Alois

2017-11-25

TVT-O production has been modified to laser cutting from mechanical cutting. We compared the behavior of laser and mechanically cut tension-free vaginal tape-obturator (TVT-O) using ultrasound at various time points after surgery. This is a retrospective analysis of clinical and ultrasound data from two previously reported randomized controlled trials with TVT-O. Behavior of mechanically cut TVT-O implanted in January 2007 to November 2009 and laser-cut TVT-O implanted in May 2010 to May 2012 was assessed by ultrasound at day 1, the 2nd week, the 3rd month, and the 1st and 2nd years post-operatively. Bladder neck and tape margins positions were described by coordinates in the orthogonal system calculated from polar coordinates. Tape mobility was measured as a change in the upper and lower tape margin position from rest to maximal Valsalva. Comparison of 2-year subjective and objective surgery outcomes was also performed. In total, 68 mechanically cut and 50 laser-cut TVT-Os were implanted. Follow-up data were available from 49 and 45 women respectively. No differences in any baseline characteristics or bladder neck mobility were observed. Significantly lower tape mobility was observed on day 1 and week 2 after mechanically cut TVT-O, although subsequent mobility was comparable to laser-cut TVT-O. The subjective and objective surgery outcomes were comparable. Although without clinical significance, early postoperative behavior of the mechanically cut and laser-cut TVT-O tapes differs. The less stiff, mechanically-cut TVT-O loosens within 2 weeks of implantation, whereas the stiffer, laser-cut TVT-O keeps its tension.

The effect of caudal vs intravenous morphine on early extubation and postoperative analgesic requirements for stage 2 and 3 single-ventricle palliation: a double blind randomized trial.

PubMed

Stuth, Eckehard A E; Berens, Richard J; Staudt, Susan R; Robertson, Frederick A; Scott, John P; Stucke, Astrid G; Hoffman, George M; Troshynski, Todd J; Tweddell, James S T; Zuperku, Edward J

2011-04-01

High-dose single-shot caudal morphine has been postulated to facilitate early extubation and to lower initial analgesic requirements after staged single-ventricle (SV) palliation. With Institutional Review Board approval and written informed parental consent, 64 SV children aged 75-1667 days were randomized to pre-incisional caudal morphine-bupivacaine (100 μg·kg(-1) morphine (concentration 0.1%), mixed with 0.25% bupivacaine with 1 : 200,000 epinephrine, total 1 ml·kg(-1)) and postcardiopulmonary bypass (CPB) intravenous (IV) droperidol (75 μg·kg(-1)) ('active caudal group') or pre-incisional caudal saline (1 ml·kg(-1)) and post-CPB IV morphine (150 μg·kg(-1)) with droperidol (75 μg·kg(-1)) ('active IV group'). Assignment remained concealed from families and the care teams throughout the trial. Early extubation failure rates (primary or reintubation within 24 h), time to first postoperative rescue morphine analgesia, and 12-h postoperative morphine requirements were assessed for extubated patients. Thirty-one (12 stage 2) SV patients received caudal morphine and 32 (15 stage 2) received IV morphine. Extubation failure rates were 6/31 (19%) for caudal and 5/32 (16%) for IV morphine. For successfully extubated patients (n = 54), active caudal treatment significantly delayed the need for postoperative rescue morphine in stage 3 patients (P = 0.02) but not in stage 2 patients (P = 0.189) (Kaplan-Meier survival analysis with LogRank test). The reduction in 12-h postoperative morphine requirements with active caudal treatment did not reach significance (P = 0.085) but morphine requirements were significantly higher for stage 2 compared with stage 3 patients (P < 0.001) (two-way anova in n = 50 extubated patients). High-dose caudal morphine with bupivacaine delayed the need for rescue morphine analgesia in stage 3 patients. All stage 2 patients required early rescue morphine and had significantly higher postoperative 12-h morphine requirements than stage 3

Cerebral Oximetry During Infant Cardiac Surgery: Evaluation of and Relationship to Early Postoperative Outcome

PubMed Central

Kussman, Barry D.; Wypij, David; DiNardo, James A.; Newburger, Jane W.; Mayer, John E.; del Nido, Pedro J.; Bacha, Emile A.; Pigula, Frank; McGrath, Ellen; Laussen, Peter C.

2009-01-01

Background We examined changes in cerebral oxygen saturation during infant heart surgery and its relationship to anatomic diagnosis and early outcome Methods Regional cerebral oxygen saturation (rSO2) was measured by near-infrared spectroscopy in 104 infants undergoing biventricular repair without aortic arch obstruction as part of a randomized trial of hemodilution to a hematocrit of 25% versus 35%. Results Prior to cardiopulmonary bypass (CPB), infants with tetralogy of Fallot had higher rSO2 values compared to those with D-transposition of the great arteries (D-TGA) or ventricular septal defect (P < 0.001). During CPB cooling, low flow and at the termination of CPB, D-TGA subjects had the highest rSO2 values (P < 0.001). There were no significant associations between intraoperative rSO2 and early postoperative outcomes after adjustment for diagnosis. In 39 D-TGA subjects with ≥5 minutes of deep hypothermic circulatory arrest, there was no correlation between the rSO2 (91 ± 6%) or hematocrit (29.2 ± 5.5%) at the onset of arrest and the rate of decline in rSO2 during arrest. Conclusions Intraoperative rSO2 varies according to anatomic diagnosis but accounts for very little of the variance in early outcome. As measured by frontal near-infrared spectroscopy, higher levels of hematocrit and current perfusion techniques appear to provide an adequate oxygen reservoir prior to relatively short periods of deep hypothermic circulatory arrest. PMID:19299774

Selective decontamination of the digestive tract helps prevent bacterial infections in the early postoperative period after liver transplant.

PubMed

Emre, S; Sebastian, A; Chodoff, L; Boccagni, P; Meyers, B; Sheiner, P A; Mor, E; Guy, S R; Atillasoy, E; Schwartz, M E; Miller, C M

1999-01-01

In liver transplant (LTx) recipients, gut-associated bacterial and fungal organisms produce significant postoperative morbidity and mortality. We sought to assess the role of selective digestive decontamination (SDD) in preventing postoperative infections in a large single-center cohort of liver recipients transplanted under two non-simultaneous protocols. In 212 consecutive patients transplanted between 1/1/91 and 7/31/92, SDD (gentamicin 80 mg, polymyxin B 100 mg, nystatin suspension 10 mL) was employed, starting after induction of anesthesia and continued until POD 21 (SDD Group). In 157 consecutive patients transplanted between 1/1/93 and 12/31/93, SDD was not used (non-SDD Group). Both groups received IV vancomycin and cefotaxime prophylaxis. All culture-positive infections within the first 30 days post-LTx were recorded and classified as bacterial or fungal. Infection-related mortality (patients who died of infectious complications without any technical complication) was recorded. Groups did not differ in patient demographics, United Network for Organ Sharing (UNOS) status, use of veno-venous bypass, total/warm ischemia, or length of ICU stay. Infections developed in fewer SDD patients (56/212; 26%) than non-SDD patients (69/157; 44%) (p<0.001). The incidence of gram-negative infection was less in the SDD group (11% vs. 26%, p<0. 001) as was gram-positive infection (16% vs. 26%, p<0.001). Among patients who developed infection, there was no difference between groups in infections per patient. Primary graft non-function (PNF) developed in 20 SDD patients (7/20 had infections) and 8 non-SDD patients (6/8 had infections) (p=0.06). There were no differences in incidence of fungal infections or of infection-related mortality between groups. In the SDD group, there were fewer abdominal (p<0. 001), lung (p<0.001), wound (p<0.01), and urinary tract infections (p<0.05). Use of SDD in liver recipients early after transplant was associated with significantly fewer

Early postoperative fluoroquinolone use is associated with an increased revision rate after arthroscopic rotator cuff repair.

PubMed

Cancienne, Jourdan M; Brockmeier, Stephen F; Rodeo, Scott A; Young, Chris; Werner, Brian C

2017-07-01

To evaluate the association of postoperative fluoroquinolone use following arthroscopic primary rotator cuff repair with failure requiring revision rotator cuff repair. An insurance database was queried for patients undergoing rotator cuff repair from 2007 to 2015. These patients were divided into three groups: (1) patients prescribed fluoroquinolones within 6 months postoperatively (divided into 0-2, 2-4, and 4-6 months), (2) a matched negative control cohort of patients not prescribed fluoroquinolones, and (3) a matched positive control cohort of patients prescribed fluoroquinolones between 6 and 18 months following rotator cuff repair. Rates of failure requiring revision rotator cuff repair were compared within 2 years. A total of 1292 patients were prescribed fluoroquinolones within 6 months after rotator cuff repair, including 442 within 2 months, 433 within 2 to 4 months, and 417 within 4 to 6 months, and were compared to 5225 matched negative controls and 1597 matched positive controls. The rate of revision rotator cuff repair was significantly higher in patients prescribed fluoroquinolones within 2 months (6.1 %) compared to matched negative (2.2 %, P = 0.0009) and positive controls (2.4 %, P = 0.0026). There were no significant differences in the rate of revision rotator cuff repair when fluoroquinolones were prescribed >2 months after rotator cuff repair. Early use of fluoroquinolones following rotator cuff repair was independently associated with significantly increased rates of failure requiring revision rotator cuff repair. This is the first clinical study examining the association of postoperative fluoroquinolone use with failure following arthroscopic rotator cuff repair. III.

Evaluation of Hematopoietic Stem Cell Mobilization Rates with Early Plerixafor Administration for Adult Stem Cell Transplantation.

PubMed

Stover, Jessica T; Shaw, J Ryan; Kuchibhatla, Maragatha; Horwitz, Mitchell E; Engemann, Ashley M

2017-08-01

The addition of plerixafor to high-dose colony-stimulating growth factor has been shown to improve stem cell mobilization rates in autologous transplant patients with multiple myeloma and non-Hodgkin lymphoma. This study evaluates the change in administration time of plerixafor to determine if cell mobilization rates are similar between the US Food and Drug Administration-approved administration time of 11 hours before apheresis and an earlier administration time of 16 hours before apheresis. Medical records of patients age ≥ 18 years undergoing autologous stem cell transplantation requiring the use of plerixafor after at least 4 days of granulocyte colony-stimulating factor therapy to complete stem cell mobilization from January 1, 2010 through September 30, 2014 were retrospectively reviewed. The primary outcome was CD34 + cell mobilization success rates when plerixafor was administered 11 ± 2 hours (standard administration group) compared with 16 ± 2 hours before cell apheresis (early administration group), as defined as collection of  ≥2 × 10 6 CD34 + cells/kg. Secondary outcomes included the number of plerixafor therapy days required to collect a total of ≥2 × 10 6 CD34 + cells/kg, the number of apheresis cycles required to achieve ≥2 × 10 6 CD34 + cells/kg, the median CD34 + cells/kg collected in each apheresis session, and the rates of reported adverse events that occurred in the standard administration time group compared with the early administration time group. Of the 197 patients included, 114 patients received plerixafor 11 ± 2 hours before apheresis and 83 patients received plerixafor 16 hours ± 2 hours before apheresis. Ninety-four percent of patients in the early administration group achieved successful stem cell mobilization compared with 81.6% in the standard administration group (P = .0111). The median number of plerixafor days to reach the collection goal of  ≥2 × 10 6 CD34 + cells/kg was 1 day for

Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients.

PubMed

Ding, Dayong; Feng, Ye; Song, Bin; Gao, Shuohui; Zhao, Jisheng

2015-03-01

Effects of preoperative one week enteral nutrition (EN) support on the postoperative nutritional status, immune function and inflammatory response of gastric cancer patients were investigated. 106 cases of gastric cancer patients were randomly divided into preoperative one week EN group (trial group) and early postoperative EN group (control group), which were continuously treated with EN support until the postoperative 9th day according to different treatment protocols. All the patients were checked for their body weight, skinfold thickness, upper arm circumference, white blood cell count (WBC), albumin (ALB), prealbumin (PA), C-reactive protein (CRP), humoral immunity (IgA, IgG), T cell subsets (CD4, CD8 and CD4/CD8), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), etc. on the preoperative and the postoperative 1st and 10th day, respectively. PA and IgG levels of the experimental group were higher than those of the control group on the postoperative 10th day, whereas IL-6 level of the experimental group was lower than that of the control group. EN support for preoperative gastric cancer patients will improve the postoperative nutritional status and immune function, alleviate inflammatory response, and facilitate the recovery of patients.

Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: A randomized double blinded controlled trial.

PubMed

Lu, Jian; Chen, Gang; Zhou, Hongmei; Zhou, Qinghe; Zhu, Zhipeng; Wu, Cheng

2017-09-01

To evaluate effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy. Randomized, double-blind study. University-affiliated teaching hospital. One hundred and fifty-two elderly patients scheduled for shoulder arthroscopy. At 15min before the induction of anesthesia, 152 patients received intravenously parecoxib sodium 40mg and dexmedetomidine at a dose of 0.5μg/kg over 15min, followed by a continuous infusion at a rate of 0.5μg/kg/h until the end of surgery. Then all patients who received postoperative patient-controlled intravenous analgesia were divided 2 groups: sufentanil(0.04μg/kg/h, S group), sufentanil (0.04μg/kg/h) plus dexmedetomidine(0.06μg/kg/h) (SD group). The mini-mental status examination score in SD group was significantly higher than S group at 1, 2 and 7days after surgery. The incidence of postoperative cognitive dysfunction during 7days after surgery in S and SD groups was respectively 17.1% and 6.7%. Compared with the S group, the visual analogue scale scores at rest and upon movement were significantly lower at 6, 14, 24, 36 and 48h after surgery in SD group; analgesia pump liquid amount during 24h after surgery and number of rescue analgesia during 48h after surgery were significantly lower in SD group. Jugular venous oxygen partial pressure and jugular venous oxygen saturation values in SD group were significantly higher than S group at postoperative 24h. The occurrence of nausea and vomiting within 48h after surgery in SD group were significantly lower than S group. We found no complications including respiratory depression and sinus bradycardia within 48h after surgery in all patients. Parecoxib sodium pretreatment combined with dexmedetomidine could reduce the incidence of early postoperative cognitive dysfunction in elderly patients. This might be related to the improvement of postoperative analgesia effect and cerebral oxygen

Day-of-Surgery Mobilization Reduces the Length of Stay After Elective Hip Arthroplasty.

PubMed

Okamoto, Taro; Ridley, Ryan J; Edmondston, Stephen J; Visser, Mariet; Headford, Julie; Yates, Piers J

2016-10-01

To determine the effect of mobilization on the day of surgery on the readiness for discharge and length of stay after elective total hip arthroplasty (THA). We devised a randomized control trial with concealed allocation and intention-to-treat analysis. Overall, 126 patients who underwent THA and met the criteria for mobilization on the day of surgery were randomly allocated into 2 groups; the intervention group was mobilized on the day of surgery, n = 58 and the control group was mobilized on the day after surgery, n = 68. Apart from timing of mobilization, both groups received the same postoperative management. The primary outcome measures were length of hospital stay and time to readiness for discharge. The early mobilization group was ready for discharge 63 hours (standard deviation [SD] = 15 hours) after surgery, compared to 70 hours (SD = 18 hours) for the control group (P = .03, 95% CI, 0.7-12.8). There was no significant difference in hospital stay in the early mobilization group (77 hours [SD = 30 hours]), compared to the control group (87 hours [SD = 35 hours]; P = .11, 95% CI, -2.1 to 21.6). Despite this at any point in time after the surgery, the intervention group was 1.8 times (P = .003, 95% CI, = 1.2-2.7) more likely to have been discharged. Mobilization on the day of THA surgery significantly increases the probability of discharge at any singular point in time compared with mobilization on the day after surgery and decreases the time to readiness for discharge. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

[Laser in the prevention of early postoperative complications in the surgical treatment of obesity].

PubMed

Grubnik, V V; Dotsenko, S A; Chuev, P N; Basenko, I L; Salamekh, A

1994-01-01

The results of conduction of operative interventions in 37 patients with alimentary-costitutional obesity are adduced. In 22 of them having the obesity of III-IV stages the small stomach 100-150 ml in volume was constructed puuling in it too tight with a synthetic ribbon. In 1-1.5 years after the operation patient loses 70-80% of excessive body mass, and severe metabolic disturbances never occur. In 15 patients cutaneo-subcutaneous aprons on the abdomen were excised. Intravascular blood irradiation with the help of helium-neon laser for the prophylaxis of early postoperative complications occurrence was conducted. The stimulating action of laserotherapy on the cell and humoral immunity groups, alike central and peripheral hemodynamics improvement, moderate hypocoagulating and analgetic effect, lowering of the purulent-septical and thromboembolic complications in 1.5-2 times was noted.

A Cardiac Early Warning System with Multi Channel SCG and ECG Monitoring for Mobile Health

PubMed Central

Sahoo, Prasan Kumar; Thakkar, Hiren Kumar; Lee, Ming-Yih

2017-01-01

Use of information and communication technology such as smart phone, smart watch, smart glass and portable health monitoring devices for healthcare services has made Mobile Health (mHealth) an emerging research area. Coronary Heart Disease (CHD) is considered as a leading cause of death world wide and an increasing number of people die prematurely due to CHD. Under such circumstances, there is a growing demand for a reliable cardiac monitoring system to catch the intermittent abnormalities and detect critical cardiac behaviors which lead to sudden death. Use of mobile devices to collect Electrocardiography (ECG), Seismocardiography (SCG) data and efficient analysis of those data can monitor a patient’s cardiac activities for early warning. This paper presents a novel cardiac data acquisition method and combined analysis of Electrocardiography (ECG) and multi channel Seismocardiography (SCG) data. An early warning system is implemented to monitor the cardiac activities of a person and accuracy assessment of the early warning system is conducted for the ECG data only. The assessment shows 88% accuracy and effectiveness of our proposed analysis, which implies the viability and applicability of the proposed early warning system. PMID:28353681

A Cardiac Early Warning System with Multi Channel SCG and ECG Monitoring for Mobile Health.

PubMed

Sahoo, Prasan Kumar; Thakkar, Hiren Kumar; Lee, Ming-Yih

2017-03-29

Use of information and communication technology such as smart phone, smart watch, smart glass and portable health monitoring devices for healthcare services has made Mobile Health (mHealth) an emerging research area. Coronary Heart Disease (CHD) is considered as a leading cause of death world wide and an increasing number of people die prematurely due to CHD. Under such circumstances, there is a growing demand for a reliable cardiac monitoring system to catch the intermittent abnormalities and detect critical cardiac behaviors which lead to sudden death. Use of mobile devices to collect Electrocardiography (ECG), Seismocardiography (SCG) data and efficient analysis of those data can monitor a patient's cardiac activities for early warning. This paper presents a novel cardiac data acquisition method and combined analysis of Electrocardiography (ECG) and multi channel Seismocardiography (SCG) data. An early warning system is implemented to monitor the cardiac activities of a person and accuracy assessment of the early warning system is conducted for the ECG data only. The assessment shows 88% accuracy and effectiveness of our proposed analysis, which implies the viability and applicability of the proposed early warning system.

Long-term preservation of early formed mantle heterogeneity by mobile lid convection: Importance of grainsize evolution

NASA Astrophysics Data System (ADS)

Foley, Bradford J.; Rizo, Hanika

2017-10-01

The style of tectonics on the Hadean and Archean Earth, particularly whether plate tectonics was in operation or not, is debated. One important, albeit indirect, constraint on early Earth tectonics comes from observations of early-formed geochemical heterogeneities: 142Nd and 182W anomalies recorded in Hadean to Phanerozoic rocks from different localities indicate that chemically heterogeneous reservoirs, formed during the first ∼500 Myrs of Earth's history, survived their remixing into the mantle for over 1 Gyrs. Such a long mixing time is difficult to explain because hotter mantle temperatures, expected for the early Earth, act to lower mantle viscosity and increase convective vigor. Previous studies found that mobile lid convection typically erases heterogeneity within ∼100 Myrs under such conditions, leading to the hypothesis that stagnant lid convection on the early Earth was responsible for the observed long mixing times. However, using two-dimensional Cartesian convection models that include grainsize evolution, we find that mobile lid convection can preserve heterogeneity at high mantle temperature conditions for much longer than previously thought, because higher mantle temperatures lead to larger grainsizes in the lithosphere. These larger grainsizes result in stronger plate boundaries that act to slow down surface and interior convective motions, in competition with the direct effect temperature has on mantle viscosity. Our models indicate that mobile lid convection can preserve heterogeneity for ≈0.4-1 Gyrs at early Earth mantle temperatures when the initial heterogeneity has the same viscosity as the background mantle, and ≈1-4 Gyrs when the heterogeneity is ten times more viscous than the background mantle. Thus, stagnant lid convection is not required to explain long-term survival of early formed geochemical heterogeneities, though these heterogeneities having an elevated viscosity compared to the surrounding mantle may be essential for their

A Mobile Early Stimulation Program to Support Children with Developmental Delays in Brazil.

PubMed

Dias, Raquel da Luz; Silva, Kátia Cristina Correa Guimarães; Lima, Marcela Raquel de Oliveira; Alves, João Guilherme Bezerra; Abidi, Syed Sibte Raza

2018-01-01

Developmental delay is a deviation development from the normative milestones during the childhood and it may be caused by neurological disorders. Early stimulation is a standardized and simple technique to treat developmental delays in children (aged 0-3 years), allowing them to reach the best development possible and to mitigate neuropsychomotor sequelae. However, the outcomes of the treatment depending on the involvement of the family, to continue the activities at home on a daily basis. To empower and educate parents of children with neurodevelopmental delays to administer standardized early stimulation programs at home, we developed a mobile early stimulation program that provides timely and evidence-based clinical decision support to health professionals and a personalized guidance to parents about how to administer early stimulation to their child at home.

Replacing Ambulatory Surgical Follow-Up Visits With Mobile App Home Monitoring: Modeling Cost-Effective Scenarios

PubMed Central

Semple, John L; Coyte, Peter C

2014-01-01

Background Women’s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile app (QoC Health Inc, Toronto) that suggests high patient satisfaction and adequate detection of postoperative complications. Objective The proposed cost-effectiveness study models the replacement of conventional, in-person postoperative follow-up care with mobile app follow-up care following ambulatory breast reconstruction in post-mastectomy breast cancer patients. Methods This is a societal perspective cost-effectiveness analysis, wherein all costs are assessed irrespective of the payer. The patient/caregiver, health care system, and externally borne costs are calculated within the first postoperative month based on cost information provided by WCH and QoC Health Inc. The effectiveness of telemedicine and conventional follow-up care is measured as successful surgical outcomes at 30-days postoperative, and is modeled based on previous clinical trials containing similar patient populations and surgical risks. Results This costing assumes that 1000 patients are enrolled in bring-your-own-device (BYOD) mobile app follow-up per year and that 1.64 in-person follow-ups are attended in the conventional arm within the first month postoperatively. The total cost difference between mobile app and in-person follow-up care is $245 CAD ($223 USD based on the current exchange rate), with in-person follow-up being more expensive ($381 CAD) than mobile app follow-up care ($136 CAD). This takes into account the total of health care system, patient, and external borne costs. If we examine

Posterior cruciate-substituting total knee replacement recovers the flexion arc faster in the early postoperative period in knees with high varus deformity: a prospective randomized study.

PubMed

Öztürk, Alpaslan; Akalın, Yavuz; Çevik, Nazan; Otuzbir, Ali; Özkan, Yüksel; Dostabakan, Yasin

2016-07-01

Posterior cruciate retention (CR) and substitution (PS) has been controversial in knee replacement surgery. Satisfactory medium and long-term results have been reported in knees with and without deformity but there are limited studies about early functional comparison in terms of recovery of flexion arc, stair activity, walking ability and straight leg raising, especially, in early postoperative period in knees with deformity. Therefore, we aimed to compare the flexion arc in CR and PS knees in postoperative first year including early postoperative days prospectively. Consecutive patients with a deformity of >10° were included and allocated to CR and PS groups randomly. KSS and Feller-patella scores were recorded both preoperatively and postoperatively (1st, 2nd, 3rd and 12th months). Flexion and extension were measured both preoperatively and postoperatively (1st, 2nd, 3rd day and discharge day as well as 1st, 2nd, 3rd and 12th months). Visual analog scale (VAS) was recorded postoperatively at the 1st, 2nd, 3rd and discharge day and at 1st, 2nd, 3rd and 12th months. The walking ability, stair activity and straight leg raising were recorded. Patients were also examined at the last visit with minimum 7-year follow-up with KSS, Feller-patella and VAS scores. Their mean flexion arcs were measured and recorded. There were 61 TKR evaluated. KSS knee and function scores at the 3rd month and KSS Knee Score at 1st year were superior in PS knees (p = 0.029, p = 0.046, p = 0.026). Flexion arc was found larger on day 1, 2, 3 and discharge day, and at 1st, 2nd, 3rd and 12th month in PS group (p = 0.048, p = 0.002, p = 0.027, p = 0.043, p = 0.014, p = 0.003, p = 0.002, p = 0.018). Walking and stair activity showed no difference but straight leg raising was better in CR knees (p = 0.02). Mean flexion arc was larger in PS knees at the last visit after 7 years (119.0° ± 7.5° in PS and 113.8° ± 8.7° in CR, p = 0.02). There was no revision

Influence of desflurane on postoperative oral intake compared with propofol.

PubMed

Yatabe, Tomoaki; Yamashita, Koichi; Yokoyama, Masataka

2014-01-01

Postoperative oral intake is an important predictor of early postoperative recovery, and anesthesia is known to influence this intake. We compared the influences of desflurane anesthesia and propofol anesthesia on early postoperative oral intake retrospectively. The subjects included a consecutive series of patients who received general anesthesia with propofol or desflurane between June and December 2013. The total amount of calories and proteins taken orally and the incidence of postoperative nausea and vomiting (PONV) on postoperative days (POD) 0, 1, and 2 were collected. A total of 147 patients were analyzed. The desflurane (Des) and the propofol (Pro) groups included 52 and 95 patients, respectively. The incidence of PONV on POD 0, 1, and 2 did not show significant intergroup differences. Total calorie intake on POD 1 and 2 was not significantly different between the 2 groups (1117 ± 508 vs. 1036 ± 549 kcal/day, p=0.39 and 1504 ± 368 vs. 1437 ± 433 kcal/day, p=0.35, respectively). Total amount of protein via oral intake on POD 1 and 2 were not significantly different between the two groups (45.9 ± 21.1 vs. 43.8 ± 22.8 g/day, p=0.60 and 61.3 ± 15.0 vs. 58.9 ± 18.0 g/day, p=0.42, respectively). These findings suggest that desflurane and propofol affect postoperative oral intake in a similar fashion. These results should be confirmed in a future prospective study.

Early initiation of aspirin after prostate and transurethral bladder surgeries is not associated with increased incidence of postoperative bleeding: a prospective, randomized trial.

PubMed

Ehrlich, Y; Yossepowitch, O; Margel, D; Lask, D; Livne, P M; Baniel, J

2007-08-01

Lower urinary tract operations are being increasingly performed in elderly patients, in whom aspirin intake is common for preventing cardiovascular disease. We determined the safety of early aspirin re-initiation after lower urinary tract surgeries. A randomized, open label clinical trial was done. The study cohort included patients referred for transurethral prostatectomy, open prostatectomy and transurethral resection of bladder tumor while receiving aspirin prophylaxis. After controlling for surgical modality patients were randomized into 2 arms, including aspirin treatment initiation 24 hours after discontinuing of bladder irrigation (early treatment group) and aspirin treatment initiation 3 weeks after surgery (late treatment group). Primary end points were pre-discharge hematuria necessitating the restoration of bladder irrigation or the cessation of aspirin treatment and late hematuria treated in an urgent care setting, requiring hospital admission or compelling the cessation of aspirin treatment. A total of 120 patients were enrolled, including 60 per treatment group. There were no significant differences between the groups in surgery related factors that could have affected postoperative bleeding. Primary end points were attained by 16 of the 120 patients (13.6%), including 10 of the 60 (16.7%) in the early treatment group and 6 (10%) in the late treatment group (p = 0.28). Time to catheter removal and persistent hematuria duration were similar in the 2 groups. Cardiovascular morbidity was noted in 3 of 120 patients, of whom all were assigned to the early treatment group. Early aspirin initiation after lower urinary tract surgeries does not appear to carry an increased risk of postoperative bleeding. Thus, it may be considered in patients at high risk for cardiovascular morbidity.

Implementation of a novel postoperative monitoring system using automated Modified Early Warning Scores (MEWS) incorporating end-tidal capnography.

PubMed

Blankush, Joseph M; Freeman, Robbie; McIlvaine, Joy; Tran, Trung; Nassani, Stephen; Leitman, I Michael

2017-10-01

Modified Early Warning Scores (MEWS) provide real-time vital sign (VS) trending and reduce ICU admissions in post-operative patients. These early warning calculations classically incorporate oxygen saturation, heart rate, respiratory rate, systolic blood pressure, and temperature but have not previously included end-tidal CO2 (EtCO 2 ), more recently identified as an independent predictor of critical illness. These systems may be subject to failure when physiologic data is incorrectly measured, leading to false alarms and increased workload. This study investigates whether the implementation of automated devices that utilize ongoing vital signs monitoring and MEWS calculations, inclusive of a score for end-tidal CO 2 (EtCO 2 ), can be feasibly implemented on the general care hospital floor and effectively identify derangements in a post-operative patient's condition while limiting the amount of false alarms that would serve to increase provider workload. From July to November 2014, post-operative patients meeting the inclusion criteria (BMI > 30 kg/m 2 , history of obstructive sleep apnea, or the use of patient-controlled analgesia (PCA) or epidural narcotics) were monitored using automated devices that record minute-by-minute VS included in classic MEWS calculations as well as EtCO 2 . Automated messages via pagers were sent to providers for instances when the device measured elevated MEWS, abnormal EtCO 2 , and oxygen desaturations below 85 %. Data, including alarm and message details from the first 133 patients, were recorded and analyzed. Overall, 3.3 alarms and pages sounded per hour of monitoring. Device-only alarms sounded 2.7 times per hour-21 % were technical alarms. The remaining device-only alarms for concerning VS sounded 2.0/h, 70 % for falsely recorded VS. Pages for abnormal EtCO 2 sounded 0.4/h (82 % false recordings) while pages for low blood oxygen saturation sounded 0.1/h (55 % false alarms). 143 times (0.1 pages/h) the devices calculated

The Development of the Recovery Assessments by Phone Points (RAPP): A Mobile Phone App for Postoperative Recovery Monitoring and Assessment.

PubMed

Jaensson, Maria; Dahlberg, Karuna; Eriksson, Mats; Grönlund, Åke; Nilsson, Ulrica

2015-09-11

In Sweden, day surgery is performed in almost 2 million patients per year. Patient satisfaction is closely related to potential adverse events during the recovery process. A way to empower patients and give them the opportunity to affect care delivery is to let them evaluate their recovery process. The most common evaluation method is a follow-up telephone call by a nurse one or two days after surgery. In recent years, mHealth apps have been used to evaluate the nurse-patient relationship for self-management in chronic diseases or to evaluate pain after surgery. To the best of our knowledge, no previous research has explored the recovery process after day surgery via mobile phone in a Swedish cohort. The objective of the study is to describe the process of developing a mobile phone app using a Swedish Web-based Quality of Recovery (SwQoR) questionnaire to evaluate postoperative recovery after day surgery. The development process included five steps: (1) setting up an interdisciplinary task force, (2) evaluating the potential needs of app users, (3) developing the Swedish Web version of a QoR questionnaire, (4) constructing a mobile phone app, and (5) evaluating the interface and design by staff working in a day-surgery department and patients undergoing day surgery. A task force including specialists in information and communication technology, eHealth, and nursing care worked closely together to develop a Web-based app. Modifications to the QoR questionnaire were inspired by instruments used in the field of recovery for both children and adults. The Web-based app, Recovery Assessment by Phone Points (RAPP) consists of two parts: (1) a mobile app installed on the patient's private mobile phone, and (2) an administrator interface for the researchers. The final version of the SwQoR questionnaire, which includes 31 items, was successfully installed in RAPP. The interface and the design were evaluated by asking for user opinions about the design and usefulness of the

Mobility Functional Outcomes of Neurofibromatosis Patients: A Preliminary Report.

PubMed

Ngo-Huang, An; Yadav, Rajesh; Fu, Jack B; Liu, Diane; Williams, Janet L; Bruera, Eduardo; Guo, Ying

2018-01-01

The aim of the study was to describe the mobility outcomes of neurofibromatosis (NF) patients who received acute inpatient rehabilitation. This is a retrospective study of 62 consecutive neurofibromatosis patients of any age who received physical medicine and rehabilitation consultations at a comprehensive cancer center. Postoperative, inpatient rehabilitation admission and discharge functional independence measures (FIM scores) of transfers and gait and length of hospital stay were obtained from 37 patients who were transferred to inpatient rehabilitation (acute rehabilitation) and 25 who had an alternative disposition (consultation only). Mean age was 34 yrs. Both groups had similar postoperative FIM transfer and gait scores; however, at approximately postoperative day 10, the consultation only group was discharged with median FIM of 5 (supervision level) as compared with the acute rehabilitation group FIM of 4 (P = 0.000). The acute rehabilitation group had improved mobility FIM scores from postoperative to rehabilitation admission and again from rehabilitation admission to discharge (P < 0.0001). At discharge, the acute rehabilitation group ambulated a significantly longer distance (500 f. vs. 300 ft) (P = 0.04). The median length of hospital stay for the acute rehabilitation and consultation only groups was 20 and 10 days, respectively (P = 0.004). Acute inpatient rehabilitation leads to improvement in mobility-associated FIM scores for neurofibromatosis patients minimizing caregiver needs at home.

A rare disease mimics postoperative bile leakage: Invasive aspergillosis.

PubMed

Yazar, Fatih Mehmet; Urfalıoğlu, Aykut; Boran, Ömer Faruk; Sayar, Hamide; Kanat, Burhan Hakan; Emre, Arif; Cengiz, Emrah; Bülbüloğlu, Ertan

2016-09-01

Aspergillus fungi can cause serious infections, including intra-abdominal infection, particularly in patients with compromised immune system. Described in the present report is case of 46-year-old female patient who had undergone laparoscopic cholecystectomy (LC) at another healthcare facility. In early postoperative period, she had increasing complaints of swelling, nausea, and vomiting. On postoperative 19th day, she was referred to our clinic with diagnosis of acute abdomen. Surgery was performed with suspected possibility of bile leakage. However, pathological examination of soft, yellow-green mass found in subhepatic space determined it was fungus ball caused by fungi of the genus Aspergillus. Patient was diagnosed postoperative intra-abdominal aspergillosis (IAA).

Treatment of Early Post-Op Wound Infection after Internal Fixation

DTIC Science & Technology

2017-10-01

the fracture stable while the bone heals. Approximately 10%-40% of severe fractures fixed with internal fixation develop a deep wound infection during...effect of treatment of post-op wound infection in bones after fracture fixation or joint fusion and either: (Group 1) operative debridement and PO

Ketorolac use may increase risk of postoperative pancreatic fistula after pancreaticoduodenectomy.

PubMed

Kowalsky, Stacy J; Zenati, Mazen S; Steve, Jennifer; Lee, Kenneth K; Hogg, Melissa E; Zeh, Herbert J; Zureikat, Amer H

2018-01-01

Ketorolac (Toradol), a commonly used nonselective nonsteroidal anti-inflammatory drug (NSAID) in the postoperative period, has been associated with increased risk of anastomotic leak after colon resection. The effect of postoperative NSAID and ketorolac use on postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is unknown. Retrospective review of consecutive PDs at a high-volume pancreas center from 2012 to 2015. POPF was identified and graded using International Study Group on Pancreatic Fistula criteria. Demographics, operative variables and 30-d postoperative NSAID use, dosage, and timing (early = postoperative day [POD] 0-5, late > POD 5) were collected. Univariate and multivariate logistic regressions were used to identify predictors of POPF. Four hundred twenty-three PDs were analyzed (mean age 66 y, 47% female), and 60% received NSAIDs postoperatively. Ketorolac (median POD 0-5 cumulative dose = 90 mg, interquartile range 60-165) was used in 35.7% (n = 151). POPF occurred in 90 patients (21.3%). Early (POD 0-5) ketorolac use was associated with increased POPF, especially grade A (odds ratio [OR] 2.16, P = 0.036). Each 25 mg incremental increase in ketorolac use was associated with a 10% increase in the incidence of POPF (OR 1.10, P = 0.021), whereas a cumulative dose of >150 mg was associated with a 44% increased risk of POPF (OR 1.44, 95% confidence interval 1.03-2.01, P = 0.035). A multivariate regression model identified estimated blood loss, soft gland, pancreatic duct diameter, body mass index, and cumulative ketorolac dose >150 mg as independent predictors of POPF (P < 0.0001, pseudo R 2  = 0.149). Increasing doses of ketorolac in the early postoperative period are associated with increased risk of POPF, whereas a cumulative dose of >150 mg is an independent predictor of POPF after PD. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial.

PubMed

Jaensson, M; Dahlberg, K; Eriksson, M; Nilsson, U

2017-11-01

Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores. The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14. On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound. Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care. NCT02492191. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

Small Dose Ketamine Improves Postoperative Analgesia and Rehabilitation After Total Knee Arthroplasty.

PubMed Central

Chauvin, Marcel; Manoir, Bertrand Du; Langlois, Mathieu; Sessler, Daniel I.; Fletcher, Dominique

2005-01-01

We designed this study to evaluate the effect of small-dose intravenous ketamine in combination with continuous femoral nerve block on postoperative pain and rehabilitation after total knee arthroplasty. Continuous femoral nerve block with ropivacaine was started before surgery and continued in the surgical ward for 48 h. Patients were randomly assigned to receive an initial bolus of 0.5 mg/kg ketamine followed by a continuous infusion of 3 μg·kg-1·min-1 during surgery and 1.5 μg·kg-1·min-1 for 48 h (Ketamine group) or an equal volume of saline (Control group). Additional postoperative analgesia was provided by patient-controlled intravenous morphine. Pain scores and morphine consumption were recorded over 48 hours. The maximal degree of active knee flexion tolerated was recorded daily until hospital discharge. Follow up was performed 6 weeks and 3 months after surgery. The Ketamine group required significantly less morphine than the Control group (45 ± 20 mg versus 69 ± 30 mg; P < 0.02). Patients in the Ketamine group reached 90° of active knee flexion more rapidly than those in the Control group (P < 0.02). Outcomes at 6 weeks and 3 months were similar in each group. These results confirm that ketamine is a useful analgesic adjuvant in perioperative multimodal analgesia with a positive impact on early knee mobilization. PMID:15673878

Efficacy and safety of perioperative parecoxib for acute postoperative pain treatment in children: a meta-analysis.

PubMed

Bu, Xueshan; Yang, Lei; Zuo, Yunxia

2015-12-01

Perioperative parecoxib administration reduces postoperative pain, opioid consumption, and adverse events in adult patients. However, the efficacy and safety of parecoxib in children remain unclear. This metaanalysis included related published studies to address this concern. Eight databases in the literature until February 2015 were systematically explored to identify randomized controlled trials (RCTs) comparing perioperative parecoxib administration and placebo/standard treatments for acute postoperative pain in children. Primary outcomes were postoperative pain scores and adverse events. The Face, Legs, Activity, Crying, Consolability scale was used to score pain in children younger than 6 years, whereas the Visual Analog Scale was used in children older than 6 years. Secondary outcomes were sedation scores (measured using the Ramsay scale), agitation scores (measured using the Sedation-Agitation Scale), and opioid consumption. The methodological quality of RCTs was independently assessed in accordance with the "Risk of bias" of Cochrane Collaboration. Data were analyzed using Review Manager 5.2. Twelve RCTs involving 994 patients met the inclusion criteria. Compared with children who received placebo treatment, those who received parecoxib demonstrated lower early (2 h) and later (12 h) postoperative pain scores; lower incidence rates of postoperative nausea, vomiting, and agitation; higher early (1 h) postoperative sedation scores; and lower agitation scores. Similarly, children who received parecoxib had lower early (2 h) and later (12 h) postoperative pain scores, lower incidence rates of postoperative nausea and vomiting, and lower early (1 h) postoperative sedation scores compared with those who received standard treatments; however, these children showed no significant difference in agitation scores. Unfortunately, data on the effect of parecoxib on opioid consumption were insufficient. Overall, these results suggested that perioperative parecoxib

[Laboratory evaluation of endogenous intoxication in patients with stomach cancer during early postoperative period].

PubMed

Afanas'eva, A N; Evtushenko, V A

2004-01-01

The total and effective concentrations of albumin, albumin-binding reserve in blood and toxicity index were determined in 25 patients with gastric cancer pre- and postoperatively as well as in 30 minutes and on days 1, 3, 5, 7 and 14 after surgery. The albumin concentration was shown to be decreasing postoperatively with its effective concentration tresspassing the norm values. As for the albumin-binding reserve, it was found to be decreased by 20-30% during the whole follow-up. The studied parameters ensure an effective monitoring of the postoperative period with their significance being more important in a worsening condition of patients.

Efficacy of postoperative pain management in head and neck cancer patients.

PubMed

Hinther, Ashley; Nakoneshny, Steven C; Chandarana, Shamir P; Wayne Matthews, T; Dort, Joseph C

2018-05-02

Our study quantifies the effectiveness of perioperative pain control in a cohort of patients undergoing major head and neck surgery with free flap reconstruction. Our long-term goal is to improve pain control and thereby increase mobility, decrease postoperative complications and decrease hospital stay. A retrospective analysis was performed at a tertiary, academic head and neck surgical oncology program in Calgary, Alberta, Canada from January 1, 2015 - December 31, 2015. Pain scores were recorded prospectively. Primary outcomes were frequency of postoperative pain assessments and pain intensity using the numeric rating scale. The cohort included 41 patients. Analysis was limited to pain scores recorded from postoperative days 1-14. There was an average of 7.3 pain measurements per day (SD 4.6, range 1-24) with the most frequent monitoring on postoperative days 1-4. Median pain scores ranged from 0 to 4.5 with the highest median score on postoperative day 6. The daily maximum pain scores recorded ranged from 8 to 10 with scores of 10 recorded on postoperative days 1, 2, 3, 5, 7, 8, and 10. Patients most frequently had inadequate pain control on postoperative days 1, 2, 4, and 5 with the majority occurring on postoperative day 1. Postoperative pain control could be improved at our centre. The frequency of pain assessments is also highly variable. Ongoing measurement, audit, and feedback of analgesic protocol effectiveness is an excellent first step in improving perioperative pain management in patients undergoing major head and neck cancer surgery with free flap reconstruction.

Effects of Intradistrict School Mobility and High Student Turnover Rates on Early Reading Achievement

ERIC Educational Resources Information Center

LeBoeuf, Whitney A.; Fantuzzo, John W.

2018-01-01

The primary aim of this study was to assess the relations between concurrent, cumulative, and contextual intradistrict school mobility and early reading achievement. Longitudinal administrative school records were used for an entire cohort of students in a large urban district from first through third grade. Findings indicated that students with a…

Ultrasound diagnosis of postoperative complications of nerve repair.

PubMed

Fantoni, Caterina; Erra, Carmen; Fernandez Marquez, Eduardo Marcos; Ortensi, Andrea; Faiola, Andrea; Coraci, Daniele; Piccinini, Giulia; Padua, Luca

2018-05-03

Peripheral nerve injuries often undergo surgical repair, but poor postoperative functional recovery is frequently observed. We describe four cases of traumatic nerve lesions in whom postoperative recovery was prevented by complications such as detachment of nerve sutures or neuroma growth. To the best of our knowledge no similar cases have been reported in literature so far. It is important an early diagnosis of such condition because it prevents recovery and delays re-intervention, which should be performed before complete muscle denervation and atrophy. Nerve ultrasound is a valuable tool in traumatic nerve injury and has proven to be useful in postoperative follow-up, especially in diagnosing surgical complications such as detachment of nerve direct sutures. Copyright © 2018 Elsevier Inc. All rights reserved.

Final Rule for Control of Hazardous Air Pollutants From Mobile Sources: Early Credit Technology Requirement Revision

EPA Pesticide Factsheets

EPA is taking final action to revise the February 26, 2007 mobile source air toxics rule’s requirements that specify which benzene control technologies a refiner may utilize to qualify to generate early benzene credits.

Early functional outcome after lateral UKA is sensitive to postoperative lower limb alignment.

PubMed

van der List, J P; Chawla, H; Villa, J C; Zuiderbaan, H A; Pearle, A D

2017-03-01

The predictive role of patient-specific characteristics and radiographic parameters on medial unicompartmental knee arthroplasty (UKA) outcomes is well known, but knowledge of these predictors is lacking in lateral UKA. Therefore, purpose of this study was to assess the predictive role of these parameters on short-term functional outcomes of lateral UKA. In this retrospective cohort study, Western Ontario and McMaster Universities Arthritis Index scores were collected at 2-year follow-up (median 2.2 years, range 2.0-4.0 years) in 39 patients who underwent lateral UKA. Patient-specific characteristics included age, BMI and gender, while radiographic parameters included osteoarthritis severity of all three compartments and both preoperative and postoperative hip-knee-ankle alignment. BMI, gender, age and preoperative valgus alignment were not correlated with functional outcomes, while postoperative valgus alignment was correlated with functional outcomes (0.561; p = 0.001). Postoperative valgus of 3°-7° was correlated with better outcomes than more neutral (-2° to 3° valgus) alignment (96.7 vs. 85.6; p = 0.011). Postoperative alignment was a predictor when corrected for patient-specific characteristics (regression coefficient 4.1; p < 0.001) and radiological parameters (regression coefficient 3.8; p = 0.002). Postoperative valgus alignment of 3°-7° was correlated with the best short-term functional outcomes in lateral UKA surgery, while patient-specific parameters and preoperative alignment were not correlated with functional outcomes. Based on these findings, a surgeon should aim for valgus alignment of 3°-7° when performing lateral UKA surgery for optimal functional outcomes. Prognostic study, Level II.

Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review.

PubMed

De Groef, An; Van Kampen, Marijke; Dieltjens, Evi; Christiaens, Marie-Rose; Neven, Patrick; Geraerts, Inge; Devoogdt, Nele

2015-06-01

studies found that active exercises were more effective than no therapy or information on the treatment of impairments of the upper limb. Three studies supported the early start of exercises for recovery of shoulder ROM, whereas 4 studies supported the delay of exercises to avoid prolonged wound healing. Multifactorial physical therapy (ie, stretching, exercises) and active exercises were effective to treat postoperative pain and impaired ROM after treatment for breast cancer. High-quality studies are necessary to determine the effectiveness of passive mobilization, stretching, and myofascial therapy as part of the multifactorial treatment. In addition, the appropriate timing and content of the exercise programs need to be further investigated. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy.

PubMed

Miyake, Hideaki; Furukawa, Junya; Hinata, Nobuyuki; Muramaki, Mototsugu; Tanaka, Kazushi; Fujisawa, Masato

2015-06-01

Our objective was to evaluate the significance of the R.E.N.A.L. nephrometry score (RNS)--developed to quantitatively evaluate the complexity of renal tumors in a reproducible manner--in perioperative and renal functional outcomes following robot-assisted partial nephrectomy (RAPN). This study assessed 48 consecutive patients with renal tumors who underwent RAPN. Preoperative RNS for each patient was calculated, and its impact on several parameters associated with perioperative outcomes, including postoperative renal function, was investigated with Spearman's rank correlation test. Mean RNS in the 48 patients was 6.8; of these 48 patients, 21 (43.7%), 24 (50.0%), and three (6.3%) were classified into low-, moderate-, and high-complexity groups, respectively. The RNS was significantly correlated with resected tumor weight and postoperative changes in estimated glomerular filtration rate (eGFR) at both 1 and 4 weeks--but not age, body mass index (BMI), preoperative eGFR, operative time, warm ischemia time, estimated blood loss, postoperative complications, or eGFR-- after RAPN. No component of the RNS (R: radius; E: exophytic/endophytic properties; N: nearness of tumor to the collecting system or sinus; A: anterior/posterior; L: location relative to polar lines) alone had a significant impact on postoperative changes in eGFR at 1 and 4 weeks, whereas resected tumor weight was significantly associated with the R and E subcategories. Measurement of total RNS is useful for predicting renal functional outcomes early after RAPN.

Parecoxib prevents early postoperative cognitive dysfunction in elderly patients undergoing total knee arthroplasty

PubMed Central

Zhu, Yang-Zi; Yao, Rui; Zhang, Zhe; Xu, Hui; Wang, Li-Wei

2016-01-01

Abstract Background: Trial design neuroinflammation and postoperative pain after surgery are increasingly reported in association with postoperative cognitive dysfunction (POCD). Parecoxib, a selective cyclooxygenase (COX)-2 inhibitor, is used for postoperative analgesia for its potent anti-inflammatory and analgesic effects. This study aimed to evaluate parecoxib's effects on POCD in elderly patients undergoing total knee arthroplasty. Methods: Around 134 elderly patients undergoing total knee arthroplasty were randomly divided into parecoxib (group P) and control (group C) groups, and treated with parecoxib sodium and saline, respectively, shortly after induction of general anesthesia and 12-h postsurgery, respectively. Perioperative plasma IL-1β, IL-6, TNF-α, and C-reactive protein (CRP) 1evels were measured. Postoperative pain was assessed following surgery. Neuropsychological tests were performed before surgery, and 1 week and 3 months postoperation. Results: POCD incidence in group P was significantly lower compared with that of group C at 1 week after surgery (16.7% vs 33.9%; P < 0.05); no significant difference was found between groups C and P at 3-month follow-up (9.7% vs 6.7%). Compared with group C values, visual analog pain scale (VAS) scores at 3, 6, and 12 hours after surgery were significantly lower in group P(P < 0.05). Plasma IL-1β, IL-6, and TNF-α levels were lower in group P than in group C after the operation (P < 0.05). No significant difference in the plasma CRP level was found between groups P and C. Conclusions: Parecoxib sodium decreases POCD incidence after total knee arthroplasty in elderly patients and may explain how this drug suppresses inflammation and acute postoperative pain caused by surgical trauma. PMID:27428192

Laparoscopic Management of Mobile Cecum

PubMed Central

Soares, Cleber; Catena, Fausto; Di Saverio, Salomone; Sartelli, Massimo; Gomes, Camila Couto; Gomes, Felipe Couto

2016-01-01

Background and Objectives: The mobile cecum is an embryologic abnormality and has been associated with functional colon disease (chronic constipation and irritable bowel syndrome). However, unlike functional disease, the primary treatment is operative, using laparoscopic cecopexy. We compare the epidemiology and pathophysiology of mobile cecum syndrome and functional colon disease and propose diagnostic and treatment guidelines. Method: This study was a case–control series of 15 patients who underwent laparoscopic cecopexy. Age, gender, recurrent abdominal pain, and constipation based on Rome III criteria were assessed. Ileocecal–appendiceal unit displacement was graded as follows: I (cecum retroperitoneal or with little mobility); II (wide mobility, crossing the midline); and III (maximum mobility, reaching the left abdomen). Patients with Grades II and III underwent laparoscopic cecopexy. The clinical outcomes were evaluated according to modified Visick's criteria, and postoperative complications were assessed according to the Clavien-Dindo classification. Results: The mean age was 31.86 ± 12.02 years, and 13 patients (86.7%) were women. Symptoms of constipation and abdominal pain were present in 14 (93.3%) and 11 (73.3%), respectively. Computed tomography was performed in 8 (53.3%) patients. The mean operative time was 41 ± 6.66 min. There were no postoperative infections. One (7.8%) patient was classified as Clavien Dindo IIIb and all patients were classified as Visick 1 or 2. Conclusion: Many patients with clinical and epidemiological features of functional colon disease in common in fact have an anatomic anomaly, for which the treatment of choice is laparoscopic cecopexy. New protocols should be developed to support this recommendation. PMID:27807396

Impact of empiric nesiritide or milrinone infusion on early postoperative recovery after Fontan surgery: a randomized, double-blind, placebo-controlled trial.

PubMed

Costello, John M; Dunbar-Masterson, Carolyn; Allan, Catherine K; Gauvreau, Kimberlee; Newburger, Jane W; McGowan, Francis X; Wessel, David L; Mayer, John E; Salvin, Joshua W; Dionne, Roger E; Laussen, Peter C

2014-07-01

We sought to determine whether empirical nesiritide or milrinone would improve the early postoperative course after Fontan surgery. We hypothesized that compared with milrinone or placebo, patients assigned to receive nesiritide would have improved early postoperative outcomes. In a single-center, randomized, double-blinded, placebo-controlled, multi-arm parallel-group clinical trial, patients undergoing primary Fontan surgery were assigned to receive nesiritide, milrinone, or placebo. A loading dose of study drug was administered on cardiopulmonary bypass followed by a continuous infusion for ≥12 hours and ≤5 days after cardiac intensive care unit admission. The primary outcome was days alive and out of the hospital within 30 days of surgery. Secondary outcomes included measures of cardiovascular function, renal function, resource use, and adverse events. Among 106 enrolled subjects, 35, 36, and 35 were randomized to the nesiritide, milrinone, and placebo groups, respectively, and all were analyzed based on intention to treat. Demographics, patient characteristics, and operative factors were similar among treatment groups. No significant treatment group differences were found for median days alive and out of the hospital within 30 days of surgery (nesiritide, 20 [minimum to maximum, 0-24]; milrinone, 18 [0-23]; placebo, 20 [0-23]; P=0.38). Treatment groups did not significantly differ in cardiac index, arrhythmias, peak lactate, inotropic scores, urine output, duration of mechanical ventilation, intensive care or chest tube drainage, or adverse events. Compared with placebo, empirical perioperative nesiritide or milrinone infusions are not associated with improved early clinical outcomes after Fontan surgery. http://www.clinicaltrials.gov. Unique identifier: NCT00543309. © 2014 American Heart Association, Inc.

Sympathetic activity and early mobilization in patients in intensive and intermediate care with severe brain injuries: a preliminary prospective randomized study.

PubMed

Rocca, A; Pignat, J-M; Berney, L; Jöhr, J; Van de Ville, D; Daniel, R T; Levivier, M; Hirt, L; Luft, A R; Grouzmann, E; Diserens, K

2016-09-13

Patients who experience severe brain injuries are at risk of secondary brain damage, because of delayed vasospasm and edema. Traditionally, many of these patients are kept on prolonged bed rest in order to maintain adequate cerebral blood flow, especially in the case of subarachnoid hemorrhage. On the other hand, prolonged bed rest carries important morbidity. There may be a clinical benefit in early mobilization and our hypothesis is that early gradual mobilization is safe in these patients. The aim of this study was to observe and quantify the changes in sympathetic activity, mainly related to stress, and blood pressure in gradual postural changes by the verticalization robot (Erigo®) and after training by a lower body ergometer (MOTOmed-letto®), after prolonged bed rest of minimum 7 days. Thirty patients with severe neurological injuries were randomized into 3 groups with different protocols of mobilization: Standard, MOTOmed-letto® or Erigo® protocol. We measured plasma catecholamines, metanephrines and blood pressure before, during and after mobilization. Blood pressure does not show any significant difference between the 3 groups. The analysis of the catecholamines suggests a significant increase in catecholamine production during Standard mobilization with physiotherapists and with MOTOmed-letto® and no changes with Erigo®. This preliminary prospective randomized study shows that the mobilization of patients with severe brain injuries by means of Erigo® does not increase the production of catecholamines. It means that Erigo® is a well-tolerated method of mobilization and can be considered a safe system of early mobilization of these patients. Further studies are required to validate our conclusions. The study was registered in the ISRCTN registry with the trial registration number ISRCTN56402432 . Date of registration: 08.03.2016. Retrospectively registered.

The Effects of Patient Obesity on Early Postoperative Complications After Shoulder Arthroscopy.

PubMed

Sing, David C; Ding, David Y; Aguilar, Thomas U; Luan, Tammy; Ma, C Benjamin; Feeley, Brian T; Zhang, Alan L

2016-11-01

To report the prevalence of obesity in shoulder arthroscopy, determine a body mass index (BMI) threshold most predictive of complication within 30 days, and evaluate obesity as an independent risk factor for medical and surgical complications. Using the National Surgical Quality Improvement Program database, we reviewed all patients who underwent shoulder arthroscopy during 2011 to 2013. Receiver operating characteristic and Youden coefficient were calculated to find an optimal BMI cutoff to predict complications within 30 days of surgery. A case-control matched analysis was then performed by stratifying patient BMI by this cutoff and matching patients one to one according to age, sex, type of shoulder arthroscopy, American Society of Anesthesiology rating, surgical setting, and 8 comorbidities. Operating time, complications, and readmissions were also compared. Of the 15,589 patients who underwent shoulder arthroscopy, 6,684 (43%) were classified as obese when using the optimal cutoff point of BMI = 30 according to the Youden coefficient. Obese patients had a higher risk of superficial site infection than nonobese patients (0.3% vs 0.0%; odds ratio [OR]: 6.00; 95% confidence interval [CI], 1.3 to 26.8; P = .015). Obese patients did not have significantly increased risk for overall early postoperative complication (1.2% compared with nonobese 0.8%; OR: 1.54; 95% CI, 1.0 to 2.4), readmissions (OR: 0.85; 95% CI, 0.5 to 1.5), or increased operating time (P = .068). Up to 43% of patients undergoing shoulder arthroscopy can be classified as obese, but early perioperative complications are uncommon. Higher patient BMI is associated with increased risk of superficial site infection but not an overall risk for complication, readmission, or increased operating time. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The efficacy of local infiltration analgesia in the early postoperative period after total knee arthroplasty: A systematic review and meta-analysis.

PubMed

Seangleulur, Alisa; Vanasbodeekul, Pramook; Prapaitrakool, Sunisa; Worathongchai, Sukhumakorn; Anothaisintawee, Thunyarat; McEvoy, Mark; Vendittoli, Pascal-André; Attia, John; Thakkinstian, Ammarin

2016-11-01

Local infiltration analgesia (LIA) has emerged as an alternative treatment for postoperative pain after total knee arthroplasty (TKA). Its efficacy remains inconclusive with inconsistent results from previous studies and meta-analyses. There is no agreement on which local anaesthetic agent and infiltration technique is most effective and well tolerated. The objective was to compare LIA after primary TKA with placebo or no infiltration in terms of early postoperative pain relief, mobilisation, length of hospital stay (LOS) and complications when used as a primary treatment or as an adjunct to regional anaesthesia. The role of injection sites, postoperative injection or infusion and multimodal drug injection with ketorolac were also explored. A systematic review and meta-analysis of randomised controlled trials (RCTs). A literature search was performed using PubMed and SCOPUS up to September 2015. RCTs comparing LIA with placebo or no infiltration after primary TKA in terms of pain score and opioid consumption at 24 and 48 h, mobilisation, LOS and complications were included. In total 38 RCTs were included. LIA groups had lower pain scores, opioid consumption and postoperative nausea and vomiting, higher range of motion at 24 h and shorter LOS than no injection or placebo. After subgroup analysis, intraoperative peri-articular but not intra-articular injection had lower pain score at 24 h than no injection or placebo with the pooled mean difference of pain score at rest of -0.89 [95% CI (-1.40 to -0.38); I = 92.0%]. Continuing with postoperative injection or infusion reduced 24-h pain score with the pooled mean difference at rest of -1.50 [95% CI (-1.92 to -1.08); I = 60.5%]. There was no additional benefit in terms of pain relief during activity, opioid consumption, range of movement or LOS when LIA was used as an adjunct to regional anaesthesia. Four out of 735 patients receiving LIA reported deep knee infection, three of whom had had postoperative

Double-bundle anterior cruciate ligament reconstruction with and without remnant preservation - Comparison of early postoperative outcomes and complications.

PubMed

Nakayama, Hiroshi; Kambara, Syunichiro; Iseki, Tomoya; Kanto, Ryo; Kurosaka, Kenji; Yoshiya, Shinichi

2017-10-01

To compare the early postoperative outcomes and complications of double-bundle anterior cruciate ligament (ACL) reconstruction with and without remnant preservation. The study population comprised 125 consecutive knees that underwent double-bundle ACL reconstruction using hamstring autograft. Among the 125 knees, remnant preservation was indicated for 50 knees, while standard double-bundle reconstruction was performed in the remaining 75 knees. Postoperative evaluations included heel-height difference (HHD) at periodical follow-ups, number of knees requiring arthroscopic debridement due to problematic extension loss within six months, re-injury within one year, graft status upon second-look arthroscopy, and clinical examinations by Lysholm score and KT measurement at one year. All patients could be followed up for a minimum of one year after surgery. When the results obtained from both groups were compared, HHD values were significantly larger in the preservation group at three and six months, and the rate of knees requiring arthroscopic debridement was also higher in this group (12% versus 4.0%). Graft status on second-look arthroscopy was considered to be good for 92% of the knees in the preservation group versus 59% in the non-preservation group. Re-injury rates within one year were 2.0% in the preservation group and 5.3% in the non-preservation group. No significant differences in clinical examinations were found between the groups at one year. Remnant preservation in double-bundle hamstring autograft ACL reconstruction may enhance tissue healing; however, retention of the remnant with its full volume resulted in an increased incidence of postoperative problematic extension loss. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors associated with postoperative complications and mortality in perforated peptic ulcer.

PubMed

Montalvo-Javé, Eduardo Esteban; Corres-Sillas, Omar; Athié-Gutiérrez, César

2011-01-01

Elective surgery for uncomplicated peptic ulcer has shown a significant decrease; however, complications such as perforation and obstruction persist and require urgent surgical management. The aim of this study was to identify factors associated with early postoperative complications and mortality of patients admitted to the emergency department with perforated peptic ulcer. We performed a clinical, retrospective, cross-sectional and descriptive study of patients who were treated at the General Hospital of Mexico with a diagnosis of perforated peptic ulcer from January 2006 to December 2008. Thirty patients were included in the study. We studied several clinical findings upon admission to the emergency department and intraoperative patient findings in order to determine the association of those with early postoperative complications and mortality. We studied 30 patients with an average age of 57.07 years (± 14.2 years). The male:female ratio was 2:1. We found that the risk of developing postoperative complications was 66.7% and is significantly influenced by time of onset of abdominal pain prior to admission, bloating, septic shock and blood type O positive. Mortality was 16.7% and was correlated with the presence of septic shock on admission. The surgical procedure performed was primary closure with Graham patch in 86.6%. Average hospital stay was 12.8 days. The presence of early postoperative complications is associated with time of onset of abdominal pain before admission, abdominal distension, blood type O positive and the presence of septic shock on admission.

Use of a unipedal standing test to assess the ambulation reacquisition time during the early postoperative stage after hip fracture in elderly Japanese: prospective study.

PubMed

Murata, Koichi; Sugitani, Shigeki; Yoshioka, Hiroki; Noguchi, Takashi; Aoto, Toshiyuki; Nakamura, Takashi

2010-01-01

The aim of this study was to predict the ambulation reacquisition time after hip fracture in elderly people using the unipedal standing test during the early postoperative stage. Patients with an intertrochanteric fracture treated with internal fixation (n = 35) and patients with a femoral neck fracture treated with hemiarthroplasty (n = 22) were included. A unipedal standing test using the nonoperated leg was performed on days 3 and 7 after the operation. Among the patients with an intertrochanteric fracture, those with a positive result on the unipedal standing test on postoperative day (POD) 3 attained gait with parallel guide bars (BG) and walker-assisted gait (WG) significantly earlier than did patients with a negative result on the unipedal standing test. Patients with a positive result on the unipedal standing test on POD 7 attained BG, WG, and cane-assisted gait (CG) significantly earlier than did patients with a negative test. Among patients with a femoral neck fracture, those with a positive unipedal standing test result on POD 3 attained BG, WG, and CG significantly earlier than did patients with a negative test. Those with a positive test result on POD 7 attained BG, WG, and CG significantly earlier than did patients with a negative test. The unipedal standing test given during the early postoperative stage is a good test for predicting the ambulation reacquisition time. Moreover, it gives information that can help determine the need for subacute rehabilitation and about discharge planning and health service provision.

New insights into the early steps of oil body mobilization during pollen germination

PubMed Central

Castro, Antonio Jesús

2013-01-01

In some plants, pollen grains accumulate storage lipids that serve as energy supply during germination. Here, three enzymes involved in early steps of oil body mobilization in the male gametophyte were functionally characterized for the first time. The effect of extracellular sugars on pollen performance and oil body dynamics was also analysed. Olive pollen oil bodies showed phospholipase A, lipase, and lipoxygenase activities on their surface. Enzyme activity levels increased during germination with a maximum after 3h. Removal of extracellular sugars from the germination medium did not affect pollen performance but increased enzyme activity rates and sped up oil body mobilization. Inhibitors seriously hampered pollen germination and pollen tube growth, leading to a characteristic accumulation of oil bodies in the germinative aperture. It can be concluded that storage lipids are sufficient for proper olive pollen germination. A lipase and a lipoxygenase are likely involved in oil body mobilization. Extracellular sugars may modulate their function, while a phospholipase A may promote their access to the storage lipids. PMID:23132905

Classes of Trajectory in Mobile Phone Dependency and the Effects of Negative Parenting on Them during Early Adolescence

ERIC Educational Resources Information Center

Seo, Mijung; Choi, Eunsil

2018-01-01

The aim of this study was to identify the classes of trajectory in mobile phone dependency using growth mixture modeling among Korean early adolescents from elementary school to the middle school transition. The effects of negative parenting on determining the classes were also examined. The participants were 2,378 early adolescents in the Korean…

Epidemiology, surgical management and early postoperative outcome in a cohort of gastric cancer patients of a tertiary referral center in relation to multi-center quality assurance studies.

PubMed

Garlipp, Benjamin; Schwalenberg, Jens; Adolf, Daniela; Lippert, Hans; Meyer, Frank

2011-03-01

The aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study - GGCS (1992) and East German Gastric Cancer Study - EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results. Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome. From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer patients were treated. In comparison with the EGGCS cohort there was a larger proportion of patients with locally advanced and proximally located tumors. 272 patients (82.9%) underwent surgery with curative intent; in 88.4% of these an R0 resection was achieved (EGGCS/GGCS: 82.5%/71.5%). 68.2% of patients underwent preoperative endoluminal ultrasound (EUS) (EGGCS: 27.4%); the proportion of patients undergoing EUS increased over the study period. Diagnostic accuracy of EUS for T stage was 50.6% (EGGCS: 42.6%). 77.2% of operated patients with curative intent underwent gastrectomy (EGGCS/GGCS: 79.8%/71.1%). Anastomotic leaks at the esophagojejunostomy occurred slightly more frequently (8.8%) than in the EGGCS (5.9%) and GGCS (7.2%); however, postoperative morbidity (36.1%) and early postoperative mortality (5.3%) were not increased compared to the multi-center quality assurance study results (EGGCS morbidity, 45%); EGGCS/GGCS mortality, 8%/8.9%). D2 lymphadenectomy was performed in 72

A prospective single-institute study of the impact of Daikenchuto on the early postoperative outcome after living donor liver transplantation.

PubMed

Takatsuki, Mitsuhisa; Hidaka, Masaaki; Soyama, Akihiko; Hara, Takanobu; Okada, Satomi; Ono, Shinichiro; Adachi, Tomohiko; Eguchi, Susumu

2018-01-20

The aim of this study was to investigate the impact of Daikenchuto (DKT) on early postoperative outcomes after living donor liver transplantation (LDLT), focusing on the prevention of abdominal distension and bacterial translocation. Adult LDLT recipients were prospectively divided into 2 groups, who were administered DKT (n = 20, group A) or not (n = 20, group B). The area of bowel gas defined as gas volume score (GVS) 7 days after LDLT was calculated. Postoperative liver function tests, the development of bacterial, viral, and fungal infections, and GVS after LDLT were reviewed. There were no significant differences in liver function tests and ammonia level after LDLT. Also, the rates of infection and the result of culture study were not different between groups. The median GVS 7 days after LDLT was not significantly different between groups A (0.26 (range, 0.12-0.58)) and B (0.23 (range, 0.15-0.42)). No positive impact was observed for 14-day DKT administration after LDLT, in terms of preventing infection or abdominal distension. Copyright © 2018. Published by Elsevier Taiwan.

Surgeon Annual and Cumulative Volumes Predict Early Postoperative Outcomes After Brain Tumor Resection.

PubMed

Ramakrishna, Rohan; Hsu, Wei-Chun; Mao, Jialin; Sedrakyan, Art

2018-06-01

Surgeon volume has been previously shown to affect patient outcomes. However, data related to neuro-oncologic surgery are limited and do not include neurologic morbidities as an outcomes measure. In this study, we aimed to determine if 5-year surgeon cumulative and annual volumes predict early postoperative outcomes in patients after brain tumor surgery. A population-based cohort of patients (n = 10,258) undergoing brain tumor resection between 2005 and 2014 were included for study using the New York Statewide Planning and Research Cooperation System. Surgeons were categorized by their cumulative and annual surgical volume. Patients treated by high cumulative/high annual (HC/HA) volume surgeons had shorter length of stay (median, 5 days vs. 8 days vs. 8 days vs. 6 days, respectively; P < 0.01), lower charges (median, 70,025 vs. $77,043 vs. $93,715 vs. $77,018 respectively; P < 0.01) and less nonroutine discharge (41% vs. 48% vs. 50.9% vs. 43.9% respectively; P < 0.01) compared with patients treated by surgeons from the low cumulative/low annual (LC/LA), LC/HA, HC/LA groups. Similarly, HC/HA volume surgeons also had lower rate of hydrocephalus (9.9% vs. 10.4% vs. 13.7% respectively; P = 0.02), medical complications (6.9% vs. 11.2% vs. 11.5% respectively; P < 0.01), neurologic complications (44.1% vs. 46.8% vs. 48.1% respectively; P = 0.03), 30-day reoperation (5.1% vs. 6.9% vs. 7.1% respectively; P < 0.01) and 30-day death (3.3% vs. 5.4% vs. 5.2%; P < 0.01) compared with LC/LA and LC/HA volume surgeons. There is some evidence for improved postoperative outcomes when surgery is performed by HC and HA volume surgeons. This finding suggests that subspecialization in surgical neuro-oncology should be considered. Copyright © 2018 Elsevier Inc. All rights reserved.

Quality of Postoperative Pain Management After Maxillofacial Fracture Repair.

PubMed

Peisker, Andre; Meissner, Winfried; Raschke, Gregor F; Fahmy, Mina D; Guentsch, Arndt; Schiller, Juliane; Schultze-Mosgau, Stefan

2018-05-01

Effective pain management is an essential component in the perioperative care of surgical patients. However, postoperative pain after maxillofacial fracture repair and its optimal therapy has not been described in detail. In a prospective cohort study, 95 adults rated their pain on the first postoperative day after maxillofacial fracture repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Quality Improvement in Postoperative Pain Management allowed for a standardized assessment of patients' characteristics and pain-related parameters. Overall, the mean maximal pain and pain on activity (numeric rating scales) were significantly higher in patients with mandibular fractures than in patients with midface fractures (P = 0.002 and P = 0.045, respectively). In patients with mandibular fractures, a longer duration of surgery was significantly associated with higher satisfaction with pain intensity (P = 0.015), but was more frequently associated with postoperative vomiting (P = 0.023). A shorter duration of surgery and an absence of preoperative pain counseling in these patients were significantly correlated to desire for more pain medication (P = 0.049 and P = 0.004, respectively). Patients with mandibular fractures that received opioids in the recovery room had significantly higher strain-related pain (P = 0.017). In patients with midface fractures, a longer duration of surgery showed significantly higher levels of decreased mobility (P = 0.003). Patients receiving midazolam for premedication had significantly less minimal pain (P = 0.021). Patients with mandibular fractures seem to have more postoperative pain than patients with midface fractures. Monitoring of postsurgical pain and a procedure-specific pain-treatment protocol should be performed in clinical routine.

Postoperative hyperglycaemia control reduces postoperative complications in patients subject to total knee arthroplasty.

PubMed

Reátegui, Diego; Tornero, Eduard; Popescu, Dragos; Sastre, Sergi; Camafort, Miquel; Gines, Gracia; Combalía, Andrés; Lozano, Luis

2017-01-01

The aim of our study was the early detection and treatment of patients with unknown alterations of the hydrocarbon metabolism subject to total knee arthroplasty in order to reduce the incidence of postoperative complications. Patients were classified as non-diabetic patients (group 1), diabetic patients (group 2) and patients with stress hyperglycaemia (group 3). The last two groups were recommended assessment by a primary care physician (PCP). After one year follow-up the groups were compared with respect to incidence of postoperative complications. The groups were also compared regarding the decrease or increase of HbA1c levels with the incidence of complications. Of the 228 patients, 116 (50%) were included in group 1, 40 (17.5%) in group 2 and 72 (31.6%) in group 3. Patients that consulted their PCP presented lower medical complication rates than those who did not (9.2% vs. 26.4%, P=0.020). Not being attended by a PCP was an independent predictive factor of medical complication (odds ratio (OR): 21.3; 95% confidence interval (95% CI): 4.6-98.5), surgical site infection (OR: 4.1; 95% CI: 1.1-15.0) and mechanical complication (OR: 5.0; 95% CI: 1.3-18.8). A decrease of HbA1c value was related to less medical systemic complications (7.3% vs. 24.2%, P=0.035). Patients with hyperglycaemia during the postoperative total knee arthroplasty period, who are controlled by the PCP present lower incidence of complications. Decrease of HbA1c value during postoperative total knee arthroplasty period leads to a lower rate of medical complications. Copyright © 2016 Elsevier B.V. All rights reserved.

Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: A systematic review and meta-analysis

PubMed Central

Yan, Huan; Cang, Jing; Xue, Zhanggang; Lu, Jianfeng; Wang, Hao

2016-01-01

Pain management after total knee arthroplasty (TKA) and total hip arthroplasty should permit early mobilization with minimal pain. Local infiltration analgesia (LIA) is a new popular method for decreasing postoperative pain. The goal of this meta-analysis is to evaluate the efficacy of LIA in comparison with epidural analgesia. A literature search was performed in PubMed, EMBASE, the OVID database, Web of Science, and the Cochrane Library databases. The risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included visual analog scale score, range of flexion, length of stay, and complications. Nine trials involving 537 patients met the inclusion criteria. LIA provides better pain relief and larger range of motion in TKA patients compared to epidural analgesia at the late postoperative period. No significant difference was observed in regard to the length of stay and complications. The current evidence shows that the use of local infiltration is effective for postoperative pain management in TKA patients. More high-quality randomized controlled trials with long-term follow-up are required for examining the long-term efficacy and safety of local infiltration. PMID:27209072

Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: A systematic review and meta-analysis.

PubMed

Yan, Huan; Cang, Jing; Xue, Zhanggang; Lu, Jianfeng; Wang, Hao

2016-11-10

Pain management after total knee arthroplasty (TKA) and total hip arthroplasty should permit early mobilization with minimal pain. Local infiltration analgesia (LIA) is a new popular method for decreasing postoperative pain. The goal of this meta-analysis is to evaluate the efficacy of LIA in comparison with epidural analgesia. A literature search was performed in PubMed, EMBASE, the OVID database, Web of Science, and the Cochrane Library databases. The risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included visual analog scale score, range of flexion, length of stay, and complications. Nine trials involving 537 patients met the inclusion criteria. LIA provides better pain relief and larger range of motion in TKA patients compared to epidural analgesia at the late postoperative period. No significant difference was observed in regard to the length of stay and complications. The current evidence shows that the use of local infiltration is effective for postoperative pain management in TKA patients. More high-quality randomized controlled trials with long-term follow-up are required for examining the long-term efficacy and safety of local infiltration.

Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review.

PubMed

Guerra, Mark L; Singh, Parminder J; Taylor, Nicholas F

2015-09-01

To systematically review the effect of early mobilization after hip or knee joint replacement surgery on length of stay in an acute hospital. Randomized controlled trials were selected from electronic databases based on inclusion criterion requiring an experimental group mobilizing (sitting out of bed/walking) earlier than a comparison group post joint replacement surgery of the hip or knee in an acute hospital. Clinically homogeneous data were analyzed with meta-analysis. Five randomized controlled trials (totaling 622 participants) were included for review. A meta-analysis of 5 trials found a reduced length of stay of 1.8 days (95% confidence interval 1.1 to 2.6) in favor of the experimental group. In 4 of the 5 trials the experimental group first sat out of bed within 24 hours post operatively. In 4 of the 5 trials the experimental group first walked within 48 hours post operatively. Individual trials reported benefits in range of motion, muscle strength and health-related quality of life in favor of the experimental group. There were no differences in discharge destinations, incidence of negative outcomes or adverse events attributable to early mobilization when compared to the comparison groups. Early mobilization post hip or knee joint replacement surgery can result in a reduced length of stay of about 1.8 days. Trials that reported these positive results showed that early mobilization can be achieved within 24 hours of operation. This positive gain was achieved without an increase in negative outcomes. © The Author(s) 2014.

NASPGHAN Clinical Report on Postoperative Recurrence in Pediatric Crohn Disease.

PubMed

Splawski, Judy B; Pffefferkorn, Marian D; Schaefer, Marc E; Day, Andrew S; Soldes, Oliver S; Ponsky, Todd A; Stein, Philip; Kaplan, Jess L; Saeed, Shehzad A

2017-10-01

Pediatric Crohn disease is characterized by clinical and endoscopic relapses. The inflammatory process is considered to be progressive and may lead to strictures, fistulas, and penetrating disease that may require surgery. In addition, medically refractory disease may be treated by surgical resection of inflamed bowel in an effort to reverse growth failure. The need for surgery in childhood suggests severe disease and these patients have an increased risk for recurrent disease and potentially more surgery. Data show that up to 55% of patients had clinical recurrence in the first 2 years after initial surgery. The current clinical report on postoperative recurrence in pediatric Crohn disease reviews the risk factors for early surgery and postoperative recurrence, operative risk factors for recurrence, and prevention and monitoring strategies for postoperative recurrence. We also propose an algorithm for postoperative management in pediatric Crohn disease.

[Personalized cell therapy for early postoperative bullous keratopathy (experimental proof and clinical results)].

PubMed

Kasparov, A A; Kasparova, Evg A; Fadeeva, L L; Subbot, A M; Borodina, N V; Kasparova, E A; Kobzova, M V; Musaeva, G M; Pavliuk, A S

2013-01-01

The article presents the results of a long-term research on development and clinical application of personalized cell therapy (PCT) for treatment of early postoperative (manifesting within the first 3 months after surgery) bullous keratopathy (BK). The method of intracameral PCT implies in vitro incubation of the patient's blood sample with poly(A:U) stimulator, separation of the serum with activated leukocytes, and injection of the final cell preparation into the anterior chamber. The fundamental part of the research was aimed at a detailed description of the cell preparation and investigation of its possible mechanisms of action. Cytokine and growth factor level in the cell preparation suggested that its high clinical efficacy might be due to its ability to improve regeneration of damaged corneal endothelium. The clinical study was conducted on a group of 52 patients with early BK. A significant effect (smoothing of the Descement's membrane folds, complete resorption of corneal edema, improvement of corneal transparency, reduction of corneal thickness and increase of visual acuity by 0.49 +/- 0.27) was achieved in 44.2% of patients, while partial effect was seen in 21.1% of patients. There was no clinical effect in 34.6% of patients. In those patients who developed significant or partial clinical effect after the PCT, many endotheliocytes appeared to have multiple nuclei (2 and more). In some patients polyploid nuclei persisted for 3-5 years after the treatment. Polyploidy results from incomplete mitosis which might be due to regenerative processes in the endothelium stimulated by the PCT. Obviously, high efficacy and relative simplicity of the method should promote its further clinical introduction.

Effect of phrenic nerve palsy on early postoperative lung function after pneumonectomy: a prospective study.

PubMed

Kocher, Gregor J; Mauss, Karl; Carboni, Giovanni L; Hoksch, Beatrix; Kuster, Roland; Ott, Sebastian R; Schmid, Ralph A

2013-12-01

The issue of phrenic nerve preservation during pneumonectomy is still an unanswered question. So far, its direct effect on immediate postoperative pulmonary lung function has never been evaluated in a prospective trial. We conducted a prospective crossover study including 10 patients undergoing pneumonectomy for lung cancer between July 2011 and July 2012. After written informed consent, all consecutive patients who agreed to take part in the study and in whom preservation of the phrenic nerve during operation was possible, were included in the study. Upon completion of lung resection, a catheter was placed in the proximal paraphrenic tissue on the pericardial surface. After an initial phase of recovery of 5 days all patients underwent ultrasonographic assessment of diaphragmatic motion followed by lung function testing with and without induced phrenic nerve palsy. The controlled, temporary paralysis of the ipsilateral hemidiaphragm was achieved by local administration of lidocaine 1% at a rate of 3 mL/h (30 mg/h) via the above-mentioned catheter. Temporary phrenic nerve palsy was accomplished in all but 1 patient with suspected catheter dislocation. Spirometry showed a significant decrease in dynamic lung volumes (forced expiratory volume in 1 second and forced vital capacity; p < 0.05) with the paralyzed hemidiaphragm. Blood oxygen saturation levels did not change significantly. Our results show that phrenic nerve palsy causes a significant impairment of dynamic lung volumes during the early postoperative period after pneumonectomy. Therefore, in these already compromised patients, intraoperative phrenic nerve injury should be avoided whenever possible. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

The role of suture cutout in the failure of meniscal root repair during the early post-operative period: a biomechanical study.

PubMed

Perez-Blanca, Ana; Prado Nóvoa, María; Lombardo Torre, Maximiano; Espejo-Reina, Alejandro; Ezquerro Juanco, Francisco; Espejo-Baena, Alejandro

2018-04-01

To assess the role of suture cutout in the mechanics of failure of the repaired posterior meniscal root during the early post-operative period when using sutures of different shape. Twenty medial porcine menisci were randomized in two groups depending on the suture shape used to repair the posterior root: thread or tape. The sutured menisci were subjected to cyclic loading (1000 cycles, (10, 30) N) followed by load-to-failure testing. Residual displacements, stiffness, and ultimate failure load were determined. During tests, the tissue-suture interface was recorded using a high-resolution camera. In cyclic tests, cutout progression at the suture insertion points was not observed for any specimen of either group and no differences in residual displacements were found between use of thread or tape. In load-to-failure tests, suture cutout started in all menisci at a load close to the ultimate failure and all specimens failed by suture pullout. Suture tape had a greater ultimate load with no other differences. In a porcine model of a repaired posterior meniscal root subjected to cyclic loads representative of current rehabilitation protocols in the early post-operative period under restricted loading conditions, suture cutout was not found as a main source of permanent root displacement when using suture thread or tape. Suture cutout progression started at high loading levels close to the ultimate load of the construct. Tape, with a meniscus-suture contact area larger than thread, produced higher ultimate load.

A randomized placebo controlled trial of preoperative carbohydrate drinks and early postoperative nutritional supplement drinks in colorectal surgery.

PubMed

Lidder, P; Thomas, S; Fleming, S; Hosie, K; Shaw, S; Lewis, S

2013-06-01

There is evidence that preoperative carbohydrate drinks and postoperative nutritional supplements improve the outcome of colorectal surgery. There is little information on their individual contribution. A prospective four-arm double-blind controlled trial was carried out in which patients were randomized to carbohydrate or placebo drinks preoperatively and a polymeric supplement or placebo drink postoperatively. The primary outcome was insulin resistance (using the short insulin tolerance test and HOMA-IR). Secondary outcomes included handgrip strength, pulmonary function, intestinal permeability and postoperative complications. A total of 120 patients were randomized to four demographically well matched groups. Patients who received preoperative and postoperative supplements had better glucose homeostasis (P = 0.004), peak expiratory flow rate (P = 0.035), handgrip strength (P = 0.002) and less insulin resistance (P = 0.001) compared with those who only received placebo drinks. Oral nutritional supplements given preoperatively and postoperatively improve postoperative handgrip strength, pulmonary function and insulin resistance. A weaker effect was seen in patients who received supplements either preoperatively or postoperatively. Oral nutritional supplements should be given both preoperatively and postoperatively. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

Ten-year experience with the muscle split technique, bioabsorbable plates, and postoperative bracing for correction of pectus carinatum: the Innsbruck protocol.

PubMed

Del Frari, Barbara; Schwabegger, Anton H

2011-06-01

We reviewed further clinical experience with our approach for pectus carinatum repair: modified surgical approach of pectoralis muscle split technique, bioabsorbable plates with screws, and postoperative compressive brace. From April 2000 to February 2010, 55 patients underwent pectus carinatum repair at our department with modifications of conventional Ravitch repair. There were 14 female and 41 male patients, mean age of 19.3 years at the onset of treatment. Postoperative treatment involved fitting of a lightweight, patient-controlled chest brace. Average follow-up was 13.7 months. Patient satisfaction was excellent for 40 patients (72.7%) and good for the remaining 15 (27.3%); aesthetic appearance was excellent for 37 patients (67.3%) and good for the remaining 18 (32.7%). Postoperative evaluation was objective measurement with a thorax caliper and clinical examination. No major perioperative complications were observed. Postoperative complications were mild recurrence of deformity (n = 3) and persistent, mild, single costal cartilage protrusion (n = 2). No patient had palpable plates or screws, and there was no material breakdown. The combination of muscle split technique and absorbable osteosynthesis represents an alternative in pectus carinatum repair. The pectoralis muscle split technique allows early patient mobilization and rehabilitation. Bioabsorbable plates get completely absorbed, avoiding second operation, and chest brace provides postoperative immobilization of the anterior thoracic wall during healing and avoids development of hypertrophic scars. Our combined approach to the correction of pectus carinatum deformities yields predominantly excellent esthetic results, with low morbidity, low costs, and less invasiveness, leading to high patient satisfaction. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Pre-operative assessment and post-operative care in elective shoulder surgery.

PubMed

Akhtar, Ahsan; Macfarlane, Robert J; Waseem, Mohammad

2013-01-01

Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery.

Dual Mobility Cemented Cups Have Low Dislocation Rates in THA Revisions

PubMed Central

Langlais, Frantz L.; Gaucher, François; Musset, Thierry; Chaix, Olivier

2008-01-01

THA revisions using standard cups are at risk of dislocation (5.1% to 14.4% incidence), especially in patients over 70 years of age. Constrained tripolar cups have reduced this risk (6% incidence) but are associated with substantial loosening rates (9%). The nonconstrained dual mobility cup was designed to improve prosthetic stability (polyethylene head ≥ 40 mm diameter) without increasing loosening rates by reducing wear and limiting impingement (rotation range of 108°). We implanted 88 cemented dual mobility cups for THA revisions in 82 patients at high risk of dislocation. Average patient age was 72 years (range, 65–86 years). Eighty-five of the 88 hips were reviewed at 2 to 5 years followup. One patient (1.1%) had a traumatic dislocation at 2 years postoperatively. Two patients (2.3%) had asymptomatic early loosening and three patients (3.5%) had localized radiographic lucencies. These results confirm those with press-fit dual mobility cups suggesting a low dislocation rate at 5 years and a cup survival of 94.6%. At middle term followup, cemented dual mobility cup achieved better results than constrained cups in cases at risk of dislocation and recurrent loosening. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196422

[Gender-specific differences of the early postoperative and oncosurgical long-term outcome in rectal cancer-data obtained in a prospective multicenter observational study].

PubMed

Katzenstein, J; Steinert, R; Ptok, H; Otto, R; Gastinger, I; Lippert, H; Meyer, F

2018-04-11

Gender-specific aspects have been increasingly considered in clinical medicine, also in oncological surgery. To analyze gender-specific differences of early postoperative and oncological outcomes after rectal cancer resection based on data obtained in a prospective multicenter observational study. As part of the multicenter prospective observational study "Quality assurance in primary rectal cancer", data on tumor site, exogenic and endogenic risk factors, neoadjuvant treatment, surgical procedures, tumor stage, intraoperative and postoperative complications of patients with the histological diagnosis of rectal cancer were registered. Data from the years 2005-2006 and 2010-2011 were investigated with respect to gender-specific differences of postoperative morbidity, hospital mortality, local recurrency rate, disease-free and overall survival by univariable and multivariable analyses. Overall, data from 10,657 patients were evaluated: 60.9% of the patients were male, who were significantly younger (p < 0.001). Men had a significantly higher rate of alcohol (p < 0.001) and nicotine abuse (p < 0.001) as well as a trend to a higher body mass index (BMI) compared with women. Although, there was no significant difference in the distribution of various tumor stages comparing men and women, neoadjuvant radiochemotherapy was used significantly more often in male patients (p < 0.001). In addition, male patients underwent an abdominoperineal rectum exstirpation more often, whereas creation of an enterostoma and Hartmann's procedure were more frequently used in women (p < 0.001 each). Multivariate analysis revealed that male patients developed a higher overall morbidity (odds ratio, OR: 1.5; p < 0.001) during both study periods and from 2010-2011 a higher hospital mortality (OR: 1.8; p < 0.001). After a median follow-up period of 36 months, gender did not have a significant impact on overall survival, disease-free survival or on the local

Identification of risk factors for postoperative dysphagia after primary anti-reflux surgery.

PubMed

Tsuboi, Kazuto; Lee, Tommy H; Legner, András; Yano, Fumiaki; Dworak, Thomas; Mittal, Sumeet K

2011-03-01

Transient postoperative dysphagia is not uncommon after antireflux surgery and usually runs a self-limiting course. However, a subset of patients report long-term dysphagia. The purpose of this study was to determine the risk factors for persistent postoperative dysphagia at 1 year after surgery. All patients who underwent antireflux surgery were entered into a prospectively maintained database. After obtaining institutional review board approval, the database was queried to identify patients who underwent primary antireflux surgery and were at least 1 year from surgery. Postoperative severity of dysphagia was evaluated using a standardized questionnaire (scale 0-3). Patients with scores of 2 or 3 were defined as having significant dysphagia. A total of 316 consecutive patients underwent primary antireflux surgery by a single surgeon. Of these, 219 patients had 1 year postoperative symptom data. Significant postoperative dysphagia at 1 year was reported by 19 (9.1%) patients. Thirty-eight patients (18.3%) required postoperative dilation for dysphagia. Multivariate logistic regression analysis identified preoperative dysphagia (odds ratio (OR), 4.4; 95% confidence interval (CI), 1.2-15.5; p = 0.023) and preoperative delayed esophageal transit by barium swallow (OR, 8.2; 95% CI, 1.6-42.2; p = 0.012) as risk factors for postoperative dysphagia. Female gender was a risk factor for requiring dilation during the early postoperative period (OR, 3.6; 95% CI, 1.3-10.2; p = 0.016). No correlations were found with preoperative manometry. There also was no correlation between a need for early dilation and persistent dysphagia at 1 year of follow-up (p = 0.109). Patients with preoperative dysphagia and delayed esophageal transit on preoperative contrast study were significantly more likely to report moderate to severe postoperative dysphagia 1 year after antireflux surgery. This study confirms that the manometric criteria used to define esophageal dysmotility are not reliable

Functional Outcomes of a New Mobile-Bearing Ultra-Congruent TKA System: Comparison With the Posterior Stabilized System.

PubMed

Machhindra, Morey Vivek; Kang, Jong Yeal; Kang, Yeon Gwi; Chowdhry, Madhav; Kim, Tae Kyun

2015-12-01

We determined whether a new mobile-bearing ultra-congruent (UC) TKA system provides better functional outcomes than an established posterior-stabilized (PS) prosthesis. The functional outcomes (motion arc, AKS scores, WOMAC Index, and SForm-36 scores evaluated at 1 and 2 years postoperatively), satisfaction and incidences of adverse events were compared between the knees implanted with mobile-bearing UC prosthesis (n=103) and the mobile-bearing PS prosthesis (n=99). At 2 years, mobile-bearing UC TKAs showed similar functional outcomes and satisfaction, but smaller motion arc compared to mobile-bearing PS TKAs (126° vs. 131°). There were no differences in the incidence of adverse events. Mobile-bearing UC prosthesis can be considered a safe and viable alternative to the PS design, with an expectation of smaller postoperative maximum flexion. Copyright © 2015 Elsevier Inc. All rights reserved.

Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis.

PubMed

Oh, Tak Kyu; Lee, Se-Jun; Do, Sang-Hwan; Song, In-Ae

2018-02-01

Transversus abdominis plane (TAP) block using a short-acting local anesthetic as part of multimodal analgesia is efficient in various abdominal surgeries, including laparoscopic surgery. However, information regarding its use in laparoscopic colorectal surgery is still limited and sometimes controversial. Therefore, we conducted a systematic review and meta-analysis to determine whether TAP block using a short-acting anesthetic has a positive postoperative analgesic outcome in patients who have undergone laparoscopic colorectal surgery. We searched for studies comparing the postoperative pain outcome after laparoscopic colorectal surgery between patients who received TAP block and a control group (placebo or no treatment). Outcome measures were early pain at rest (numeric rating scale [NRS] score at 0-2 h postoperatively), late pain at movement (NRS score at 24 h postoperatively), late pain at rest (NRS score at 24 h postoperatively), and postoperative opioid consumption (up to 24 h postoperatively). We used a random-effects model for the meta-analysis and Egger's regression test to detect publication bias. We included six studies involving 452 patients (224 in the TAP block group, 228 in the control group). Early and late pain scores at movement were significantly different between the TAP block and control groups (standardized mean difference: - 0.695, P < 0.0001 for early pain and - 0.242, P = 0.029 for late pain). There was no significant difference between the TAP block and control groups in early pain at rest (P = 0.475), late pain at rest (P = 0.826), and postoperative opioid consumption (P = 0.257). The TAP block using a short-acting anesthetic had a significant effect on the postoperative pain outcome in the early (0-2 h) and late (24 h) period at movement. However, it did not have a significant effect on the postoperative pain outcome in the early (0-2 h) and late (24 h) periods at rest after laparoscopic surgery.

Early Reading Skills and Academic Achievement Trajectories of Students Facing Poverty, Homelessness, and High Residential Mobility

ERIC Educational Resources Information Center

Herbers, Janette E.; Cutuli, J. J.; Supkoff, Laura M.; Heistad, David; Chan, Chi-Keung; Hinz, Elizabeth; Masten, Ann S.

2012-01-01

This investigation tested the importance of early academic achievement for later achievement trajectories among 18,011 students grouped by level of socioeconomic risk. Students considered to be at highest risk were those who experienced homelessness or high residential mobility (HHM). HHM students were compared with students eligible for free…

Early carbon mobilization and radicle protrusion in maize germination.

PubMed

Sánchez-Linares, Luis; Gavilanes-Ruíz, Marina; Díaz-Pontones, David; Guzmán-Chávez, Fernando; Calzada-Alejo, Viridiana; Zurita-Villegas, Viridiana; Luna-Loaiza, Viridiana; Moreno-Sánchez, Rafael; Bernal-Lugo, Irma; Sánchez-Nieto, Sobeida

2012-07-01

Considerable amounts of information is available on the complex carbohydrates that are mobilized and utilized by the seed to support early seedling development. These events occur after radicle has protruded from the seed. However, scarce information is available on the role of the endogenous soluble carbohydrates from the embryo in the first hours of germination. The present work analysed how the soluble carbohydrate reserves in isolated maize embryos are mobilized during 6-24 h of water imbibition, an interval that exclusively embraces the first two phases of the germination process. It was found that sucrose constitutes a very significant reserve in the scutellum and that it is efficiently consumed during the time in which the adjacent embryo axis is engaged in an active metabolism. Sucrose transporter was immunolocalized in the scutellum and in vascular elements. In parallel, a cell-wall invertase activity, which hydrolyses sucrose, developed in the embryo axis, which favoured higher glucose uptake. Sucrose and hexose transporters were active in the embryo tissues, together with the plasma membrane H(+)-ATPase, which was localized in all embryo regions involved in both nutrient transport and active cell elongation to support radicle extension. It is proposed that, during the initial maize germination phases, a net flow of sucrose takes place from the scutellum towards the embryo axis and regions that undergo elongation. During radicle extension, sucrose and hexose transporters, as well as H(+)-ATPase, become the fundamental proteins that orchestrate the transport of nutrients required for successful germination.

Acute cholecystitis as a postoperative complication.

PubMed Central

Ottinger, L W

1976-01-01

The clinical course and management of 40 patients who underwent operation for acute cholecystitis developing as a postoperative complication were reviewed. Of note was the mortality of 47%, the high incidence of gangrene, perforation, empyema, and cholangitis, and the atypical clinical presentation of acute cholecystitis under these conditions. Awareness of this possible complication, knowledge of its clinical features, and early surgical intervention are important facets of successful management. PMID:952563

[Role of hemodynamic factors and heart volume in the prognosis of acute cardiac insufficiency during the early postoperative period in patients with mitral valve stenosis].

PubMed

Guliamov, D S; Amanov, A A; Andres, Iu P; Bazhenova, T F

1983-07-01

Investigations performed in 172 patients have shown that the state of the myocardium (such parameters as the heart volume, degree of lung hypertension, end-diastolic pressure in the right and left ventricles) is of great importance in pathogenesis of the development of acute heart failure in the early postoperative period in patients with mitral stenosis of the IIIrd and IVth stage of the blood circulation insufficiency.

Endoscopic ultrasound-guided transmural drainage of postoperative pancreatic collections.

PubMed

Tilara, Amy; Gerdes, Hans; Allen, Peter; Jarnagin, William; Kingham, Peter; Fong, Yuman; DeMatteo, Ronald; D'Angelica, Michael; Schattner, Mark

2014-01-01

Pancreatic leak is a major cause of morbidity after pancreatectomy. Traditionally, peripancreatic fluid collections have been managed by percutaneous or operative drainage. Data for endoscopic ultrasound (EUS)-guided drainage of postoperative fluid collections are limited. Here we report on the safety, efficacy, and timing of EUS-guided drainage of postoperative peripancreatic collections. This is a retrospective review of 31 patients who underwent EUS-guided drainage of fluid collections after pancreatic resection. Technical success was defined as successful transgastric deployment of at least one double pigtail plastic stent. Clinical success was defined as resolution of the fluid collection on follow-up CT scan and resolution of symptoms. Early drainage was defined as initial transmural stent placement within 30 days after surgery. Endoscopic ultrasound-guided drainage was performed effectively with a technical success rate of 100%. Clinical success was achieved in 29 of 31 patients (93%). Nineteen of the 29 patients (65%) had complete resolution of their symptoms and collection with the first endoscopic procedure. Repeat drainage procedures, including some with necrosectomy, were required in the remaining 10 patients, with eventual resolution of collection and symptoms. Two patients who did not achieve durable clinical success required percutaneous drainage by interventional radiology. Seventeen (55%) of 31 patients had successful early drainage completed within 30 days of their operation. Endoscopic ultrasound-guided drainage of fluid collections after pancreatic resection is safe and effective. Early drainage (<30 days) of postoperative pancreatic fluid collections was not associated with increased complications in this series. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Early Postoperative Results of Percutaneous Needle Fasciotomy in 451 Patients with Dupuytren Disease.

PubMed

Molenkamp, Sanne; Schouten, Tanneke A M; Broekstra, Dieuwke C; Werker, Paul M N; Moolenburgh, J Daniel

2017-06-01

Percutaneous needle fasciotomy is a minimally invasive treatment modality for Dupuytren disease. In this study, the authors analyzed the efficacy and complication rate of percutaneous needle fasciotomy using a statistical method that takes the multilevel structure of data, regarding multiple measurements from the same patient, into account. The data of 470 treated rays from 451 patients with Dupuytren disease that underwent percutaneous needle fasciotomy were analyzed retrospectively. The authors described the early postoperative results of percutaneous needle fasciotomy and applied linear mixed models to compare mean correction of passive extension deficit between joints and efficacy of primary versus secondary percutaneous needle fasciotomy. Mean preoperative passive extension deficits at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 37, 40, and 31 degrees, respectively. Mean preoperative total passive extension deficit was 54 degrees. Results were excellent, with a mean total passive extension deficit correction of 85 percent. Percutaneous needle fasciotomy was most effective for metacarpophalangeal joints and less effective for proximal interphalangeal and distal interphalangeal joints. Secondary percutaneous needle fasciotomy was as effective as primary percutaneous needle fasciotomy. Complications were rare and mostly minor. The results of this study confirm that percutaneous needle fasciotomy is an effective and safe treatment modality for patients with mild to moderate disease who prefer a minimally invasive procedure. Therapeutic, IV.

Safe surgery: validation of pre and postoperative checklists 1

PubMed Central

Alpendre, Francine Taporosky; Cruz, Elaine Drehmer de Almeida; Dyniewicz, Ana Maria; Mantovani, Maria de Fátima; Silva, Ana Elisa Bauer de Camargo e; dos Santos, Gabriela de Souza

2017-01-01

ABSTRACT Objective: to develop, evaluate and validate a surgical safety checklist for patients in the pre and postoperative periods in surgical hospitalization units. Method: methodological research carried out in a large public teaching hospital in the South of Brazil, with application of the principles of the Safe Surgery Saves Lives Programme of the World Health Organization. The checklist was applied to 16 nurses of 8 surgical units and submitted for validation by a group of eight experts using the Delphi method online. Results: the instrument was validated and it was achieved a mean score ≥1, level of agreement ≥75% and Cronbach’s alpha >0.90. The final version included 97 safety indicators organized into six categories: identification, preoperative, immediate postoperative, immediate postoperative, other surgical complications, and hospital discharge. Conclusion: the Surgical Safety Checklist in the Pre and Postoperative periods is another strategy to promote patient safety, as it allows the monitoring of predictive signs and symptoms of surgical complications and the early detection of adverse events. PMID:28699994

High resolution OCT quantitative analysis of the space between the IOL and the posterior capsule during the early cataract postoperative period.

PubMed

Tao, Aizhu; Lu, Ping; Li, Jin; Shao, Yilei; Wang, Jianhua; Shen, Meixiao; Zhao, Yinying; Lu, Fan

2013-10-25

We quantitatively characterized the space between the IOL and the posterior capsule (IOL-PC space) during the early postphacoemulsification period, using high resolution optical coherence tomography (OCT). We recruited 30 eyes of 30 patients who underwent phacoemulsification and randomly divided them into two groups. Acrysof Natural IQ IOLs were implanted in one group (n = 15), and Adapt-AO IOLs were implanted into the other (n = 15). A custom-built OCT instrument was used to image the IOL-PC space at 1 day, 1 week, and 1 month after surgery. Slit-lamp examination and auto refraction were performed at each visit. The IOL-PC spaces in the IQ group were 0.72 ± 0.35, 0.40 ± 0.24, and 0.23 ± 0.16 mm(2) at 1 day, 1 week, and 1 month after surgery, respectively. At each of these times, the values for the AO group were significantly smaller (P < 0.001). Compared to 1 day after surgery, significant changes in the ACDs and refractive errors occurred up to 1 month postoperatively in the IQ group; however, changes in the ACD and refractive error were significant only at 1 week in the AO group. The decreases in IOL-PC space and in ACD during the early postoperative period were associated with a myopic shift. It appeared that the different IOL designs had a role in closure of the IOL-PC space. High resolution OCT was suitable for quantitative analysis of IOL-PC space. (ClinicalTrials.gov number, NCT01605812.).

Duration of post-operative hypocortisolism predicts sustained remission after pituitary surgery for Cushing’s disease

PubMed Central

Bansal, Prachi; Goroshi, Manjunath; Jadhav, Swati; Lomte, Nilesh; Thakkar, Kunal; Goel, Atul; Shah, Abhidha; Sankhe, Shilpa; Goel, Naina; Jaguste, Neelam; Bandgar, Tushar; Shah, Nalini

2017-01-01

Purpose Transsphenoidal surgery (TSS) is the primary treatment modality for Cushing’s disease (CD). However, the predictors of post-operative remission and recurrence remain debatable. Thus, we studied the post-operative remission and long-term recurrence rates, as well as their respective predictive factors. Methods A retrospective analysis of case records of 230 CD patients who underwent primary microscopic TSS at our tertiary care referral centre between 1987 and 2015 was undertaken. Demographic features, pre- and post-operative hormonal values, MRI findings, histopathological features and follow-up data were recorded. Remission and recurrence rates as well as their respective predictive factors were studied. Results Overall, the post-operative remission rate was 65.6% (early remission 46%; delayed remission 19.6%), while the recurrence rate was 41% at mean follow-up of 74 ± 61.1 months (12–270 months). Significantly higher early remission rates were observed in patients with microadenoma vs macroadenoma (51.7% vs 30.6%, P = 0.005) and those with unequivocal vs equivocal MRI for microadenoma (55.8% vs 38.5%, P = 0.007). Patients with invasive macroadenoma had poorer (4.5% vs 45%, P = 0.001) remission rates. Recurrence rates were higher in patients with delayed remission than those with early remission (61.5% vs 30.8%, P = 0.001). Duration of post-operative hypocortisolemia ≥13 months predicted sustained remission with 100% specificity and 46.4% sensitivity. Recurrence could be detected significantly earlier (27.7 vs 69.2 months, P < 0.001) in patients with available serial follow-up biochemistry as compared to those with infrequent follow-up after remission. Conclusion In our study, remission and recurrence rates were similar to that of reported literature, but proportion of delayed remission was relatively higher. Negative/equivocal MRI findings and presence of macroadenoma, especially those with cavernous sinus invasion were

The impact of obesity on early postoperative outcomes in adults with congenital heart disease.

PubMed

Zaidi, Ali N; Bauer, John A; Michalsky, Marc P; Olshove, Vincent; Boettner, Bethany; Phillips, Alistair; Cook, Stephen C

2011-01-01

As the prevalence of obesity continues to increase, it now includes the growing number of patients with congenital heart disease (CHD). This particular obese patient population may pose additional intraoperative as well as postoperative challenges that may contribute to poor outcomes. Our aims were to determine the influence of obesity on morbidity and mortality in adults with CHD undergoing surgical repair at a free standing children's hospital. A retrospective analysis of adult (≥18 years) CHD surgery cases from 2002 to 2008 was performed. Congenital heart lesions were defined as mild, moderate, or complex. Patients were categorized by body mass index (BMI): underweight (BMI < 20 kg/m(2)), normal (BMI 20-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and obese (BMI ≥ 30 kg/m(2)). Demographics, incidence of mortality, or specific morbidities were statistically compared using Fisher's exact test and analyses of variance (anovas). In this population (n = 165), overweight (29%) and obese (22%) patients were prevalent. Hypertension (HTN) and pre-HTN were more prevalent in obese and overweight patients. Postoperative renal dysfunction was observed in obese patients with complex CHD (P = .04). Mortality was not different among groups. Obesity is becoming increasingly common among adults with CHD. Despite marginal evidence of postoperative renal complications in obese patients with CHD of severe complexity, the overall presence of obesity did not influence mortality or short term postoperative morbidities. © 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.

Transversus abdominis plane block reduces morphine consumption in the early postoperative period following microsurgical abdominal tissue breast reconstruction: a double-blind, placebo-controlled, randomized trial.

PubMed

Zhong, Toni; Ojha, M; Bagher, Shaghayegh; Butler, Kate; Srinivas, Coimbatore; McCluskey, Stuart A; Clarke, Hance; O'Neill, Anne C; Novak, Christine B; Hofer, Stefan O P

2014-11-01

The analgesic efficacy of the transversus abdominis plane peripheral nerve block following abdominal tissue breast reconstruction has not been studied in a randomized controlled trial. The authors conducted a double-blind, placebo-controlled, 1:1 allocation, two-arm parallel group, superiority design, randomized controlled trial in patients undergoing microsurgical abdominally based breast reconstruction. Intraoperatively, epidural catheters were inserted under direct vision through the triangle of Petit on both sides of the abdomen into the transversus abdominis plane just before rectus fascial closure. Patients received either bupivacaine (study group) or saline (placebo group) through the catheters for 2 postoperative days. All patients received hydromorphone by means of a patient-controlled analgesic pump. The primary outcome was the difference in the parenteral opioid consumption on each postoperative day between the groups. The secondary outcome measures included the following: total in-hospital opioid; antinausea medication; pain, nausea, and sedation scores; Quality of Recovery Score; time to ambulation; and hospital stay duration. Between September of 2011 and June of 2013, 93 patients were enrolled: 49 received bupivacaine and 44 received saline. There were 11 postoperative complications (13 percent); none were related to the catheter. Primary outcomes were completed by 85 of 93 patients (91.3 percent); the mean parenteral morphine consumption was significantly reduced on postoperative day 1 in the bupivacaine group (20.7±20.1 mg) compared with 30.0±19.1 mg in the control group (p=0.02). There were no significant differences in secondary outcomes. Following abdominally based breast reconstruction, transversus abdominis plane peripheral nerve block is safe and significantly reduces morphine consumption in the early postoperative period. Therapeutic, II.

Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis

PubMed Central

Kim, Hye Jin; Park, Jun Seok; Park, Soo Yeun; Choi, Wohn Ho; Ryuk, Jong Pil

2012-01-01

Purpose We evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy. Methods From August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery. Results The median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis. Conclusion Laparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP. PMID:23166888

Management of pediatric postoperative chylothorax.

PubMed

Bond, S J; Guzzetta, P C; Snyder, M L; Randolph, J G

1993-09-01

Questions persist about the management of postoperative chylothorax in infants and children. Our experience with postoperative chylothorax over the most recent decade (1980 to 1990) has been reviewed. The type and amount of drainage, data from cardiac catheterization and echocardiography, operative decisions and details, and eventual outcomes have been cataloged. All patients were initially treated with total gut rest, with operation reserved for unabated drainage. Chylothorax developed postoperatively in 15 infants and 11 children (18 with a cardiac procedure and 8 with a noncardiac procedure). The average age was 3.1 years. Spontaneous cessation and cure occurred in 19 (73.1%) of these 26 patients, with an average drainage duration of 11.9 days (range, 4 to 30 days). Those for whom operation was chosen drained preoperatively for an average of 29.2 days (range, 25 to 40 days). There were no deaths in either group. Complications were lymphopenia (2 patients) and fungal sepsis (1 patient). The amount of drainage per day was not significantly different between patients treated operatively and those treated nonoperatively. Failure of nonoperative management was associated with venous hypertension from increased right-sided cardiac pressures or central venous thrombosis (p < 0.05, Fisher's exact test). Presumably this increased pressure is transmitted to the lymphatic system. These patients should be identified early and considered for thoracic duct suture or pleuroperitoneal shunting.

Preliminary evaluation of the effects of photobiomodulation therapy and physical rehabilitation on early postoperative recovery of dogs undergoing hemilaminectomy for treatment of thoracolumbar intervertebral disk disease.

PubMed

Bennaim, Michael; Porato, Mathilde; Jarleton, Astrid; Hamon, Martin; Carroll, James D; Gommeren, Kris; Balligand, Marc

2017-02-01

OBJECTIVE To evaluate the effects of postoperative photobiomodulation therapy and physical rehabilitation on early recovery variables for dogs after hemilaminectomy for treatment of intervertebral disk disease. ANIMALS 32 nonambulatory client-owned dogs. PROCEDURES Dogs received standard postoperative care with photobiomodulation therapy (n = 11), physical rehabilitation with sham photobiomodulation treatment (11), or sham photobiomodulation treatment only (10) after surgery. Neurologic status at admission, diagnostic and surgical variables, duration of postoperative IV analgesic administration, and recovery grades (over 10 days after surgery) were assessed. Time to reach recovery grades B (able to support weight with some help), C (initial limb movements present), and D (ambulatory [≥ 3 steps unassisted]) was compared among groups. Factors associated with ability to ambulate on day 10 or at last follow-up were assessed. RESULTS Time to reach recovery grades B, C, and D and duration of postoperative IV opioid administration did not differ among groups. Neurologic score at admission and surgeon experience were negatively associated with the dogs' ability to ambulate on day 10. The number of disk herniations identified by diagnostic imaging before surgery was negatively associated with ambulatory status at last follow-up. No other significant associations and no adverse treatment-related events were identified. CONCLUSIONS AND CLINICAL RELEVANCE This study found no difference in recovery-related variables among dogs that received photobiomodulation therapy, physical rehabilitation with sham photobiomodulation treatment, or sham photobiomodulation treatment only. Larger studies are needed to better evaluate effects of these postoperative treatments on dogs treated surgically for intervertebral disk disease.

Comparison of TVT and TOT on urethral mobility and surgical outcomes in stress urinary incontinence with hypermobile urethra.

PubMed

Cavkaytar, Sabri; Kokanalı, Mahmut Kuntay; Guzel, Ali Irfan; Ozer, Irfan; Aksakal, Orhan Seyfi; Doganay, Melike

2015-07-01

To compare the change of urethral mobility after midurethral sling procedures in stress urinary incontinence with hypermobile urethra and assess these findings with surgical outcomes. 141 women who agreed to undergo midurethral sling operations due to stress urinary incontinence with hypermobile urethra were enrolled in this non-randomized prospective observational study. Preoperatively, urethral mobility was measured by Q tip test. All women were asked to complete Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7) to assess the quality of life. Six months postoperatively, Q tip test and quality of life assessment were repeated. The primary surgical outcomes were classified as cure, improvement and failure. Transient urinary obstruction, de novo urgency, voiding dysfunction were secondary surgical outcomes. Of 141 women, 50 (35. 5%) women underwent TOT, 91 (64.5%) underwent TVT. In both TOT and TVT groups, postoperative Q tip test values, IIQ-7 and UDI-6 scores were statistically reduced when compared with preoperative values. Postoperative Q tip test value in TVT group was significantly smaller than in TOT group [25°(15-45°) and 20° (15-45°), respectively]. When we compared the Q-tip test value, IIQ-7 and UDI-6 scores changes, there were no statistically significant changes between the groups. Postoperative urethral mobility was more frequent in TOT group than in TVT group (40% vs 23.1%, respectively). Postoperative primary and secondary outcomes were similar in both groups. Although midurethral slings decrease the urethtal hypermobility, postoperative mobility status of urethra does not effect surgical outcomes of midurethral slings in women with preoperative urethral hypermobility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications

PubMed Central

Abdelaziz, Omar; Attia, Hussein

2016-01-01

Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intra-operative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure. PMID:27468207

Stapled haemorrhoidopexy: extent of tissue excision and clinical implications in the early postoperative period.

PubMed

Behboo, R; Zanella, S; Ruffolo, C; Vafai, M; Marino, F; Scarpa, M

2011-06-01

This study quantified prospectively the amount of rectal wall removed during stapled haemorrhoidopexy and assessed its effect on ano-rectal function and health-related quality of life. Thirty-three consecutive patients who underwent stapled haemorrhoidopexy for second- or third- degree haemorrhoids, or for failed medical treatment, in the Department of Surgery and Gastroenterological Sciences at the University of Padova were included. All patients were assessed preoperatively and postoperatively using a structured questionnaire to determine the number of defecations per week, incomplete defecations, time taken to defecate any difficulty in defecating, soiling, the use of drugs and continence. All patients were reassessed at 1 and 2 weeks and at 30 days after the procedure using the Cleveland Global Quality of Life (CGQL) questionnaire. All patients underwent preoperative and postoperative ano-rectal manometry at least 30 days after stapled haemorrhoidopexy. The median surface area of the resected rectal wall was 10.5 (range, 9-15) mm(2) and the median thickness was 3 (range, 2-4) mm. Muscle tissue was included in all specimens. The median thickness of the resected rectal wall correlated inversely with the rectal volume when the recto-anal inhibitory reflex (RAIR) was initiated during postoperative manometry (ρ = -0.50, P = 0.07). A significant, direct correlation was found between the surface area of the resected rectal wall and the rectal volume during postoperative manometry (ρ = 0.53, P = 0.08) and the use of analgesic drugs after 2 weeks (ρ = 0.63, P = 0.04). Significant correlations were found between being female and postoperative resting pressure (ρ = -0.74, P < 0.01), squeeze pressure (ρ = -0.64, P = 0.01) and maximum tolerated volume (ρ = -0.78, P < 0.01). Stapled haemorrhoidopexy is safe and effective. The thicker the resected rectal wall, the lower the volume of initiation of the RAIR. © 2011 The Authors. Colorectal Disease © 2011 The Association

Early clinical outcomes following laparoscopic inguinal hernia repair.

PubMed

Tolver, Mette Astrup

2013-07-01

Laparoscopic inguinal hernia repair (TAPP) has gained increasing popularity because of less post-operative pain and a shorter duration of convalescence compared with open hernia repair technique (Lichtenstein). However, investigation of duration of convalescence with non-restrictive recommendations, and a procedure-specific characterization of the early clinical outcomes after TAPP was lacking. Furthermore, optimization of the post-operative period with fibrin sealant versus tacks for fixation of mesh, and the glucocorticoid dexamethasone versus placebo needed to be investigated in randomized clinical trials. The objective of this PhD thesis was to characterize the early clinical outcomes after TAPP and optimize the post-operative period. The four studies included in this thesis have investigated duration of convalescence and procedure-specific post-operative pain and other early clinical outcomes after TAPP. Furthermore, it has been shown that fibrin sealant can improve the early post-operative period compared with tacks, while dexamethasone showed no advantages apart from reduced use of antiemetics compared with placebo. Based on these findings, and the existing knowledge, 3-5 days of convalescence should be expected when 1 day of convalescence is recommended and future studies should focus on reducing intraabdominal pain after TAPP. Fibrin sealant can optimize the early clinical outcomes but the risk of hernia recurrence and chronic pain needs to be evaluated. Dexamethasone should be investigated in higher doses.

Local anaesthetic infiltration at the end of carotid endarterectomy improves post-operative analgesia.

PubMed

Cherprenet, A-L; Rambourdin-Perraud, M; Laforêt, S; Faure, M; Guesmi, N; Baud, C; Rosset, E; Schoeffler, P; Dualé, C

2015-01-01

Wound infiltration at the end of carotid endarterectomy under general anaesthesia is a simple technique that can be delegated to the surgeon. It was hypothesised that this technique could improve early post-operative analgesia by reducing the need for post-operative opioids. Forty patients underwent carotid endarterectomy under general anaesthesia with desflurane and remifentanil supplemented with morphine for post-operative analgesia. In a prospective double-blinded randomised study, patients were allocated pre-operatively to receive either subcutaneous infiltration of both wound edges with 20 ml of 0.75% ropivacaine or infiltration with isotonic saline. The primary outcome was morphine consumption while in the post-anaesthesia care unit (PACU). Pain scores at rest and movement, sedation, and patient satisfaction were the other main outcomes used to assess post-operative analgesia. The median dose of morphine administered in the PACU was 2 mg [0-3] in the ropivacaine vs. 4 mg [3-6] in the placebo group (P = 0.0004, Mann-Whitney's test). Pain at rest and at movement was lower in the ropivacaine group throughout observation in the PACU. No difference was found for both pain and opioid consumption after discharge from the PACU or for patient satisfaction. Sedative events in the early post-operative period were less frequent in the ropivacaine group. Local anaesthetic wound infiltration performed before closure reduces the need for additional opioids, lowers the immediate post-operative pain and improves alertness. These results argue for the use of local infiltration anaesthesia for carotid endarterectomy. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

[Repair of Achilles tendon rupture and early rehabilitation].

PubMed

Delgado-Brambila, H A; Cristiani, D G; Tinajero, E C; Burgos-Elías, V

2012-01-01

The frequency of Achilles tendon tear has increased worldwide. Several factors have been described that help explain the mechanism of injury. The treatment of choice continues to be surgery; conservative treatment is reserved for patients with a high morbidity and mortality. Surgical treatment consists of an open or percutaneous technique. In both modalities we try to achieve prompt mobilization of the operated tendon to obtain better and quicker healing. This prospective study describes our experience with 35 patients enrolled from February 2004 to August 2010. They were treated with open repair, physical rehabilitation and active ankle mobilization before the second postoperative week, and with colchicine. We obtained satisfactory results. Patients recovered complete mobility approximately at postoperative week 6, and from weeks 8 to 10 they could resume their daily work activities and participate in sports and recreational activities. Patients were assessed according to the ATRS classification to measure their clinical results. We had no infections or other major complications. We conclude that the open surgical repair of Achilles tendon tear, prompt mobility, and colchicine provide good results.

[Postoperative entero-cutaneus fistulas--a study of 24 cases].

PubMed

Draganov, K; Dimitrova, V; Bulanov, D; Rusenov, D; Tosheva, E; Dimitrov, K; Tonev, S

2005-01-01

To perform a retrospective study on the experience of the Clinic of General, Liver, Biliary and Pancreatic Surgery, Alexandrovska Hospital in the diagnosis and treatment of patients with acquired entero-cutaneus fistulas and to analyse the early postoperative results. We treated 24 patients with postoperative entero-cutaneous fistulas in the period Jan., 2000 - Aug., 2004. The male sex and the age above 50 were dominent. The primary disease was of oncological origin in 22 cases (91.66%). Anemia, hypoprotenemia and hypoalbuminemia were predisposing and risk factors in 19 cases (79.17%). Fistulography was routinely used for establishing the diagnosis. Surgical treatment was received by all the 6 patients (100%) with small bowel fistulas and by 15 from the 18 patients with large bowel fistulas (83.33%). EARLY POSTOPERATIVE RESULTS: The mortality rate was 4.54% (1 fatal outcome from 22 operated patients). The morbidity rate was 36,36% (8 cases) but none of the complications needed a reoperation. 1. The most frequent causal factor for entero-cutaneus fistulas in our material was an anastomotic leakige after bowel resection (95.83%); 2. The risk for such a coplication is higher in cancer patients with other predisposing pathological factors; 3. From the pahtological and clinical point of view the entero-cutaneus fistulas caused significant disturbances in base-alkaline and electrolyte balance, malnutrition and cahexia; 4. The clinical signs and the fistulography prooved to be reliable diagnostic methods; 5. The preoperative substitution and nutritional therapy had a significant benefit on the postoperative results, especially in cases of small bowel fistulas; 6. The open surgery was the main therapeutical method in the complex treatment of those patients.

Postoperative Copeptin Concentration Predicts Diabetes Insipidus After Pituitary Surgery.

PubMed

Winzeler, Bettina; Zweifel, Christian; Nigro, Nicole; Arici, Birsen; Bally, Martina; Schuetz, Philipp; Blum, Claudine Angela; Kelly, Christopher; Berkmann, Sven; Huber, Andreas; Gentili, Fred; Zadeh, Gelareh; Landolt, Hans; Mariani, Luigi; Müller, Beat; Christ-Crain, Mirjam

2015-06-01

Copeptin is a stable surrogate marker of vasopressin release; the peptides are stoichiometrically secreted from the neurohypophysis due to elevated plasma osmolality or nonosmotic stress. We hypothesized that following stress from pituitary surgery, patients with neurohypophyseal damage and eventual diabetes insipidus (DI) would not exhibit the expected pronounced copeptin elevation. The objective was to evaluate copeptin's accuracy to predict DI following pituitary surgery. This was a prospective multicenter observational cohort study. Three Swiss or Canadian referral centers were used. Consecutive pituitary surgery patients were included. Copeptin was measured postoperatively daily until discharge. Logistic regression models and diagnostic performance measures were calculated to assess relationships of postoperative copeptin levels and DI. Of 205 patients, 50 (24.4%) developed postoperative DI. Post-surgically, median [25th-75th percentile] copeptin levels were significantly lower in patients developing DI vs those not showing this complication: 2.9 [1.9-7.9] pmol/L vs 10.8 [5.2-30.4] pmol/L; P < .001. Logistic regression analysis revealed strong association between postoperative copeptin concentrations and DI even after considering known predisposing factors for DI: adjusted odds ratio (95% confidence interval) 1.41 (1.16-1.73). DI was seen in 22/27 patients with copeptin <2.5 pmol/L (positive predictive value, 81%; specificity, 97%), but only 1/40 with copeptin >30 pmol/L (negative predictive value, 95%; sensitivity, 94%) on postoperative day 1. Lack of standardized DI diagnostic criteria; postoperative blood samples for copeptin obtained during everyday care vs at fixed time points. In patients undergoing pituitary procedures, low copeptin levels despite surgical stress reflect postoperative DI, whereas high levels virtually exclude it. Copeptin therefore may become a novel tool for early goal-directed management of postoperative DI.

Postoperative constipation risk assessment in Turkish orthopedic patients.

PubMed

Şendir, Merdiye; Büyükıylmaz, Funda; Aştı, Türkinaz; Gürpınar, Şengül; Yazgan, İlknur

2012-01-01

This descriptive, correlational study was conducted to describe constipation risk assessment and the affecting factors of constipation risk of patients who have undergone major orthopedic surgery. Data were collected using a patient information form and the Constipation Risk Assessment Scale (CRAS) on the second postoperative day. Data were analyzed using the SPSS version 11.5 for Windows. The mean age of the 83 patients studied was 53.75 ± 21.29 years. Subjects were hospitalized in the orthopedic wards for 14.39 ± 15.17 days, and their current bowel habit was 2.18 ± 1.80 stools per week. Of the sample, 63.9% were female, 69.9% of the patients had a history of previous surgery, 45.8% had hip/knee arthroplasty surgery, and 55.4% had bowel problems during the hospitalization period. Patients had a medium risk for constipation according to the CRAS subscale (gender, mobility, and pharmacological agents). Total CRAS score was 12.73 ± 4.75 (medium risk) on the second postoperative day. In addition, age, marital status, educational level, having a history of surgery, and bowel elimination problems did have a significant effect on constipation risk. On the basis of the findings from this study, nurses must learn the postoperative constipation risk of orthopedic patients to implement safe and effective interventions.

Sentinel lymph node biopsy in early-stage cervical cancer: utility of intraoperative versus postoperative assessment.

PubMed

Fader, A Nickles; Edwards, R P; Cost, M; Kanbour-Shakir, A; Kelley, J L; Schwartz, B; Sukumvanich, P; Comerci, J; Sumkin, J; Elishaev, E; Rohan, L Cencia

2008-10-01

To determine the diagnostic accuracy of sentinel lymph node (SLN) detection using lymphoscintigraphy, intraoperative blue dye, and radiocolloid in patients with early-stage cervical cancer. Intra-cervical injection of technetium-99 sulfur colloid and lymphoscintigraphy were performed preoperatively. Isosulfan blue was injected intra-cervically immediately prior to surgery. SLNs were excised and examined intraoperatively (imprint cytology and frozen section) and postoperatively (H and E histology and immunohistochemistry (IHC) for cytokeratin). Thirty eight patients were evaluable. Laparoscopy and laparotomy were performed in 28.9% and 71.1%, respectively. Subjects had squamous cell carcinoma (n=26), adenocarcinoma (n=10) or adenosquamous (n=2) histologies. 55.3% had cervical tumors <2 cm. The overall SLN detection rate was 92.1%. The external iliac region just distal to the common iliac bifurcation was the most common SLN location. A mean of 2.1 SLNs were detected per patient with bilateral SLNs observed in 47.4%. On final pathology, metastatic nodal disease was identified in 15.7% of patients. Of these, 83.3% were detected in the SLNs. Sensitivity of SLN detection of metastasis was 100% for patients with cervical tumors <2 cm. However intraoperative evaluation by imprint cytology and frozen section correctly identified lymph node metastasis in only 33.3%. SLN detection is feasible and accurately reflects pelvic nodal basin status when performed in early-stage cervical cancer patients. However, while current intraoperative pathology techniques for assessing nodal metastases reliably detect metastases larger than 2 mm, they lack sufficient sensitivity to detect micrometastasis and isolated tumor cells.

Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia.

PubMed

AlQahtani, Awad; Parsyan, Armen; Payne, Richard; Tabah, Roger

2014-08-01

Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. A simple, reliable indicator to identify patients at risk would permit earlier pharmacologic prophylaxis to avoid these adverse outcomes. We examined the role of intact parathormone (PTH) levels 1 hour after surgery as a predictor of post-thyroidectomy hypocalcemia. We prospectively reviewed the cases of consecutive patients undergoing total or completion thyroidectomy. Ionized calcium (Ca(2+)) and intact PTH levels were measured preoperatively and at 1-, 6- and 24-hour intervals postoperatively. The specificity, sensitivity, negative and positive predictive values of the 1-hour PTH serum levels (PTH-1) in predicting 24-hour post-thyroidectomy hypocalcemia and eucalcemia were determined. We reviewed the cases of 149 patients. Biochemical hypocalcaemia (Ca(2+) < 1.1 mmol/L) developed in 38 of 149 (25.7%) patients 24 hours after thyroidectomy. The sensitivity, specificity, positive and negative predictive values of a low PTH-1 were 89%, 100%, 97% and 100%, respectively. We found that PTH-1 levels were predictive of symptomatic hypocalcemia 24 hours after thyroidectomy. Routine use of this assay should be considered, as it could prompt the early administration of calcitriol in patients at risk of hypocalcemia and allow for the safe and timely discharge of patients expected to remain eucalcemic.

PRK vs LASEK vs Epi-LASIK: a comparison of corneal haze, postoperative pain and visual recovery in moderate to high myopia.

PubMed

Reilly, C D; Panday, V; Lazos, V; Mittelstaedt, B R

2010-01-01

The field of refractive surgery continues to evolve amid continued concerns as to which surgical technique minimizes the risk of inducing ectasia. To compare clinical outcomes between PRK, LASEK and Epi-LASIK in moderately to highly myopic eyes (-4.00 D to -8.00 D). A retrospective chart review of 100 PRK eyes, 100 LASEK eyes (with alcohol) and 97 Epi-LASIK eyes was performed. Post-operative pain, uncorrected visual acuity, and corneal haze data was recorded and analyzed at post-op days 1, 4 and 7 and at post-op months 1, 3, 6 and 12. In all groups surgical corrections ranged from -4.00 D to -8.00 D. There was less pain associated with the epi-LASIK procedure especially early (post-op days 1 and 4). Visual recovery was superior within the PRK group during the first post-operative week but by post-op week 4 all three were equal. Haze scores were similar but a trend for less haze was demonstrated with epi-LASIK at 6 and 12 months. Epi-LASIK has a slight advantage over PRK and LASEK early on in the post-op course with regards to pain. Visual recovery is similar by 4 weeks and is better with PRK early. In addition, epi-LASIK trends toward less significant haze. © Nepal Ophthalmic Society.

[Chronic postoperative endophthalmitis caused by Propionibacterium acnes].

PubMed

Kocur, I; Baráková, D; Kuchynka, P; Fiser, I

1998-07-01

There is a report of three cases of chronic postoperative endophthalmitis following cataract operations. In two patients there was proven Propionibacterium acnes. There is presented a technique to obtain specimens for microbiological examination and an overview of clinical experience in treatment of the mentioned less common types of endophthalmitis. Early surgical treatment as well as intraocular injection of vancomycin can help to restore a good visual acuity despite of longlasting inflammation.

Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial.

PubMed

Fukata, Shinji; Kawabata, Yasuji; Fujishiro, Ken; Kitagawa, Yuichi; Kuroiwa, Kojiro; Akiyama, Hirotoshi; Takemura, Marie; Ando, Masahiko; Hattori, Hideyuki

2017-07-01

The aim of this study was to evaluate the safety and efficacy of the early administration haloperidol in preventing the aggravation of postoperative delirium in elderly patients. A total of 201 patients (age ≥75 years) who underwent elective surgery were enrolled. The patients were divided into two groups: the intervention group (n = 101) received prophylactic haloperidol (5 mg); the control group (n = 100) did not. Haloperidol was administered daily during postoperative days 0-5 to the patients who presented with NEECHAM scores of 20-24 when measured at 18:00. The primary endpoint was the incidence of severe postoperative delirium. The incidence of severe postoperative delirium in all patients was 25.1%. The incidence of severe postoperative delirium in the intervention group (18.2%) was significantly lower than that in the control group (32.0%) (p = 0.02). The difference between the two groups was larger when the analysis was limited to the 70 patients who had NEECHAM scores of 20-24 for at least one day during postoperative days 0-5. No adverse effects of the haloperidol were observed. The prophylactic administration of haloperidol at the early stage of delirium significantly reduced the incidence of severe postoperative delirium in elderly patients. Clinical Trial Registration UMIN000007204.

Hematogenous Renal Cell Carcinoma Metastasis in the Postoperative Temporal Bone

PubMed Central

Konishi, Masaya; Suzuki, Kensuke; Iwai, Hiroshi

2017-01-01

Metastatic renal cell carcinoma (RCC) involving the temporal bone is a rare entity. It is usually asymptomatic and misdiagnosis as acute otitis media, mastoiditis, and Ramsay-Hunt syndrome in early onset is not uncommon. We report a case of RCC metastasis to the postoperative temporal bone in the middle of molecular targeted therapy. A 60-year-old man presented left facial palsy with severe retro-auricular pain and he also underwent left middle ear surgery for cholesteatoma more than 30 years before and had been aware of discontinuous otorrhea; therefore, initially we speculated that facial palsy was derived from recurrent cholesteatoma or Ramsay-Hunt syndrome. Exploratory tympanotomy revealed RCC metastasis and postoperative MR indicated hematogenous metastasis. To the best of our knowledge, no report was obtained on temporal bone metastasis in the middle of chemotherapy or hematogenous metastasis in the postoperative middle ear. Metastasis in the temporal bone is still a possible pathological condition despite the development of present cancer therapy. Besides, this case indicates that hematogenous metastasis can occur in the postoperative state of the temporal bone. PMID:28611633

Thermo-responsive in-situ forming hydrogels as barriers to prevent post-operative peritendinous adhesion.

PubMed

Chou, Pang-Yun; Chen, Shih-Heng; Chen, Chih-Hao; Chen, Shih-Hsien; Fong, Yi Teng; Chen, Jyh-Ping

2017-11-01

In this study, we aimed to assess whether thermo-responsive in-situ forming hydrogels based on poly(N-isopropylacrylamide) (PNIPAM) could prevent post-operative peritendinous adhesion. The clinical advantages of the thermo-responsive hydrogels are acting as barrier material to block penetration of fibroblasts, providing mobility and flexibility during application and enabling injection through a small opening to fill spaces of any shape after surgery. The thermo-responsiveness of hydrogels was determined to ensure their clinic uses. By grafting hydrophilic biopolymers chitosan (CS) and hyaluronic acid (HA) to PNIPAM, the copolymer hydrogels show enhanced water retention and lubrication, while reduced volume shrinkage during phase transition. In cell culture experiments, the thermo-responsive hydrogel has good biocompatibility and reduces fibroblast penetration. In animal experiments, the effectiveness of preventing post-operative peritendinous adhesion was studied in a rabbit deep flexor tendon model. From gross examination, histology, bending angles of joints, tendon gliding excursion and pull-out force, HA-CS-PNIPAM (HACPN) was confirmed to be the best barrier material to prevent post-operative peritendinous adhesion compared to PNIPAM and CS-PNIPAM (CPN) hydrogels and a commercial barrier film Seprafilm®. There was no significant difference in the breaking strength of HACPN-treated tendons and spontaneously healed ones, indicating HACPN hydrogel application did not interfere with normal tendon healing. We conclude that HACPN hydrogel can provide the best functional outcomes to significantly prevent post-operative tendon adhesion in vivo. We prepared thermo-responsive in-situ forming hydrogels based on poly(N-isopropylacrylamide) (PNIPAM) to prevent post-operative peritendinous adhesion. The injectable barrier hydrogel could have better anti-adhesive properties than current commercial products by acting as barrier material to block penetration of fibroblasts

Preoperative left ventricular internal dimension in end-diastole as earlier identification of early patent ductus arteriosus operation and postoperative intensive care in very low birth weight infants.

PubMed

Saida, Ken; Nakamura, Tomohiko; Hiroma, Takehiko; Takigiku, Kiyohiro; Yasukochi, Satoshi

2013-10-01

Patent ductus arteriosus (PDA) is common in premature infants. In very low birth weight infants (VLBWI), PDA requires surgical therapy in many cases. It is unclear to know at-risk infants showing cardio-dysfunction after PDA surgery. The purpose of this study was to identify at-risk infants showing cardio-dysfunction after surgery for patent ductus arteriosus (PDA). We examined the relationship between left ventricular (LV) performance before and after PDA ligation in a retrospective observational cohort study. We studied 64 preterm neonates with symptomatic PDA before and after surgical ligation. Echocardiographic examinations were performed pre- and postoperatively. M-mode measurements included left ventricular internal dimension in end-diastole (LVIDd) and LV fractional shortening (FS). All cases showed decreased LVFS after PDA closure. Most cases (49/64, 77%) showed postoperative FS decreased to below normal (<28%). Preoperative relative LVIDd was significantly larger in abnormal FS infants (137 ± 18%) than in normal FS infants (118 ± 11%; p<0.01). A cut-off value of preoperative relative LVIDd (absolute LVIDd/normal value) for predicting postoperative cardio-dysfunction was 127.4% (sensitivity, 0.735; specificity, 0.933; area under curve, 0.817). Determination of preoperative LVIDd might facilitate earlier identification of infants needing early PDA surgery and postoperative intensive care. © 2013 Elsevier Ireland Ltd. All rights reserved.

Functional recovery following early mobilization after middle third clavicle osteosynthesis for acute fractures or nonunion: A case-control study.

PubMed

Lädermann, A; Abrassart, S; Denard, P J; Tirefort, J; Nowak, A; Schwitzguebel, A J

2017-10-01

Good outcomes have been reported after surgical treatment for acute or nonunion of displaced midshaft clavicle fractures. However, the postoperative rehabilitation and timeline for a complete functional recovery are poorly documented. The purpose of the current study was to evaluate the efficacy of an immediate motion protocol following plate fixation of a midshaft clavicle fracture and to compare functional recovery between acute and nonunion cases. Between October 2011 and July 2015, all patients above the age of 18, having either an acute or a nonunion of the midshaft clavicle fracture, were considered as potentially eligible for inclusion in this prospective case-control study. Postoperatively, no immobilization was recommended and patients were to undergo rehabilitation protocol consisting of hourly stretching. Forty-two patients were included (31 with acute and 11 with delayed fixation) at a mean follow-up of 33months (range, 12 to 78months). Surgical complications consisted of one transient frozen shoulder, one delayed union, and two superficial infections. All patients returned to work, retrieved full shoulder range of motion (ROM), and returned to heavy sports and activities. Function returned faster in the acute group compared to the nonunion group based on the SANE score at 2weeks (73±21 vs. 45±26 respectively, P=0.01), SANE score at 6weeks (89±15 vs. 66±23 respectively, P=0.01), SANE score at 3months (96±10 vs. 85±14 respectively, P=0.03), and based on return of full ROM (17±25 vs. 44±31 days respectively, P=0.01). A trend was observed for nonunion cases needing more time to return to work and sports activities. Functional outcome is excellent following the treatment of both acute and non-united clavicle fractures, but recovery occurs earlier following acute treatment. An early mobilization rehab protocol can be safely recommended for both types of conditions and may result in substantial healthcare cost-savings, without increasing

Pilot Study on Early Postoperative Discharge in Pituitary Adenoma Patients: Effect of Socioeconomic Factors and Benefit of Specialized Pituitary Centers.

PubMed

Sarkiss, Christopher A; Lee, James; Papin, Joseph A; Geer, Eliza B; Banik, Rudrani; Rucker, Janet C; Oudheusden, Barbara; Govindaraj, Satish; Shrivastava, Raj K

2015-08-01

Introduction Pituitary neoplasms are benign entities that require distinct diagnostic and treatment considerations. Recent advances in endoscopic transsphenoidal surgery have resulted in shorter lengths of stay (LOS). We implemented a postoperative day (POD) 1 discharge paradigm involving a multidisciplinary approach and detailed preoperative evaluation and review of both medical and socioeconomic factors. Methods The experience of a single neurosurgeon/ears, nose, throat (ENT) team was reviewed, generating a preliminary retrospective database of the first 30 patients who underwent resection of pituitary lesions under the POD 1 discharge paradigm. We assessed multiple axes from their preoperative, in-house, and postoperative care. Results There were 14 men and 16 women with an average age of 53.8 years (range: 27-76 years). There were 22 nonsecretory and 8 secretory tumors with average size of 2.80 cm (range: 1.3-5.0 cm). All 30 patients underwent preoperative ENT evaluation. Average LOS was 1.5 ± 0.7 days. A total of 18 of 30 patients were discharged on POD 1. The insurance status included 15 with public insurance such as emergency Medicaid and 15 with private insurance. Four patients had transient diabetes insipidus (DI); none had permanent DI. Overall, 28 of 30 patients received postoperative steroids. Factors that contributed to LOS > 1 day included public insurance status, two or more medical comorbidities, diabetes mellitus, transient panhypopituitarism, and DI. Conclusion The implementation of a POD 1 discharge plan for pituitary tumors is feasible and safe for elective patients. This implementation requires the establishment of a dedicated Pituitary Center model with experienced team members. The consistent limitation to early discharge was socioeconomic status. Efforts that incorporate the analysis of social disposition parameters with proper management of clinical sequelae are crucial to the maintenance of ideal LOS and optimal patient

Interobserver agreement on the echocardiographic parameters that estimate right ventricular systolic function in the early postoperative period of cardiac surgery.

PubMed

Olmos-Temois, S G; Santos-Martínez, L E; Álvarez-Álvarez, R; Gutiérrez-Delgado, L G; Baranda-Tovar, F M

2016-11-01

To know the variability of transthoracic echocardiographic parameters that assess right ventricular systolic function by analyzing interobserver agreement in the early postoperative period of cardiovascular surgery. To assess the feasibility of these echocardiographic measurements. A cross-sectional study, double-blind pilot study was carried out from May 2011 to February 2013. Cardiovascular postoperative critical care at the National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico. Consecutive, non-probabilistic sampling. Fifty-six patients were studied in the postoperative period of cardiac surgery. The first echocardiographic parameters were obtained between 6-8hours after cardiac surgery, followed by blinded second measurements. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity on tissue Doppler imaging (VSPAT), diameters and right ventricular outflow area, tract fractional shortening. The agreement was analyzed by the Bland-Altman method, and its magnitude was assessed by the intraclass correlation coefficient (95% confidence interval). Both observers evaluated TAPSE and VSPAT in 48 patients (92%). The average TAPSE was 11.68±4.53mm (range 4-27mm). Right ventricular systolic dysfunction was observed in 41 cases (85%) and normal TAPSE in 7 patients (15%). The average difference and its limits according to TAPSE were -0.917±2.95 (-6.821, 4.988), with a magnitude of 0.725 (0.552, 0.837); the tricuspid annular peak systolic velocity on tissue Doppler imaging was -0.001±0.015 (-0.031, 0.030), and its magnitude 0.825 (0.708, 0.898), respectively. VSPAT and TAPSE were estimated by both observers in 92% of the patients, these parameters exhibiting the lowest interobserver variability. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Early postoperative cartilage evaluation by magnetic resonance imaging using T2 mapping after arthroscopic partial medial meniscectomy.

PubMed

Kato, Kammei; Arai, Yuji; Ikoma, Kazuya; Nakagawa, Shuji; Inoue, Hiroaki; Kan, Hiroyuki; Matsuki, Tomohiro; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2015-12-01

This study was performed to quantitatively evaluate postoperative changes in cartilage by T2 mapping after arthroscopic partial medial meniscectomy. The study enrolled 17 patients with 20 knees that underwent arthroscopic partial medial meniscectomy. MRI was performed preoperatively and at six months postoperatively, with subjects evaluated by T2 mapping of the central part of the medial condyle of the femur in the sagittal plane. Regions of interest (ROIs) were set at 10 points between the point of intersection of the anatomical axis of the femur and the articular surface of the medial condyle and posterior area approximately 90 degrees to the anatomical axis. Pre- and postoperative T2 values at each ROI were evaluated. Postoperative T2 values were significantly longer than preoperative values at approximately 20, 30, 40, and 50 degrees to the anatomical axis of the femur. The maximum change between pre- and postoperative T2 values was +6.65% at 30 degrees to the anatomical axis. Mechanical stress at positions approximately 20, 30, 40, and 50 degrees relative to the anatomical axis of the femur increased soon after arthroscopic medial meniscectomy. These findings indicate the start of degeneration, via disorganization of collagen arrays, of the articular cartilage and increased water content. Copyright © 2015. Published by Elsevier Inc.

Early Toxicity in Patients Treated With Postoperative Proton Therapy for Locally Advanced Breast Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cuaron, John J.; Chon, Brian; Tsai, Henry

Purpose: To report dosimetry and early toxicity data in breast cancer patients treated with postoperative proton radiation therapy. Methods and Materials: From March 2013 to April 2014, 30 patients with nonmetastatic breast cancer and no history of prior radiation were treated with proton therapy at a single proton center. Patient characteristics and dosimetry were obtained through chart review. Patients were seen weekly while on treatment, at 1 month after radiation therapy completion, and at 3- to 6-month intervals thereafter. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Frequencies of toxicities were tabulated. Results: Median dose delivered wasmore » 50.4 Gy (relative biological equivalent [RBE]) in 5 weeks. Target volumes included the breast/chest wall and regional lymph nodes including the internal mammary lymph nodes (in 93%). No patients required a treatment break. Among patients with >3 months of follow-up (n=28), grade 2 dermatitis occurred in 20 patients (71.4%), with 8 (28.6%) experiencing moist desquamation. Grade 2 esophagitis occurred in 8 patients (28.6%). Grade 3 reconstructive complications occurred in 1 patient. The median planning target volume V95 was 96.43% (range, 79.39%-99.60%). The median mean heart dose was 0.88 Gy (RBE) [range, 0.01-3.20 Gy (RBE)] for all patients, and 1.00 Gy (RBE) among patients with left-sided tumors. The median V20 of the ipsilateral lung was 16.50% (range, 6.1%-30.3%). The median contralateral lung V5 was 0.34% (range, 0%-5.30%). The median maximal point dose to the esophagus was 45.65 Gy (RBE) [range, 0-65.4 Gy (RBE)]. The median contralateral breast mean dose was 0.29 Gy (RBE) [range, 0.03-3.50 Gy (RBE)]. Conclusions: Postoperative proton therapy is well tolerated, with acceptable rates of skin toxicity. Proton therapy favorably spares normal tissue without compromising target coverage. Further follow-up is necessary to assess for clinical outcomes and

Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy.

PubMed

Shi, Hao-Jun; Jin, Chen; Fu, De-Liang

2017-01-14

To evaluate the impact of glycemic control and nutritional status after total pancreatectomy (TP) on complications, tumor recurrence and overall survival. Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified. High early postoperative fasting blood glucose (FBG) levels (OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels (OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative HbA1c levels over 7% (HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative HbA1c levels over 7% had much poorer overall survival than those with HbA1c levels less than 7% (9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus (HR = 15.019, 95%CI: 1.278-176.211, P = 0.031) and alcohol history (B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively. At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on long-term outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

Albumin, a marker for post-operative myocardial damage in cardiac surgery.

PubMed

van Beek, Dianne E C; van der Horst, Iwan C C; de Geus, A Fred; Mariani, Massimo A; Scheeren, Thomas W L

2018-06-06

Low serum albumin (SA) is a prognostic factor for poor outcome after cardiac surgery. The aim of this study was to estimate the association between pre-operative SA, early post-operative SA and postoperative myocardial injury. This single center cohort study included adult patients undergoing cardiac surgery during 4 consecutive years. Postoperative myocardial damage was defined by calculating the area under the curve (AUC) of troponin (Tn) values during the first 72 h after surgery and its association with SA analyzed using linear regression and with multivariable linear regression to account for patient related and procedural confounders. The association between SA and the secondary outcomes (peri-operative myocardial infarction [PMI], requiring ventilation >24 h, rhythm disturbances, 30-day mortality) was studied using (multivariable) log binomial regression analysis. In total 2757 patients were included. The mean pre-operative SA was 29 ± 13 g/l and the mean post-operative SA was 26 ± 6 g/l. Post-operative SA levels (on average 26 min after surgery) were inversely associated with postoperative myocardial damage in both univariable analysis (regression coefficient - 0.019, 95%CI -0.022/-0.015, p < 0.005) and after adjustment for patient related and surgical confounders (regression coefficient - 0.014 [95% CI -0.020/-0.008], p < 0.0005). Post-operative albumin levels were significantly correlated with the amount of postoperative myocardial damage in patients undergoing cardiac surgery independent of typical confounders. Copyright © 2018. Published by Elsevier Inc.

Revisiting the applicability of adult early post-operative nausea and vomiting risk factors for the paediatric patient: A prospective study using cotinine levels in children undergoing adenotonsillectomies

PubMed Central

Chau, Destiny F; Reddy, Arundathi; Breheny, Patrick; Young, Anna Rebecca; Ashford, Eric; Song, Megan; Zhang, Christina; Taylor, Tammy; Younes, Abbas; Vazifedan, Turaj

2017-01-01

Background and Aims: Post-operative vomiting (POV) in children remains a significant clinical problem. This prospective study aims to investigate the applicability of well-established adult early post-operative nausea and vomiting (PONV) risk factors on paediatric POV after adenotonsillectomies under regulated anaesthetic conditions. Methods: After Institutional Review Board approval, 213 children aged 3–10-year-old were enrolled. The participants had pre-operative questionnaires completed, followed protocolised anaesthetic plans and had saliva analysed for cotinine. The primary outcomes were POV as correlated with age, gender, family or personal history of PONV, motion sickness history, opioid use, surgical time, anaesthetic time and environmental tobacco smoke (ETS) exposure, as assessed by cotinine levels and questionnaire reports. Data on analgesics, antiemetics and POV incidence before post-anaesthesia care unit discharge were collected. Statistical analysis was done through multiple logistic regression. Results: A total of 200 patients finalised the study. Early POV occurred in 32%. Family history of PONV (odds ratio [OR] = 5.3, P < 0.01) and motion sickness history (OR = 4.4, P = 0.02) were highly significant risk factors. Age reached borderline statistical significance (OR = 1.4, P = 0.05). None of the other factors reached statistical significance. Conclusion: Early POV occurs frequently in paediatric patients undergoing adenotonsillectomies. In this paediatric-aged group, the incidence of POV was affected by the family history of PONV, and history of motion sickness. Age, female gender, opioid use, surgical and anaesthetic times did not affect the incidence of POV. ETS exposure, as assessed by cotinine levels and questionnaire reports, had no protective effect on early paediatric POV. PMID:29307901

The effect of implant macro-thread design on implant stability in the early post-operative period: a randomized, controlled pilot study.

PubMed

McCullough, Jeffrey J; Klokkevold, Perry R

2017-10-01

Available literature suggests there is a transient drop in implant stability from approximately week 0 to week 3-4 as a result of peri-implant bone remodeling as it transitions from a primary, mechanical stability to a secondary, biological stability. Research investigating the influence of macro-thread design on this process is scant. The specific aim of this study was to evaluate the role of macro-thread design on implant stability in the early post-operative healing period using resonance frequency analysis (RFA). Seven patients, each missing at least two posterior teeth in the same arch, were included in the study. Three patients qualified for four implants resulting in a total of 10 matched pairs. All sites were healed (>6 months), non-grafted sites with sufficient bone to place implants. Each site in a matched pair was randomly assigned to receive either a control (Megagen EZ Plus Internal; EZ) or test (Megagen AnyRidge; AR) implant. The test implant incorporates a novel thread design with a wide thread depth and increased thread pitch. RFA was used to determine implant stability quotient (ISQ) values for each implant at the time of placement and weekly for the first 8 weeks. Implants consistently achieved a relatively high insertion torque (30-45 N/cm) and high initial ISQ value (79.8 ± 1.49). Baseline ISQ values for test (AR; 79.55 ± 1.61) and control (EZ; 80.05 ± 1.37) implants were similar. A general pattern of stability from baseline through all eight follow-up evaluations was observed for the test implants. A pattern of decreasing ISQ values was observed for the control implants across the early follow-up evaluations up to week four, where the value plateaued. There was a statistically significant main effect due to implant type (P < 0.01) and a statistically significant interaction between implant type and time (P < 0.01), indicating that the test and control implants performed differently at certain time points. Within the limitations

Postoperative management of dogs with gastric dilatation and volvulus.

PubMed

Bruchim, Yaron; Kelmer, Efrat

2014-09-01

The objective of the study was to review the veterinary literature for evidence-based and common clinical practice supporting the postoperative management of dogs with gastric dilatation and volvulus (GDV). GDV involves rapid accumulation of gas in the stomach, gastric volvulus, increased intragastric pressure, and decreased venous return. GDV is characterized by relative hypovolemic-distributive and cardiogenic shock, during which the whole body may be subjected to inadequate tissue perfusion and ischemia. Intensive postoperative management of the patients with GDV is essential for survival. Therapy in the postoperative period is focused on maintaining tissue perfusion along with intensive monitoring for prevention and early identification of ischemia-reperfusion injury (IRI) and consequent potential complications such as hypotension, cardiac arrhythmias, acute kidney injury (AKI), gastric ulceration, electrolyte imbalances, and pain. In addition, early identification of patients in need for re-exploration owing to gastric necrosis, abdominal sepsis, or splenic thrombosis is crucial. Therapy with intravenous lidocaine may play a central role in combating IRI and cardiac arrhythmias. The most serious complications of GDV are associated with IRI and consequent systemic inflammatory response syndrome and multiple organ dysfunction syndrome. Other reported complications include hypotension, AKI, disseminated intravascular coagulation, gastric ulceration, and cardiac arrhythmias. Despite appropriate medical and surgical treatment, the reported mortality rate in dogs with GDV is high (10%-28%). Dogs with GDV that are affected with gastric necrosis or develop AKI have higher mortality rates. Copyright © 2014 Elsevier Inc. All rights reserved.

Understanding postoperative fatigue.

PubMed

Rose, E A; King, T C

1978-07-01

Performance characteristics of the central nervous, cardiovascular, respiratory and muscular systems in man postoperatively have received little investigative attention, despite the well known syndrome of postoperative fatigue. The impairmen in perception and psychomotor skills that has been shown to result from caloric restriction, bedrest, sedation and sleep deprivation suggests that a similar deficit may occur after surgical procedures. After a simple elective surgical procedure, maximal oxygen uptake decreases and the adaptability of heart rate to submaximal workloads is impaired. Similar deleterious effects on cardiorespiratory performance have been documented with starvation and bedrest; an understanding of cardiorespiratory performance postoperatively awaits further investigation. Maximal muscular force of contraction is also impaired by caloric restriction and bedrest, suggesting that similar effects may be seen in the postoperative state, although this has not been studied. A better understanding of the syndrome of postoperative fatigue could be achieved by a descriptive analysis of physiologic performance postoperatively. Such descriptive data could form the basis for objective evaluation of therapeutic measures intended to improve performance, such as nutritional supplementation and pharmacologic intervention. The observation that exercise with the patient in the supine position may decrease the impairment in maximal aerobic power otherwise expected in immobilized patients suggests that controlled exercise therapy may be of value in reducing physiologic impairment postoperatively.

Early agriculture and crop transmission among Bronze Age mobile pastoralists of Central Eurasia.

PubMed

Spengler, Robert; Frachetti, Michael; Doumani, Paula; Rouse, Lynne; Cerasetti, Barbara; Bullion, Elissa; Mar'yashev, Alexei

2014-05-22

Archaeological research in Central Eurasia is exposing unprecedented scales of trans-regional interaction and technology transfer between East Asia and southwest Asia deep into the prehistoric past. This article presents a new archaeobotanical analysis from pastoralist campsites in the mountain and desert regions of Central Eurasia that documents the oldest known evidence for domesticated grains and farming among seasonally mobile herders. Carbonized grains from the sites of Tasbas and Begash illustrate the first transmission of southwest Asian and East Asian domesticated grains into the mountains of Inner Asia in the early third millennium BC. By the middle second millennium BC, seasonal camps in the mountains and deserts illustrate that Eurasian herders incorporated the cultivation of millet, wheat, barley and legumes into their subsistence strategy. These findings push back the chronology for domesticated plant use among Central Eurasian pastoralists by approximately 2000 years. Given the geography, chronology and seed morphology of these data, we argue that mobile pastoralists were key agents in the spread of crop repertoires and the transformation of agricultural economies across Asia from the third to the second millennium BC.

Association Between Preoperative Hemoglobin A1c Levels, Postoperative Hyperglycemia, and Readmissions Following Gastrointestinal Surgery.

PubMed

Jones, Caroline E; Graham, Laura A; Morris, Melanie S; Richman, Joshua S; Hollis, Robert H; Wahl, Tyler S; Copeland, Laurel A; Burns, Edith A; Itani, Kamal M F; Hawn, Mary T

2017-11-01

Preoperative hyperglycemia is associated with adverse postoperative outcomes among patients who undergo surgery. Whether preoperative hemoglobin A1c (HbA1c) or postoperative glucose levels are more useful in predicting adverse events following surgery is uncertain in the current literature. To examine the use of preoperative HbA1c and early postoperative glucose levels for predicting postoperative complications and readmission. In this observational cohort study, inpatient gastrointestinal surgical procedures performed at 117 Veterans Affairs hospitals from 2007 to 2014 were identified, and cases of known infection within 3 days before surgery were excluded. Preoperative HbA1c levels were examined as a continuous and categorical variable (<5.7%, 5.7%-6.5%, and >6.5%). A logistic regression modeled postoperative complications and readmissions with the closest preoperative HbA1c within 90 days and the highest postoperative glucose levels within 48 hours of undergoing surgery. Postoperative complications and 30-day unplanned readmission following discharge. Of 21 541 participants, 1193 (5.5%) were women, and the mean (SD) age was 63.7 (10.6) years. The cohort included 23 094 operations with measurements of preoperative HbA1c levels and postoperative glucose levels. The complication and 30-day readmission rates were 27.2% and 14.7%, respectively. In logistic regression models adjusting for HbA1c, postoperative glucose levels, postoperative insulin use, diabetes, body mass index (calculated as weight in kilograms divided by height in meters squared), and other patient and procedural factors, peak postoperative glucose levels of more than 250 mg/dL were associated with increased 30-day readmissions (odds ratio, 1.18; 95% CI, 0.99-1.41; P = .07). By contrast, a preoperative HbA1c of more than 6.5% was associated with decreased 30-day readmissions (odds ratio, 0.85; 95% CI, 0.74-0.96; P = .01). As preoperative HbA1c increased, the frequency of 48-hour

The effect of sugammadex on postoperative cognitive function and recovery.

PubMed

Pişkin, Özcan; Küçükosman, Gamze; Altun, Deniz Utku; Çimencan, Murat; Özen, Banu; Aydın, Bengü Gülhan; Okyay, Rahşan Dilek; Ayoğlu, Hilal; Turan, Işıl Özkoçak

2016-01-01

Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1h later the MoCA tests were repeated. Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p>0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (p<0.0001). Recovery time was 8.26min in Group S and 16.93min in Group N (p<0.0001). We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Electrical Acupoint Stimulation for Postoperative Recovery

ClinicalTrials.gov

2018-03-30

Postoperative Complications; Postoperative Nausea and Vomiting; Postoperative Infection; Postoperative Delirium; Postoperative Pneumonia; Deep Vein Thrombosis; Postoperative Retention of Urine; Postoperative Recovery

Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years.

PubMed

Nathan, Meena; Karamichalis, John; Liu, Hua; Gauvreau, Kimberley; Colan, Steven; Saia, Matthew; Pigula, Frank; Fynn-Thompson, Francis; Emani, Sitaram; Baird, Christopher; Mayer, John E; del Nido, Pedro J

2014-01-01

Previous work in our institution has indicated that the Technical Performance Score (TPS) is highly associated with early outcomes in select subsets of procedures and age groups. We hypothesized that the TPS could predict early outcomes in a wide range of diagnoses and age groups. Consecutive patients discharged from January 2011 to March 2013 were prospectively evaluated. The TPS was assigned according to the discharge echocardiographic findings and the need for reinterventions in the anatomic area of interest. Case complexity was determined using Risk Adjustment for Congenital Heart Surgery (RACHS-1) categories. Early mortality and postoperative adverse events were recorded. Relationships between the TPS and outcomes were assessed after adjusting for the baseline patient characteristics. The median age of the 1926 patients was 1.8 years (range, 0 days to 68 years). Bypass was used in 1740 (90%); 322 (17%) were neonates, 520 (27%) infants, 873 (45%) children, 211 (11%) adults. TPS was class 1 (optimal) in 956 (50%), class 2 (adequate) in 584 (30%), and class 3 (inadequate) in 226 (12%); 160 patients (8%) could not be scored. A total of 51 early deaths (2.6%) and 111 adverse events (5.7%) occurred. On univariate analysis, age, RACHS-1 category, and TPS were significantly associated with mortality and the occurrence of adverse events. On multivariate modeling, class 3 (inadequate) TPS was strongly associated with mortality (odds ratio, 16.9; 95% confidence interval, 6.7-42.9; P < .001), adverse events (odds ratio, 6.9; 95% confidence interval, 4.1-11.6; P < .001), and postoperative intensive care unit length of stay (coefficient, 2.3; 95% confidence interval, 2.0-2.6; P < .001) after adjusting for other covariates. The TPS is strongly associated with early outcomes across a wide range of ages and disease complexity and can serve as important tool for self-assessment and quality improvement. Copyright © 2014 The American Association for Thoracic Surgery

Mobile phone base stations and early childhood cancers: case-control study.

PubMed

Elliott, Paul; Toledano, Mireille B; Bennett, J; Beale, L; de Hoogh, K; Best, N; Briggs, D J

2010-06-22

To investigate the risk of early childhood cancers associated with the mother's exposure to radiofrequency from and proximity to macrocell mobile phone base stations (masts) during pregnancy. Case-control study. Cancer registry and national birth register data in Great Britain. 1397 cases of cancer in children aged 0-4 from national cancer registry 1999-2001 and 5588 birth controls from national birth register, individually matched by sex and date of birth (four controls per case). Incidence of cancers of the brain and central nervous system, leukaemia, and non-Hodgkin's lymphomas, and all cancers combined, adjusted for small area measures of education level, socioeconomic deprivation, population density, and population mixing. Mean distance of registered address at birth from a macrocell base station, based on a national database of 76,890 base station antennas in 1996-2001, was similar for cases and controls (1107 (SD 1131) m v 1073 (SD 1130) m, P=0.31), as was total power output of base stations within 700 m of the address (2.89 (SD 5.9) kW v 3.00 (SD 6.0) kW, P=0.54) and modelled power density (-30.3 (SD 21.7) dBm v -29.7 (SD 21.5) dBm, P=0.41). For modelled power density at the address at birth, compared with the lowest exposure category the adjusted odds ratios were 1.01 (95% confidence interval 0.87 to 1.18) in the intermediate and 1.02 (0.88 to 1.20) in the highest exposure category for all cancers (P=0.79 for trend), 0.97 (0.69 to 1.37) and 0.76 (0.51 to 1.12), respectively, for brain and central nervous system cancers (P=0.33 for trend), and 1.16 (0.90 to 1.48) and 1.03 (0.79 to 1.34) for leukaemia and non-Hodgkin's lymphoma (P=0.51 for trend). There is no association between risk of early childhood cancers and estimates of the mother's exposure to mobile phone base stations during pregnancy.

Early clinical results of a high-flexion, posterior-stabilized, mobile-bearing total knee arthroplasty: a US investigational device exemption trial.

PubMed

Scuderi, Giles R; Hedden, David R; Maltry, John A; Traina, Steven M; Sheinkop, Mitchell B; Hartzband, Mark A

2012-03-01

Between May 2001 and June 2004, 388 total knee arthroplasty cases were enrolled in a prospective, randomized, multicenter investigational device exemption trial. Patients received either the investigational high-flexion mobile-bearing knee or a fixed-bearing control. At 2 to 4 years of follow-up, results in 293 patients with degenerative joint disease were compared using Knee Society Assessment and Function scores, radiographic results, complications analysis, and survival estimates. The mobile-bearing and fixed-bearing groups demonstrated similar, significant improvement over preoperative assessments in Knee Scores, maximum flexion, and range of motion. One mobile-bearing arthroplasty required revision. Radiographic results were unremarkable, and implant-related complications were rare in both groups. At this early follow-up, the investigational high-flexion mobile-bearing knee and its fixed-bearing counterpart demonstrated comparable, effective performance. Copyright © 2012 Elsevier Inc. All rights reserved.

Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia

PubMed Central

AlQahtani, Awad; Parsyan, Armen; Payne, Richard; Tabah, Roger

2014-01-01

Background Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. A simple, reliable indicator to identify patients at risk would permit earlier pharmacologic prophylaxis to avoid these adverse outcomes. We examined the role of intact parathormone (PTH) levels 1 hour after surgery as a predictor of post-thyroidectomy hypocalcemia. Methods We prospectively reviewed the cases of consecutive patients undergoing total or completion thyroidectomy. Ionized calcium (Ca2+) and intact PTH levels were measured preoperatively and at 1-, 6- and 24-hour intervals postoperatively. The specificity, sensitivity, negative and positive predictive values of the 1-hour PTH serum levels (PTH-1) in predicting 24-hour post-thyroidectomy hypocalcemia and eucalcemia were determined. Results We reviewed the cases of 149 patients. Biochemical hypocalcaemia (Ca2+ < 1.1 mmol/L) developed in 38 of 149 (25.7%) patients 24 hours after thyroidectomy. The sensitivity, specificity, positive and negative predictive values of a low PTH-1 were 89%, 100%, 97% and 100%, respectively. Conclusion We found that PTH-1 levels were predictive of symptomatic hypocalcemia 24 hours after thyroidectomy. Routine use of this assay should be considered, as it could prompt the early administration of calcitriol in patients at risk of hypocalcemia and allow for the safe and timely discharge of patients expected to remain eucalcemic. PMID:25078927

Rich do not rise early: spatio-temporal patterns in the mobility networks of different socio-economic classes

PubMed Central

Hurtado, Rafael G.; Floría, Luis Mario

2016-01-01

We analyse the urban mobility in the cities of Medellín and Manizales (Colombia). Each city is represented by six mobility networks, each one encoding the origin-destination trips performed by a subset of the population corresponding to a particular socio-economic status. The nodes of each network are the different urban locations whereas links account for the existence of a trip between two different areas of the city. We study the main structural properties of these mobility networks by focusing on their spatio-temporal patterns. Our goal is to relate these patterns with the partition into six socio-economic compartments of these two societies. Our results show that spatial and temporal patterns vary across these socio-economic groups. In particular, the two datasets show that as wealth increases the early-morning activity is delayed, the midday peak becomes smoother and the spatial distribution of trips becomes more localized. PMID:27853531

Postoperative treatment of metacarpal fractures-Classical physical therapy compared with a home exercise program.

PubMed

Gülke, Joachim; Leopold, Barbara; Grözinger, Daniel; Drews, Björn; Paschke, Stephan; Wachter, Nikolaus J

Prospective cohort randomized controlled trial. Is either a home exercise (HE) program or traditional physical therapy (PT) more effective in the postoperative management of metacarpal fractures? Sixty patients suffering from nonthumb metacarpal fractures who received mobilization-stable open reduction and internal fixation were included. All patients were prospectively randomized into either the PT group or the HE group. Follow-up examinations at 2, 6 and 12 weeks postoperatively. After 2 weeks, the range of motion (ROM) in both groups was still severely reduced. Twelve weeks after surgery the ROM improved to 245° (PT) and 256° (HE). Grip strength after 6 weeks was 68% (PT) and 71% (HE) when compared to the non-injured hand, improving to 91% (PT) and 93% (HE) after 12 weeks. Study results show that both HE program and traditional PT are effective in the postoperative management of metacarpal fractures. II. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Transcutaneous electrical nerve stimulation effect on postoperative complications.

PubMed

Sezen, Celal Bugra; Akboga, Suleyman Anil; Celik, Ali; Kalafat, Cem Emrah; Tastepe, Abdullah Irfan

2017-05-01

Objectives Transcutaneous electrical nerve stimulation has been used to control post-thoracotomy pain, with conflicting results. We aimed to assess its efficacy on post-thoracotomy pain and early complications. Methods Between January 2012 and December 2014, 87 patients underwent a standard posterolateral thoracotomy and were randomized in 2 groups: group T was 43 patients who had transcutaneous electrical nerve stimulation and group C was 44 patients who had placebo stimulation with an inoperative device. Pain score was measured using a visual analogue scale ranging from 0 to 10. The frequency of the device was set at 100 Hz and pulse width at 100 ms. Results There were no statistically significant differences in the demographic characteristics of the 2 groups, and there was no difference in the duration of hospitalization (4.74 ± 1.6 vs. 5.23 ± 1.5 days; p = 0.06). Postoperative pain scores of the two groups showed that on postoperative day 0, 1, and 2, the mean pain scores of group T were significantly lower ( p = 0.001, p < 0.001, and p = 0.003). There were no significant differences in early complications or surgical technique. Conclusion We concluded that electrical stimulation is a safe and effective adjunctive therapy for acute post-thoracotomy pain control. However, it does not affect the duration of hospitalization or early pulmonary complications.

Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy.

PubMed

Oh, Sang Gi; Jung, Yochun; Jheon, Sanghoon; Choi, Yunhee; Yun, Ju Sik; Na, Kook Joo; Ahn, Byoung Hee

2017-01-23

Results of studies to predict prolonged air leak (PAL; air leak longer than 5 days) after pulmonary lobectomy have been inconsistent and are of limited use. We developed a new scale representing the amount of early postoperative air leak and determined its correlation with air leak duration and its potential as a predictor of PAL. We grade postoperative air leak using a 5-grade scale. All 779 lobectomies from January 2005 to December 2009 with available medical records were reviewed retrospectively. We devised six 'SUM' variables using air leak grades in the initial 72 h postoperatively. Excluding unrecorded cases and postoperative broncho-pleural fistulas, there were 720 lobectomies. PAL occurred in 135 cases (18.8%). Correlation analyses showed each SUM variable highly correlated with air leak duration, and the SUM 4to9 , which was the sum of six consecutive values of air leak grades for every 8 h record on postoperative days 2 and 3, was proved to be the most powerful predictor of PAL; PAL could be predicted with 75.7% and 77.7% positive and negative predictive value, respectively, when SUM 4to9  ≥ 16. When 4 predictors derived from multivariable logistic regression of perioperative variables were combined with SUM 4to9 , there was no significant increase in predictability compared with SUM 4to9 alone. This simple new method to predict PAL using SUM 4to9 showed that the amount of early postoperative air leak is the most powerful predictor of PAL, therefore, grading air leak after pulmonary lobectomy is a useful method to predict PAL.

Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery? Cluster randomised controlled trial.

PubMed

Silva, Y R; Li, S K; Rickard, M J F X

2013-09-01

To investigate whether the inclusion of deep breathing exercises in physiotherapy-directed early mobilisation confers any additional benefit in reducing postoperative pulmonary complications (PPCs) when patients are treated once daily after elective open upper abdominal surgery. This study also compared postoperative outcomes following early and delayed mobilisation. Cluster randomised controlled trial. Single-centre study in a teaching hospital. Eighty-six high-risk patients undergoing elective open upper abdominal surgery. Three groups: early mobilisation (Group A), early mobilisation plus breathing exercises (Group B), and delayed mobilisation (mobilised from third postoperative day) plus breathing exercises (Group C). PPCs and postoperative outcomes [number of days until discharge from physiotherapy, physiotherapy input and length of stay (LOS)]. There was no significant difference in PPCs between Groups A and B. The LOS for Group A {mean 10.7 [standard deviation (SD) 5.0] days} was significantly shorter than the LOS for Groups B [mean 16.7 (SD 9.7) days] and C [mean 15.2 (SD 9.8) days; P=0.036]. The greatest difference was between Groups A and B (mean difference -5.93, 95% confidence interval -10.22 to -1.65; P=0.008). Group C had fewer smokers (26%) and patients with chronic obstructive pulmonary disease (0%) compared with Group B (53% and 14%, respectively). This may have led to fewer PPCs in Group C, but the difference was not significant. Despite Group C having fewer PPCs and less physiotherapy input, the number of days until discharge from physiotherapy and LOS were similar to Group B. The addition of deep breathing exercises to physiotherapy-directed early mobilisation did not further reduce PPCs compared with mobility alone. PPCs can be reduced with once-daily physiotherapy if the patients are mobilised to a moderate level of exertion. Delayed mobilisation tended to increase physiotherapy input and the number of days until discharge from physiotherapy

Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study.

PubMed

Pawanindra, Lal; Vindal, Anubhav; Midha, Manoj; Nagpal, Prashant; Manchanda, Alpana; Chander, Jagdish

2015-10-01

Pre- and post-operative stomach volumes can be important determinants for effectiveness of laparoscopic sleeve gastrectomy (LSG) in causing weight loss. There is little existing data on the volumes of stomach preoperatively and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi-detector CT and to correlate it with early post-operative weight loss. Twenty consecutive patients with BMI ≥ 40 kg/m(2) and medical comorbidities underwent LSG between October 2011 and October 2013 and were analysed prospectively. The pre-operative stomach volume was measured by MDCT done 1-3 days before the surgery. LSG was performed in the standard manner using a 36F bougie. The volume of excised stomach was measured by distending the specimen with saline. MDCT of the upper abdomen was repeated 3 months postoperatively to calculate the gastric sleeve volume. Weight loss and resolution of comorbidities were documented. The mean pre-operative weight of patients was 123.90 kg, and the mean pre-operative stomach volume on MDCT was 1,067 ml. The stomach volume on pre-operative MDCT correlated with pre-operative weight and BMI. The mean volume of the excised stomach was 859 ml when measured by distension of the specimen and 850 ml on MDCT. After 3 months post surgery, the mean volume of gastric sleeve on MDCT was 217 ml, and the mean weight of the patients was 101.22 kg. The volume of the excised stomach calculated by MDCT correlated with the weight loss achieved 3 months postoperatively. However, no correlation was seen between the gastric sleeve volume 3 months postoperatively and weight loss during this period. MDCT is a good method to measure gastric volume before and after LSG. Early post-operative weight loss (3 months) correlates well with the volume of the excised stomach but not with that of the gastric sleeve.

Modelling physiological deterioration in post-operative patient vital-sign data.

PubMed

Pimentel, Marco A F; Clifton, David A; Clifton, Lei; Watkinson, Peter J; Tarassenko, Lionel

2013-08-01

Patients who undergo upper-gastrointestinal surgery have a high incidence of post-operative complications, often requiring admission to the intensive care unit several days after surgery. A dataset comprising observational vital-sign data from 171 post-operative patients taking part in a two-phase clinical trial at the Oxford Cancer Centre, was used to explore the trajectory of patients' vital-sign changes during their stay in the post-operative ward using both univariate and multivariate analyses. A model of normality based vital-sign data from patients who had a "normal" recovery was constructed using a kernel density estimate, and tested with "abnormal" data from patients who deteriorated sufficiently to be re-admitted to the intensive care unit. The vital-sign distributions from "normal" patients were found to vary over time from admission to the post-operative ward to their discharge home, but no significant changes in their distributions were observed from halfway through their stay on the ward to the time of discharge. The model of normality identified patient deterioration when tested with unseen "abnormal" data, suggesting that such techniques may be used to provide early warning of adverse physiological events.

Effect of chewing gum on the postoperative recovery of gastrointestinal function

PubMed Central

Ge, Wei; Chen, Gang; Ding, Yi-Tao

2015-01-01

Postoperative gastrointestinal dysfunction remains a source of morbidity and the major determinant of length of stay after abdominal operation. There are many different reasons for postoperative gastrointestinal dysfunction such as stress response, perioperative interventions, bowel manipulation and so on. The mechanism of enhanced recovery from postoperative gastrointestinal dysfunction with the help of chewing gum is believed to be the cephalic-vagal stimulation of digestion which increases the promotability of neural and humoral factors that act on different parts of the gastrointestinal tract. Recently, there were a series of randomized controlled trials to confirm the role of chewing gum in the recovery of gastrointestinal function. The results suggested that chewing gum enhanced early recovery of bowel function following abdominal surgery expect the gastrointestinal surgery. However, the effect of chewing gum in gastrointestinal surgery was controversial. PMID:26550107

Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring

PubMed Central

Wiseman, Jason

2016-01-01

Background Surgical patients are increasingly using mobile health (mHealth) platforms to monitor recovery and communicate with their providers in the postdischarge period. Despite widespread enthusiasm for mHealth, few studies evaluate the usability or user experience of these platforms. Objective Our objectives were to (1) develop a novel image-based smartphone app for postdischarge surgical wound monitoring, and (2) rigorously user test it with a representative population of vascular and general surgery patients. Methods A total of 9 vascular and general surgery inpatients undertook usability testing of an internally developed smartphone app that allows patients to take digital images of their wound and answer a survey about their recovery. We followed the International Organization for Standardization (ISO) 9241-11 guidelines, focusing on effectiveness, efficiency, and user satisfaction. An accompanying training module was developed by applying tenets of adult learning. Sessions were audio-recorded, and the smartphone screen was mirrored onto a study computer. Digital image quality was evaluated by a physician panel to determine usefulness for clinical decision making. Results The mean length of time spent was 4.7 (2.1-12.8) minutes on the training session and 5.0 (1.4-16.6) minutes on app completion. 55.5% (5/9) of patients were able to complete the app independently with the most difficulty experienced in taking digital images of surgical wounds. Novice patients who were older, obese, or had groin wounds had the most difficulty. 81.8% of images were sufficient for diagnostic purposes. User satisfaction was high, with an average usability score of 83.3 out of 100. Conclusion Surgical patients can learn to use a smartphone app for postoperative wound monitoring with high user satisfaction. We identified design features and training approaches that can facilitate ease of use. This protocol illustrates an important, often overlooked, aspect of mHealth development

Impaired Circulating Angiogenic Cells Mobilization and Metalloproteinase-9 Activity after Dynamic Exercise in Early Metabolic Syndrome

PubMed Central

Rocha, Natalia G.; Sales, Allan R. K.; Penedo, Leticia A.; Pereira, Felipe S.; Silva, Mayra S.; Miranda, Renan L.; Silva, Jemima F. R.; Silva, Bruno M.; Santos, Aline A.; Nobrega, Antonio C. L.

2015-01-01

Increased levels of adhesion molecules or metalloproteinases (MMPs) may indicate endothelial dysfunction. Exercise mobilizes circulating angiogenic cells (CACs) from bone marrow in healthy subjects, improving vascular function. However, it is unclear whether this mechanism is preserved in the early stages of metabolic syndrome (early MetS). We aimed to evaluate the acute effects of exercise on adhesion molecules, angiogenic factors, MMPs, and CACs in early MetS. Fifteen subjects with early MetS and nine healthy controls underwent an exercise session and a nonexercise session, randomly. Adhesion molecules, angiogenic factors, CACs, and MMPs were evaluated before and after exercise or nonexercise sessions. At baseline, levels of sE-selectin, sICAM-1, and MMP-9 were higher in early MetS than in controls (P ≤ 0.03). After exercise, sE-selectin, sICAM-1, and MMP-9 levels were still higher in early MetS (P < 0.05). Subjects with early MetS presented less CACs (P = 0.02) and higher MMP-9 activity (P ≤ 0.04), while healthy controls presented higher MMP-2 activity after exercise. There was no difference between moments in nonexercise session (P > 0.05). In conclusion, subjects with early MetS already presented impaired endothelial function at rest along with a decrease in CACs and an increase in MMP-9 activity in response to exercise. PMID:26557715

Impaired Circulating Angiogenic Cells Mobilization and Metalloproteinase-9 Activity after Dynamic Exercise in Early Metabolic Syndrome.

PubMed

Rocha, Natalia G; Sales, Allan R K; Penedo, Leticia A; Pereira, Felipe S; Silva, Mayra S; Miranda, Renan L; Silva, Jemima F R; Silva, Bruno M; Santos, Aline A; Nobrega, Antonio C L

2015-01-01

Increased levels of adhesion molecules or metalloproteinases (MMPs) may indicate endothelial dysfunction. Exercise mobilizes circulating angiogenic cells (CACs) from bone marrow in healthy subjects, improving vascular function. However, it is unclear whether this mechanism is preserved in the early stages of metabolic syndrome (early MetS). We aimed to evaluate the acute effects of exercise on adhesion molecules, angiogenic factors, MMPs, and CACs in early MetS. Fifteen subjects with early MetS and nine healthy controls underwent an exercise session and a nonexercise session, randomly. Adhesion molecules, angiogenic factors, CACs, and MMPs were evaluated before and after exercise or nonexercise sessions. At baseline, levels of sE-selectin, sICAM-1, and MMP-9 were higher in early MetS than in controls (P ≤ 0.03). After exercise, sE-selectin, sICAM-1, and MMP-9 levels were still higher in early MetS (P < 0.05). Subjects with early MetS presented less CACs (P = 0.02) and higher MMP-9 activity (P ≤ 0.04), while healthy controls presented higher MMP-2 activity after exercise. There was no difference between moments in nonexercise session (P > 0.05). In conclusion, subjects with early MetS already presented impaired endothelial function at rest along with a decrease in CACs and an increase in MMP-9 activity in response to exercise.

Cost-Effectiveness of Postoperative Ketamine in Chiari Decompression.

PubMed

McDowell, Michael M; Alhourani, Ahmad; Pearce-Smith, Beverly A; Mazurkiewicz, Anna; Friedlander, Robert M

2018-02-01

In Chiari I patients, postoperative pain and discomfort frequently slow the transition back to the home setting. We sought to determine the effect of standardized ketamine infusion protocols on hospital length of stay (LOS). This retrospective cohort study reviewed 100 consecutive adult patients undergoing Chiari I decompression. Fifty-nine patients were placed on a 2-3 mg/hr ketamine drip until postoperative day 1. This group was compared with a group who received 2-3 mg/hr of ketamine until postoperative day 2 (19 patients) and patients who did not receive ketamine at all (22 patients). Clinical characteristics, opioid use, LOS, and relative hospitalization costs were assessed. All narcotic amounts were converted into milligram equivalents of morphine. LOS of the short-ketamine group was 46.5 hours when compared with the long-ketamine group (66.8 hours) and no-ketamine group (56.9 hours). There was a statistically significant difference when comparing the short-ketamine group with the long-ketamine group and no-ketamine group together (P < 0.001), as well as when compared individually (P = 0.001 and 0.004). The mean cost of hospitalization was 20% less when a short-ketamine protocol was used (P < 0.001). Mean morphine milligram equivalents used postoperatively were 148 mg in the short-ketamine group, 196 mg in the long-ketamine group, and 187 mg in the no-ketamine group (P = 0.65). No adverse events from ketamine were noted. Ketamine at subanesthetic levels may be an effective tool to facilitate early return home postoperatively and may significantly reduce medical costs. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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.

Impact of exercise pulmonary hypertension on postoperative outcome in primary mitral regurgitation.

PubMed

Magne, Julien; Donal, Erwan; Mahjoub, Haifa; Miltner, Beatrice; Dulgheru, Raluca; Thebault, Christophe; Pierard, Luc A; Pibarot, Philippe; Lancellotti, Patrizio

2015-03-01

The management of asymptomatic patients with mitral regurgitation (MR) remains controversial. Exercise-induced pulmonary hypertension (ExPHT) was recently reported as a strong predictor of rapid onset of symptoms. We hypothesised that ExPHT is a predictor of postoperative cardiovascular events in patients with primary MR. One hundred and two patients with primary MR, no or mild symptoms (New York heart association (NYHA) ≤2), and no LV dysfunction/dilatation, were prospectively recruited in 3 centres and underwent exercise-stress echocardiography. The presence of ExPHT was defined as an exercise systolic pulmonary arterial pressure >60 mm Hg. All patients were closely followed up and operated on when indication for surgery was reached. Postoperative events were defined as the occurrence of atrial fibrillation (AF), stroke, cardiac-related hospitalisation or death. Among the 102 patients included, 59 developed ExPHT (58%). These patients were significantly older than those without ExPHT (p=0.01). During a mean postoperative follow-up of 50±23 months, 28 patients (26%) experienced a predefined cardiovascular event. Patients with ExPHT had significantly higher rate of postoperative events (39% vs 12%, p=0.005); the rate of events was still higher in these patients (32% vs 9%, p=0.013), even when excluding early postoperative AF (ie, within 48 h). Event-free survival was significantly lower in the ExPHT group (all events: 5-year: 60±8% vs 88±5%, p=0.007, events without early AF: 5-year: 67±7% vs 90±4%, p=0.02). Using Cox multivariable analysis, ExPHT remained independently associated with higher risk of postoperative events in all models (all p≤0.04). ExPHT is associated with increased risk of adverse cardiac events following mitral valve surgery in patients with primary MR. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Implementing a Mobility Program to Minimize Post-Intensive Care Syndrome.

PubMed

Hopkins, Ramona O; Mitchell, Lorie; Thomsen, George E; Schafer, Michele; Link, Maggie; Brown, Samuel M

2016-01-01

Immobility in the intensive care unit (ICU) is associated with neuromuscular weakness, post-intensive care syndrome, functional limitations, and high costs. Early mobility-based rehabilitation in the ICU is feasible and safe. Mobility-based rehabilitation varied widely across 5 ICUs in 1 health care system, suggesting a need for continuous training and evaluation to maintain a strong mobility-based rehabilitation program. Early mobility-based rehabilitation shortens ICU and hospital stays, reduces delirium, and increases muscle strength and the ability to ambulate. Long-term effects include increased ability for self-care, faster return to independent functioning, improved physical function, and reduced hospital readmission and death. Factors that influence early mobility-based rehabilitation include having an interdisciplinary team; strong unit leadership; access to physical, occupational, and respiratory therapists; a culture focused on patient safety and quality improvement; a champion of early mobility; and a focus on measuring performance and outcomes.

Use of abdominal field block injections with liposomal bupivicaine to control postoperative pain after abdominoplasty.

PubMed

Morales, Rolando; Mentz, Henry; Newall, Germán; Patronella, Christopher; Masters, Oscar

2013-11-01

It is well known that improving postoperative pain control in plastic surgery procedures leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. The authors evaluate the use of abdominal field block injections with liposomal bupivicaine (Exparel; Pacira Pharmaceuticals, Inc, San Diego, California) in postoperative pain management in patients undergoing abdominoplasty with rectus plication. Case records from 64 female patients who underwent abdominoplasty with rectus plication were reviewed. We performed a total of 118 abdominoplasties with rectus plication, alone or in combination with other surgical procedures, from August 2012 to December 2012, but 54 patients were excluded from the series due to inadequate follow-up. Patients received liposomal bupivicaine injections in an abdominal field block fashion. Patient age, height, weight, and smoking status were recorded. Delivery of standardized postoperative intramuscular or intravenous injections and oral pain pills was recorded. Postoperative data and questionnaires were used to evaluate clinical efficacy. The average number of procedures (including abdominoplasty with rectus plication) per patient was 7. Average patient body mass index was 27 kg/m(2). Average pain scores were 3.5 (postoperative visit 1) and 2.8 (visit 2). The average number of oral pain pills required was 14 at the first postoperative visit and 11.5 at the second postoperative visit. Patients were able to resume normal activity at an average of 6.4 days. Our experience with liposomal bupivicaine injections for regional blocks in abdominoplasty with rectus plication indicates that patients experienced reduced postoperative pain, required less postoperative narcotic medication, and resumed both earlier ambulation and normal activity. Further investigation is warranted with more clinical cases to recommend the use of this medication for routine pain management after an abdominoplasty.

The Impact of Educational Status on the Postoperative Perception of Pain

PubMed Central

Mimigianni, Christina; Raptis, Demetris; Sourtse, Gionous; Sgourakis, George; Karaliotas, Constantine

2015-01-01

Background Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. Methods This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1st PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. Results There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2nd to the 6th). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. Conclusions The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old. PMID:26495081

The Impact of Educational Status on the Postoperative Perception of Pain.

PubMed

Lanitis, Sophocles; Mimigianni, Christina; Raptis, Demetris; Sourtse, Gionous; Sgourakis, George; Karaliotas, Constantine

2015-10-01

Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1(st) PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2(nd) to the 6(th)). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old.

Can Valeriana officinalis root extract prevent early postoperative cognitive dysfunction after CABG surgery? A randomized, double-blind, placebo-controlled trial.

PubMed

Hassani, Soghra; Alipour, Abbas; Darvishi Khezri, Hadi; Firouzian, Abolfazl; Emami Zeydi, Amir; Gholipour Baradari, Afshin; Ghafari, Rahman; Habibi, Wali-Allah; Tahmasebi, Homeyra; Alipour, Fatemeh; Ebrahim Zadeh, Pooneh

2015-03-01

We hypothesized that valerian root might prevent cognitive dysfunction in coronary artery bypass graft (CABG) surgery patients through stimulating serotonin receptors and anti-inflammatory activity. The aim of this study was to evaluate the effect of Valeriana officinalis root extract on prevention of early postoperative cognitive dysfunction after on-pump CABG surgery. In a randomized, double-blind, placebo-controlled trial, 61 patients, aged between 30 and 70 years, scheduled for elective CABG surgery using cardiopulmonary bypass (CPB), were recruited into the study. Patients were randomly divided into two groups who received either one valerian capsule containing 530 mg of valerian root extract (1,060 mg/daily) or placebo capsule each 12 h for 8 weeks, respectively. For all patients, cognitive brain function was evaluated before the surgery and at 10-day and 2-month follow-up by Mini Mental State Examination (MMSE) test. Mean MMSE score decreased from 27.03 ± 2.02 in the preoperative period to 26.52 ± 1.82 at the 10th day and then increased to 27.45 ± 1.36 at the 60th day in the valerian group. Conversely, its variation was reduced significantly after 60 days in the placebo group, 27.37 ± 1.87 at the baseline to 24 ± 1.91 at the 10th day, and consequently slightly increased to 24.83 ± 1.66 at the 60th day. Valerian prophylaxis reduced odds of cognitive dysfunction compared to placebo group (OR = 0.108, 95 % CI 0.022-0.545). We concluded that, based on this study, the cognitive state of patients in the valerian group was better than that in the placebo group after CABG; therefore, it seems that the use of V. officinalis root extract may prevent early postoperative cognitive dysfunction after on-pump CABG surgery.

Postoperative Pleural Effusions After Orthotopic Heart Transplant: Cause, Clinical Manifestations, and Course.

PubMed

Ulubay, Gaye; Küpeli, Elif; Er Dedekargınoğlu, Balam; Savaş Bozbaş, Şerife; Alekberov, Mahal; Salman Sever, Özlem; Sezgin, Atilla

2016-11-01

Postoperative pleural effusions are common in patients who undergo cardiac surgery and orthotopic heart transplant. Postoperative pleural effusions may also occur as postcardiac injury syndrome. Most of these effusions are nonspecific and develop as a harmless complication of the surgical procedure itself and generally have a benign course. Here, we investigated the cause and clinical and laboratory features of postoperative early and late pleural effusions in orthotopic heart transplant patients. We retrospectively reviewed the medical records of 50 patients who underwent orthotopic heart transplant between 2004 and 2015 at Baskent University. Patient demographics and clinical and laboratory data, including cause of heart failure, presence of pleural effusions at chest radiography in the first year after transplant, timing of onset, microbiologic and biochemical analyses of pleural effusions, and treatment strategies were noted. Mean age of patients was 39.22 ± 13.83 years (39 men, 11 women). Reason for heart failure was dilated cardiomyopathy in most patients (76%). Nineteen patients (38%) had postoperative pleural effusions, with 15 patients (78.9%) with pleural effusion during the first week after transplant. Of these, 4 patients had recurrent pleural effusion. A diagnostic thoracentesis was performed in 10 patients, with 4 showing transudative effusion and 6 showing exudative effusion secondary to infection (2 patients), postcardiac injury syndrome (1 patient), and hemothorax (3 patients). Aspergillus fumigatus was detected by quantitative culture from pleural effusion in 1 patient. Tube thoracoscopy drainage was performed in 10 patients (25%), and 2 patients received antibiotic therapy. Pleural effusions are frequent after cardiac transplant. Complications may occur in a small portion of patients, with most effusions being nonspecific and having a benign course with spontaneous resolution. Early diagnostic thoracentesis could improve postoperative outcomes

Early rehabilitation after elective total knee arthroplasty.

PubMed

Lisi, Claudio; Caspani, Patrick; Bruggi, Marco; Carlisi, Ettore; Scolè, Donatella; Benazzo, Francesco; Dalla Toffola, Elena

2017-10-18

Outcomes after TKA surgery are supposed to be related to the intensity and type of post-operative rehabilitation. Aim of this paper is to describe our early rehabilitation protocol following TKA with mini-invasive surgery in the immediate post-operative period and analyze functional recovery and changes in pain scores in these patients. in this observational study, data were collected on 215 total knee arthroplasty patients referred to Orthopedics and Traumatology inpatient ward from July 2012 to January 2014, treated with the same early start rehabilitation protocol. We recorded times to reach functional goals (sitting, standing and assisted ambulation) and pain after the treatment. length of hospital stay in TKA was 4.6±1.8 days, with a rehabilitation treatment lenght of 3.3±1.3 days. The mean time needed to achieve the sitting position was 2.3±0.7 days, to reach the standing position was 2.6±1.0 days to reach the walking functional goal was 2.9±1.0 days.  Pain NRS scores remained below 4 in the first and second post-operative day and below 3 from the third post-operative day. Our study confirms that rehabilitation started as soon as 24 hours after surgery with mini-invasive approach, enables early verticalization of patients and early recovery of walking with a good control of pain.

Early agriculture and crop transmission among Bronze Age mobile pastoralists of Central Eurasia

PubMed Central

Spengler, Robert; Frachetti, Michael; Doumani, Paula; Rouse, Lynne; Cerasetti, Barbara; Bullion, Elissa; Mar'yashev, Alexei

2014-01-01

Archaeological research in Central Eurasia is exposing unprecedented scales of trans-regional interaction and technology transfer between East Asia and southwest Asia deep into the prehistoric past. This article presents a new archaeobotanical analysis from pastoralist campsites in the mountain and desert regions of Central Eurasia that documents the oldest known evidence for domesticated grains and farming among seasonally mobile herders. Carbonized grains from the sites of Tasbas and Begash illustrate the first transmission of southwest Asian and East Asian domesticated grains into the mountains of Inner Asia in the early third millennium BC. By the middle second millennium BC, seasonal camps in the mountains and deserts illustrate that Eurasian herders incorporated the cultivation of millet, wheat, barley and legumes into their subsistence strategy. These findings push back the chronology for domesticated plant use among Central Eurasian pastoralists by approximately 2000 years. Given the geography, chronology and seed morphology of these data, we argue that mobile pastoralists were key agents in the spread of crop repertoires and the transformation of agricultural economies across Asia from the third to the second millennium BC. PMID:24695428

Postoperative PTH measurement as a predictor of hypocalcaemia after thyroidectomy.

PubMed

Proczko-Markuszewska, M; Kobiela, J; Stefaniak, T; Lachiński, A J; Sledziński, Z

2010-01-01

Hypocalcaemia after thyroidectomy is the most common postoperative complication, with a reported incidence from 0.5% to even 50% of the operated patients. Hypoparathyroidism could be a result of careless or inadequate preparation during the surgical procedure. There is a variety of proposed options for the prediction of the incidence of hypocalcaemia. The most effective of them are the peri-operative and intra-operative measurements of the parathyroid hormone (PTH) level. A prospective study was performed on 100 patients who underwent total thyroidectomy from January 2007 to June 2008. The total calcium level and intact human PTH (iPTH) levels were measured 24 hours before as well as 1 hour and 24 hours after the surgery. The goal of the study was to assess the potential correlation between the iPTH levels after the operation and the development of hypocalcaemia. The possible prediction value of postoperative iPTH levels was to be assessed. We have presented a significant correlation between early iPTH measurement and the risk of hypocalcaemia. Moreover, a significant correlation between the iPTH level one hour after operation with the calcium level 24 hours after the operation was demonstrated. Early postoperative assessment of iPTH levels can be used to identify the group of patients at risk of hypocalcaemia after thyroidectomy. Pre-emptive calcium supplementation can lead to the avoidance of complications causing prolonged hospital stay and most importantly to prevent severe hypocalcaemia.

Postoperative Functional Recovery After Gastrectomy in Patients Undergoing Enhanced Recovery After Surgery

PubMed Central

Jeong, Oh; Ryu, Seong Yeob; Park, Young Kyu

2016-01-01

Abstract Enhanced recovery after surgery (ERAS) is increasingly used in several abdominal surgeries to accelerate postoperative recovery and reduce the length of stay. The aim of this study was to investigate the pattern of functional recovery after gastrectomy in patients undergoing ERAS and to analyze factors that affect postoperative recovery. In all, 168 gastric cancer patients enrolled in a clinical trial evaluating ERAS compliance after gastrectomy were prospectively assessed with respect to postoperative functional recovery using discharge criteria, evaluating 4 major functional outcomes: adequate pain control, ability to mobilize and self-care, tolerance of oral intake, and no abnormal physical findings or laboratory test. The mean completion time of overall discharge criteria was 5.1 ± 3.2 days. The mean completion time for each dimension were 4.4 ± 0.9 days for adequate pain control, 4.1 ± 0.8 days for ability to mobilize and self-care, 4.3 ± 1.1 days for no abnormal physical signs or laboratory test, and 4.6 ± 1.2 days for tolerance of oral intake. The mean length of stay was 7.2 ± 3.2 days, and readmission rate was 2.4% (n = 4). There was 9.5% (n = 16) of morbidity and no hospital mortality. Female sex (P < 0.001) and age (≥65 years; P = 0.049) were significantly associated with a slower recovery in tolerance of oral intake, and total gastrectomy was significantly associated with delayed completion of adequate pain control (P = 0.003). Functional recovery after gastrectomy can be achieved after about 5 days in patients undergoing ERAS. Female sex, old age, and total gastrectomy are factors that delay normal functional recovery after gastrectomy. PMID:27057836

Optimising postoperative pain management in the ambulatory patient.

PubMed

Shang, Allan B; Gan, Tong J

2003-01-01

treatment of acute pain.Non-pharmacological methods for the management of postoperative pain include acupuncture, electromagnetic millimetre waves, hypnosis and the use of music during surgery. However, further research of these techniques is warranted to elucidate their effectiveness in this indication. Pain is a multifactorial experience, not just a sensation. Emotion, perception and past experience all affect an individual's response to noxious stimuli. Improved postoperative pain control through innovation and creativity may improve compliance, ease of delivery, reduce length of hospital stay and improve patient satisfaction. Patient education, early diagnosis of symptoms and aggressive treatment of pain using an integrative approach, combining pharmacotherapy as well as complementary technique, should serve us well in dealing with this complex problem.

Continuous monitoring of intracranial pressure for prediction of postoperative complications of hypertensive intracerebral hemorrhage.

PubMed

Yu, S-X; Zhang, Q-S; Yin, Y; Liu, Z; Wu, J-M; Yang, M-X

2016-11-01

This study evaluates the value of continuous dynamic monitoring of intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage to predict early postoperative complications. Data from 80 patients treated in our hospital from February 2014 to February 2015 were analyzed. The patients all underwent decompressive craniectomies, and their ICP changes were monitored invasively and continuously for 1 to 7 days after surgery. The average blood loss during surgery for the group of patients was 65.3 ± 12.4 ml and the mean GCS score 8.7 ± 2.4. Cases were divided into three groups according to ICP values to compare early postoperative complications of the groups: a normal and mildly increased group (51 cases), a moderately increased group (19 cases) and a severely increased group (10 cases). To validate the analysis we first showed that comparisons among groups based on gender, age, systolic pressure, diastolic pressure, bleeding time, blood loss, operation time, craniectomy localization, and preoperative mannitol dosage yielded no statistically significant differences. In contrast, the following comparisons produced statistically significant differences: the comparison of postoperative Glasgow Coma Scale (GCS) scores showing that the lower intracranial pressure, the higher the GCS score; the postoperative rehemorrhage, cerebral edema and death ratios showing the higher the intracranial pressure, the higher the rehemorrhage ratio; the average ICP and the time to occurrence of rehemorrhage, cerebral edema or cerebral infarction, showing the relationship between the average ICP and the time to a complication. Patients with higher ICP averages suffered a complication of rehemorrhage within the first 9.6 ± 2.5 hours on average. Nevertheless, the comparison of GCS scores in those patients and the others showed no significant differences. Based on the findings, the dynamic monitoring of intracranial pressure can early and sensitively predict postoperative

Low-Dose Epinephrine Plus Tranexamic Acid Reduces Early Postoperative Blood Loss and Inflammatory Response: A Randomized Controlled Trial.

PubMed

Zeng, Wei-Nan; Liu, Jun-Li; Wang, Fu-You; Chen, Cheng; Zhou, Qiang; Yang, Liu

2018-02-21

The reductions of perioperative blood loss and inflammatory response are important in total knee arthroplasty. Tranexamic acid reduced blood loss and the inflammatory response in several studies. However, the effect of epinephrine administration plus tranexamic acid has not been intensively investigated, to our knowledge. In this study, we evaluated whether the combined administration of low-dose epinephrine plus tranexamic acid reduced perioperative blood loss or inflammatory response further compared with tranexamic acid alone. This randomized placebo-controlled trial consisted of 179 consecutive patients who underwent primary total knee arthroplasty. Patients were randomized into 3 interventions: Group IV received intravenous low-dose epinephrine plus tranexamic acid, Group TP received topical diluted epinephrine plus tranexamic acid, and Group CT received tranexamic acid alone. The primary outcome was perioperative blood loss on postoperative day 1. Secondary outcomes included perioperative blood loss on postoperative day 3, coagulation and fibrinolysis parameters (measured by thromboelastography), inflammatory cytokine levels, transfusion values (rate and volume), thromboembolic complications, length of hospital stay, wound score, range of motion, and Hospital for Special Surgery (HSS) score. The mean calculated total blood loss (and standard deviation) in Group IV was 348.1 ± 158.2 mL on postoperative day 1 and 458.0 ± 183.4 mL on postoperative day 3, which were significantly reduced (p < 0.05) compared with Group TP at 420.5 ± 188.4 mL on postoperative day 1 and 531.1 ± 231.4 mL on postoperative day 3 and Group CT at 520.4 ± 228.4 mL on postoperative day 1 and 633.7 ± 237.3 mL on postoperative day 3. Intravenous low-dose epinephrine exhibited a net anti-inflammatory activity in total knee arthroplasty and did not induce an obvious hypercoagulable status. Transfusion values were significantly reduced (p < 0.05) in Group IV, but no significant

Single-incision laparoscopic distal gastrectomy for early gastric cancer through a homemade single port access device.

PubMed

Jiang, Zhi-Wei; Zhang, Shu; Wang, Gang; Zhao, Kun; Liu, Jiang; Ning, Li; Li, Jieshou

2015-01-01

We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments. A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer. This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved. This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.

Mobility and reliability performance measurement.

DOT National Transportation Integrated Search

2013-06-01

This project grew out of the fact that mobility was identified early on as one of the key performance focus areas of NCDOTs : strategic transformation effort. The Transformation Management Team (TMT) established a TMT Mobility Workstream Team : in...

Effect of early oral feeding on length of hospital stay following gastrectomy for gastric cancer: a Japanese multicenter, randomized controlled trial.

PubMed

Shimizu, Nobuyuki; Oki, Eiji; Tanizawa, Yutaka; Suzuki, Yutaka; Aikou, Susumu; Kunisaki, Chikara; Tsuchiya, Takashi; Fukushima, Ryoji; Doki, Yuichiro; Natsugoe, Shoji; Nishida, Yasunori; Morita, Masaru; Hirabayashi, Naoki; Hatao, Fumihiko; Takahashi, Ikuo; Choda, Yasuhiro; Iwasaki, Yoshiaki; Seto, Yasuyuki

2018-05-02

This multicenter, randomized controlled study evaluates the safety of early oral feeding following gastrectomy, and its effect on the length of postoperative hospital stay. The subjects of this study were patients who underwent distal gastrectomy (DG) or total gastrectomy (TG) for gastric cancer between January 2014 and December 2015. Patients were randomly assigned to the early oral feeding group (intervention group) or the conventional postoperative management group (control group) for each procedure. We evaluated the length of postoperative hospital stay and the incidence of postoperative complications in each group. No significant differences in length of postoperative stay were found between the intervention and control groups of the patients who underwent DG. The incidence of postoperative complications was significantly greater in the DG intervention group. In contrast, the length of postoperative stay was significantly shorter in the TG intervention group, although the TG group did not attain the established target sample size. Early oral feeding did not shorten the postoperative hospital stay after DG. The higher incidence of postoperative complications precluded the unselected adoption of early oral feeding for DG patients. Further confirmative studies are required to definitively establish the potential benefits of early oral feeding for TG patients.

Intraoperative Inducibility of Atrial Fibrillation Does Not Predict Early Postoperative Atrial Fibrillation.

PubMed

Lanters, Eva A H; Teuwen, Christophe P; Yaksh, Ameeta; Kik, Charles; van der Does, Lisette J M E; Mouws, Elisabeth M J P; Knops, Paul; van Groningen, Nicole J; Hokken, Thijmen; Bogers, Ad J J C; de Groot, Natasja M S

2018-03-10

Early postoperative atrial fibrillation (EPoAF) is associated with thromboembolic events, prolonged hospitalization, and development of late PoAF (LPoAF). It is, however, unknown if EPoAF can be predicted by intraoperative AF inducibility. The aims of this study are therefore to explore (1) the value of intraoperative inducibility of AF for development of both EPoAF and LPoAF and (2) the predictive value of de novo EPoAF for recurrence of LPoAF. Patients (N=496, 75% male) undergoing cardiothoracic surgery for coronary and/or valvular heart disease were included. AF induction was attempted by atrial pacing, before extracorporeal circulation. All patients were on continuous rhythm monitoring until discharge to detect EPoAF. During a follow-up period of 2 years, LPoAF was detected by ECGs and Holter recordings. Sustained AF was inducible in 56% of patients. There was no difference in patients with or without AF before surgery ( P =0.159), or between different types of surgery ( P =0.687). In patients without a history of AF, incidence of EPoAF and LPoAF was 37% and 2%, respectively. EPoAF recurred in 58% patients with preoperative AF, 53% developed LPoAF. There were no correlations between intraoperative inducibility and EPoAF or LPoAF ( P >0.05). EPoAF was not correlated with LPoAF in patients without a history of AF ( P =0.116), in contrast to patients with AF before surgery ( P <0.001). Intraoperative AF inducibility does not predict development of either EPoAF or LPoAF. In patients with AF before surgery, EPoAF is correlated with LPoAF recurrences. This correlation is absent in patients without AF before surgery. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

The role of nerve monitoring to predict postoperative recurrent laryngeal nerve function in thyroid and parathyroid surgery.

PubMed

Eid, Issam; Miller, Frank R; Rowan, Stephanie; Otto, Randal A

2013-10-01

To determine the role and efficacy of intraoperative recurrent laryngeal nerve (RLN) stimulation in the prediction of early and permanent postoperative nerve function in thyroid and parathyroid surgery. A retrospective review of thyroid and parathyroid surgeries was performed with calculation of sensitivity and specificity of the response of intraoperative stimulation for different pathological groups. Normal electromyography (EMG) response with 0.5 mAmp stimulation was considered a positive stimulation response with postoperative function determined by laryngoscopy. No EMG response at >1-2 mAmps was considered a negative response. The rates of early and permanent paralysis, as well as sensitivity, specificity, and positive and negative predictive values for postoperative nerve function were calculated for separate pathological groups. The number of nerves at risk analyzed was 909. The overall early and permanent paralysis rates were 3.1% and 1.2%, respectively, with the highest rate being for Grave's disease cases. The overall sensitivity was 98.4%. The specificity was lower at 62.5% but acceptable in thyroid carcinoma and Grave's disease patients. The majority of nerves with a positive stimulation result and postoperative paralysis on laryngoscopy recovered function in 3 to 12 weeks, showing positive stimulation to be a good predictor of eventual recovery. Stimulation of the RLN during thyroid and parathyroid surgery is a useful tool in predicting postoperative RLN function. The sensitivity of stimulation is high, showing positive stimulation to be an excellent predictor of normal nerve function. Negative stimulation is more predictive of paralysis in cases of thyroid carcinoma and Grave's disease. 2b. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Mobile phone base stations and early childhood cancers: case-control study

PubMed Central

Toledano, Mireille B; Bennett, J; Beale, L; de Hoogh, K; Best, N; Briggs, D J

2010-01-01

Objective To investigate the risk of early childhood cancers associated with the mother’s exposure to radiofrequency from and proximity to macrocell mobile phone base stations (masts) during pregnancy. Design Case-control study. Setting Cancer registry and national birth register data in Great Britain. Participants 1397 cases of cancer in children aged 0-4 from national cancer registry 1999-2001 and 5588 birth controls from national birth register, individually matched by sex and date of birth (four controls per case). Main outcome measures Incidence of cancers of the brain and central nervous system, leukaemia, and non-Hodgkin’s lymphomas, and all cancers combined, adjusted for small area measures of education level, socioeconomic deprivation, population density, and population mixing. Results Mean distance of registered address at birth from a macrocell base station, based on a national database of 76 890 base station antennas in 1996-2001, was similar for cases and controls (1107 (SD 1131) m v 1073 (SD 1130) m, P=0.31), as was total power output of base stations within 700 m of the address (2.89 (SD 5.9) kW v 3.00 (SD 6.0) kW, P=0.54) and modelled power density (−30.3 (SD 21.7) dBm v −29.7 (SD 21.5) dBm, P=0.41). For modelled power density at the address at birth, compared with the lowest exposure category the adjusted odds ratios were 1.01 (95% confidence interval 0.87 to 1.18) in the intermediate and 1.02 (0.88 to 1.20) in the highest exposure category for all cancers (P=0.79 for trend), 0.97 (0.69 to 1.37) and 0.76 (0.51 to 1.12), respectively, for brain and central nervous system cancers (P=0.33 for trend), and 1.16 (0.90 to 1.48) and 1.03 (0.79 to 1.34) for leukaemia and non-Hodgkin’s lymphoma (P=0.51 for trend). Conclusions There is no association between risk of early childhood cancers and estimates of the mother’s exposure to mobile phone base stations during pregnancy. PMID:20570865

[The effects of perioperative continuous administration of mivazerol on early postoperative hemodynamics and plasma catecholamines after major surgery].

PubMed

Apitzsch, H; Olthoff, D; Thieme, V; Vetter, B; Wiegel, M

2000-08-01

During and after surgical procedures a strong activation of the sympatho-adrenergic system is common with correlation to adverse cardiac outcome. Several drugs (alpha 2-adrenoceptor-agonists, beta blockers) are discussed to prevent this reaction. The new alpha 2-adrenoceptor-agonist mivazerol with marked specificity for alpha 2-adrenergic receptors may be suitable for this indication. The aim of the present study was to investigate the effects of perioperative continuous administration of mivazerol on plasma catecholamines, body temperature and calculated haemodynamic parameters in the early postoperative period in cardiac risk patients undergoing non-cardiac surgery. 36 patients with known coronary heart disease or risk factors for coronary heart disease scheduled for elective abdominal or vascular surgery were included in the study. Patients received either mivazerol (n = 18) or placebo (n = 18) [initial dose 4 micrograms kg-1 for 10 minutes before induction of anaesthesia, followed by a continuous infusion of 1.5 micrograms kg-1 h-1 intraoperatively and for as long as 72 h after surgery] in a double-blinded, randomized manner. Blood pressure, heart rate and body temperature were measured every 10 minutes until 240 minutes after arrival at the ICU. During 240 minutes after arrival at the ICU measured parameters (CVP, PAP, PCWP, SaO2, SvO2, CO), calculated parameters (CI, SVR, PVR, VO2) and plasma catecholamines were measured at defined time intervalls. The plasma concentrations of epinephrine and norepinephrine and the heart rate were significantly lower in the mivazerol group in the study period. Regarding blood pressure and body temperature there were no differences between the groups. At some measuring points preload was higher in the mivazerol group, but there were no differences between the groups for measured (SaO2, SvO2, CO) and calculated (CI, SVR, PVR, VO2) cardiorespiratory parameters. The incidence of shivering, nausea and vomiting were similar in both

Keep on Movin'? Research Mobility's Meanings for Italian Early-Stage Researchers

ERIC Educational Resources Information Center

Carrozza, Chiara; Minucci, Sara

2014-01-01

Research mobility is a core notion for the European Research Area (ERA), and a wide body of literature has focused on the factors facilitating and hindering researchers' mobility. The European discourse tends to promote mobility as a value, but to what extent is it perceived as such by researchers? What role does mobility play in career…

Perfusion Controlled Mobilization after Lower Extremity Free Flaps-Pushing the Limits of Time and Intensity.

PubMed

Dornseifer, Ulf; Kleeberger, Charlotte; Kargl, Lukas; Schönberger, Markus; Rohde, Daniel; Ninkovic, Milomir; Schilling, Arndt

2017-03-01

Background  The current standard to gradually adapt the fragile perfusion in lower extremity free flaps to an upright posture is the dangling maneuver. This type of flap training neither fits the orthostatic target load of an upright posture, nor does it assist in mobilizing the patients effectively. In this study, we quantitatively analyzed training effects of an early and full mobilization on flap perfusion. Methods  A total of 15 patients with gracilis flaps for distal lower extremity reconstruction were included. Flap training was performed daily by mobilizing the patients on a tilt table into a fully upright posture for 5 minutes between the third and fifth postop days (PODs). Changes in micro- and macrocirculation were analyzed by laser Doppler flowmetry, remission spectroscopy, and an implanted Doppler probe. Results  All flaps healed without complications. Yet, in three patients, the increased orthostatic load required an adjustment of the training duration due to a critical blood flow. The others showed an increasing compensation in the microcirculation. When tilting the patients, blood flow and oxygen saturation dropped significantly less on POD5 than on POD3. Furthermore, a significant increase of the blood flow was noted after an initial decrease during the mobilization on all days. An increasing compensation in the macrocirculation could not be determined. Conclusion  Full mobilization of patients with lower extremity free flaps can be performed safely under perfusion monitoring, already starting on POD3. Additionally, monitoring allows a consideration of the individual orthostatic competence and therefore, exploitation of the maximum mobilization potential. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Opening of Borders and Scientific Mobility: The Impact of EU Enlargement on the Movement of Early Career Scientists

ERIC Educational Resources Information Center

Guth, Jessica

2008-01-01

This paper, based on extensive empirical work with Polish and Bulgarian scientists in Germany and the UK, examines the impact of the EU enlargement including the free movement of persons provisions on the mobility of scientists from Eastern to Western Europe. It focuses on early career researchers and particularly PhD candidates and begins by…

Influence of a New "Call-Out Algorithm" for Management of Postoperative Pain and Its Side Effects on Length of Stay in Hospital: A Two-Centre Prospective Randomized Trial.

PubMed

Dybvik, Lisa; Skraastad, Erlend; Yeltayeva, Aigerim; Konkayev, Aidos; Musaeva, Tatiana; Zabolotskikh, Igor; Bjertnaes, Lars; Dahl, Vegard; Raeder, Johan; Kuklin, Vladimir

2017-01-01

We recently introduced the efficacy safety score (ESS) as a new "call-out algorithm" for management of postoperative pain and side effects. In this study, we report the influence of ESS recorded hourly during the first 8 hours after surgery on the mobility degree, postoperative nonsurgical complications, and length of hospital stay (LOS). We randomized 1152 surgical patients into three groups for postoperative observation: (1) ESS group ( n = 409), (2) Verbal Numeric Rate Scale (VNRS) for pain group ( n = 417), and (3) an ordinary qualitative observation (Control) group ( n = 326). An ESS > 10 or VNRS > 4 at rest or a nurse's observation of pain or adverse reaction to analgesic treatment in the Control group served as a "call-out alarm" for an anaesthesiologist. We found no significant differences in the mobility degree and number of postoperative nonsurgical complications between the groups. LOS was significantly shorter with 12.7 ± 6.3 days (mean ± SD) in the ESS group versus 14.2 ± 6.2 days in the Control group ( P < 0.001). Postoperative ESS recording in combination with the possibility to call upon an anaesthesiologist when exceeding the threshold score might have contributed to the reductions of LOS in this two-centre study. This trial is registered with NCT02143128.

Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model.

PubMed

Bove, Geoffrey M; Chapelle, Susan L

2012-01-01

Peritoneal adhesions are almost ubiquitous following surgery. Peritoneal adhesions can lead to bowel obstruction, digestive problems, infertility, and pain, resulting in many hospital readmissions. Many approaches have been used to prevent or treat adhesions, but none offer reliable results. A method that consistently prevented or treated adhesions would benefit many patients. We hypothesized that an anatomically-based visceral mobilization, designed to promote normal mobility of the abdominal contents, could manually lyse and prevent surgically-induced adhesions. Cecal and abdominal wall abrasion was used to induce adhesions in 3 groups of 10 rats (Control, Lysis, and Preventive). All rats were evaluated 7 days following surgery. On postoperative day 7, unsedated rats in the Lysis group were treated using visceral mobilization, consisting of digital palpation, efforts to manually lyse restrictions, and mobilization of their abdominal walls and viscera. This was followed by immediate post-mortem adhesion evaluation. The rats in the Preventive group were treated daily in a similar fashion, starting the day after surgery. Adhesions in the Control rats were evaluated 7 days after surgery without any visceral mobilization. The therapist could palpate adhesions between the cecum and other viscera or the abdominal wall. Adhesion severity and number of adhesions were significantly lower in the Preventive group compared to other groups. In the Lysis and Preventive groups there were clear signs of disrupted adhesions. These initial observations support visceral mobilization may have a role in the prevention and treatment of post-operative adhesions. Copyright © 2011 Elsevier Ltd. All rights reserved.

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.

Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty.

PubMed

Lum, Z C; Lombardi, A V; Hurst, J M; Morris, M J; Adams, J B; Berend, K R

2016-10-01

Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts. A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed. The mean follow-up for UKA and TKA groups was 5.4 and 5.5 years, respectively. Six TKA (3.2%) versus three UKAs (1.5%) were revised which was not significant (p = 0.269). Manipulation was more frequent after TKA (16; 8.5%) versus none in the UKA group (p < 0.001). UKA patients had higher post-operative KS function scores versus TKA patients (78 versus 66, p < 0.001) with a trend toward greater improvement, but there was no difference in ROM and KS clinical improvement (p = 0.382 and 0.420, respectively). We found fewer manipulations, and higher functional outcomes for patients treated with medial mobile-bearing UKA compared with TKA. TKA had twice the revision rate as UKA although this did not reach statistical significance with the numbers available. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):28-33. ©2016 Berend et al.

The efficacy of gum chewing in reducing postoperative ileus: a multisite randomized controlled trial.

PubMed

Forrester, David Anthony Tony; Doyle-Munoz, Janet; McTigue, Toni; D'Andrea, Stephanie; Natale-Ryan, Angela

2014-01-01

The purpose of this prospective, attention-controlled, randomized study was to determine whether postoperative gum chewing reduces the duration of postoperative ileus symptoms following elective open or laparoscopic sigmoid colectomy when compared with standard care or an attention-control intervention. Forty-seven subjects scheduled for either an open or laparoscopic colon resection participated in the study. Subjects were recruited preoperatively at the preadmission learning centers of the 2 acute care medical centers that comprised the study settings. Subjects were randomized to 3 groups: (1) standard postoperative care (n = 18); (2) standard care and a silicone-adhesive patch applied to the deltoid region of the upper arm as an attention control (n = 16); and (3) standard care and gum chewing (n = 13). Standard postoperative care included removal of the nasogastric tube, early ambulation, nothing by mouth with ice chips only until the first passage of flatus, and then advancement of diet until tolerance of solid food. No statistically significant differences were found among the 3 study groups for the 4 postoperative outcome variables measured: (1) first passage of flatus; (2) first bowel movement; (3) return of hunger; and (4) ability to tolerate solid food for one meal. Postoperative gum chewing was not found to be more effective than standard postoperative care or our attention-control intervention in reducing the duration of postoperative ileus symptoms, length of stay, or complications among patients following open/laparoscopic sigmoid colectomy.

Comparison of Transcutaneous Electrical Nerve Stimulation and Parasternal Block for Postoperative Pain Management after Cardiac Surgery

PubMed Central

Ozturk, Nilgun Kavrut; Baki, Elif Dogan; Kavakli, Ali Sait; Sahin, Ayca Sultan; Ayoglu, Raif Umut; Karaveli, Arzu; Emmiler, Mustafa; Inanoglu, Kerem; Karsli, Bilge

2016-01-01

Background. Parasternal block and transcutaneous electrical nerve stimulation (TENS) have been demonstrated to produce effective analgesia and reduce postoperative opioid requirements in patients undergoing cardiac surgery. Objectives. To compare the effectiveness of TENS and parasternal block on early postoperative pain after cardiac surgery. Methods. One hundred twenty patients undergoing cardiac surgery were enrolled in the present randomized, controlled prospective study. Patients were assigned to three treatment groups: parasternal block, intermittent TENS application, or a control group. Results. Pain scores recorded 4 h, 5 h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block group than in the TENS and control groups. Total morphine consumption was also lower in the parasternal block group than in the TENS and control groups. It was also significantly lower in the TENS group than in the control group. There were no statistical differences among the groups regarding the extubation time, rescue analgesic medication, length of intensive care unit stay, or length of hospital stay. Conclusions. Parasternal block was more effective than TENS in the management of early postoperative pain and the reduction of opioid requirements in patients who underwent cardiac surgery through median sternotomy. This trial is registered with Clinicaltrials.gov number NCT02725229. PMID:27445610

Postoperative Cerebral Infarction Risk Factors and Postoperative Management of Pediatric Patients with Moyamoya Disease.

PubMed

Muraoka, Shinsuke; Araki, Yoshio; Kondo, Goro; Kurimoto, Michihiro; Shiba, Yoshiki; Uda, Kenji; Ota, Shinji; Okamoto, Sho; Wakabayashi, Toshihiko

2018-05-01

Although revascularization surgery for patients with moyamoya disease can effectively prevent ischemic events and thus improve the long-term clinical outcome, the incidence of postoperative ischemic complications affects patients' quality of life. This study aimed to clarify the risk factors associated with postoperative ischemic complications and to discuss the appropriate perioperative management. Fifty-eight revascularization operations were performed in 37 children with moyamoya disease. Patients with moyamoya syndrome were excluded from this study. Magnetic resonance imaging was performed within 7 days after surgery. Postoperative cerebral infarction was defined as a diffusion-weighted imaging high-intensity lesion with or without symptoms. We usually use fentanyl and dexmedetomidine as postoperative analgesic and sedative drugs for patients with moyamoya disease. We used barbiturate coma therapy for pediatric patients with moyamoya disease who have all postoperative cerebral infarction risk factors. Postoperative ischemic complications were observed in 10.3% of the children with moyamoya disease (6 of 58). Preoperative cerebral infarctions (P = 0.0005), younger age (P = 0.038), higher Suzuki grade (P = 0.003), and posterior cerebral artery stenosis/occlusion (P = 0.003) were related to postoperative ischemic complications. Postoperative cerebral infarction occurred all pediatric patients using barbiturate coma therapy. The risk factors associated with postoperative ischemic complications for children with moyamoya disease are preoperative infarction, younger age, higher Suzuki grade, and posterior cerebral artery stenosis/occlusion. Barbiturate coma therapy for pediatric patients with moyamoya disease who have the previous risk factors is insufficient for prevention of postoperative cerebral infarction. More studies are needed to identify the appropriate perioperative management. Copyright © 2018 Elsevier Inc. All rights reserved.

Communication with Orthopedic Trauma Patients via an Automated Mobile Phone Messaging Robot.

PubMed

Anthony, Chris A; Volkmar, Alexander; Shah, Apurva S; Willey, Mike; Karam, Matt; Marsh, J Lawrence

2017-12-20

Communication with orthopedic trauma patients is traditionally problematic with low response rates (RRs). The purpose of this investigation was to (1) evaluate the feasibility of communicating with orthopedic trauma patients postoperatively, utilizing an automated mobile phone messaging platform; and (2) assess the first 2 weeks of postoperative patient-reported pain and opioid use after lower extremity orthopedic trauma procedures. This was a prospective investigation at a Level 1 trauma center in the United States. Adult patients who were capable of mobile phone messaging and were undergoing common, lower extremity orthopedic trauma procedures were enrolled in the study. Patients received a daily mobile phone message protocol inquiring about their current pain level and amount of opioid medication they had taken in the past 24 h starting on postoperative day (POD) 3 and continuing through POD 17. Our analysis considered (1) Patient completion rate of mobile phone questions, (2) Patient-reported pain level (0-10 scale), and (3) Number and percentage of daily prescribed opioid medication patients reported taking. Twenty-five patients were enrolled in this investigation. Patients responded to 87.5% of the pain and opioid medication inquiries they received over the 2-week study period. There were no differences in RRs by patient age, sex, or educational attainment. Patient-reported pain decreased over the initial 2-week study period from an average of 4.9 ± 1.7 on POD 3 to 3 ± 2.2 on POD 16-17. Patients took an average of 68% of their maximum daily narcotic prescription on POD 3 compared with 35% of their prescribed pain medication on POD 16-17. We found that in orthopedic trauma patients, an automated mobile phone messaging platform elicited a high patient RR that improved upon prior methods in the literature. This method may be used to reliably obtain pain and medication utilization data after trauma procedures.

EVALUATION OF EFFICACY AND SAFETY POSTOPERATIVE PAIN MANAGEMENT BY INTRAMUSCULAR ANALGESIA AFTER DIFFERENT TYPES OF ANAESTHESIA: PILOT CLINICAL PROSPECTIVE STUDY.

PubMed

Konkaev, A K; Eltaeva, A A; Zabolotskikh, I B; Musaeva, T S; Dibvik, L Z; Kuklin, V N

2016-11-01

Efficacy Safety Score (ESS) with "call-out algorithm" developed in Kongsberg hospital, Norway was used for the validation. ESS consists of the mathematical sum ofscorefrom: 2 subjective (Visual Analog Scale: VAS at rest and during mobilization) and 4 vital (conscious levels, PONV circulation and respiration status) parameters and ESS > 10 is a "call-out alarm "for visit ofpatient by anaesthesiologist. Hourly registration of ESS, mobility degree and amounts of analgetics during the first 8 hours after surgery was recorded in the specially designed IPad program. According to the type ofanaesthesia all patients were allocated in 4 groups: I spinal anaesthesia (SA), II general anesthesia (GA), III peripheral blockade (PB) and IV Total intravenous anaesthesia (TIVA). A total of 223 patients were included in the study. Statistically low levels of both VAS and ESS in the first 2-4 postoperative hours were found in SA and PB groups compared to GA and TIVA groups. During 8 post-operative hours, VAS> 3 was recorded in 10.5% of SA, 13.9% in GA, 12.8% in PG and 23.5% in TIVA patients. Intramuscular postoperative analgesia was effective in SA, GA and PG groups. More attention of anaesthesiologist must be paid to patients ofter TIVA.

Mobile kidney pain provocation ultrasonography before surgery for symptomatic mobile kidney: A prospective study of 43 consecutive patients.

PubMed

Arnerlöv, Conny; Söderström, Minette; Öhberg, Lars

2016-01-01

The aim of this study was to evaluate whether mobile kidney pain provocation ultrasonography together with intravenous pyelography in supine and standing positions and a full medical history can confirm the diagnosis of the clinical condition of symptomatic mobile kidney and aid the selection of patients for surgical treatment. In a consecutive study, 43 patients with the clinical picture of symptomatic mobile kidney, a positive mobile kidney pain provocation ultrasonography and a renal descent of at least 2 lumbar vertebral heights on intravenous pyelography in the standing position, were operated on with nephropexy. Patients' pain relief after nephropexy was evaluated by clinical follow-up, a questionnaire and visual analogue scale (VAS) scoring. Reduction of pain after nephropexy was associated with a significant decrease in VAS scoring from a median of 8 (range 4-10) preoperatively to a median of 0 (range 0-7) postoperatively (p < 0.001). Thirty-four patients (79%) were cured of their pain and seven patients (16%) experienced substantial relief from their pain symptoms. In two patients (5%) the symptoms were unchanged. The results indicate that mobile kidney pain provocation ultrasonography and intravenous pyelography in supine and standing positions can verify the diagnosis of symptomatic mobile kidney and aid the selection of patients who will benefit from nephropexy.

Postoperative hyperglycaemia of diabetic patients undergoing cardiac surgery - a clinical audit.

PubMed

Lehwaldt, Daniela; Kingston, Mary; O'Connor, Sheila

2009-01-01

Previous studies have shown that hyperglycaemia is associated with postoperative complications in cardiac surgical patients. Conversely, well-controlled glucose levels are said to reduce major infectious complications in diabetic patients. The purpose of this clinical audit was to evaluate the blood glucose levels of diabetic patients undergoing cardiac surgery and to determine the effectiveness of postoperative glycaemic control. A group of 150 patients from a large Irish cardiac surgery centre was selected by convenience sampling. An audit tool was designed to capture the patients' blood glucose levels, treatment regimes and postoperative complications. The findings showed major variations between 'high', 'good' and 'borderline' blood glucose levels in the pre- and postoperative phase. Although blood glucose testing practices seemed inconsistent, mean levels measured 'borderline'. Furthermore, the treatment regimes varied greatly and suggest a lack of consensus regarding the management of postoperative hyperglycaemia. A total of 52% (n = 78) patients developed 114 complications with a level of 21.4% (n = 32) postoperative wound infections. The findings from this audit highlight the importance of regular blood glucose testing to enable early detection of hyperglycaemia and timely initiation of appropriate treatments regimes for diabetic patients undergoing cardiac surgery. Findings also show that hyperglycaemia derangement may make a difference in the recovery phase. While patients will benefit from lesser wound infections, hospitals might save costs involved with treating postoperative complications. More consistent blood glucose testing might be achieved through the use of evidence-based protocols. However, the education of staff is as important as it develops knowledge on the complex metabolic interactions of diabetic patients undergoing cardiac surgery. While this means investing in staff education and policy development, costs for daily care and expensive

Experiences of four parents with physical therapy and early mobility of their children in a pediatric critical care unit: A case series.

PubMed

Parisien, Rachel B; Gillanders, Kirstie; Hennessy, Erin K; Herterich, Lisa; Saunders, Kendra; Lati, Jamil; Dos Santos, Stephanie; Hassall, Alison; O'Brien, Kelly K

2016-05-31

The aim of this study was to conduct a preliminary investigation into parents' experiences of physical therapy and early mobility (EM) for their children in a pediatric critical care unit (PCCU). We conducted a series of four qualitative case studies using in-depth semi-structured face-to-face interviews. We recruited parents of children who had undergone surgery and received at least one EM physical therapy intervention while intubated. We conducted a thematic analysis of transcribed interviews to illuminate the factors that influenced EM experiences. Four parents participated in the study. We developed an overview of Parental Experiences with Physical Therapy and Early Mobility in a PCCU, which includes four themes that parents believed influenced their experiences: (1) environmental factors; (2) awareness of physical therapist and health care professional (HCP) roles; (3) communication among parents and HCPs; and (4) parental participation in their child's EM, within the overarching parental experiences in the PCCU. This study affords a preliminary understanding of parents' experiences with physical therapy and EM in a PCCU setting. Results provide an important foundation for future research on mobility in the context of pediatric critical care research and practice.

A contemporary comparative analysis of immediate postoperative prosthesis placement following below-knee amputation.

PubMed

Ali, Mujtaba M; Loretz, Lorraine; Shea, Art; Poorvu, Eli; Robinson, William P; Schanzer, Andres; Messina, Louis M; Baril, Donald T

2013-11-01

Despite advances in the treatment of peripheral arterial disease, a significant number of patients ultimately require major amputations. Traditionally, postoperative management of a below-knee amputation involves soft compressive dressings to allow for complete stump healing before initial prosthesis fitting. This technique is associated with a prolonged period of limited mobility, placing patients at risk for deconditioning or fall with a risk of injury to the stump. In contrast, immediate postoperative prosthesis (IPOP) placement allows patients to begin ambulation and rehabilitation on postoperative day 1, which may be of significant physiologic and psychological benefit. The purpose of this study is to compare the outcomes of patients undergoing IPOP placement to those of a historical control group managed with traditional soft compressive dressing placement. Medical records of all consecutive below-knee amputation patients who underwent IPOP (IPOP group; 37 patients, 2007-2010) and all patients who underwent traditional soft compressive dressing placement and were IPOP candidates (non-IPOP group; 35 patients, 2006-2007) were retrospectively reviewed. Patient comorbidities and preoperative ambulation status were compared between the IPOP and the non-IPOP groups. Primary outcomes evaluated included perioperative systemic complications, wound complications, need for surgical revision, and the time until placement of a definitive prosthesis. Data were analyzed using the chi-squared and Student's t-test. Preoperative comorbidities and patient characteristics of the 2 groups were similar, although the IPOP group was younger (61.5 vs. 69.0 years; P=0.01). Immediate perioperative systemic complication rates were not significantly different between the 2 groups (IPOP 29.7% vs. non-IPOP 31.4%; P=0.876). Postoperative wound complication rates were as follows: wound infection (IPOP 18.9% vs. non-IPOP 25.0%; P=0.555), wound dehiscence (IPOP 29.7% vs. non-IPOP 25.0%; P=0

Inflammatory cytokine levels in synovial fluid 3, 4 days postoperatively and its correlation with early-phase functional recovery after anterior cruciate ligament reconstruction: a cohort study.

PubMed

Inoue, Makiko; Muneta, Takeshi; Ojima, Miyoko; Nakamura, Kaori; Koga, Hideyuki; Sekiya, Ichiro; Okazaki, Mutsumi; Tsuji, Kunikazu

2016-12-01

Synovial fluid was collected prior to and at 3 to 4 days after ACL reconstruction to investigate the correlation between inflammatory cytokine levels in the acute phase after surgery and physical functional recovery at 3 months postoperatively.  For this purpose, 79 patients with ACL reconstruction using semitendinosus tendons were included in the study. Median days from injury to surgery were 80 days (13-291 days). Synovial fluid was obtained just before surgery and at 3 to 4 days after surgery. Physical activity of each patient was evaluated at 3 months postoperatively, and scored from 0 (hard to walk) to 5 (run). Patients able to jog (score 4) or run (score 5) were considered as the "quick recovery" group and others (scores 1-3) as the "delayed recovery" group. Physical activity recovery scores in the early surgery group (preoperative period less than 60 days; Group I) were significantly better than those in the delayed surgery group (Group II). Among the cytokines tested, TNF-alpha and IL10 levels in synovial fluid were significantly higher in Group II at 3 to 4 days postoperatively, while levels of these cytokines were quite comparable preoperatively between the groups. Increased IL1-beta expression was noted in the delayed recovery group at 3 to 4 days postoperatively. In addition, levels of IL6, IL10 and IFN-gamma also tended to increase in patients with delayed recovery. Delayed ACL reconstruction increases levels of inflammatory cytokines in synovial fluid after surgery and correlates with a prolonged recovery of short-period physical activity of the patients.

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

PubMed

Harris, Andrew S; Prades, Eduardo; Tkachuk, Olena; Zeitoun, Hisham

2016-12-01

Hypocalcaemia is the most common complication following thyroidectomy. This study aimed to establish the factors associated with increased risk of hypocalcaemia on day 1 following thyroidectomy. All patients who underwent thyroidectomy under a single consultant during a 5-year period were included. A multivariate analysis was undertaken to ascertain which variables had the most effect on the risk of hypocalcaemia. A prognosis table was constructed to allow risk to be predicted for individual patients based on these factors. Included in the analysis were 210 procedures and 194 patients. Eighty-two percent of patients had no calcium derangement postoperatively. Fourteen point nine percent were categorised as early hypocalcaemia, 1 % had protracted hypocalcaemia and 2.1 % had permanent hypocalcaemia. For hemi-thyroidectomies 2.8 % had postoperative hypocalcaemia and 0.9 % had permanent hypocalcaemia. The multivariate analysis revealed total thyroidectomy (risk ratio 26.5, p < 0.0001), diabetes (risk ratio 4.8, p = 0.07) and thyrotoxicosis (risk ratio 3.1, p = 0.04) as statistically significant variables for early postoperative hypocalcaemia. Gender as an isolated factor did not reach significance but was included in the model. The p value for the model was p < 1 × 10 -12 . Total thyroidectomy increases risk of early hypocalcaemia when compared to hemithyroidectomy. Gender, diabetes and thyrotoxicosis were also been found to influence the risk. All of these factors are available pre-operatively and can therefore be used to predict a more specific risk for individual patients. It is hoped that this can lead to better informed consent, prevention and better resource allocation.

Off-pump grafting does not reduce postoperative pulmonary dysfunction.

PubMed

Izzat, Mohammad Bashar; Almohammad, Farouk; Raslan, Ahmad Fahed

2017-02-01

Objectives Pulmonary dysfunction is a recognized postoperative complication that may be linked to use of cardiopulmonary bypass. The off-pump technique of coronary artery bypass aims to avoid some of the complications that may be related to cardiopulmonary bypass. In this study, we compared the influence of on-pump or off-pump coronary artery bypass on pulmonary gas exchange following routine surgery. Methods Fifty patients (mean age 60.4 ± 8.4 years) with no preexisting lung disease and good left ventricular function undergoing primary coronary artery bypass grafting were prospectively randomized to undergo surgery with or without cardiopulmonary bypass. Alveolar/arterial oxygen pressure gradients were calculated prior to induction of anesthesia while the patients were breathing room air, and repeated postoperatively during mechanical ventilation and after extubation while inspiring 3 specific fractions of oxygen. Results Baseline preoperative arterial blood gases and alveolar/arterial oxygen pressure gradients were similar in both groups. At both postoperative stages, the partial pressure of arterial oxygen and alveolar/arterial oxygen pressure gradients increased with increasing fraction of inspired oxygen, but there were no statistically significant differences between patients who underwent surgery with or without cardiopulmonary bypass, either during ventilation or after extubation. Conclusions Off-pump surgery is not associated with superior pulmonary gas exchange in the early postoperative period following routine coronary artery bypass grafting in patients with good left ventricular function and no preexisting lung disease.

Colorectal surgery patients prefer simple solid foods to clear fluids as the first postoperative meal.

PubMed

Yeung, Sophia E; Fenton, Tanis R

2009-09-01

Randomized controlled trials have established that there is no benefit to withholding oral food and fluids from colorectal surgery patients postoperatively. The aim of this survey was to determine food preferences for the first postoperative meal and compare these with a traditional clear-fluid diet. One hundred forty-five elective colorectal surgery patients were surveyed about their preferences for 35 common foods within 72 hours of surgery and their levels of nausea, hunger, and pain. Preferences were examined by postoperative day (one vs. two) and levels of nausea, hunger, and pain. The survey showed that patients significantly preferred solid foods as early as the first postoperative day and their preferences had little congruency with the traditional clear-fluid diet. Foods highest in preference, such as eggs, regular broth soup (e.g., chicken noodle soup), toast, and potatoes, were significantly more preferred than common clear-fluid diet items such as gelatin, clear broth, and carbonated beverages (P < 0.01). Oral supplements were preferred by only 44%. Patients reported low levels of nausea, hunger, and pain. Postoperative colorectal surgery patients prefer to receive simple solid foods rather than a clear-fluid diet as their first postoperative meal.

Cytoreduction of diaphragmatic metastasis from ovarian cancer with involvement of the liver using a ventral liver mobilization technique.

PubMed

Kato, Kazuyoshi; Katsuda, Takahiro; Takeshima, Nobuhiro

2016-03-01

Upper abdominal spreading of advanced-stage ovarian cancer often involves the diaphragm. In addition, bulky diaphragmatic tumors occasionally infiltrate the liver. Here, we describe our early experiences with a ventral liver mobilization technique to remove diaphragmatic tumors with liver involvement. Two patients with primary ovarian cancer and 1 patient with recurrent ovarian cancer underwent en bloc resections of a diaphragmatic tumor together with the full-thickness diaphragm and the liver tissue using a ventral liver mobilization technique. The surgical technique involved a full-thickness division of the diaphragm at the central tendon and a ventral mobilization of the right lobe of the liver, with entry into the pleural cavity. During the parenchymal transection of the liver, the posterior area of the right lobe of the liver was pressed using the surgeon's hand to reduce bleeding from the resection surface. After the completion of the en bloc resection, the diaphragmatic opening was closed using running sutures. All the diaphragmatic tumors were completely removed without severe bleeding in the current series. No intraoperative or postoperative complications occurred. Diaphragmatic tumors with involvement of the liver can be safely and effectively removed using a ventral liver mobilization technique. This surgical procedure may be suitable for the management of bulky diaphragmatic tumors in select patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Potential of mobile intraoperative radiotherapy technology.

PubMed

Goer, Donald A; Musslewhite, Chapple W; Jablons, David M

2003-10-01

Mobile IORT units have the potential to change the way patients who have cancer are treated. The integration of IORT into cancer treatment programs, made possible by the new technologies of mobile linear accelerators that can be used in unshielded operating rooms, makes IORT significantly less time-consuming, less costly, and less risky to administer. It is now practical for IORT to be used in early-stage disease, in addition to advanced disease, and in sites for which patient transportation in the middle of surgery is considered too risky. Preliminary results of trials for early-stage breast and rectal cancer indicate benefits of IORT. Pediatric patients and patients who have lung cancer, previously underserved by IORT therapies, can be offered potential gains when patient transport issues do not limit IORT. Furthermore, because many of these mobile systems require no shielding, it is now practical for mobile units to be shared between hospitals, making this new mobile technology much more widely available.

Men's mobility into management from blue collar and white collar jobs: race differences across the early work-career.

PubMed

Wilson, George; Maume, David

2014-07-01

Within the context of the "particularistic mobility thesis" we examine racial differences in the incidence, and determinants of, as well as timing to, mobility into management across the critical early career years at a refined level, namely, when groups share similar white collar and blue collar jobs. Findings from a Panel Study of Income Dynamics sample of men support theory and indicate that from both job levels a racial hierarchy exists: African Americans have the lowest rate of mobility, reach management through a route that is relatively formal and structured by a traditional range of stratification-based causal factors and take longest to reach management. Whites, in contrast, have the highest mobility rate, reach management through a relatively informal path that is less structured by traditional stratification-based factors, and reach management the quickest, and, across all three issues Latinos occupy an intermediate ground between African Americans and Latinos. Further, as predicted by theory, racial differences, particularly, relative to whites, are greater among those tracked from blue collar jobs than white collar jobs. Discussed are implications of the findings for understanding racial disadvantage in the American labor market across the work-career and on an inter-generational basis. Copyright © 2014 Elsevier Inc. All rights reserved.

Liver mobilization and liver hanging for totally laparoscopic right hepatectomy: an easy way to do it.

PubMed

Rotellar, Fernando; Pardo, Fernando; Martí-Cruchaga, Pablo; Zozaya, Gabriel; Valentí, Victor; Bellver, Manuel; Lopez-Olaondo, Luis; Hidalgo, Francisco

2017-02-01

The purpose of this study is to describe a technical modification that facilitates right liver mobilization in laparoscopic right hepatectomy (LRH). In the supine position, an inflatable device is placed under the patient's right chest. For right hemiliver mobilization, the table is placed in 30° anti-Trendelenburg and full-left tilt. Balloon inflation offers an additional 30° left inclination that places the patient in an almost left lateral position. Foot and lateral supports are placed to prevent patient slippage during changes in the patient positioning. From December 2013 to October 2015, this technique has been used in 10 consecutive LRH. The indications for these procedures were as follows: four donor hepatectomies for living donor liver transplant, three hepatocellular carcinomas and one peripheral cholangiocarcinoma in cirrhotic patients, one hepatocellular carcinoma in a non-cirrhotic patient, and one case of colorectal cancer metastases. In this period, it has also been used to facilitate mobilization and resection in the posterior segments of the liver in seven patients. In every case, right hemiliver mobilization was easily performed in a maximum time of 15 min and placement of a tape or plastic tube for liver hanging was prepared. We have not observed any complication directly attributable to the technique herein described (i.e. right brachialgia; arms, back or left flank pain) in the early or late postoperative follow-up. The additional left inclination obtained with the inflation of a balloon under the right chest facilitates right hemiliver mobilization. Its use may help in the performance and adoption of LRH.

Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study.

PubMed

Haines, K J; Skinner, E H; Berney, S

2013-06-01

Previous Australian studies reported that postoperative pulmonary complications affect 13% of patients undergoing upper abdominal laparotomy. This study measured the incidence of postoperative pulmonary complications, risk factors for the diagnosis of postoperative pulmonary complications and barriers to physiotherapy mobilisation in a cohort of patients undergoing high-risk abdominal surgery. Prospective, observational cohort study. Two surgical wards in a tertiary Australian hospital. Seventy-two patients undergoing high-risk abdominal surgery (participants in a larger trial evaluating a novel model of medical co-management). Incidence of, and risk factors for, postoperative pulmonary complications, barriers to mobilisation and length of stay. The incidence of postoperative pulmonary complications was 39%. Incision type and time to mobilise away from the bed were independently associated with a diagnosis of postoperative pulmonary complications. Patients were 3.0 (95% confidence interval 1.2 to 8.0) times more likely to develop a postoperative pulmonary complication for each postoperative day they did not mobilise away from the bed. Fifty-two percent of patients had a barrier to mobilisation away from the bed on the first postoperative day, with the most common barrier being hypotension, although cessation criteria were not defined objectively by physiotherapists. Development of a postoperative pulmonary complication increased median hospital length of stay (16 vs 13 days; P=0.046). This study demonstrated an association between delayed postoperative mobilisation and postoperative pulmonary complications. Randomised controlled trials are required to test the role of early mobilisation in preventing postoperative pulmonary complications in patients undergoing high-risk upper abdominal surgery. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial.

PubMed

Chesov, Ion; Belîi, Adrian

2017-10-01

Effective postoperative analgesia is a key element in reducing postoperative morbidity, accelerating recovery and avoiding chronic postoperative pain. The aim of this study was to evaluate the effectiveness of ultrasound-guided Transversus Abdominis Plane (TAP) block, performed before surgical incision, in providing postoperative analgesia for patients undergoing open ventral hernia repair under general anaesthesia. Seventy elective patients scheduled for open ventral hernia repair surgery under general anaesthesia were divided randomly into two equal groups: Group I received bilateral TAP block performed before surgical incision (n = 35); Group II received systemic postoperative analgesia with parenteral opioid (morphine) alone (n = 35). Postoperatively pain scores at rest and with movement, total morphine consumption and opioid related side effects were recorded. Postoperative pain scores at rest and mobilization/cough were significantly higher in patients without TAP block (p < 0.05). Mean intraoperative fentanyl consumption was comparable between the two groups: 0.75 ± 0.31 mg in group I (TAP) and 0.86 ± 0.29 mg in group II (MO), p = 0.1299. Patients undergoing preincisional TAP block had reduced morphine requirements during the first 24 hours after surgery, compared to patients from group II, without TAP block (p = 0.0001). There was no difference in the incidence of opioid related side effects (nausea, vomiting) in the both groups during the first 24 postoperative hours. The use of preincisional ultrasound guided TAP block reduced the pain scores at rest and with movement/cough, opioid consumption and opioid-related side effects after ventral hernia repair when compared with opioid-only analgesia.

Fundamentals of management of acute postoperative pulmonary hypertension.

PubMed

Taylor, Mary B; Laussen, Peter C

2010-03-01

In the last several years, there have been numerous advancements in the field of pulmonary hypertension as a whole, but there have been few changes in the management of children with pulmonary hypertension after cardiac surgery. Patients at particular risk for postoperative pulmonary hypertension can be identified preoperatively based on their cardiac disease and can be grouped into four broad categories based on the mechanisms responsible for pulmonary hypertension: 1) increased pulmonary vascular resistance; 2) increased pulmonary blood flow with normal pulmonary vascular resistance; 3) a combination of increased pulmonary vascular resistance and increased blood flow; and 4) increased pulmonary venous pressure. In this review of the immediate postoperative management of pulmonary hypertension, various strategies are discussed including medical therapies, monitoring, ventilatory strategies, and weaning from these supports. With early recognition of patients at particular risk for severe pulmonary hypertension, management strategies can be directed at preventing or minimizing hemodynamic instability and thereby prevent the development of ventricular dysfunction and a low output state.

Managing acetabular fractures in the elderly with fixation and primary arthroplasty: aiming for early weightbearing.

PubMed

Rickman, Mark; Young, James; Trompeter, Alex; Pearce, Rachel; Hamilton, Mark

2014-11-01

Osteoporotic acetabular fractures in the elderly are becoming more common. Regardless of treatment, most patients are managed with a period of protected weightbearing, even if a THA has been performed. We have tried to treat these patients analogously to geriatric femoral neck fractures in a way that allows immediate full weightbearing. We determined return to mobility, length of hospital stay (LOS), radiographic outcomes, and complications in a series of elderly osteoporotic patients treated for acetabular fractures with early fracture fixation and simultaneous THA, allowing full weightbearing immediately postoperatively. Since 2009, one surgeon (MR) used a consistent approach for fracture fixation and THA with immediate weightbearing in all patients older than 65 years with acetabular fractures who were fit for surgery and whose injuries were deemed osteoporotic fractures (low-energy mechanisms) meeting particular radiographic criteria (significant marginal impaction or femoral head damage). Twenty-four patients met these criteria and were reviewed at a mean of 24 months (range, 8-38 months). Mean age was 77 years (range, 63-90 years), and eight patients were women. The surgical technique included plate stabilization of both acetabular columns plus simultaneous THA using a tantalum socket and a cemented femoral stem. Clinical and note reviews were conducted to ascertain return to mobility, LOS, and postoperative complications. Component migration and fracture healing were assessed on plain radiographs. All patients mobilized with full weightbearing by Day 7 postoperatively. Only one patient remained dependent on a frame to mobilize at discharge. At 6 weeks, two patients already required no walking aids. At 6 months, patients were using a single stick at home at most, and all patients had managed stairs. Mean LOS was 18 days (range, 10-36 days). Radiographically, no component migration was seen in any patient. Seventeen of 24 fractures (71%) healed

Clinical assessment of ossicular mobility by a ceramic vibrator designed for implantable hearing aids.

PubMed

Gyo, K; Yanagihara, N

1986-01-01

Ossicular mobility was assessed by direct coupling of a piezoelectric ceramic vibrator to the ossicles during middle ear surgery. The sites excited were body of the incus, head of the stapes, and footplate of the stapes through a hydroxyapatite ceramic strut. The threshold of the vibratory hearing was determined by the patient's response as a minimum audition, and the vibration threshold was obtained by subtracting the preoperative bone conduction threshold from the vibratory hearing threshold. The results were analyzed by the state of hearing after the operation, which revealed that a patient with a good vibration threshold during the operation had a tendency to get good postoperative hearing. This may mean that postoperative hearing can be predicted to some extent during the operation by the measurement of ossicular mobility.

Higher forgotten joint score for fixed-bearing than for mobile-bearing total knee arthroplasty.

PubMed

Thienpont, E; Zorman, D

2016-08-01

To compare the postoperative subjective outcome for fixed- and mobile-bearing total knee arthroplasty (TKA) by using the forgotten joint score (FJS-12), a new patient-reported outcome score of 12 questions evaluating the potential of a patient to forget about his operated joint. The hypothesis of this study was that a mobile-bearing TKA would have a higher level of forgotten joint than a fixed-bearing model of the same design. A retrospective cohort study was conducted in 100 patients who underwent TKA at least 1 year [mean (SD) 18 (5) months] before with either a fixed-bearing (N = 50) or a mobile-bearing (N = 50) TKA from the same implant family. Clinical outcome was evaluated with the knee society score and patient-reported outcome with the forgotten joint score. No difference was observed for demographics in between both study groups. The mean (SD) postoperative FJS-12 for the fixed-bearing TKA was 71 (28) compared to a mean (SD) of 56.5 (30) for the mobile-bearing TKA. The clinical relevance of the present retrospective study is that it shows for the first time a significant difference between fixed- and mobile-bearing TKA by using a new patient-reported outcome score. The hypothesis that mobile-bearing TKA would have a higher degree of forgotten joint than a fixed-bearing TKA could not be confirmed. A level I prospective study should be set up to objectivise these findings. IV.

How fresh is maple syrup? Sugar maple trees mobilize carbon stored several years previously during early springtime sap-ascent.

PubMed

Muhr, Jan; Messier, Christian; Delagrange, Sylvain; Trumbore, Susan; Xu, Xiaomei; Hartmann, Henrik

2016-03-01

While trees store substantial amounts of nonstructural carbon (NSC) for later use, storage regulation and mobilization of stored NSC in long-lived organisms like trees are still not well understood. At two different sites with sugar maple (Acer saccharum), we investigated ascending sap (sugar concentration, δ(13) C, Δ(14) C) as the mobilized component of stored stem NSC during early springtime. Using the bomb-spike radiocarbon approach we were able to estimate the average time elapsed since the mobilized carbon (C) was originally fixed from the atmosphere and to infer the turnover time of stem storage. Sites differed in concentration dynamics and overall δ(13) C, indicating different growing conditions. The absence of temporal trends for δ(13) C and Δ(14) C indicated sugar mobilization from a well-mixed pool with average Δ(14) C consistent with a mean turnover time (TT) of three to five years for this pool, with only minor differences between the sites. Sugar maple trees hence appear well buffered against single or even several years of negative plant C balance from environmental stress such as drought or repeated defoliation by insects. Manipulative investigations (e.g. starvation via girdling) combined with Δ(14) C measurements of this mobilized storage pool will provide further new insights into tree storage regulation and functioning. © 2015 The Authors. New Phytologist © 2015 New Phytologist Trust.

Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility (ABCDE) Bundle

PubMed Central

Balas, Michele C.; Vasilevskis, Eduard E.; Olsen, Keith M.; Schmid, Kendra K.; Shostrom, Valerie; Cohen, Marlene Z.; Peitz, Gregory; Gannon, David E.; Sisson, Joseph; Sullivan, James; Stothert, Joseph C.; Lazure, Julie; Nuss, Suzanne L.; Jawa, Randeep S.; Freihaut, Frank; Ely, E. Wesley; Burke, William J.

2014-01-01

Objective The debilitating and persistent effects of intensive care unit (ICU)-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle into everyday practice. Design Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012. Setting Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center. Patients Two hundred ninety-six patients (146 pre- and 150 post-bundle implementation), age ≥ 19 years, managed by the institutions’ medical or surgical critical care service. Interventions ABCDE bundle. Measurements For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between ABCDE bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Main Results Patients in the post-implementation period spent three more days breathing without mechanical assistance than did those in the pre-implementation period (median [IQR], 24 [7 to 26] vs. 21 [0 to 25]; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the ABCDE bundle experienced a near halving of the odds of delirium (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.33–0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (OR, 2.11; 95% CI, 1.29–3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates. Conclusions Critically ill patients managed

Analysis of postoperative biochemical values and clinical outcomes after adrenalectomy for primary aldosteronism.

PubMed

Swearingen, Andrew J; Kahramangil, Bora; Monteiro, Rosebel; Krishnamurthy, Vikram; Jin, Judy; Shin, Joyce; Siperstein, Allan; Berber, Eren

2018-04-01

Primary aldosteronism causes hypertension and hypokalemia and is often surgically treatable. Diagnosis includes elevated plasma aldosterone, suppressed plasma renin activity, and elevated aldosterone renin ratio. Adrenalectomy improves hypertension and hypokalemia. Postoperative plasma aldosterone and plasma renin activity may be useful in documenting cure or failure. A retrospective analysis of patients who underwent adrenalectomy for primary aldosteronism from 2010 to 2016 was performed, analyzing preoperative and postoperative plasma aldosterone, plasma renin activity, hypertension, and hypokalemia. The utility of postoperative testing was assessed. Clinical cure was defined as improved hypertension control and resolution of potassium loss. Biochemical cure was defined as aldosterone renin ratio reduction to <23.6. Forty-four patients were included; 20 had plasma aldosterone and plasma renin activity checked on postoperative day 1. In the study, 40/44 (91%) were clinically cured. All clinical failures had of biochemical failure at follow-up. Postoperative day 1aldosterone renin ratio <23.6 had PPV of 95% for clinical cure. Cured patients had mean plasma aldosterone drop of 33.1 ng/dL on postoperative day 1; noncured patient experienced 3.9 ng/dL increase. A cutoff of plasma aldosterone decrease of 10 ng/dL had high positive predictive value for clinical cure. Changes in plasma aldosterone and plasma renin activity after adrenalectomy correlate with improved hypertension and hypokalemia. The biochemical impact of adrenalectomy manifests as early as postoperative day 1. We propose a plasma aldosterone decrease of 10 ng/dL as a criterion to predict clinical cure. Copyright © 2017 Elsevier Inc. All rights reserved.

Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement

PubMed Central

Amofah, Hege Andersen; Broström, Anders; Fridlund, Bengt; Bjorvatn, Bjørn; Haaverstad, Rune; Hufthammer, Karl Ove; Kuiper, Karel KJ; Ranhoff, Anette Hylen; Norekvål, Tone M

2015-01-01

Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase. Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI. Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days. Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01). Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase. PMID:26635329

Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement.

PubMed

Amofah, Hege Andersen; Broström, Anders; Fridlund, Bengt; Bjorvatn, Bjørn; Haaverstad, Rune; Hufthammer, Karl Ove; Kuiper, Karel Kj; Ranhoff, Anette Hylen; Norekvål, Tone M

2016-04-01

Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase. To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep-wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI. A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep-wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days. SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01). Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep-wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase. © The European Society of Cardiology 2015.

Intrathecal morphine for postoperative pain control following robot-assisted prostatectomy: a prospective randomized trial.

PubMed

Bae, Junyeol; Kim, Hyun-Chang; Hong, Deok Man

2017-08-01

Robot-assisted laparoscopic prostatectomy (RALP) is minimally invasive surgery, but also causes moderate to severe pain during the immediate postoperative period. We evaluated the efficacy and safety of intrathecal morphine (ITM) for postoperative pain control in patients undergoing RALP. Thirty patients scheduled for RALP were randomly assigned into one of two groups. In the ITM group (n = 15), postoperative pain was managed using 300 µg intrathecal morphine with intravenous patient-controlled analgesia (IV-PCA). In the IV-PCA group (n = 15), only intravenous patient-controlled analgesia was used. The numerical pain score (NPS; 0 = no pain, 100 = worst pain imaginable), postoperative IV-PCA requirements and opioid-related complications including nausea, vomiting, dizziness, headache and pruritus were compared between the two groups. The NPSs on coughing were 20 (IQR 10-50) in the ITM group and 60 (IQR 40-80) in the IV-PCA group at postoperative 24 h (p = 0.001). The NPSs were significantly lower in the ITM group up to postoperative 24 h. The ITM group showed less morphine consumption at postoperative 24 h in the ITM group than in the IV-PCA group [5 (IQR 3-15) mg vs 17 (IQR 11-24) mg, p = 0.001]. Complications associated with morphine were comparable between the two groups and respiratory depression was not reported in either group. Intrathecal morphine provided more satisfactory analgesia without serious complications during the early postoperative period in patients undergoing RALP.

Local infiltration analgesia in TKA patients reduces length of stay and postoperative pain scores.

PubMed

Tripuraneni, Krishna R; Woolson, Steven T; Giori, Nicholas J

2011-03-11

Numerous postoperative pain protocols exist for patients undergoing total knee arthroplasty (TKA). We compared the length of stay, early range of motion (ROM), and pain scores of a control group with a femoral nerve block to those of a group with femoral nerve block and local infiltration analgesia following TKA. In a consecutive series of patients undergoing primary TKA at a Veteran's Administration hospital, 40 patients (40 TKAs) who had local infiltration analgesia were compared to a historical group of 43 patients (43 TKAs) who had a long-acting femoral nerve block without local infiltration analgesia. Local infiltration analgesia consisted of intraoperative injection of 150 mL of 300 mg ropivacaine, 30 mg ketorolac, and 500 μg epinephrine using 50 mL into each of 3 areas: (1) posterior capsule, (2) medial and lateral capsule, and (3) anterior capsule and subcutaneous tissues. A 17-gauge intra-articular catheter was used to inject an additional 100 mg of ropivacaine on postoperative day 1. The control group had a single-shot femoral nerve block using 150 mg of ropivacaine with epinephrine. Mean length of stay for the local infiltration analgesia group compared to controls was 3.2±1.4 days vs 3.8±1.6 days, respectively (P=.03). No significant differences existed in average ROM (6 weeks), discharge hematocrit, transfusions, and temperature. Mean pain scores were lower in the local infiltration analgesia group on postoperative day 1 (P=.04), but not on postoperative day 2 or 3. Maximum visual analog scale scores (P<.01) were reduced in the local infiltration analgesia group. Our early experience with local infiltration analgesia demonstrated a significantly reduced length of stay due to decreased postoperative pain. Copyright 2011, SLACK Incorporated.

Predictive Power of the NSQIP Risk Calculator for Early Post-Operative Outcomes After Whipple: Experience from a Regional Center in Northern Ontario.

PubMed

Jiang, Henry Y; Kohtakangas, Erica L; Asai, Kengo; Shum, Jeffrey B

2017-05-02

NSQIP Risk Calculator was developed to allow surgeons to inform their patients about their individual risks for surgery. Its ability to predict complication rates and length of stay (LOS) has made it an appealing tool for both patients and surgeons. However, the NSQIP Risk Calculator has been criticized for its generality and lack of detail towards surgical subspecialties, including the hepatopancreaticobiliary (HPB) surgery. We wish to determine whether the NSQIP Risk Calculator is predictive of post-operative complications and LOS with respect to Whipple's resections for our patient population. As well, we wish to identify strategies to optimize early surgical outcomes in patients with pancreatic cancer. We conducted a retrospective review of patients who underwent elective Whipple's procedure for benign or malignant pancreatic head lesions at Health Sciences North (Sudbury, Ontario), a tertiary care center, from February 2014 to August 2016. Comparisons of LOS and post-operative complications between NSQIP-predicted and actual ones were carried out. NSQIP-predicted complications rates were obtained using the NSQIP Risk Calculator through pre-defined preoperative risk factors. Clinical outcomes examined, at 30 days post-operation, included pneumonia, cardiac events, surgical site infection (SSI), urinary tract infection (UTI), venous thromboembolism (VTE), renal failure, readmission, and reoperation for procedural complications. As well, mortality, disposition to nursing or rehabilitation facilities, and LOS were assessed. A total of 40 patients underwent Whipple's procedure at our center from February 2014 to August 2016. The average age was 68 (50-85), and there were 22 males and 18 females. The majority of patients had independent baseline functional status (39/40) with minimal pre-operative comorbidities. The overall post-operative morbidity was 47.5% (19/40). The rate of serious complication was 17.5% with four Clavien grade II, two grade III, and one grade

Effects of Intraperitoneal Local Anaesthetics Bupivacaine and Ropivacaine versus Placebo on Postoperative Pain after Laparoscopic Cholecystectomy: A Randomised Double Blind Study

PubMed Central

Das, Neha T

2017-01-01

Introduction Laparoscopic Cholecystectomy (LC) is the most frequently performed elective daycare surgery and provision of postoperative pain relief is of importance. After laparoscopic cholecystectomy shoulder and abdominal pain causes considerable distress. Visceral pain during coughing, respiration and mobilization increases morbidity, hospital stay and costs. Aim To compare the analgesic efficacy of intraperitoneally instilled equipotent concentrations of bupivacaine and ropivacaine versus placebo in relieving postoperative pain after laparoscopic cholecystectomy when used as a part of multimodal analgesia. Materials and Methods In this randomised, prospective, double blind, placebo controlled study, 90 ASA Class I or II patients were randomly divided into three groups of 30 each. Group S received intraperitoneal infiltration with 35 ml of 0.9% normal saline, Group B with 35 ml of 0.25% bupivacaine and Group R with 35 ml of 0.375% ropivacaine. All groups received standard general endotracheal anaesthesia and analgesia with IV paracetamol 15 mg/kg and diclofenac 1.5 mg/kg. Numerical Rating Scale (NRS) score of analgesia at rest and on cough/movement, duration of analgesia, haemodynamic parameters, need for a rescue analgesic (IV tramadol 1 mg/kg) was recorded and adverse effects of procedure and drugs if any were monitored. Data was analysed with SPSS statistical software version 21.0. One way ANOVA or the Kruskal–Wallis test was used to compare continuous data across all three groups as appropriate. Subsequent analysis of continuous data between two groups was achieved by Tukey’s post hoc test. Significance was accepted as p<0.05. Results The mean NRS was <5 till only four hours in Group S, till eight hours in Group B and till 16 hours in Group R. The duration of analgesia was 13.47±1.38 hours in Group R, 7.93±1.44 hours in Group B and 4.47±0.86 hours in Group S. Conclusion Intraperitoneal infiltration of LA significantly reduces pain intensity scores in

Effects of Intraperitoneal Local Anaesthetics Bupivacaine and Ropivacaine versus Placebo on Postoperative Pain after Laparoscopic Cholecystectomy: A Randomised Double Blind Study.

PubMed

Das, Neha T; Deshpande, Charulata

2017-07-01

Laparoscopic Cholecystectomy (LC) is the most frequently performed elective daycare surgery and provision of postoperative pain relief is of importance. After laparoscopic cholecystectomy shoulder and abdominal pain causes considerable distress. Visceral pain during coughing, respiration and mobilization increases morbidity, hospital stay and costs. To compare the analgesic efficacy of intraperitoneally instilled equipotent concentrations of bupivacaine and ropivacaine versus placebo in relieving postoperative pain after laparoscopic cholecystectomy when used as a part of multimodal analgesia. In this randomised, prospective, double blind, placebo controlled study, 90 ASA Class I or II patients were randomly divided into three groups of 30 each. Group S received intraperitoneal infiltration with 35 ml of 0.9% normal saline, Group B with 35 ml of 0.25% bupivacaine and Group R with 35 ml of 0.375% ropivacaine. All groups received standard general endotracheal anaesthesia and analgesia with IV paracetamol 15 mg/kg and diclofenac 1.5 mg/kg. Numerical Rating Scale (NRS) score of analgesia at rest and on cough/movement, duration of analgesia, haemodynamic parameters, need for a rescue analgesic (IV tramadol 1 mg/kg) was recorded and adverse effects of procedure and drugs if any were monitored. Data was analysed with SPSS statistical software version 21.0. One way ANOVA or the Kruskal-Wallis test was used to compare continuous data across all three groups as appropriate. Subsequent analysis of continuous data between two groups was achieved by Tukey's post hoc test. Significance was accepted as p<0.05. The mean NRS was <5 till only four hours in Group S, till eight hours in Group B and till 16 hours in Group R. The duration of analgesia was 13.47±1.38 hours in Group R, 7.93±1.44 hours in Group B and 4.47±0.86 hours in Group S. Intraperitoneal infiltration of LA significantly reduces pain intensity scores in the early postoperative period after LC surgery and helps in

Postoperative MRI Evaluation of a Radiofrequency Cordotomy Lesion for Intractable Cancer Pain

PubMed Central

Vedantam, A.; Hou, P.; Chi, T.L.; Hess, K.R; Dougherty, P.M.; Bruera, E.; Viswanathan, A.

2017-01-01

BACKGROUND AND PURPOSE There are limited data on the use of postoperative imaging to evaluate the cordotomy lesion. We aimed to describe the cordotomy lesion by using postoperative MR imaging in patients after percutaneous cordotomy for intractable cancer pain. MATERIALS AND METHODS Postoperative MR imaging and clinical outcomes were prospectively obtained for 10 patients after percutaneous cordotomy for intractable cancer pain. Area, signal intensity, and location of the lesion were recorded. Clinical outcomes were measured by using the Visual Analog Scale and the Brief Pain Inventory–Short Form, and correlations with MR imaging metrics were evaluated. RESULTS Ten patients (5 men, 5 women; mean age, 58.5 ± 9.6 years) were included in this study. The cordotomy lesion was hyperintense with central hypointense foci on T2-weighted MR imaging, and it was centered in the anterolateral quadrant at the C1–C2 level. The mean percentage of total cord area lesioned was 24.9% ± 7.9%, and most lesions were centered in the dorsolateral region of the anterolateral quadrant (66% of the anterolateral quadrant). The number of pial penetrations correlated with the percentage of total cord area that was lesioned (r = 0.78; 95% CI, 0.44–0.89; P = .008) and the length of T2-weighted hyperintensity (r = 0.85; 95% CI, 0.54–0.89; P = .002). No significant correlations were found between early clinical outcomes and quantitative MR imaging metrics. CONCLUSIONS We describe qualitative and quantitative characteristics of a cordotomy lesion on early postoperative MR imaging. The size and length of the lesion on MR imaging correlate with the number of pial penetrations. Larger studies are needed to further investigate the clinical correlates of MR imaging metrics after percutaneous cordotomy. PMID:28209581

Early mobilization after stroke: an example of an individual patient data meta-analysis of a complex intervention.

PubMed

Craig, Louise E; Bernhardt, Julie; Langhorne, Peter; Wu, Olivia

2010-11-01

Very early mobilization (VEM) is a distinctive characteristic of care in some stroke units; however, evidence of the effectiveness of this approach is limited. To date, only 2 phase II trials have compared VEM with standard care: A Very Early Rehabilitation Trial (AVERT) in Australia and the recently completed Very Early Rehabilitation or Intensive Telemetry after Stroke trial in the United Kingdom. The Very Early Rehabilitation or Intensive Telemetry after Stroke protocol was designed to complement that of AVERT in a number of key areas. The aim of this analysis was to investigate the impact of VEM on independence by pooling data from these 2 comparable trials. Individual data from the 2 trials were pooled. Overall, patients were between 27 and 97 years old, had first or recurring stroke, and were treated within 36 hours after stroke onset. The primary outcome was independence, defined as modified Rankin scale score of 0 to 2 at 3 months. The secondary outcomes included complications of immobility and activities of daily living. Logistic regression was used to assess the effect of VEM on outcome, adjusting for known confounders including age, baseline stroke severity, and premorbid modified Rankin scale score. Findings-All patients in AVERT and Very Early Rehabilitation or Intensive Telemetry after Stroke were included, resulting in 54 patients in the VEM group and 49 patients in the standard care group. The baseline characteristics of VEM patients were largely comparable with standard care patients. Time to first mobilization from symptom onset was significantly shorter among VEM patients (median, 21 hours; interquartile range, 15.8-27.8 hours) compared with standard care patients (median, 31 hours; interquartile range, 23.0-41.2 hours). VEM patients had significantly greater odds of independence compared with standard care patients (adjusted odds ratio, 3.11; 95% confidence interval, 1.03-9.33). Planned collaborations between stroke researchers to conduct trials

Postoperative Changes in Presepsin Level and Values Predictive of Surgical Site Infection After Spinal Surgery: A Single-Center, Prospective Observational Study.

PubMed

Koakutsu, Tomoaki; Sato, Tetsuya; Aizawa, Toshimi; Itoi, Eiji; Kushimoto, Shigeki

2018-04-15

Single-institutional, prospective observational study. To elucidate the perioperative kinetics of presepsin (PSEP) in patients undergoing spinal surgery, and to evaluate the possibility of PSEP in the early diagnosis of surgical site infection (SSI). Early diagnosis of SSI after spinal surgery is important. Although several biomarkers have been used as early indicators of SSI, the specificity of these markers in SSI diagnosis was not high. PSEP was found as a novel diagnostic marker for bacterial sepsis in 2004. However, its kinetics after spinal surgery and its usefulness in early diagnosis of SSI have never been evaluated. A total of 118 patients who underwent elective spinal surgery were enrolled. PSEP was measured before, immediately after, 1 day after, and 1 week after surgery. In patients without postoperative infection, perioperative kinetics of PSEP were analyzed. PSEP levels in patients with postoperative infection were also recorded separately, and their utility in SSI diagnosis was evaluated. In the 115 patients without postoperative infection, the median PSEP value was 126, 171, 194, and 147 pg/mL before, immediately after, 1 day after, and 1 week after surgery, respectively. Compared with the preoperative value, PSEP was significantly higher immediately after surgery and the next day, and return to the preoperative level 1 week after surgery. The estimated reference value for 95 percentile in patients without postoperative infection was 297 pg/mL 1 week after surgery. In three patients with postoperative infection, higher levels (>300 pg/mL) were observed 1 week after surgery. In patients after spinal surgery without infectious complications, blood levels of PSEP may immediately increase and return to preoperative levels 1 week after surgery. The PSEP value of 300 pg/mL 1 week after surgery might be used as a novel indicator for suspected SSI. 4.

Outbreak of multidrug-resistant acute postoperative endophthalmitis due to Enterobacter aerogenes.

PubMed

Bhat, Shailaja S; Undrakonda, Vivekanand; Mukhopadhyay, Chiranjay; Parmar, Prachi Vikramsinh

2014-04-01

To report the clinical features, management, and outcome of 7 cases of culture-proven multidrug-resistant Enterobacter postoperative endophthalmitis following cataract surgery. Medical records of 7 cases of acute postoperative endophthalmitis after uneventful cataract surgery were reviewed. Details regarding age, gender, visual acuity and clinical features at presentation, microbiological profile, treatment interventions, and visual acuity and clinical features at 1 week, 1 month, and 3 months follow-up were collected. All patients reported decreased visual acuity and pain as presenting symptoms. All patients were resistant to intravitreal antibiotics such as vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL). Culture of aqueous and vitreous sample was positive for Enterobacter aerogenes and sensitive to co-trimoxazole, cefoperazone-sulbactam, imipenem-meropenem, and piperacillin-tazobactem. Two patients with panophthalmitis and no perception of light underwent evisceration. Three patients had visual acuity of ≥6/24 at the final follow-up. Multidrug-resistant Enterobacter acute postoperative endophthalmitis has a poor prognosis if not intercepted early.

[Postoperative cognitive deficits].

PubMed

Kalezić, Nevena; Dimitrijević, Ivan; Leposavić, Ljubica; Kocica, Mladen; Bumbasirević, Vesna; Vucetić, Cedomir; Paunović, Ivan; Slavković, Nemanja; Filimonović, Jelena

2006-01-01

Cognitive dysfunctions are relatively common in postoperative and critically ill patients. This complication not only compromises recovery after surgery, but, if persistent, it minimizes and compromises surgery itself. Risk factors of postoperative cognitive disorders can be divided into age and comorbidity dependent, and those related to anesthesia and surgery. Cardiovascular, orthopedic and urologic surgery carries high risk of postoperative cognitive dysfunction. It can also occur in other types of surgical treatment, especially in elderly. Among risk factors of cognitive disorders, associated with comorbidity, underlying psychiatric and neurological disorders, substance abuse and conditions with elevation of intracranial pressure are in the first place in postoperative patients. Preoperative and perioperative predisposing conditions for cognitive dysfunction and their incidence were described in our paper. These are: geriatric patients, patients with substance abuse, preexisting psychiatric or cognitive disorders, neurologic disease with high intracranial pressure, cerebrovascular insufficiency, epilepsia, preeclampsia, acute intermittent porphyria, operation type, brain hypoxia, changes in blood glucose level, electrolyte imbalance, anesthetic agents, adjuvant medication and intraoperative awareness. For each of these factors, evaluation, prevention and treatment strategies were suggested, with special regard on anesthetic technique.

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

Impact of Operative and Postoperative Factors on Neurodevelopmental Outcomes After Cardiac Operations.

PubMed

2016-09-01

Neurodevelopmental disability is common after operations for congenital heart defects. We previously showed that patient and preoperative factors, center, and calendar year of birth explained less than 30% of the variance for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development-Second Edition. Here we investigate how much additional variance in PDI and MDI is contributed by operative variables and postoperative events. We analyzed neurodevelopmental outcomes after operations with cardiopulmonary bypass at age 9 months or younger between 1996 and 2009. We used linear regression to investigate the effect of operative factors (age, weight, and cardiopulmonary bypass variables) and postoperative events on neurodevelopmental outcomes, adjusting for center, type of congenital heart defect, year of birth, and preoperative factors. We analyzed 1,770 children from 22 institutions with neurodevelopmental testing at age 13.3 months (range, 6 to 30 months). Among operative factors, longer total support time was associated with lower PDI and MDI (p < 0.05). When postoperative events were added, use of either extracorporeal membrane oxygenation or ventricular assist device support, and longer postoperative length of stay were associated with lower PDI and MDI (p < 0.05). Longer total support time was not a significant predictor in these models. After adjusting for patient, preoperative, intraoperative, and postoperative factors, measured intraoperative and postoperative factors accounted for 5% of the variances in PDI and MDI. Operative factors may be less important than innate patient and preoperative factors and postoperative events in predicting early neurodevelopmental outcomes after cardiac operations in infants. Neurodevelopmental outcomes improved over calendar time when adjusted for patient and medical variables. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

Influence of a New “Call-Out Algorithm” for Management of Postoperative Pain and Its Side Effects on Length of Stay in Hospital: A Two-Centre Prospective Randomized Trial

PubMed Central

Dybvik, Lisa; Skraastad, Erlend; Yeltayeva, Aigerim; Konkayev, Aidos; Musaeva, Tatiana; Zabolotskikh, Igor; Dahl, Vegard; Raeder, Johan

2017-01-01

Background We recently introduced the efficacy safety score (ESS) as a new “call-out algorithm” for management of postoperative pain and side effects. In this study, we report the influence of ESS recorded hourly during the first 8 hours after surgery on the mobility degree, postoperative nonsurgical complications, and length of hospital stay (LOS). Methods We randomized 1152 surgical patients into three groups for postoperative observation: (1) ESS group (n = 409), (2) Verbal Numeric Rate Scale (VNRS) for pain group (n = 417), and (3) an ordinary qualitative observation (Control) group (n = 326). An ESS > 10 or VNRS > 4 at rest or a nurse's observation of pain or adverse reaction to analgesic treatment in the Control group served as a “call-out alarm” for an anaesthesiologist. Results We found no significant differences in the mobility degree and number of postoperative nonsurgical complications between the groups. LOS was significantly shorter with 12.7 ± 6.3 days (mean ± SD) in the ESS group versus 14.2 ± 6.2 days in the Control group (P < 0.001). Conclusion Postoperative ESS recording in combination with the possibility to call upon an anaesthesiologist when exceeding the threshold score might have contributed to the reductions of LOS in this two-centre study. This trial is registered with NCT02143128. PMID:28855800

Metabotyping Patients’ Journeys Reveals Early Predisposition to Lung Injury after Cardiac Surgery

PubMed Central

Maltesen, Raluca Georgiana; Rasmussen, Bodil Steen; Pedersen, Shona; Hanifa, Munsoor Ali; Kucheryavskiy, Sergey; Kristensen, Søren Risom; Wimmer, Reinhard

2017-01-01

Cardiovascular disease is the leading cause of death worldwide and patients with severe symptoms undergo cardiac surgery. Even after uncomplicated surgeries, some patients experience postoperative complications such as lung injury. We hypothesized that the procedure elicits metabolic activity that can be related to the disease progression, which is commonly observed two-three days postoperatively. More than 700 blood samples were collected from 50 patients at nine time points pre-, intra-, and postoperatively. Dramatic metabolite shifts were observed during and immediately after the intervention. Prolonged surgical stress was linked to an augmented anaerobic environment. Time series analysis showed shifts in purine-, nicotinic acid-, tyrosine-, hyaluronic acid-, ketone-, fatty acid, and lipid metabolism. A characteristic ‘metabolic biosignature’ was identified correlating with the risk of developing postoperative complications two days before the first clinical signs of lung injury. Hence, this study demonstrates the link between intra- and postoperative time-dependent metabolite changes and later postoperative outcome. In addition, the results indicate that metabotyping patients’ journeys early, during or just after the end of surgery, may have potential impact in hospitals for the early diagnosis of postoperative lung injury, and for the monitoring of therapeutics targeting disease progression. PMID:28074924

[PROtocol-based MObilizaTION on intensive care units : Design of a cluster randomized pilot study].

PubMed

Nydahl, P; Diers, A; Günther, U; Haastert, B; Hesse, S; Kerschensteiner, C; Klarmann, S; Köpke, S

2017-10-12

Despite convincing evidence for early mobilization of patients on intensive care units (ICU), implementation in practice is limited. Protocols for early mobilization, including in- and exclusion criteria, assessments, safety criteria, and step schemes may increase the rate of implementation and mobilization. Patients (population) on ICUs with a protocol for early mobilization (intervention), compared to patients on ICUs without protocol (control), will be more frequently mobilized (outcome). A multicenter, stepped-wedge, cluster-randomized pilot study is presented. Five ICUs will receive an adapted, interprofessional protocol for early mobilization in randomized order. Before and after implementation, mobilization of ICU patients will be evaluated by randomized monthly one-day point prevalence surveys. Primary outcome is the percentage of patients mobilized out of bed, operationalized as a score of ≥3 on the ICU Mobility Scale. Secondary outcome parameters will be presence and/or length of mechanical ventilation, delirium, stay on ICU and in hospital, barriers to early mobilization, adverse events, and process parameters as identified barriers, used strategies, and adaptions to local conditions. Exploratory evaluation of study feasibility and estimation of effect sizes as the basis for a future explanatory study.

Mobile Creches: Pioneering Early Childhood Care and Development in India

ERIC Educational Resources Information Center

Young Children, 2007

2007-01-01

Mobile Creche ("creche" means "day nursery") was founded on one woman's determination to change life for India's most vulnerable children. Within its first decade, Mobile Creches' network of child care centers spread from construction sites to urban slums and from the capital city of Delhi to the commercial and cultural centers…

Invasive aspergillosis associated with systemic lupus erythematosus and cardiac postoperative complication

PubMed Central

Macêdo, Danielle Patrícia Cerqueira; Silva-Júnior, Heraldo Maia; de Souza-Motta, Cristina Maria; Milan, Eveline Pípolo; Neves, Rejane Pereira

2009-01-01

Aspergillus is a ubiquitous fungus which can cause a variety of clinical syndromes. This fungus has emerged as agent of systemic infections and has therefore gained considerable public health importance. This paper describes two cases of invasive aspergillosis caused by A. fumigatus in immuno-suppressed patients and underscores the importance of early identification of Aspergillus infection associated with systemic lupus erythematosus and cardiac postoperative complications. PMID:24031340

Necrotizing fasciitis: microbiological characteristics and predictors of postoperative outcome

PubMed Central

2009-01-01

Objective Necrotizing fasciitis is a life threatening soft-tissue infection with a high morbidity and mortality. Prompt treatment based on extensive surgical debridement and antibiotic therapies are the therapeutic principles. Methods The medical records of patients with necrotizing fasciitis (n = 26) from 1996 to 2005 were retrospectively analyzed. Results The localization of necrotizing fasciitis was most commonly the trunk (42.3%). Type I polymicrobial infection was the dominating infection. The involvement of anaerobic bacteria was associated with an increase in the number of surgical revisions (p = 0.005). Length of postoperative intensive care unit stay, duration of postoperative ventilation and mortality were significantly increased in the ASA IV-V group. Computed tomography displayed only a limited significance as diagnostic tool for initial diagnosis. Conclusions In severe cases the combination of necrotic skin and soft tissue gas facilitates the correct diagnosis, which should than be followed by immediate - and most often - repeated debridement. If anaerobes are isolated an early and aggressive second look is necessary. PMID:19258208

Postoperative Radiation Therapy With or Without Concurrent Chemotherapy for Node-Positive Thoracic Esophageal Squamous Cell Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Junqiang; Pan, Jianji; Liu, Jian, E-mail: liujianfj@yahoo.com.cn

Purpose: To retrospectively compare the efficacy of radiation therapy (RT) and chemotherapy plus RT (CRT) for the postoperative treatment of node-positive thoracic esophageal squamous cell carcinoma (TESCC) and to determine the incidence and severity of toxic reactions. Methods and Materials: We retrospectively reviewed data from 304 patients who had undergone esophagectomy with 3-field lymph node dissection for TESCC and were determined by postoperative pathology to have lymph node metastasis without distant hematogenous metastasis. Of these patients, 164 underwent postoperative chemotherapy (cisplatin 80 mg/m{sup 2}, average days 1-3, plus paclitaxel 135 mg/m{sup 2}, day 1; 21-day cycle) plus RT (50 Gy),more » and 140 underwent postoperative RT alone. Results: The 5-year overall survival rates for the CRT and RT groups were 47.4% and 38.6%, respectively (P=.030). The distant metastasis rate, the mixed (regional lymph node and distant) metastasis rate, and the overall recurrence rate were significantly lower in the CRT group than in the RT group (P<.05). However, mild and severe early toxic reactions, including neutropenia, radiation esophagitis, and gastrointestinal reaction, were significantly more common in the CRT group than in the RT group (P<.05). No significant differences in incidence of late toxic reactions were found between the 2 groups. Conclusions: Our results show that in node-positive TESCC patients, postoperative CRT is significantly more effective than RT alone at increasing the overall survival and decreasing the rates of distant metastasis, mixed metastasis, and overall recurrence. Severe early toxic reactions were more common with CRT than with RT alone, but patients could tolerate CRT.« less

The impact of childhood residential mobility on mental health outcomes in adolescence and early adulthood: a record linkage study.

PubMed

Tseliou, Foteini; Maguire, Aideen; Donnelly, Michael; O'Reilly, Dermot

2016-03-01

Understanding the causes of poor mental health in early childhood and adolescence is important as this can be a significant determinant of mental well-being in later years. One potential and relatively unexplored factor is residential mobility in formative years. Previous studies have been relatively small and potentially limited due to methodological issues. The main aim of this study was to investigate the relationship between early residential instability and poor mental health among adolescents and young adults in Northern Ireland. A Census-based record linkage study of 28% of children aged 0-8 years in 2001 in Northern Ireland (n=49,762) was conducted, with six monthly address change assessments from health registration data and self-reported mental health status from the 2011 Census. Logistic regression models were built adjusting for socioeconomic status (SES), household composition and marital dissolution. There was a graded relationship between the number of address changes and mental ill-health (adjusted OR 3.67, 95% CIs 2.11 to 6.39 for 5 or more moves). This relationship was not modified by SES or household composition. Marital dissolution was associated with poor mental health but did not modify the relationship between address change and mental health (p=0.206). There was some indication that movement after the age of five was associated with an increased likelihood of poor mental health. This large study clearly confirms the close relationship between address change in early years and later poor mental health. Residential mobility may be a useful marker for children at risk of poorer mental health in adolescence and early adulthood. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Comparison of Alignment Correction Angles Between Fixed-Bearing and Mobile-Bearing UKA.

PubMed

Inoue, Atsuo; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Yamazoe, Shoichi; Kubo, Toshikazu

2016-01-01

Good outcomes have been reported with both fixed-bearing and mobile-bearing unicompartmental knee arthroplasty (UKA). However, overcorrected alignment could induce the progression of arthritis on the non-arthroplasty side. Changes of limb alignment after UKA with both types of bearings (fixed bearing: 24 knees, mobile bearing: 28 knees) were investigated. The mean difference between the preoperative standing femoral-tibial angle (FTA) and postoperative standing FTA was significantly larger in mobile bearing UKA group. In fixed-bearing UKA, there must be some laxity in MCL tension so that a 2-mm tension gauge can be inserted. In mobile-bearing UKA, appropriate MCL tension is needed to prevent bearing dislocation. This difference in MCL tension may have caused the difference in the correction angle between the groups. Copyright © 2016 Elsevier Inc. All rights reserved.

Patients recovering from abdominal surgery who walked with volunteers had improved postoperative recovery profiles during their hospitalization.

PubMed

Le, Hai; Khankhanian, Pouya; Joshi, Neha; Maa, John; Crevensten, Henry

2014-08-01

Early walking as part of a perioperative care program benefits patients who have had surgery. However, the impact of early walking by itself on the mental and physical recovery of postoperative patients has not been examined. We established a program called walking to recovery (WTR) in which college volunteers provided walking assistance to patients recovering after abdominal surgery. Patients who participated in the program were compared with patients who did not. The postoperative recovery profile survey (PRP-17) was administered on day of discharge to 15 participants and 15 non-participants. Medical records were reviewed to obtain indication for surgery, type of surgery, length of hospital stay, and postoperative complications. At 1 month post-discharge, a short form (SF)-12v2 questionnaire was administered by telephone to assess postoperative quality of life as defined by mental and physical level of function and measured with the mental component score (MCS) and the physical component score (PCS). The average age of participants and non-participants was similar (48.9 ± 9.8 vs. 51.4 ± 8.7 years; p = 0.28). When the two groups were approximately matched by type and severity of surgery, participants had lower PRP-17 composite scores (9.9 vs. 12.5, p = 0.003) and higher indicator sums (9.8 vs. 8.4, p = 0.04) than non-participants, both of which indicate better postoperative recovery in participants. The mean immobilization score was significantly lower in participants (0.3 vs. 0.8, p = 0.04). Postoperative length of stay and MCS did not differ between the two groups, but in participants there was a trend for higher scores in the PCS. Walking with volunteers was associated with a better PRP during the hospitalization period but not at 1 month follow-up. The WTR program is a sustainable, cost-effective model program for other hospitals to emulate as part of the standard of care of postoperative patients.

Middle School Student Perceptions and Actual Use of Mobile Devices: Highlighting Disconnects in Student Planned and Actual Usage of Mobile Devices in Class

ERIC Educational Resources Information Center

Bartholomew, Scott R.; Reeve, Edward

2018-01-01

Discussion surrounding the inclusion of mobile devices in K-12 classrooms has escalated since the early 2000s, and the literature base dedicated to mobile devices, mobile-learning, and e-learning has likewise grown. The majority of the research related to mobile devices and their inclusion in educational settings has largely revolved around…

The Social Mobility Index: Further Information

ERIC Educational Resources Information Center

Sutton Trust, 2015

2015-01-01

The "Social Mobility Index" ranks all 533 parliamentary constituencies in England according to five measures of social mobility through education: (1) Performance of disadvantaged pupils in early years test; (2) Performance of disadvantaged pupils in Key Stage 2 tests; (3) Performance of disadvantaged pupils at GCSE; (4) Progress of…

The impact of early powered mobility on parental stress, negative emotions, and family social interactions.

PubMed

Tefft, Donita; Guerette, Paula; Furumasu, Jan

2011-02-01

Powered mobility has been found to have positive effects on young children with severe physical disabilities, but the impact on the family has been less well documented. We evaluated the impact of early powered mobility on parental stress, negative emotions, perceived social interactions, and parental satisfaction with wheelchair characteristics such as size and durability. The participants were parents of 23 children with disabilities-10 with orthopedic disabilities (average age 30.1 months) and 13 with cerebral palsy (average age 47.0 months). Pretest assessments were completed two times: at initial wheelchair evaluation and at wheelchair delivery. A posttest assessment was completed after each child had used the wheelchair for 4-6 months. Parents reported a lower perceived level of stress at the time of wheelchair delivery, although the magnitude of this effect was fairly small, standardized mean difference (δ) = .27. They also reported an increased satisfaction with their child's social and play skills (δ = .38), ability to go where desired (δ = .86), sleep/wake pattern (δ = .61), and belief that the general public accepts their child (δ = .39) after several months using the wheelchair. Parents reported an increase in interactions within the family at the time of wheelchair delivery (δ = .66). There was no decrease in negative emotions. Parents were satisfied with most factors relating to the wheelchair itself, with areas of concern being wheelchair size and difficulty adjusting the wheelchair. The findings suggest that self-initiated powered mobility for a young child had a positive impact on the family.

Surrogate mobility and orientation affect the early neurobehavioral development of infant rhesus macaques (Macaca mulatta).

PubMed

Dettmer, Amanda M; Ruggiero, Angela M; Novak, Melinda A; Meyer, Jerrold S; Suomi, Stephen J

2008-05-01

A biological mother's movement appears necessary for optimal development in infant monkeys. However, nursery-reared monkeys are typically provided with inanimate surrogate mothers that move very little. The purpose of this study was to evaluate the effects of a novel, highly mobile surrogate mother on motor development, exploration, and reactions to novelty. Six infant rhesus macaques (Macaca mulatta) were reared on mobile hanging surrogates (MS) and compared to six infants reared on standard stationary rocking surrogates (RS) and to 9-15 infants reared with their biological mothers (MR) for early developmental outcome. We predicted that MS infants would develop more similarly to MR infants than RS infants. In neonatal assessments conducted at Day 30, both MS and MR infants showed more highly developed motor activity than RS infants on measures of grasping (p = .009), coordination (p = .038), spontaneous crawl (p = .009), and balance (p = .003). At 2-3 months of age, both MS and MR infants displayed higher levels of exploration in the home cage than RS infants (p = .016). In a novel situation in which only MS and RS infants were tested, MS infants spent less time near their surrogates in the first five minutes of the test session than RS infants (p = .05), indicating a higher level of comfort. Collectively, these results suggest that when nursery-rearing of infant monkeys is necessary, a mobile hanging surrogate may encourage more normative development of gross motor skills and exploratory behavior and may serve as a useful alternative to stationary or rocking surrogates.

Sonography in the postoperative evaluation of laparoscopic inguinal hernia repair.

PubMed

Furtschegger, A; Sandbichler, P; Judmaier, W; Gstir, H; Steiner, E; Egender, G

1995-09-01

We evaluated the use of sonography as a means of assessing hernial occlusion and possible postoperative changes such as hematomas or seromas in the inguinal and scrotal regions after 1139 laparoscopic repairs of hernias between August 1992 and November 1994. Changes after laparoscopic hernia repair were found in 307 patients (27%). Hematomas or seromas were seen in 132 patients, protrusion of the prosthetic mesh in 17, mesh infection in two, and small bowel entrapment in an insufficient peritoneal suture in two. Recurrences were diagnosed correctly in six patients, mobile preperitoneal lipomas in five. Sonography is useful in the evaluation of complications after laparoscopic hernia repair, including recurrent hernia. In the absence of symptoms, sonography is not indicated.

Mobile satellite business networks: A part of the European mobile system

NASA Technical Reports Server (NTRS)

deMateo, M. L.; Jongejans, A.; Loisy, C.; VanHimbeeck, C.; Marchal, J. P.; Borella, A.; Sartori, M.

1995-01-01

The European Space Agency (ESA) is presently procuring an L-band payload EMS, to be embarked on the ITALSAT-2 satellite due for launch in early 1996, in order to promote a regional European mobile system. One of the Land Mobile Communication systems supported by EMS is the MSBN (Mobile Satellite Business Network) voice and data system which will offer the services of a business network on a seamless European coverage. This paper will first recall the characteristics of the MSBN system, which is based on quasi-synchronized CDMA (Code Division Multiple Access) techniques in both directions, and then describe the CDMA receivers implementation. Main validation test results will also be reported confirming predicted performances.

Modern dual-mobility cup implanted with an uncemented stem: about 100 cases with 12-year follow-up.

PubMed

Philippot, Remi; Meucci, Jean Francois; Boyer, Bertrand; Farizon, Frederic

2013-09-01

We report the results of a 12-year follow-up retrospective series of 100 total hip arthroplasties using cementless, press-fit, dual-mobility acetabular cups. The aim of our study was to evaluate the clinical and radiographic results of this acetabular cup at last follow-up. This continuous and homogeneous series included 100 primary total hip arthroplasties performed during the year 2000. The THA combined a Corail® stem (Corail®, Depuy, Warsaw, IN) with a stainless steel Novae Sunfit® (Serf, Decines, France) acetabular cup. Fifteen patients died and 2 were lost to follow-up. Two cases of early dislocation were observed, and 3 cases of aseptic loosening of the acetabular component were reported. The mean stem subsidence was 0.71 mm, the mean craniopodal acetabular migration was 1.37 mm, and the mean medio-lateral acetabular migration was 1.52 mm. The 12-year survivorship is comparable to the data from the literature. The low dislocation rate at 12 years confirms the long-term, high stability of dual mobility, which should be recommended in primary THA for patients at risk for postoperative instability. The absence of true intraprosthetic dislocation events at 12-year follow-up provides evidence of the good quality of the latest generation of polyethylene liners and the necessity of combining thin-mirror, polished femoral necks with dual-mobility cups.

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

The postoperative course of gamma-glutamyl transpeptidase--a marker of cytomegalovirus (CMV) replication risk?

PubMed

Schenk, M; Zipfel, A; Kratt, T; Petersen, P; Becker, H D; Viebahn, R

2000-11-01

Cytomegalovirus (CMV) infection is a common complication in the postoperative course of liver transplantation. In order to start early prophylactic therapy, but to avoid unnecessary treatment, or expensive screening, a desirable goal in post-transplant monitoring is to find appropriate markers in standard laboratory diagnostics. In the present study, the results of a 6-week CMV replication monitoring schedule by the pp65 antigenemia assay in 100 liver graft recipients were included. The activities of transaminases, glutamate dehydrogenase and gamma-glutamyl transpeptidase (gamma-GT) were measured by routine laboratory methods. In contrast to the transaminases, the serum activity of gamma-GT increased during the first postoperative week. The maximum levels were 246 +/- 211 U/l in patients without (n = 46) and 140 +/- 89 U/l in patients with early CMV replication (n = 54; p = 0.02). Patients with gamma-GT levels below 200 U/l on the 5th postoperative day (n = 72) had a CMV replication risk of 65%, whereas those patients with gamma-GT levels above this threshold had a risk of 30% (n = 28; p = 0.0007; relative risk = 2.9). These findings provide a routinely usable marker for the identification of patients at an increased risk of CMV replication. It can be considered that these phenomena may be caused by an additional immunosuppressive effect of the CMV virus.

Acceptance of Illness after Surgery in Patients with Breast Cancer in the Early Postoperative Period.

PubMed

Nowicki, Andrzej; Krzemkowska, Elżbieta; Rhone, Piotr

2015-11-01

The breast cancer is the most common cancer in women, both in Poland and in the world. Consequences entail a disruption in the physical, psychological and social functioning. The aim of the study was to assess the acceptance of illness by patients treated for breast cancer in the early postoperative period. The research was conducted on the group of 100 consecutive patients aged 32-80 years (median 56 years) who underwent surgery for breast cancer in the Centre of Oncology in Bydgoszcz w 2014 roku. 68 of women had mastectomy, 32 of women had conservative surgery. Polling was conducted in the early period after surgery. The original questionnaire containing closed questions the scale of acceptance of the disease (AIS) as well as mental adaptation to cancer (Mini-Mac) was used in the study. 38% of patients had high acceptance of the disease, 48% average and 14% had low acceptance. Patients after conservative surgery had a higher average values for the mental strategies to cope with the disease, for the fighting spirit (23.1), helplessness and hopelessness (13.5), positive revaluation (23), the patients had a lower average (16.5) in the strategy to absorb anxiety. Patients after conservative surgery had a higher average for constructive style (2.6) but lower for destructive style (1.5). High level of mental coping with the disease was observed in 53%of patients with constructive style and 4% of patients with destructive style. While, a low level of mental coping with the dosease was observed in 5% of patients with constructive style and 46% of patients with destructive style. Almost half of women after mastectomy or conservative surgery had an average acceptance of the disease. The disease was accepted best by educated women living in the cities, white-collar workers with a good economic situation. The following factors were affected the better management of the disease, in order: age, education, current occupation and economic situation, while the type of surgery did

Post-operative fatigue - a real phenomenon attributable to the metabolic effects of surgery on body nutritional stores.

PubMed

Stock, S E; Clague, M B; Johnston, I D

1991-10-01

Ambulatory monitoring of activity was undertaken in 97 patients before and at intervals following surgery employing a lightweight recorder and sensors to monitor posture and movement over 24h periods. A subjective assessment of fatigue, anthropometric measurements and clinical details were noted prior to each recording. Results were assessed using multiple regression analysis. Few patients exhibited any subjective feeling of fatigue. However, objective assessment did show a reduction in activity, several of the changes correlating with factors related to surgical stress and post-operative nutritional depletion. Reduction in time standing was related to both weight change at 2 weeks (p < 0.005) and duration of surgery (p < 0.05). Increase in time spent lying correlated with muscle loss at 2 weeks (p < 0.005). Number of steps walked was only influenced by weight change at 2 weeks (p < 0.05). Reduction in post-operative mobility may be related to the metabolic consequences of the surgery and its effects on depletion of nutritional stores. Manipulation of the response and aggressive nutritional support might well reduce post-operative fatigue.

Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay.

PubMed

Souza Possa, S; Braga Amador, C; Meira Costa, A; Takahama Sakamoto, E; Seiko Kondo, C; Maida Vasconcellos, A L; Moran de Brito, C M; Pereira Yamaguti, W

2014-01-01

The aim of this study was to evaluate the effectiveness of implementing a physical therapy guideline for patients undergoing upper abdominal surgery (UAS) in reducing the incidence of atelectasis and length of hospital stay in the postoperative period. A "before and after" study design with historical control was used. The "before" period included consecutive patients who underwent UAS before guideline implementation (intervention). The "after" period included consecutive patients after guideline implementation. Patients in the pre-intervention period were submitted to a program of physical therapy in which the treatment planning was based on the individual experience of each professional. On the other hand, patients who were included in the post-intervention period underwent a standardized program of physical therapy with a focus on the use of additional strategies (EPAP, incentive spirometry and early mobilization). There was a significant increase in the use of incentive spirometry and positive expiratory airway pressure after guideline implementation. Moreover, it was observed that early ambulation occurred in all patients in the post-intervention period. No patient who adhered totally to the guideline in the post-intervention period developed atelectasis. Individuals in the post-intervention period presented a shorter length of hospital stay (9.2±4.1 days) compared to patients in the pre-intervention period (12.1±8.3 days) (p<0.05). The implementation of a physical therapy guideline for patients undergoing UAS resulted in reduced incidence of atelectasis and reduction in length of hospital stay in the postoperative period. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

[Recent advances of monitoring and glycaemia control during early postoperative period in patients after pancreas surgery].

PubMed

Lishova, E A; Nikoda, V V; Bondarenko, A V; Ragozin, A K; Skipenko, O G

2013-01-01

Recently new technologies of diagnostics and correction of carbohydrates metabolism disturbances are introduced in the ICU to improve the safety for patients during intensive care. 33 patients after pancreas surgery were included into the study 13 patients (39%) had underlying diabetes mellitus. Glucose level changes in the interstitial liquid of the subcutaneous fat during postoperative period were monitored by system of CGM Medtronic MiniMed Guardian RT, MiniMed Paradigm Real-time. Valid values of glucose were from 4.1 to 10.1 mmol/L. Episodes of glucose level increasing occurred in 94% of patients in postoperative period after pancreas surgery. Average level of glucose was within the limits of valid values. However in 64% of cases patients needed insulin therapy Used systems of continuous glucose monitoring in the ICU allow improving the safety for patients receiving artificial nutrition and intravenous insulin therapy.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF): incremental validity in predicting early postoperative outcomes in spine surgery candidates.

PubMed

Marek, Ryan J; Block, Andrew R; Ben-Porath, Yossef S

2015-03-01

A substantial proportion of individuals who undergo surgical procedures to relieve spine pain continue to report significant pain and dysfunction after recovery. Psychopathology and patient expectations have been linked to poor results, leading to an increasing reliance on presurgical psychological screening (PPS) as part of the surgical diagnostic process. The original Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) and the MMPI-2 (Butcher, Graham, Ben-Porath, Tellegen, & Dahlstrom, 2001) were among the measures most commonly used in PPS evaluations and research. This study focuses on the newest version of the test, the MMPI-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011; Tellegen & Ben-Porath, 2008/2011) as a predictor of outcomes for spine surgery candidates. Using a sample of 172 men and 210 women who underwent a PPS, we examined the ability of MMPI-2-RF scale scores to predict early surgical outcomes independent of other presurgical risk factors identified by other means, as well as patients' presurgical expectations. MMPI-2-RF results accounted for up to 11% of additional variance in measures of early postoperative functioning. MMPI-2-RF scales that assess for emotional/internalizing problems, specifically Demoralization, measures of somatoform dysfunction, and interpersonal problems contributed most to the prediction of diminished outcome. 2015 APA, all rights reserved

Dose-Volume Histogram Predictors of Chronic Gastrointestinal Complications After Radical Hysterectomy and Postoperative Concurrent Nedaplatin-Based Chemoradiation Therapy for Early-Stage Cervical Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Isohashi, Fumiaki, E-mail: isohashi@radonc.med.osaka-u.ac.jp; Yoshioka, Yasuo; Mabuchi, Seiji

2013-03-01

Purpose: The purpose of this study was to evaluate dose-volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in cervical cancer patients who underwent radical hysterectomy and postoperative concurrent nedaplatin-based chemoradiation therapy. Methods and Materials: This study analyzed 97 patients who underwent postoperative concurrent chemoradiation therapy. The organs at risk that were contoured were the small bowel loops, large bowel loop, and peritoneal cavity. DVH parameters subjected to analysis included the volumes of these organs receiving more than 15, 30, 40, and 45 Gy (V15-V45) and their mean dose. Associations between DVH parameters or clinical factors andmore » the incidence of grade 2 or higher chronic GI complications were evaluated. Results: Of the clinical factors, smoking and low body mass index (BMI) (<22) were significantly associated with grade 2 or higher chronic GI complications. Also, patients with chronic GI complications had significantly greater V15-V45 volumes and higher mean dose of the small bowel loops compared with those without GI complications. In contrast, no parameters for the large bowel loop or peritoneal cavity were significantly associated with GI complications. Results of the receiver operating characteristics (ROC) curve analysis led to the conclusion that V15-V45 of the small bowel loops has high accuracy for prediction of GI complications. Among these parameters, V40 gave the highest area under the ROC curve. Finally, multivariate analysis was performed with V40 of the small bowel loops and 2 other clinical parameters that were judged to be potential risk factors for chronic GI complications: BMI and smoking. Of these 3 parameters, V40 of the small bowel loops and smoking emerged as independent predictors of chronic GI complications. Conclusions: DVH parameters of the small bowel loops may serve as predictors of grade 2 or higher chronic GI complications after postoperative

Postoperative venous thromboembolism predicts survival in cancer patients.

PubMed

Auer, Rebecca Ann C; Scheer, Adena Sarah; McSparron, Jakob I; Schulman, Allison R; Tuorto, Scott; Doucette, Steve; Gonsalves, Jamie; Fong, Yuman

2012-05-01

To determine whether a postoperative venous thromboembolism (VTE) is associated with a worse prognosis and/or a more advanced cancer stage and to evaluate the association between a postoperative VTE and cancer-specific survival when known prognostic factors, such as age, stage, cancer type, and type of surgery, are controlled. It is unknown whether oncology patients who develop a venous thromboembolism after a complete curative resection are at the same survival disadvantage as oncology patients with a spontaneous VTE. A retrospective case control study was conducted at Memorial Sloan-Kettering Cancer Center. Years of study: January 1, 2000, to December 31, 2005. Median follow-up: 24.9 months (Interquartile range 13.0, 43.0). All cancer patients who underwent abdominal, pelvic, thoracic, or soft tissue procedures and those who developed a VTE within 30 days of the procedure were identified from a prospective morbidity and mortality database. Overall survival (OS) was calculated for the entire cohort. In the matched cohort, OS and disease-specific survival (DSS) were calculated for stages 0 to 3 and stages 0 to 2. A total of 23,541 cancer patients underwent an invasive procedure and 474 (2%) had a postoperative VTE. VTE patients had a significantly worse 5-year OS compared to no-VTE patients (43.8% vs 61.2%; P < 0.0001); 205 VTE patients (stages 0-3) were matched to 2050 controls by age, sex, cancer type, stage, and surgical procedure. In this matched analysis, VTE patients continued to demonstrate a significantly worse prognosis with an inferior 5-year OS (54.7% vs 66.3%; P < 0.0001) and DSS (67.8% vs 79.5%; P = 0.0007) as compared to controls. The survival difference persisted in early stage disease (stage 0-2), with 5-year DSS of 82.9% versus 87.3% (P = 0.01). Postoperative VTE in oncology patients with limited disease and a complete surgical resection is associated with an inferior cancer survival. A postoperative VTE remains a poor prognostic factor, even when

Characterizing Early Adolescent Plate Waste Using the Mobile Food Record.

PubMed

Panizza, Chloe E; Boushey, Carol J; Delp, Edward J; Kerr, Deborah A; Lim, Eunjung; Gandhi, Krupa; Banna, Jinan C

2017-01-26

This study aimed to assess the amount of plate waste and how plate waste was disposed by early adolescent girls using a mobile food record (mFR). Participants were girls nine to thirteen years residing in O'ahu, Hawai'i ( n = 93). Foods selected and leftover were estimated using a three day mFR. Each leftover food was then classified as thrown into the trash, fed to a pet, eaten later, or other (e.g., composted). Repeated measures analyses of variance (ANOVA) were conducted and Tukey's post-hoc test were used to adjust for multiple comparisons between times (breakfast, lunch, dinner, and snack) on leftover food and leftover food thrown into the trash. The percentage of food leftover and thrown into the trash was highest at lunch. The percentage of protein, grain, vegetables, fruit, and dairy leftover at lunch were unexpectedly low compared to previous studies. The median for percentage of food thrown into the trash at lunch was <5% for all food groups, and was consistently low across the day (<10%). Average energy intake was 436 kcal (±216) at lunch, and 80% of caregivers reported total household income as ≥$70,000. Studies in real-time using technology over full days may better quantify plate waste among adolescents.

Characterizing Early Adolescent Plate Waste Using the Mobile Food Record

PubMed Central

Panizza, Chloe E.; Boushey, Carol J.; Delp, Edward J.; Kerr, Deborah A.; Lim, Eunjung; Gandhi, Krupa; Banna, Jinan C.

2017-01-01

This study aimed to assess the amount of plate waste and how plate waste was disposed by early adolescent girls using a mobile food record (mFR). Participants were girls nine to thirteen years residing in O’ahu, Hawai’i (n = 93). Foods selected and leftover were estimated using a three day mFR. Each leftover food was then classified as thrown into the trash, fed to a pet, eaten later, or other (e.g., composted). Repeated measures analyses of variance (ANOVA) were conducted and Tukey’s post-hoc test were used to adjust for multiple comparisons between times (breakfast, lunch, dinner, and snack) on leftover food and leftover food thrown into the trash. The percentage of food leftover and thrown into the trash was highest at lunch. The percentage of protein, grain, vegetables, fruit, and dairy leftover at lunch were unexpectedly low compared to previous studies. The median for percentage of food thrown into the trash at lunch was <5% for all food groups, and was consistently low across the day (<10%). Average energy intake was 436 kcal (±216) at lunch, and 80% of caregivers reported total household income as ≥$70,000. Studies in real-time using technology over full days may better quantify plate waste among adolescents. PMID:28134757

Intraoperative ketamine reduces immediate postoperative opioid consumption after spinal fusion surgery in chronic pain patients with opioid dependency: a randomized, blinded trial.

PubMed

Nielsen, Rikke Vibeke; Fomsgaard, Jonna Storm; Siegel, Hanna; Martusevicius, Robertas; Nikolajsen, Lone; Dahl, Jørgen Berg; Mathiesen, Ole

2017-03-01

Perioperative handling of surgical patients with opioid dependency represents an important clinical problem. Animal studies suggest that ketamine attenuates central sensitization and hyperalgesia and thereby reduces postoperative opioid tolerance. We hypothesized that intraoperative ketamine would reduce immediate postoperative opioid consumption compared with placebo in chronic pain patients with opioid dependency undergoing lumbar spinal fusion surgery. Primary outcome was morphine consumption 0 to 24 hours postoperatively. Secondary outcomes were acute pain at rest and during mobilization 2 to 24 hours postoperatively (visual analogue scale), adverse events, and persistent pain 6 months postoperatively. One hundred fifty patients were randomly assigned to intraoperative S-ketamine bolus 0.5 mg/kg and infusion 0.25 mg·kg·h or placebo. Postoperatively, patients received their usual opioids, paracetamol and IV patient-controlled analgesia with morphine. In the final analyses, 147 patients were included. Patient-controlled analgesia IV morphine consumption 0 to 24 hours postoperatively was significantly reduced in the ketamine group compared with the placebo group: 79 (47) vs 121 (53) mg IV, mean difference 42 mg (95% confidence interval -59 to -25), P < 0.001. Sedation was significantly reduced in the ketamine group 6 and 24 hours postoperatively. There were no significant differences regarding acute pain, nausea, vomiting, hallucinations, or nightmares. Back pain at 6 months postoperatively compared with preoperative pain was significantly more improved in the ketamine group compared with the placebo group, P = 0.005. In conclusion, intraoperative ketamine significantly reduced morphine consumption 0 to 24 hours after lumbar fusion surgery in opioid-dependent patients. The trend regarding less persistent pain 6 months postoperatively needs further investigation.

Association Between Exercise Therapy Dose and Functional Improvements in the Early Postoperative Phase After Hip and Knee Arthroplasty: An Observational Study.

PubMed

Zech, Astrid; Hendrich, Simon; Pfeifer, Klaus

2015-10-01

To determine whether intensity and duration of standard exercise therapy are associated with changes in function after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Prospective cohort study. Orthopedic inpatient rehabilitation center. A total of 123 patients 2 weeks after THA (n = 58; age, 62.5 ± 10.4 years) and TKA (n = 65; age, 66.6 ± 7.6 years). Standard rehabilitation (hands-on physiotherapy, group exercise therapy, strength training, cycle ergometer therapy, continuous passive motion therapy, and water exercise therapy). The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and hip and knee range of motion (ROM) were assessed before and after inpatient rehabilitation. The individual rehabilitation period varied between 12-25 days and included 48.1 ± 12.5 (THA) or 41.9 ± 9.7 (TKA) exercise interventions with intensities between 9.6 and 14.0 points on the Borg Rate of Perceived Exertion Scale. WOMAC pain (P < .001), stiffness (P < .001), and function (P < .001), as well as hip (P < .001) and knee (P < .001) ROM, improved significantly in THA and TKA patients. Analysis of covariance showed that these changes could not be explained by the total duration or mean intensity of exercise therapy. The findings show a low dose-response relationship between early postoperative exercise therapy and the improvements in function or ROM after THA and TKA. Although the findings raise questions about the efficacy of existing rehabilitation programs, the small sample size, single setting, and geographic differences in postoperative treatment standards limit the generalizability of findings. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Postoperative ascitic leaks: the ongoing challenge.

PubMed

Rosemurgy, A S; Statman, R C; Murphy, C G; Albrink, M H; McAllister, E W

1992-06-01

The leak of ascitic fluid from surgical incisions is thought to be associated with a very high mortality rate. There have been few reports, however, focusing on the clinical characteristics, management, or mortality rates of this condition. During a 10-year period, 18 patients with postoperative ascitic fluid leaks were treated. All patients had ascites before surgery and all had liver disease; in 13 of the 18 patients alcoholic liver disease was the cause of ascites. Ten of the 18 patients died (56%). Midline incisions were more often associated with recalcitrant leaks and fatal complications than were transverse incisions. Early consideration of fascial dehiscence and prompt repair is emphasized. The most effective predictor of survival was cessation of the leak.

Unilateral lesion of dorsal hippocampus in adult rats impairs contralateral long-term potentiation in vivo and spatial memory in the early postoperative phase.

PubMed

Li, Hongjie; Wu, Xiaoyan; Bai, Yanrui; Huang, Yan; He, Wenting; Dong, Zhifang

2012-05-01

It is well documented that bilateral hippocampal lesions or unilateral hippocampal lesion at birth causes impairment of contralateral LTP and long-term memory. However, effects of unilateral hippocampal lesion in adults on contralateral in vivo LTP and memory are not clear. We here examined the influence of unilateral electrolytic dorsal hippocampal lesion in adult rats on contralateral LTP in vivo and spatial memory during different postoperative phases. We found that acute unilateral hippocampal lesion had no effect on contralateral LTP. However, contralateral LTP was impaired at 1 week after lesion, and was restored to the control level at postoperative week 4. Similarly, spatial memory was also impaired at postoperative week 1, and was restored at postoperative week 4. In addition, the rats at postoperative week 1 showed stronger spatial exploratory behavior in a novel open-field environment. The sham operation had no effects on contralateral LTP, spatial memory and exploration at either postoperative week 1 or week 4. These results suggest that unilateral dorsal hippocampal lesion in adult rats causes transient contralateral LTP impairment and spatial memory deficit. Copyright © 2012 Elsevier B.V. All rights reserved.

Intravenous non-opioid analgesia for peri- and postoperative pain management: a scientific review of intravenous acetaminophen and ibuprofen

PubMed Central

Koh, Wonuk; Nguyen, Kimngan Pham

2015-01-01

Pain is a predictable consequence following operations, but the management of postoperative pain is another challenge for anesthesiologists and inappropriately controlled pain may lead to unwanted outcomes in the postoperative period. Opioids are indeed still at the mainstream of postoperative pain control, but solely using only opioids for postoperative pain management may be connected with risks of complications and adverse effects. As a consequence, the concept of multimodal analgesia has been proposed and is recommended whenever possible. Acetaminophen is one of the most commonly used analgesic and antipyretic drug for its good tolerance and high safety profiles. The introduction of intravenous form of acetaminophen has led to a wider flexibility of its use during peri- and postoperative periods, allowing the early initiation of multimodal analgesia. Many studies have revealed the efficacy, safety and opioid sparing effects of intravenous acetaminophen. Intravenous ibuprofen has also shown to be well tolerated and demonstrated to have significant opioid sparing effects during the postoperative period. However, the number of randomized controlled trials confirming the efficacy and safety is small and should be used in caution in certain group of patients. Intravenous acetaminophen and ibuprofen are important options for multimodal postoperative analgesia, improving pain and patient satisfaction. PMID:25664148

Intravenous non-opioid analgesia for peri- and postoperative pain management: a scientific review of intravenous acetaminophen and ibuprofen.

PubMed

Koh, Wonuk; Nguyen, Kimngan Pham; Jahr, Jonathan S

2015-02-01

Pain is a predictable consequence following operations, but the management of postoperative pain is another challenge for anesthesiologists and inappropriately controlled pain may lead to unwanted outcomes in the postoperative period. Opioids are indeed still at the mainstream of postoperative pain control, but solely using only opioids for postoperative pain management may be connected with risks of complications and adverse effects. As a consequence, the concept of multimodal analgesia has been proposed and is recommended whenever possible. Acetaminophen is one of the most commonly used analgesic and antipyretic drug for its good tolerance and high safety profiles. The introduction of intravenous form of acetaminophen has led to a wider flexibility of its use during peri- and postoperative periods, allowing the early initiation of multimodal analgesia. Many studies have revealed the efficacy, safety and opioid sparing effects of intravenous acetaminophen. Intravenous ibuprofen has also shown to be well tolerated and demonstrated to have significant opioid sparing effects during the postoperative period. However, the number of randomized controlled trials confirming the efficacy and safety is small and should be used in caution in certain group of patients. Intravenous acetaminophen and ibuprofen are important options for multimodal postoperative analgesia, improving pain and patient satisfaction.

Ultra-sensitive PSA Following Prostatectomy Reliably Identifies Patients Requiring Post-Op Radiotherapy

PubMed Central

Kang, Jung Julie; Reiter, Robert; Steinberg, Michael; King, Christopher R.

2015-01-01

PURPOSE Integrating ultra-sensitive PSA (uPSA) into surveillance of high-risk patients following radical prostatectomy (RP) potentially optimizes management by correctly identifying actual recurrences, promoting an early salvage strategy and minimizing overtreatment. The power of uPSA following surgery to identify eventual biochemical failures is tested. PATIENTS AND METHODS From 1991–2013, 247 high-risk patients with a median follow-up was 44 months after RP were identified (extraprostatic extension and/or positive margin). Surgical technique, initial PSA (iPSA), pathology and post-op PSA were analyzed. The uPSA assay threshold was 0.01 ng/mL. Conventional biochemical relapse (cBCR) was defined as PSA ≥0.2 ng/mL. Kaplan Meier and Cox multivariate analyses (MVA) compared uPSA recurrence vs. cBCR rates. RESULTS Sensitivity analysis identified uPSA ≥0.03 as the optimal threshold identifying recurrence. First post-op uPSA ≥0.03, Gleason grade, T-stage, iPSA, and margin status predicted cBCR. On MVA, only first post-op uPSA ≥0.03, Gleason grade, and T-stage independently predicted cBCR. First post-op uPSA ≥0.03 conferred the highest risk (HR 8.5, p<0.0001) and discerned cBCR with greater sensitivity than undetectable first conventional PSA (70% vs. 46%). Any post-op PSA ≥0.03 captured all failures missed by first post-op value (100% sensitivity) with accuracy (96% specificity). Defining failure at uPSA ≥0.03 yielded a median lead-time advantage of 18 months (mean 24 months) over the conventional PSA ≥0.2 definition. CONCLUSION uPSA ≥0.03 is an independent factor, identifies BCR more accurately than any traditional risk factors, and confers a significant lead-time advantage. uPSA enables critical decisions regarding timing and indication for post-op RT among high-risk patients following RP. PMID:25463990

A review of recent advances in data analytics for post-operative patient deterioration detection.

PubMed

Petit, Clemence; Bezemer, Rick; Atallah, Louis

2018-06-01

Most deaths occurring due to a surgical intervention happen postoperatively rather than during surgery. The current standard of care in many hospitals cannot fully cope with detecting and addressing post-surgical deterioration in time. For millions of patients, this deterioration is left unnoticed, leading to increased mortality and morbidity. Postoperative deterioration detection currently relies on general scores that are not fully able to cater for the complex post-operative physiology of surgical patients. In the last decade however, advanced risk and warning scoring techniques have started to show encouraging results in terms of using the large amount of data available peri-operatively to improve postoperative deterioration detection. Relevant literature has been carefully surveyed to provide a summary of the most promising approaches as well as how they have been deployed in the perioperative domain. This work also aims to highlight the opportunities that lie in personalizing the models developed for patient deterioration for these particular post-surgical patients and make the output more actionable. The integration of pre- and intra-operative data, e.g. comorbidities, vitals, lab data, and information about the procedure performed, in post-operative early warning algorithms would lead to more contextualized, personalized, and adaptive patient modelling. This, combined with careful integration in the clinical workflow, would result in improved clinical decision support and better post-surgical care outcomes.

Modeling neck mobility in fossil turtles.

PubMed

Werneburg, Ingmar; Hinz, Juliane K; Gumpenberger, Michaela; Volpato, Virginie; Natchev, Nikolay; Joyce, Walter G

2015-05-01

Turtles have the unparalleled ability to retract their heads and necks within their shell but little is known about the evolution of this trait. Extensive analysis of neck mobility in turtles using radiographs, CT scans, and morphometry reveals that basal turtles possessed less mobility in the neck relative to their extant relatives, although the anatomical prerequisites for modern mobility were already established. Many extant turtles are able to achieve hypermobility by dislocating the central articulations, which raises cautions about reconstructing the mobility of fossil vertebrates. A 3D-model of the Late Triassic turtle Proganochelys quenstedti reveals that this early stem turtle was able to retract its head by tucking it sideways below the shell. The simple ventrolateral bend seen in this stem turtle, however, contrasts with the complex double-bend of extant turtles. The initial evolution of neck retraction therefore occurred in a near-synchrony with the origin of the turtle shell as a place to hide the unprotected neck. In this early, simplified retraction mode, the conical osteoderms on the neck provided further protection. © 2014 Wiley Periodicals, Inc.

Postoperative Takotsubo cardiomyopathy triggered by intraoperative fluid overload and acute hypertensive crisis.

PubMed

Varutti, Rosanna; Setti, Tommaso; Ezri, Tiberiu; Nicolosi, Gianluigi; Rellini, Gianluigi; Cassin, Matteo; Leykin, Yigal

2015-04-01

The Takotsubo cardiomyopathy is a rare haemodynamic dysfunction, only recently reported perioperatively. While the diagnostic criteria have been established and the outcome is known as favorable, the pathophysiological mechanisms are not entirely understood. Here we present the case of a patient scheduled for laparoscopic hysterectomy and adnexectomy, who early postoperatively developed a Takotsubo cardiomyopathy supposedly triggered by an acute hypertensive crisis due to intraoperative fluid overload.

Surrogate Mobility and Orientation Affect the Early Neurobehavioral Development of Infant Rhesus Macaques (Macaca mulatta)

PubMed Central

Dettmer, Amanda M.; Ruggerio, Angela M.; Novak, Melinda A.; Meyer, Jerrold S.; Suomi, Stephen J.

2008-01-01

A biological mother’s movement appears necessary for optimal development in infant monkeys. However, nursery-reared monkeys are typically provided with inanimate surrogate mothers that move very little. The purpose of this study was to evaluate the effects of a novel, highly mobile surrogate mother on motor development, exploration, and reactions to novelty. Six infant rhesus macaques (Macaca mulatta) were reared on mobile hanging surrogates (MS) and compared to six infants reared on standard stationary rocking surrogates (RS) and to 9-15 infants reared with their biological mothers (MR) for early developmental outcome. We predicted that MS infants would develop more similarly to MR infants than RS infants. In neonatal assessments conducted at day 30, both MS and MR infants showed more highly developed motor activity than RS infants on measures of grasping (p=.009), coordination (p=.038), spontaneous crawl (p=.009), and balance (p=.003). At 2-3 months of age, both MS and MR infants displayed higher levels of exploration in the home cage than RS infants (p=.016). In a novel situation in which only MS and RS infants were tested, MS infants showed less of a stress response, spending less time near their surrogates in the first five minutes of the test session than RS infants (p=.05) and exhibiting a significantly lower rise in salivary cortisol after the test than RS infants (p=.018). Collectively, these results suggest that when nursery-rearing of infant monkeys is necessary, a mobile hanging surrogate may encourage more normative development of gross motor skills and exploratory behavior and may serve as a useful alternative to stationary or rocking surrogates. PMID:19810188

Modified ride-on toy cars for early power mobility: a technical report.

PubMed

Huang, Hsiang-Han; Galloway, James C

2012-01-01

Children with significantly decreased mobility have limited opportunities to explore their physical and social environment. A variety of assistive technologies are available to increase mobility; however, no single device provides the level of functional mobility that children developing typically enjoy. The purpose of this technical report is to formally introduce a new power mobility option--the modified ride-on toy car. This report will provide (a) an overview of toy car features, (b) examples of basic electrical and mechanical modifications, and (c) a brief clinical case. With creative use and customized modifications, toy cars can function as a "general learning environment" for use in the clinic, home, and school. As such, we anticipate that these cars will become a multiuse clinical tool to address not only mobility goals but also goals involving body function and structure such as posture and movement impairments.

The treatment of postoperative endophthalmitis: should we still follow the endophthalmitis vitrectomy study more than two decades after its publication?

PubMed

Grzybowski, Andrzej; Turczynowska, Magdalena; Kuhn, Ferenc

2017-12-02

Conducted in the early 1990s Endophthalmitis Vitrectomy Study (EVS) have helped in establishing reasonable guidelines for the management of infectious postoperative endophthalmitis. However at present, more than 20 years after its publication, tremendous progress has been introduced in vitrectomy technology, which now permits the vitreoretinal surgeon to perform surgery more safely, and with better outcomes. Moerover, performing a complete vitreous removal, along with the moving up of the surgical intervention to as early as possible allows the prevention of complications that would limit the functional improvement postoperatively. Thus, it is now highly needed to re-evaluate the conclusions of the EVS study. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Starflo glaucoma implant: early experience in Hungary

PubMed Central

István, Cseke; Péter, Vámosi; Mária, Bausz

2016-01-01

Aim: To present the early experience with the implantation technique, safety and efficiency of STARflo™ device for open angle glaucoma (OAG). Methods: referring intra- and postoperative clinical experience with a series of seven cases in three glaucoma centers in Hungary. Results: No intraoperative complications were observed. Postoperative inflammatory signs disappeared rapidly. The mean IOP reduction was from 27,6 ± 5,0 mmHg to 18,9±3,4 mmHg (32% reduction/ patient) at six months postoperatively. Conclusion: STARflo™ implant was safe and (except for one case with neovascular glaucoma) effective in our cases. The learning curve for experienced anterior segment surgeons was short. PMID:27220226

Postoperative complications do not influence the pattern of early lung function recovery after lung resection for lung cancer in patients at risk.

PubMed

Ercegovac, Maja; Subotic, Dragan; Zugic, Vladimir; Jakovic, Radoslav; Moskovljevic, Dejan; Bascarevic, Slavisa; Mujovic, Natasa

2014-05-19

The pattern and factors influencing the lung function recovery in the first postoperative days are still not fully elucidated, especially in patients at increased risk. Prospective study on 60 patients at increased risk, who underwent a lung resection for primary lung cancer. complete resection and one or more known risk factors in form of COPD, cardiovascular disorders, advanced age or other comorbidities. Previous myocardial infarction, myocardial revascularization or stenting, cardiac rhythm disorders, arterial hypertension and myocardiopathy determined the increased cardiac risk. The severity of COPD was graded according to GOLD criteria. The trend of the postoperative lung function recovery was assessed by performing spirometry with a portable spirometer. Cardiac comorbidity existed in 55%, mild and moderate COPD in 20% and 35% of patients respectively. Measured values of FVC% and FEV1% on postoperative days one, three and seven, showed continuous improvement, with significant difference between the days of measurement, especially between days three and seven. There was no difference in the trend of the lung function recovery between patients with and without postoperative complications. Whilst pO2 was decreasing during the first three days in a roughly parallel fashion in patients with respiratory, surgical complications and in patients without complications, a slight hypercapnia registered on the first postoperative day was gradually abolished in all groups except in patients with cardiac complications. Extent of the lung resection and postoperative complications do not significantly influence the trend of the lung function recovery after lung resection for lung cancer.

Improving patient health engagement with mobile texting: A pilot study in the head and neck postoperative setting.

PubMed

Sosa, Alan; Heineman, Nathan; Thomas, Kimberly; Tang, Kai; Feinstein, Marie; Martin, Michelle Y; Sumer, Baran; Schwartz, David L

2017-05-01

Cell phone ownership is nearly universal. Messaging is one of its most widely used features. Texting-based interventions may improve patient engagement in the postoperative setting, but remain understudied. Patients were recruited before discharge from the hospital and received automated daily texts for 1 week providing information about expected recovery. Patients were encouraged to text questions to providers, which were triaged for intervention. Web-based surveys solicited patient feedback about the platform. Thirty-two patients were approached, and 23 patients (72%) were enrolled in the study. All study patients texted their providers, although frequency (median, 7 texts; range, 2-44 texts) varied. Unmarried patients and those facing surgical complications used the platform more frequently. Mean patient satisfaction with the platform was high (mean, 3.8 on a 4-point Likert scale). Text messaging seems feasible in the acute postoperative setting and potentially improves engagement of patients with head and neck cancer. Further study is warranted to confirm scalability and impact. © 2017 Wiley Periodicals, Inc. Head Neck 39: 988-995, 2017. © 2017 Wiley Periodicals, Inc.

Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis.

PubMed

Takagi, Hisato; Ando, Tomo; Umemoto, Takuya

2017-12-01

We performed a systematic review and meta-analysis to determine whether perioperative depression and anxiety are associated with increased postoperative mortality in patients undergoing cardiac surgery. MEDLINE and EMBASE were searched through January 2017 using PubMed and OVID, to identify observational studies enrolling patients undergoing cardiac surgery and reporting relative risk estimates (RREs) (including odds, hazard, or mortality ratios) of short term (30 days or in-hospital) and/or late all-cause mortality for patients with versus without perioperative depression or anxiety. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic RREs in the random-effects models. Our search identified 16 eligible studies. In total, the present meta-analysis included data on 236,595 patients undergoing cardiac surgery. Pooled analysis demonstrated that perioperative depression was significantly associated with increased both postoperative early (RRE, 1.44; 95% confidence interval [CI] 1.01-2.05; p = 0.05) and late mortality (RRE, 1.44; 95% CI 1.24-1.67; p < 0.0001), and that perioperative anxiety significantly correlated with increased postoperative late mortality (RRE, 1.81; 95% CI 1.20-2.72; p = 0.004). The relation between anxiety and early mortality was reported in only one study and not statistically significant. In the association of depression with late mortality, there was no evidence of significant publication bias and meta-regression indicated that the effects of depression are not modulated by the duration of follow-up. In conclusion, perioperative depression and anxiety may be associated with increased postoperative mortality in patients undergoing cardiac surgery.

Using the Mouse Grimace Scale to Reevaluate the Efficacy of Postoperative Analgesics in Laboratory Mice

PubMed Central

Matsumiya, Lynn C; Sorge, Robert E; Sotocinal, Susana G; Tabaka, John M; Wieskopf, Jeffrey S; Zaloum, Austin; King, Oliver D; Mogil, Jeffrey S

2012-01-01

Postoperative pain management in animals is complicated greatly by the inability to recognize pain. As a result, the choice of analgesics and their doses has been based on extrapolation from greatly differing pain models or the use of measures with unclear relevance to pain. We recently developed the Mouse Grimace Scale (MGS), a facial-expression–based pain coding system adapted directly from scales used in nonverbal human populations. The MGS has shown to be a reliable, highly accurate measure of spontaneous pain of moderate duration, and therefore is particularly useful in the quantification of postoperative pain. In the present study, we quantified the relative intensity and duration of postoperative pain after a sham ventral ovariectomy (laparotomy) in outbred mice. In addition, we compiled dose–response data for 4 commonly used analgesics: buprenorphine, carprofen, ketoprofen, and acetaminophen. We found that postoperative pain in mice, as defined by facial grimacing, lasts for 36 to 48 h, and appears to show relative exacerbation during the early dark (active) photophase. We find that buprenorphine was highly effective in inhibiting postoperative pain-induced facial grimacing in mice at doses equal to or lower than current recommendations, that carprofen and ketoprofen are effective only at doses markedly higher than those currently recommended, and that acetaminophen was ineffective at any dose used. We suggest the revision of practices for postoperative pain management in mice in light of these findings. PMID:22330867

Background and Employability of Mobile vs. Non-Mobile Students

ERIC Educational Resources Information Center

Wiers-Jenssen, Jannecke

2011-01-01

In this paper, a comparison is made of the background and the early career of graduates with higher education from abroad to graduates with all domestic degrees, based on a survey among Norwegian graduates. Results show that those who have studied abroad constitute a selected group regarding social origin and mobility capital (exposure to…