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Sample records for evaluierung und postoperative

  1. Postoperative management.

    PubMed

    Schraag, Stefan

    2016-09-01

    Most patients undergoing major aortic surgery have multiple comorbidities and are at high risk of postoperative complications that affect multiple organ systems. Different aortic pathologies and surgical repair techniques have specific impact on the postoperative course. Ischemia-reperfusion injury is the common denominator in aortic surgery and influences the integrity of end-organ function. Common postoperative problems include hemodynamic instability due to the immediate inflammatory response, renal impairment, spinal cord ischemia, respiratory failure with prolonged mechanical ventilation, and gastrointestinal symptoms such as ileus or mesenteric ischemia. Focused care bundles to establish homeostasis and a team working toward an early functional recovery determine the success of effective rehabilitation and outcomes after aortic surgery. PMID:27650347

  2. Branchen und Unternehmensbereiche

    NASA Astrophysics Data System (ADS)

    Kramer, Regine

    Dieses Kapitel gibt einen Überblick über die Haupteinsatzgebiete von Mathematikern, Informatikern, Naturwissenschaftlern und Ingenieuren in den wichtigsten Wirtschaftsbranchen und Unternehmensbereichen. Dabei werden ausbildungsnahe Aufgabenbereiche ebenso beschrieben wie eher fachferne Tätigkeiten und neben den klassischen Branchen und Berufsbildern auch neue Tätigkeitsfelder für MINT-Fachkräfte beschrieben.

  3. Information und Kommunikation

    NASA Astrophysics Data System (ADS)

    Wesoly, Michael; Ohlhausen, Peter; Bucher, Michael; Hichert, Rolf; Korge, Gabriele; Schnabel, Ulrich; Gairola, Arun; Reichwald, Ralf; Habicht, Hagen; Möslein, Kathrin; Schwarz, Torsten; Schönsleben, Paul; Scherer, Eric; Schloske, Alexander; Adlbrecht, Gerald; Federhen, Jens

    Wissen ist mittlerweile unverzichtbar für den entscheidenden Vorsprung auf dem Markt. Unabhängig davon, ob sich das Wissen in Innovationen, neuen Produkten und Dienstleistungen oder in der Verbesserung interner Unternehmensprozesse manifestiert: Wissen ist Treiber von Innovation, Wissen bringt Schnelligkeit und Wissen ist die Voraussetzung für Problemlösungen [40]. Wissensmanagement ist daher der Schlüssel für Unternehmenserfolg und bezeichnet den "bewussten und systematischen Umgang mit der Ressource Wissen und den zielgerichteten Einsatz von Wissen in der Organisation“ [6]. In dieser umfassenden Sichtweise ist Wissensmanagement ein Begriff, der Konzepte, Strategien und Methoden umfasst.

  4. Welt und Wirkungsprinzip

    NASA Astrophysics Data System (ADS)

    Landgraf, Werner

    1997-05-01

    Modell einer kausalen Bewirkung der Welt, und logische, geometrische, physikalische Interprätation dieser Kausalmenge und Fortwirkung der frühsten ihrer sukzessiv als echt Neues bewirkten und durch Vorhandenes oder Späteres nicht darstellbaren oder widerrufbaren Ereignisse als Dimensionen und sie verkörpernde primäre Naturkräfte, mit Korrespondenz zur beobachteten Welt und ihrer grundlegendsten Eigenschaften. Wirklich ist nur was wirkt, wo und wie. Entsprechend ist im Bogenelement statt der Eigenzeit die variante Anzahl Wirkungen relevant, 0 ≈ 1/h2 dS2 - 1/tpl2 (dt2 - 1/c2 {dq12 + G02/G2 [dq2,32 - ...]}) mit G0 = c4lpl/Epl ≈ G. Die heutigen Dimensionen und Naturkräfte entstanden in dieser Reihenfolge, haben 'komplementäre' aber gleichwertige statische und dynamische Aspekte, entsprechend ihren Termen in Bogenelement bzw. Vierervektor, aus derem Vergleich sowie mit denen ihrer Nachbarn folgen Grundgleichungen bzw. Erhaltungssätze. Jeweils individuelle Eigenschaften wie ihre Naturkonstante konkretisieren sie und tragen zu gattungsmäßigen wie globale Affinität und Äquivalenzen bei. Ältestes Gebiet oder räumlicher Rand jeder Dimension sind die ersten vom Vorgänger bewirkten Ereignisse, selbst raumzeitlicher Ursprung des Nachfolgers, dort einmalig und ewig maximal rotverschoben fortwirkend und nicht lokalisierbar, um neue Elementareinheiten verschieden und lichtartig mit deren Verhältnis oder dem ihrer globalen Zustandsgrößen als konstanten Anfangsimpuls, Expansion, Längen- oder Ereignisdichte zueinander. Der Übergang vom diskreten Modell weniger Informationen zum Kontinuum und die Korrespondenz zur Physik ist problemlos, Details wie ein kontinuierlicher, abrupter oder ganz fehlender Abfall der Metrik beim ältesten Gebiet sind aber nur durch Beobachtungen entscheidbar. Erörtert werden allgemeine und individuelle Eigenschaften und ihre Konsequenzen der Dimensionen mit ihren Kräften, selbst und im Verhältnis zueinander, etwa ihrer begrenzten

  5. Lymph- und Immunsystem

    NASA Astrophysics Data System (ADS)

    Perry, Steven F.

    Alle Lebewesen müssen sich gegen Eindringlinge wehren. Ihre Abwehrmechanismen wirken auf verschiedenen Ebenen, von übergeordneten Feindvermeidungsstrategien und Putzverhalten bis hin zu molekularen Erkennungs- und Tötungsmechanismen. Da Eindringlinge über Kontaktflächen mit der Außenwelt, wie z.B. Körperoberfläche, Darmwand und Atmungsoberflächen, in den Organismus gelangen, sind an diesen Stellen immer primäre Abwehrmechanismen zu finden. Dazu zählen (1) Schleimabsonderung (Schleimhäute bei allen Schädeltieren, Fischkiemen, epidermale Schleimdrüsen (Fische, Amphibien)), (2) Stoffwechselgifte und antibakteriell wirkende Substanzen in der Haut (Fische, Amphibien) und im Speichel (Amnioten), (3) Flimmerepithelien zum Abtransport von Eindringlingen und (4) starke Keratinbildung in der mehrschichtigen Epidermis und schützende Strukturen wie Schuppen, Federn und Haare (Amnioten) (S. 20). Auch die starke Säurebildung im Magen kann als Schutz gegen Eindringlinge betrachtet werden.

  6. Postoperative pain control.

    PubMed

    Lovich-Sapola, Jessica; Smith, Charles E; Brandt, Christopher P

    2015-04-01

    Prevention and control of postoperative pain are essential. Inadequate treatment of postoperative pain continues to be a major problem after many surgeries and leads to worse outcomes, including chronic postsurgical pain. Optimal management of postoperative pain requires an understanding of the pathophysiology of pain, methods available to reduce pain, invasiveness of the procedure, and patient factors associated with increased pain, such as anxiety, depression, catastrophizing, and neuroticism. Use of a procedure-specific, multimodal perioperative pain management provides a rational basis for enhanced postoperative pain control, optimization of analgesia, decrease in adverse effects, and improved patient satisfaction.

  7. Postoperative Spine Infections.

    PubMed

    Pawar, Abhijit Yuvaraj; Biswas, Samar Kumar

    2016-02-01

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

  8. Postoperative Spine Infections

    PubMed Central

    Biswas, Samar Kumar

    2016-01-01

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

  9. Geoinformation und Staat

    NASA Astrophysics Data System (ADS)

    Zypries, Brigitte

    2002-09-01

    Geoinformationen besaßen als Grundlage militärischer Interventionen schon immer einen hohen Stellenwert für den Staat. Im Zeitalter der modernen Informations- und Kommunikationstechnologien wächst in demokratischen Staaten die Bedeutung von Geodaten weit über den Verteidigungsbereich hinaus. Brigitte Zypries, Staatssekretärin im Bundesministerium des Innern (BMI) und Vorsitzende des Interministeriellen Ausschusses für Geoinformationswesen (IMAGI), sprach mit Dipl.-Geogr. Ute C. Bauerüber die Anwendung und Koordinierung von Geodaten in Politik und Staat.

  10. Integument und Anhangsorgane

    NASA Astrophysics Data System (ADS)

    Schliemann, Harald

    Das Integument umhüllt den Wirbeltierkörper lückenlos. In der embryonalen Mundbucht (Stomodaeum) und der Afterbucht (Proctodaeum) grenzt es an die Auskleidung des Darmrohres. Über die generelle Bedeutung einer Haut als Abgrenzung zwischen Körperinnenraum und Außenmedium hinaus hat es bei Schädeltieren ein breites Spektrum von Funktionen. Die wichtigsten sind: Mechanischer Schutz durch Verhornungen und Verknöch erungen; Wundheilung; Schutz vor Wasserverlust; Schutz vor Infektionen durch bakterizide Drüsensekrete und immunkompetente Zellen; Schutz vor kurzwelliger Strahlung durch Pigmente; Schutz vor Überwärmung durch Schweißdrüsensekrete und Schutz vor Wärmeverlust durch Federn und Haare; Ausbildung lokomotorisch wichtiger Strukturen wie Federn, Flug- und Schwimmhäute, Krallen und Hufe; Redukt ion des Strömungswiderstandes durch Dämpfungshaut; Abgabe von Sekreten zur Ernährung (Milch); Ausbildung von Strukturen zu Nahrungserwerb und_-bearbeitung, z. B. Zähne, Barten;

  11. [Postoperative pain in craniotomy].

    PubMed

    Peón, Andréa Ungaro; Diccini, Solange

    2005-01-01

    In the postoperative period, 47% to 75% of the patients report some degree of pain. This study aimed to evaluate pain in the pre and postoperative period of patients submitted to craniotomy. This prospective research was carried out at the neurosurgery unit of a large Brazilian hospital. For a quantitative evaluation of pain, the verbal numeric 0-10 rating scale was used. Forty patients with a mean age of 36 years were evaluated. In the preoperative period, 34 (85%) patients indicated headache as the main cause of pain. In the postoperative period, 37 (93%) patients complained of pain while three (7%) reported absence of pain. Pain peaks were observed on the 2nd postoperative day, when 12 (32%) of the patients reported severe pain and 10 (27%) moderate pain. Absence of severe pain occurred after the 8th postoperative day. It was concluded that protocols of analgesia in craniotomy are needed, such as training nurses to better evaluate and handle pain. PMID:16211171

  12. Postoperative Pain Control

    PubMed Central

    Garimella, Veerabhadram; Cellini, Christina

    2013-01-01

    The effective relief of pain is of the utmost importance to anyone treating patients undergoing surgery. Pain relief has significant physiological benefits; hence, monitoring of pain relief is increasingly becoming an important postoperative quality measure. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Various agents (opioid vs. nonopioid), routes (oral, intravenous, neuraxial, regional) and modes (patient controlled vs. “as needed”) for the treatment of postoperative pain exist. Although traditionally the mainstay of postoperative analgesia is opioid based, increasingly more evidence exists to support a multimodal approach with the intent to reduce opioid side effects (such as nausea and ileus) and improve pain scores. Enhanced recovery protocols to reduce length of stay in colorectal surgery are becoming more prevalent and include multimodal opioid sparing regimens as a critical component. Familiarity with the efficacy of available agents and routes of administration is important to tailor the postoperative regimen to the needs of the individual patient. PMID:24436674

  13. Postoperative Spine Infections

    PubMed Central

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

    2015-01-01

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

  14. Milch, Milchprodukte, Analoge und Speiseeis

    NASA Astrophysics Data System (ADS)

    Coors, Ursula

    Die Produktpalette Milch und Erzeugnisse aus Milch beinhaltet Konsummilch, die aus Milch oder Bestandteilen der Milch hergestellten Milcherzeugnisse wie Sauermilch-, Joghurt-, Kefir-, Buttermilch-, Sahne-, Kondensmilch-, Trockenmilch- und Molkenerzeugnisse, Milchmisch- und Molkenmischprodukte (Produkte mit beigegebenen Lebensmitteln), Milchzucker, Milcheiweißerzeugnisse, Milchfette und Käse.

  15. Neuausrichtung und Konsolidierung

    NASA Astrophysics Data System (ADS)

    Grohmann, Heinz

    Mit der Wahl von Wolfgang Wetzel zum Vorsitzenden der Deutschen Statistischen Gesellschaft im Jahre 1972 begann eine 32jährige Ära, in der die praktische und die theoretische Statistik in einem ausgewogenen Verhältnis gepflegt wurden. Ein regelmäßiger vierjähriger Wechsel im Vorsitz stärkte die Gemeinschaft und die praktische wie die wissenschaftliche Arbeit gleichermaßen. Die jährlichen Hauptversammlungen behandelten gesellschaftlich aktuelle wie zukunftsorientierte Themen, und die Ausschüsse sowie weitere Veranstaltungen gaben Gelegenheit zur Förderung und Pflege einer Vielzahl von Arbeitsgebieten der Statistik. Darüber wird nicht nur in diesem Kapitel, sondern auch in den Teilen II und III des Bandes berichtet.

  16. Falten und fliegen: Papierflieger und ihre Physik

    NASA Astrophysics Data System (ADS)

    Gruber, Werner

    2004-09-01

    Mit Papierfliegern können wichtige Eigenschaften der Aerodynamik anschaulich vermittelt werden: ein Blatt Papier, ein paar Faltungen und schon kann man experimentieren. Allerdings sind beim Trimmen des Fliegers einige Punkte zu beachten. Besonders wichtig ist die Y-Stellung der Flügel, die ihm Flugstabilität verleiht. Ist der Flieger fertig, dann gilt es, die dem Modell am besten angepasste Wurftechnik herauszufinden. Dazu variiert man Wurfgeschwindigkeit und Abwurfwinkel. Den Boden kann ein Papierflieger auf vier prinzipiell verschiedenen Flugkurven erreichen: Optimal ist die Gerade, dann fliegt er am weitesten.

  17. Messung und Analyse

    NASA Astrophysics Data System (ADS)

    Bathelt, Hartmut; Scheinhardt, Michael; Sell, Hendrik; Sottek, Roland; Guidati, Sandro; Helfer, Martin

    Für die Beurteilung von Akustik und Fahrkomfort eines Fahrzeugs gilt in der Fahrzeugentwicklung immer noch der alte Grundsatz: "Der Kunde fährt nicht am Prüfstand, sondern auf der Straße“. Daher werden Gesamtbeurteilungen des Entwicklungsstandes und Konkurrenzvergleiche (Benchmarking) nach wie vor auf der Straße durchgeführt, meist auf ausgewählten Fahrbahnen am Prüfgelände oder im Rahmen der regelmäßigen Winter- und Sommererprobungen unter extremen Witterungsverhältnissen.

  18. Postoperative pain management.

    PubMed

    Joshi, G P

    1994-01-01

    Inadequately treated pain is a major cause of unanticipated hospital admissions after ambulatory surgery. The ability to provide adequate pain relief by simple methods that are readily available to the day-care patient in his or her home environment is one of the major challenges for providers of ambulatory surgery and anesthesia. The increasing number of extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee construction, hysterectomies) being undertaken on an ambulatory basis presents new challenges with respect to acute postoperative pain. Hence the availability of more sophisticated and effective treatment modalities, such as ambulatory PCA and continuous local and regional anesthetic blocks, with minimal side effects, are necessary to optimize the benefits of ambulatory surgery for both patient and health care provider. However, outcome studies are needed to evaluate the effect of these newer therapeutic approaches with respect to postoperative side effects and other important recovery parameters. Recent studies suggest that factors other than pain per se must be controlled to reduce postoperative morbidity and facilitate the recovery process. Not surprisingly, the anesthetic technique can influence analgesic requirement in the early postoperative period. Although oral analgesic agents will continue to play an important role, the adjunctive use of local anesthetic agents is likely to assume an even greater role in the future. Use of drug combinations (e.g., opiates and local anesthetics, opiates and NSAIDs) may provide improved analgesia with fewer side effects. Finally, safer and simpler analgesic delivery systems are needed to improve our ability to provide cost-effective pain relief after ambulatory surgery. In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress-free" anesthesia with minimal postoperative

  19. Getreide, Brot und Feine Backwaren

    NASA Astrophysics Data System (ADS)

    von Grabowski, Hans-Uwe; Rolfe, Birgit

    Getreide und Getreideerzeugnisse sind ebenso wie Brot und Feine Backwaren nach dem Lebensmittel- und Futtermittel-Gesetzbuch (LFGB) [1] Lebensmittel im Sinne des Artikels 2 der VO (EG) Nr. 178/2002 (BasisVO) (s. auch Kap. 1.6/2.4.1/3.2). Gesetzlich festgelegte Begriffsbestimmungen gibt es für diese Lebensmittel nicht. Man muss sich daher allgemeiner Verkehrsauffassungen bedienen, wie sie von der Deutschen Lebensmittelbuch-Kommission in Form von Leitsätzen erarbeitet und veröffentlicht wurden [2]. Der Gesundheitsschutz und der Schutz des Verbrauchers vor Täuschung sind in der Basis-VO und dem LFGB geregelt.

  20. Postoperative pain management

    PubMed Central

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

    2015-01-01

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

  1. [Postoperative medical icterus].

    PubMed

    Cerf, M

    1978-06-01

    The onset of jaundice following a surgical operation sometimes raises difficult problems. It is rarely due to hemolysis, infective hepatitis or decomposated cirrhosis of the liver. One should seek as a routine hepatitis due to halotane. However the most frequent cause is "benign postoperative cholestasis". This variety of jaundice presents in the form of an icterus due to conjugated bilirubine with often a large increase in alkaline phosphatase levels. The ocurse is variable. Almost always due to severe surgical or septic trauma, accompanied by shock and/or anoxia, it raises difficult diagnostic problems. The clinical and physiopathological aspects of benign postoperative cholestasis are recalled. One should remember, above all, that this is not an autonomous clinical entity but the sign of local or general complications which should be sought carefully.

  2. [Sclerotherapy of postoperative lymphocele].

    PubMed

    Ravid, A; Papo, J; Kaplan, O; Klausner, J

    1994-12-15

    Postoperative lymphocele is a well-documented complication of gynecological operations involving pelvic and retroperitoneal lymph node dissection. It is not uncommon following renal transplantation. We report a 77-year-old woman with a lymphocele which developed 4 months after panhysterectomy. Diagnosis was by CT scan, confirmed by aspiration and cytology. Percutaneous drainage and sclerotherapy with tetracycline was curative. This appears to be the treatment of choice for lymphocele and is superior to repeated aspirations and surgical intervention, the current usual treatment.

  3. Unternehmens- und Marktstatistik

    NASA Astrophysics Data System (ADS)

    Grömling, Michael; Scheinost, Ulrich

    Deutschland verfügt über ein gut ausgebautes System amtlicher und nicht amtlicher Unternehmens- und Marktstatistiken, das sich in einem fortwährenden Wandel befindet. Wird es sinnvoll genutzt, können für einzelne Marktteilnehmer wie für die gesamte Gesellschaft kostspielige Fehlentwicklungen vermieden werden. Dazu bedarf es eines sachkundigen Überblicks über die Vielfalt der Statistiken und der zwischen ihnen bestehenden Beziehungen sowie einer ständigen Anpassung an die wirtschaftliche Entwicklung. Als eine mögliche Orientierung kann der auf der Güter- und Faktorebene zu beobachtende Wandel dienen. Einer adäquaten Abbildung der ökonomischen Realität stehen in Deutschland mit seiner starken Verrechtlichung der Statistik jedoch mancherlei Schwierigkeiten im Wege. Teilweise tiefgreifende Reformbestrebungen sind vor allem auf europäischer Ebene im Gange. Als eine ergebnisorientierte Innovation für das Gesamtsystem der Unternehmens- und Marktstatistik wird ein modular aufgebautes System vorgestellt, das auch bei unterschiedlichen und sich wandelnden Rahmenbedingungen schrittweise realisiert werden kann.

  4. Datenintegration und Deduplizierung

    NASA Astrophysics Data System (ADS)

    Bleiholder, Jens; Schmid, Joachim

    In Unternehmen liegen viele Daten heutzutage immer seltener vollständig an einem einzigen physikalischen Ort vor, sondern sind weltweit verteilt. Dies liegt zum einen an der immer besser gewordenen Infrastruktur, die eine solche Verteilung auf einfache Art und Weise ermöglicht, und zum anderen an der Tatsache, dass viele Unternehmen weltweit tätig sind. So fallen Daten weltweit an, werden aber jeweils lokal - vor Ort - gespeichert. Daher müssen oft mehrere Datenquellen genutzt werden, um einen aktuellen, vollständigen und genauen Überblick über die vorhandenen Daten zu gewinnen. Datenintegration hilft, indem sie Daten aus mehreren Quellen zusammenführt und einheitlich darstellt. Diese integrierten Daten können genutzt werden, um sich einen Überblick über das Unternehmen zu verschaffen, z.B. wenn Unternehmen fusionieren und nur noch eine Kundendatenbank bestehen bleiben soll, oder wenn zu einem Kunden die Daten aus den verschiedenen Fachabteilungen zusammengeführt werden sollen. Anhand eines solchen Beispiels, der Integration von Kundendaten zu Kfz- und Lebensversicherungen erläutern wir im Folgenden einzelne Techniken.

  5. Face lift postoperative recovery.

    PubMed

    Mottura, A Aldo

    2002-01-01

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

  6. Postoperative conversion disorder.

    PubMed

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

    2016-05-01

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

  7. Postoperative conversion disorder.

    PubMed

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

    2016-05-01

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

  8. Postoperative extradural hematomas.

    PubMed

    Pichierri, Angelo; Ruggeri, Andrea; Donnarumma, Pasquale; Delfini, Roberto

    2013-01-01

    Postoperative extradural hematoma (POEH) is a possible complication after head surgery, often neglected in the literature. In a single surgeon experience we found 13 cases of POEH (0.8%). We distinguished two subtypes: (1) larger hematomas (>40 cc) with typical features and overt clinical picture that always needed evacuation, and (2) smaller hematomas (<40 cc) with insidious clinical onset and different radiological features compared with traumatic and spontaneous extradural hematomas. On the basis of our experience, we propose that clinical picture and radiologic appearance lead the decision between conservative or interventional treatment of type II hematomas.

  9. Mikrostrukturtechnik und Biomaterialien

    NASA Astrophysics Data System (ADS)

    Guber, Andreas E.; Saile, Volker; Weibezahn, Karl-Friedrich

    In der Biomedizintechnik zeichnet sich derzeit ein Trend zu einer verstärkten Miniaturisierung des operativen Instrumentariums und der Peripheriegeräte ab, da zur sicheren Durchführung vieler minimal invasiv auszuführender chirurgischer Eingriffe sehr kleine Instrumente und Zusatzgeräte benötigt werden. Weiterhin werden für verschiedene Anwendungen im Life-Sciences-Bereich, wie z. B. innerhalb der klinischen Diagnostik und der pharmazeutischen Chemie, in zunehmendem Masse Komponenten mit eingearbeiteten Mikrostrukturen benötigt. Mit den inzwischen verfügbaren mikrotechnischen Herstellungsverfahren (siehe Kapitel 40.2) ist man in der Lage, unterschiedliche geometrische Formen von kleinen dreidimensionalen Bauteilen und Baugruppen im Mikrometerbereich zu fertigen. Für spezielle Anwendungen können aber auch Strukturen im Bereich von einigen 100 nm erzeugt werden. Mikrostrukturierte Komponenten und Baugruppen können entweder in Form von Implantaten in den menschlichen Körper gelangen oder in extrakorporal einsetzbaren Geräten zum Einsatz kommen (siehe Kapitel 40.3). Dabei ist zwischen Kurzzeit- und Langzeitimplantaten zu unterscheiden. Typische Kurzzeitimplantate sind beispielsweise Operationsinstrumente während eines operativen Eingriffes und für kurze Zeiträume gelegte Spezialkatheter zur gezielten Entnahme von Körpersäften oder zur temporären Medikamentenapplikation. Zur Kategorie der Langzeitimplantate gehören beispielsweise auf Dauer eingesetzte Gefässendoprothesen (Stents), Herzschrittmacher, Cochleaimplantate, miniaturisierte Medikamentendosiersysteme auf Basis mikrofluidischer Baugruppen (Mikropumpen, Mikrokanäle, etc.), implantierbare Arrays von Mikroelektroden, welche innerhalb der Neurobionik verstärkt Anwendung finden werden, sowie in der Zukunft auch künstliche Organe.

  10. Karamell und Schokolade optimal

    NASA Astrophysics Data System (ADS)

    Eichhorn, Andreas

    In verschiedenen Situationen in Technik, Wirtschaft oder Politik ist man daran interessiert unter einer Anzahl von möglichen Entscheidungen die jeweils beste auszuwählen, also die optimale Entscheidung zu treffen, die den größtmöglichen Nutzen bringt. In den meisten Fällen sind Nutzen und Entscheidungsalternativen nicht exakt gegeben, Entscheidungen werden dann entweder sprachlichargumentativ ausgewählt und begründet oder gar aus dem Bauch heraus gefällt. In manchen Fällen ist es aber möglich, Entscheidungsalternativen und Nutzen in Zahlen und Formeln so auszudrücken, dass über diese Beschreibung im Prinzip die optimalen Entscheidungen und der maximale Nutzen festgelegt sind. Dabei ist zu beachten, dass bei mehreren (gleichzeitig oder hintereinander) zu treffenden Entscheidungen gewisse Abhängigkeiten zu berücksichtigen sind, bezüglich der möglichen Alternativen. Wenn beispielsweise die Umsetzung einer bestimmten (Teil-)Entscheidung mit bestimmten Kosten verbunden wäre, so stünde dieser Geldbetrag für andere Entscheidungen nicht mehr zur Verfügung.

  11. Technikwissenschaft - Erfinden und Entdecken

    NASA Astrophysics Data System (ADS)

    Linnemann, Gerhard

    Umrissen wird das allgemeine Ziel der Technikwissenschaft, konstruktiv zu verwerten und nicht-natürlich Entdeckbares zu erfinden. Wir befinden uns in einer Umwälzung der Technik im Verlauf der wissenschaftlich-technischen Revolution, auf dem Wege zu einem neuen Techniktyp. Dieser schafft und nutzt die künstliche Intelligenz. Dazu benötigt der in der Technik tätige Mensch spezielle Kenntnisse und Erfahrungen in kreativ-konstruktiver, -gestalterischer und erfinderischer Sicht mit dem Einsatz spezieller Strukturen und Sprachen. Vorschläge zur Arbeitsweise in der Technik werden gegeben.Translated AbstractTechnological Science-Invent and DiscoverThe general aim of engineering science is outlined to utilize results constructively and to invent something that cannot be discovered in nature. We are now in a period of transformation of technology in the course of scientific-technological revolution, on the way to a new type of technology. This new type creates and utilizes artificial intelligence. For this, man acitive in this field requires special knowledge and experiences in a creative, constructive, design-oriented and ultimately inventive way by deploying special structures and languages. There are also made some proposals concerning the method of working in the field of technology.

  12. Patentierung und Patentlage

    NASA Astrophysics Data System (ADS)

    Herrmann, Uwe

    Gewerbliche Schutzrechte nehmen in der nationalen Rechts- und Wirtschaftsordnung sowie auch auf internationaler Ebene stetig an Bedeutung zu. Sie dienen dem Schutz geistigen Eigentums und sind für jeden Gewerbetreibenden nicht nur im Hinblick darauf von Bedeutung, eigene Rechte zu sichern, sondern auch insofern von Relevanz, dass ein Verstoß gegen Rechte Dritter zu vermeiden ist. Zu den gewerblichen Schutzrechten gehören unter anderem Kennzeichenrechte, Geschmacksmusterrechte sowie die sogenannten technischen Schutzrechte in Form des Patents sowie des Gebrauchsmusters. Die folgenden Ausführungen befassen sich ausschließlich mit den technischen Schutzrechten und geben eine kurze Einführung in die Voraussetzungen, das Entstehen und den Wegfall sowie in die Wirkungen technischer Schutzrechte. Beleuchtet wird die Situation im Wesentlichen im Hinblick auf nationale technische Schutzrechte, d. h. auf Deutsche Patente und Gebrauchsmuster sowie auf Europäische Patente, die Schutz in Deutschland entfalten. Die Möglichkeit der Erlangung von Schutzrechten im außereuropäischen Ausland wird nur am Rande gestreift.

  13. Postoperative fiberoptic choledochoscopy.

    PubMed Central

    Birkett, D H; Williams, L F

    1981-01-01

    Twenty-eight patients underwent fiberoptic T-tube tract choledochoscopy for the diagnosis, management, and treatment of filling defects seen on postoperative T-tube cholangiograms. In 22 patients, 59 retained stones were treated by extraction. In six other patients with diagnostic problems arising from cholangiogram defects, the diagnosis was made by direct vision and biopsy specimen examination. There were multiple papillary adenocarcinomas in one patient, and normal mucosal folds in two patients. The procedure was accompanied by a low complication rate, with two patients developing pancreatitis and five patients developing transient fever. The advantages of the procedure are a direct examination of the biliary tree with the facility to remove stones and biopsy lesions under direct vision. PMID:7294933

  14. [Postoperative epidural analgesia].

    PubMed

    Donato, S; Malisano, A M; Dogareschi, T; Chiarandini, P; Spasiano, A; Pasetto, A

    1995-01-01

    Epidural analgesia with local anesthetics and opioids is one of the most effective methods for postoperative pain control. In critical patients it seems to improve outcome as well as pain control. This technique works better when started in the intraoperative time. Epidural analgesia is safe on surgical wards if nursing staff is trained in managing epidural catheters and in early detection and treatment of major and minor side effects. Nursing staff cooperates with the Acute Pain Service doctors and nurses who are on call on a 24 hour basis. Many perspective and retrospective studies showed a very low incidence of major side effects with epidurals. So we can consider it safe and effective even if we consider its invasiveness.

  15. Postoperative nausea and vomiting

    PubMed Central

    2014-01-01

    Postoperative nausea and vomiting (PONV) is a long-standing issue, not a new concept in anesthesiology. Despite many studies over the last several decades, PONV remains a significant problem due to its complex mechanism. This review presents a summary of the mechanism underlying the pathogenesis of PONV, focusing on preventive treatment, particularly the use of new drugs. In addition, we discuss the latest meta-analysis results regarding correct clinical use of classic drugs. I also summarize the latest trends of postdischarge nausea and vomiting and the pharmacogenetics, which is attracting a great deal of attention from other medical fields in PONV-related studies. Finally, we discuss the drawbacks of existing studies on PONV and suggest a focus for future investigations. PMID:25302092

  16. Keratoplasty postoperative treatment update.

    PubMed

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

    2013-11-01

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

  17. Postoperative infections: prevention and management.

    PubMed

    Gaston, R Glenn; Kuremsky, Marshall A

    2010-05-01

    Postoperative infections continue to be a challenging problem. The incidence of bacterial antibiotic resistance such as methicillin-resistant Staphylococcus aureus is rising. There are numerous intrinsic patient factors that should be optimized before surgery to minimize the risk of surgical site infections. When postoperative infections develop, treatment must be individualized. This article outlines the principles that can help guide treatment.

  18. [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.

  19. Tipps und Tricks

    NASA Astrophysics Data System (ADS)

    Häger, Wolfgang; Bauermeister, Dirk

    Hier wollen wir einige uns nützlich erscheinende Hinweise zur Arbeit mit dem Inventor geben. Dabei geht es vor allem darum, das Arbeiten mit dem Inventor zu vereinfachen. Die Beispiele stellen eine unvollständige Aufzählung dar und sollen dazu anregen, nach alternativen Vorgehensweisen zu suchen (hier sei noch einmal ausdrücklich auf das Internet verwiesen).

  20. Kometen und Asteroiden

    NASA Astrophysics Data System (ADS)

    Borgeest, Ulf; Staude, Jakob; Hahn, Gerhard; Harris, Alan W.; Jaumann, Ralf; Köhler, Ulrich; Kührt, Ekkehard; Schulz, Rita; Neukum, Gerhard; Arnold, Gabriele; Keller, Horst Uwe; Denk, Tilmann; Müller, Thomas; Wulff, André; Maruhn, Nicolaus; Fischer, Daniel; Trieloff, Mario; Althaus, Tilmann

    Contents: Die Kleinkörper des Sonnensystems. Kern, Koma und Schweife. Ziele der Planetenforschung. ROSETTA: Naherkundung von Kometen. Asteroiden: Trümmer aus planetarer Urzeit. Kleinkörper im Infrarotweltall. Selbs beobachten! Apocalypse - not now! Meteoriten - Boten aus der Urzeit des Sonnensystems.

  1. Postoperative Peritoneal Adhesions

    PubMed Central

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

    1971-01-01

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

  2. Wirkstoffe, Medikamente und Mathematische Bildverarbeitung

    NASA Astrophysics Data System (ADS)

    Bauer, Günter J.; Lorenz, Dirk A.; Maaß, Peter; Preckel, Hartwig; Trede, Dennis

    Die Entwicklung neuer Medikamente ist langwierig und teuer. Der erste Schritt ist hierbei die Suche nach neuen Wirkstoffkandidaten, die für die Behandlung bislang schwer therapierbarer Krankheiten geeignet sind. Hierfür stehen der Pharma- und Biotechnologieindustrie riesige Substanzbibliotheken zur Verfügung. In diesen Bibliotheken werden die unterschiedlichsten Substanzen gesammelt, die entweder synthetisch hergestellt oder aus Pilzen, Bakterienkulturen und anderen Lebewesen gewonnen werden können.

  3. Imaging of the Postoperative Orbit.

    PubMed

    Learned, Kim O; Nasseri, Farbod; Mohan, Suyash

    2015-08-01

    Imaging evaluation of the postoperative orbit remains challenging even for the expert neuroradiologist. This article provides a simplified framework for understanding the complex postoperative appearances of the orbit, in an attempt to enhance the diagnostic accuracy of postoperative computed tomography and MR imaging of the orbit. Readers are familiarized with the normal appearances of common eye procedures and orbit reconstructions to help avoid interpretative pitfalls. Also reviewed are imaging features of common surgical complications, and evaluation of residual/recurrent neoplasm in the setting of oncologic imaging surveillance.

  4. Pyropheophorbide und a as a catabolite of ethylene-induced chlorophyll und a degradation

    SciTech Connect

    Shimokawa, Keishi; Hashizume, Akihito ); Shioi, Yuzo )

    1990-05-01

    An enzyme extract prepared from ethylene-induced degreening Citrus fruits contains chlorophyll (Chl) degrading enzymes. The fate of Chl carbons during an enzymatic degradation was investigated using Chl {und a}-{sup 14}C. Accompanying the disappearance of labelled Chl {und a}, pheophorbide {und a} and pyropheophorbide {und a} appeared and accumulation of pyropheophorbide {und a} was observed. HydroxyChl {und a} was also detected, but this is thought to be an artifact during chromatography. Unlike ethylene-induced Citrus fruits (in vivo), further degradation of pyropheophorbide {und a} did not occur in vitro enzyme system. This suggests that there is a lack of enzyme(s) and/or cofactor(s) for further degradation. It is concluded that Chl {und a} degraded enzymatically by the following order: Chl {und a}, chlorophyllide {und a}, pheophorbide {und a} and pyropheophorbide {und a}.

  5. Bildanalyse in Medizin und Biologie

    NASA Astrophysics Data System (ADS)

    Athelogou, Maria; Schönmeyer, Ralf; Schmidt, Günther; Schäpe, Arno; Baatz, Martin; Binnig, Gerd

    Heutzutage sind bildgebende Verfahren aus medizinischen Untersuchungen nicht mehr wegzudenken. Diverse Methoden - basierend auf dem Einsatz von Ultraschallwellen, Röntgenstrahlung, Magnetfeldern oder Lichtstrahlen - werden dabei spezifisch eingesetzt und liefern umfangreiches Datenmaterial über den Körper und sein Inneres. Anhand von Mikroskopieaufnahmen aus Biopsien können darüber hinaus Daten über die morphologische Eigenschaften von Körpergeweben gewonnen werden. Aus der Analyse all dieser unterschiedlichen Arten von Informationen und unter Konsultation weiterer klinischer Untersuchungen aus diversen medizinischen Disziplinen kann unter Berücksichtigung von Anamnesedaten ein "Gesamtbild“ des Gesundheitszustands eines Patienten erstellt werden. Durch die Flut der erzeugten Bilddaten kommt der Bildverarbeitung im Allgemeinen und der Bildanalyse im Besonderen eine immer wichtigere Rolle zu. Gerade im Bereich der Diagnoseunterstützung, der Therapieplanung und der bildgeführten Chirurgie bilden sie Schlüsseltechnologien, die den Forschritt nicht nur auf diesen Gebieten maßgeblich vorantreiben.

  6. Postoperative infections: general principles and considerations.

    PubMed

    Downey, M S; Lamy, C J

    1990-07-01

    Every surgeon should have a thorough knowledge and awareness of the general principles of postoperative infections. The key to postoperative infections is in their prevention. Even with the most prudent and ardent regimens, however, postoperative wound infections will occasionally occur. Thus, the aforementioned knowledge will allow an improved clinical acumen and permit the early diagnosis of postoperative infection. Early and vigorous local wound care combined with systemic antibiotics are necessary to minimize the potentially debilitating sequelae of the postoperative wound infection.

  7. [Surgical controversy. Limiting postoperative scarring].

    PubMed

    Lachkar, Y

    2005-06-01

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

  8. Beschallungstechnik, Beschallungsplanung und Simulation

    NASA Astrophysics Data System (ADS)

    Ahnert, Wolfgang; Goertz, Anselm

    Die primäre Aufgabe einer Lautsprecheranlage ist es, Musik, Sprache oder auch Signaltöne und Geräusche wiederzugeben. Diese können von einem Tonträger kommen (CD, Sprachspeicher), von einem anderen Ort übertragen (Zuspielung über Radio, TV, Telefon) oder vor Ort erzeugt werden. Letzteres umfasst Konzerte, Ansprachen, Durchsagen oder künstlerische Darbietungen, bei denen es meist darum geht, eine bereits vorhandene Quelle einer größeren oder weiter verteilten Anzahl von Personen zugänglich zu machen.

  9. Postoperative posterior spinal wound infections.

    PubMed

    Massie, J B; Heller, J G; Abitbol, J J; McPherson, D; Garfin, S R

    1992-11-01

    The incidence of postoperative spinal infections increases with the complexity of the procedure. Diskectomy is associated with less than a 1% risk of infection; spinal fusion without instrumentation is associated with a 1%-5% risk; and fusion with instrumentation may be associated with a risk of 6% or more. Twenty-two postoperative posterior spinal infections that occurred during a three-year period were reviewed for this report. Staphylococcus aureus was the most frequent organism cultured (more than 50% of the cases). Other recurring organisms were Staphylococcus epidermis, Peptococcus, Enterobacter cloacae, and Bacteroides. Many patients had multiple organisms. Risk factors appeared to include advanced age, prolonged hospital bed rest, obesity, diabetes, immunosuppression, and infection at remote sites. Operative factors included prolonged surgery (greater than five hours), high volume of personnel moving through the operating room, and instrumentation. Postoperative contamination may occur and may be related to prolonged postoperative bed rest, skin maceration (thoracolumbosacral orthoses), and drainage tubes exiting distally from lumbar wounds (toward the rectum). Effective treatment includes early diagnosis, surgical debridement and irrigation, and parenteral antibiotics. Superficial infections were treated successfully with wound closure over outflow tubes, and deep infections with inflow-outflow systems. Maintaining the instrumentation in place was possible in most cases. Parenteral antibiotics were maintained for six weeks in every case. PMID:1395319

  10. Postoperative make-up techniques.

    PubMed

    Marvaldi, D A

    1978-01-01

    Guiding the postoperative patient to a happy self-acceptance is the common endeavor of the make-up artist and the cosmetic surgeon. It is my hope that this article will somehow help the patient bridge the gap which so many are unable to cross unassisted.

  11. Faszination Weltall. Sehen und Verstehen.

    NASA Astrophysics Data System (ADS)

    Humphrey, C.

    This book is a German translation, by T. Bührke, of the English original "The amateur astronomer's pathfinder" published in 1992. Contents: 1. Die Erde im Universum. 2. Der Nachthimmel. 3. Die Erforschung von Raum und Zeit.

  12. Renaturierung und Management von Heiden

    NASA Astrophysics Data System (ADS)

    Härdtle, Werner; Assmann, Thorsten; van Diggelen, Rudy; von Oheimb, Goddert

    Heiden zählen zu den ältesten und besonders reizvollen Kulturlandschaften Nordwesteuropas. Sie sind bezeichnend für nährstoffarme Böden in wintermilden Gebieten mit hohen Sommerniederschlägen. Während Heiden vor wenigen Jahrhunderten noch weit verbreitet und für manche Landschaften sogar prägend waren, hat sich ihr Areal heute auf wenige, meist in Naturschutzgebieten gelegene Restbestände verkleinert. Zu diesem Rückgang haben maßgeblich Änderungen der Landnutzung, aber auch Nährstoffeinträge aus umgebenden Agrarflächen und atmogene Depositionen beigetragen. In den meisten Ländern der Europäischen Union sind Heiden heute gesetzlich geschützte Ökosysteme, da diese, neben ihrem Erholungswert für den Menschen, Pflanzen- und Tierarten beherbergen, die außerhalb von Heiden nicht oder kaum überlebensfähig sind.

  13. Komet Halley: Bahnelemente und Perihelzeiten

    NASA Astrophysics Data System (ADS)

    Landgraf, Werner

    1985-02-01

    Verbesserte Bahnelemente und Perihelzeiten -2316 bis 2284 für Komet Halley. Zusammenfassung der für ein breiteres Publikum relevantesten Ergebnisse von "On the Motion of Comet Halley". ESTEC EP/14.7/6184 Final Report

  14. Welt und Wirkungsprinzip (2nd Aufl.)

    NASA Astrophysics Data System (ADS)

    Landgraf, Werner

    2010-03-01

    Modell einer kausalen Bewirkung der Welt, und logische, geometrische, physikalische Interprätation dieser Kausalmenge und Fortwirkung der frühsten ihrer sukzessiv als echt Neues bewirkten und durch Vorhandenes oder Späteres nicht darstellbaren oder widerrufbaren Ereignisse als Dimensionen und sie verkörpernde primäre Naturkräfte, mit Korrespondenz zur beobachteten Welt und ihrer grundlegendsten Eigenschaften. Wirklich ist nur was wirkt, wo und wie. Entsprechend ist im Bogenelement statt der Eigenzeit die variante Anzahl Wirkungen relevant, 0 ≈ 1/h2 dS2 - 1/tpl2 (dt2 - 1/c2 {dq12 + G02/G2 [dq2,32 - ...]}) mit G0 = c4lpl/Epl ≈ G. Die heutigen Dimensionen und Naturkräfte entstanden in dieser Reihenfolge, haben 'komplementäre' aber gleichwertige statische und dynamische Aspekte, entsprechend ihren Termen in Bogenelement bzw. Vierervektor, aus derem Vergleich sowie mit denen ihrer Nachbarn folgen Grundgleichungen bzw. Erhaltungssätze. Jeweils individuelle Eigenschaften wie ihre Naturkonstante konkretisieren sie und tragen zu gattungsmäßigen wie globale Affinität und Äquivalenzen bei. Ältestes Gebiet oder räumlicher Rand jeder Dimension sind die ersten vom Vorgänger bewirkten Ereignisse, selbst raumzeitlicher Ursprung des Nachfolgers, dort einmalig und ewig maximal rotverschoben fortwirkend und nicht lokalisierbar, um neue Elementareinheiten verschieden und lichtartig mit deren Verhältnis oder dem ihrer globalen Zustandsgrößen als konstanten Anfangsimpuls, Expansion, Längen- oder Ereignisdichte zueinander. Der Übergang vom diskreten Modell weniger Informationen zum Kontinuum und die Korrespondenz zur Physik ist problemlos, Details wie ein kontinuierlicher, abrupter oder ganz fehlender Abfall der Metrik beim ältesten Gebiet sind aber nur durch Beobachtungen entscheidbar. Erörtert werden allgemeine und individuelle Eigenschaften und ihre Konsequenzen der Dimensionen mit ihren Kräften, selbst und im Verhältnis zueinander, etwa ihrer begrenzten

  15. Computed tomography of the postoperative abdominal aorta

    SciTech Connect

    Hilton, S.; Megibow, A.J.; Naidich, D.P.; Bosniak, M.A.

    1982-11-01

    Computed tomography (CT) of the abdomen was performed on 46 patients who had undergone graft replacement of abdominal aortic aneurysms. Twelve post-operative complications were found in nine patients. They included hemorrhage, infection, anastomotic pseudoaneurysms, major vessel occlusion, postoperative pancreatitis, and others. The varied apperance of the normal postoperative graft is also presented. It is concluded that CT is a rapid, sensitive, and noninvasive method for detecting or excluding postoperative complications of abdominal aortic surgery.

  16. Postoperative radiosurgery of pituitary adenomas.

    PubMed

    Valentino, V

    1991-01-01

    From 1984-1990, 52 patients with pituitary adenomas had postoperative radiosurgery for incomplete surgical removal or regrowth of the tumor. The atraumatic Greitz-Bergström fixation head device was adopted for the stereotactic procedure and irradiation was performed with a linear accelerator. Because of the variability of the tumor response, a 10-20 Gy single dose was directed at 1-2 targets and radiosurgery repeated if the result was unsatisfactory. The median radiation dose was 30 Gy. No adverse effects occurred. Regression of pretreatment symptoms caused by tumor mass was observed in 67% of patients. GH and PRL activity decreased in 20 patients, was stable in 11 and increased in 2 prolactinomas. CT studies showed disappearance of the tumor in 4 patients and shrinkage in 36. Postoperative radiosurgery is a valuable method of treatment whenever pituitary surgery has been incomplete.

  17. Postoperative Care of the Facial Laceration

    PubMed Central

    Medel, Nicholas; Panchal, Neeraj; Ellis, Edward

    2010-01-01

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

  18. [Modification of postoperative wound healing by showering].

    PubMed

    Neues, C; Haas, E

    2000-02-01

    Usually postoperative wounds are kept dry until the stitches are removed. In a prospective randomized study early water contact was allowed in order to test postoperative wound healing in 817 patients operated on for varicose veins. Regardless of whether the wounds were kept dry or had water contact with or without shower foam from the second postoperative day, no infection was registered.

  19. Risk factors for postoperative ileus

    PubMed Central

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

    2011-01-01

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

  20. Kernspaltung und Westintegration Beispiel österreich

    NASA Astrophysics Data System (ADS)

    Forstner, Christian

    Während des Kalten Krieges erreichte in Europa sowohl die Verflechtung physikalischer Forschung mit Staat, Politik und Industrie als auch deren öffentliche Verhandlung und Bewertung eine qualitativ neuartige Dimension. Dieser Aspekt tritt am schärfsten in der Geschichte der Kernphysik und Kerntechnik hervor.

  1. [Evidenzbasierte Leitlinien, Anspruch und Wirklichkeit].

    PubMed

    Gutsch, Johannes; Reif, Marcus; Müller-Hübenthal, Boris; Matthiessen, Peter F

    2016-01-01

    Mit der Konzeption der «Evidenzbasierten Medizin» und den «Evidenzbasierten Leitlinien» soll mithilfe von Formalisierungsprozeduren die ärztliche Irrtumsanfälligkeit kalkulierbar gemacht werden. Quantifizierte objektive Aussagen über die therapeutische Wirksamkeit einer Behandlung sollen die individuelle ärztliche Beurteilung der therapeutischen Wirksamkeit überflüssig machen. Damit kommt der Befolgung von formalen Regeln die entscheidende Rolle bei der Beantwortung der Frage nach dem Wahrheitsgehalt und dem Wirklichkeitsbezug zu. Im Rahmen evidenzbasierter Leitlinien werden vorrangig die Ergebnisse randomisierter kontrollierter Studien (RCT) oder Meta-Analysen solcher Studien herangezogen. Am Beispiel der S3-Leitlinie «Malignes Melanom» wird hier eine evidenzbasierte Urteilsbildung zur Wirksamkeit einer unkonventionellen Therapie - hier mit einem Mistelpräparat - analytisch nachvollzogen. Die für die Beurteilung dieser unkonventionellen Therapie herangezogene randomisierte Studie wird genauer methodisch analysiert. Obwohl sie keine statistisch basierte Aussage zulässt, wurde eine Leitlinienempfehlung auf Basis dieser Studie abgeleitet. Es wird gezeigt, dass 1) allein die Existenz einer einzigen RCT mit hoher Evidenz gleichgesetzt wird, 2) die Ergebnisse trotz beträchtlicher Fehlinterpretationen in eine S3-Leitlinie einfließen und 3) Meinungen anstelle kritischer wissenschaftlicher Analysen verarbeitet werden. Unsere Untersuchung zeigt, dass noch so ausgefeilte epistemologische und methodologische Formalien den Arzt nicht von der Pflicht entbinden, auf Basis seiner ärztlichen Erfahrung und professionellen Kompetenz den Realitätswert der ihm zur Verfügung stehenden Information zu beurteilen. PMID:27161555

  2. [Vegetarische und vegane Ernährung bei Kindern - Stand der Forschung und Forschungsbedarf].

    PubMed

    Keller, Markus; Müller, Stine

    2016-01-01

    Die Praxis vegetarischer Ernährungsformen ist in Deutschland im letzten Jahrzehnt deutlich angestiegen. Allerdings ist der Anteil vegetarischer und veganer Kinder dabei unbekannt. Studien mit Erwachsenen zeigen das präventive Potenzial, aber auch potenzielle Schwachstellen pflanzenbasierter Kostformen. Die Vorteile und Risiken einer vegetarischen bzw. veganen Ernährung im Kindesalter wurden bisher jedoch relativ selten untersucht. Außerdem lassen das unterschiedliche Alter der Kinder, das heterogene Studiendesign sowie die teilweise geringe Probandenzahl der Studien keine verbindlichen Aussagen zu. In dieser Übersichtsarbeit werden die Ergebnisse der wenigen Studien zu vegetarisch und vegan ernährten Kindern (< 12 Jahren) in Nordamerika und Europa zusammengefasst. Demnach lag die Zufuhr von Nahrungsenergie und Makronährstoffen vegetarischer und veganer Kinder meist näher an den Empfehlungen der Fachgesellschaften als die Ernährung gleichaltriger Mischkostkinder. Ebenso wiesen vegetarisch und vegan ernährte Kinder eine höhere Zufuhr von und bessere Versorgung mit verschiedenen Vitaminen und Mineralstoffen auf. Häufiger zeigten sich jedoch Defizite bei Vitamin B12, Zink, Kalzium, Eisen und Vitamin D. Das Wachstum und die Entwicklung vegetarisch und vegan ernährter Kinder entsprachen weitgehend den Referenzstandards, wobei sie dazu tendierten, leichter, schlanker und (< 5 Jahren) auch kleiner zu sein. Aufgrund der unzureichenden Studienlage besteht erheblicher Forschungsbedarf zu den Auswirkungen einer vegetarischen und veganen Ernährung im Kindesalter.

  3. [Vegetarische und vegane Ernährung bei Kindern - Stand der Forschung und Forschungsbedarf].

    PubMed

    Keller, Markus; Müller, Stine

    2016-01-01

    Die Praxis vegetarischer Ernährungsformen ist in Deutschland im letzten Jahrzehnt deutlich angestiegen. Allerdings ist der Anteil vegetarischer und veganer Kinder dabei unbekannt. Studien mit Erwachsenen zeigen das präventive Potenzial, aber auch potenzielle Schwachstellen pflanzenbasierter Kostformen. Die Vorteile und Risiken einer vegetarischen bzw. veganen Ernährung im Kindesalter wurden bisher jedoch relativ selten untersucht. Außerdem lassen das unterschiedliche Alter der Kinder, das heterogene Studiendesign sowie die teilweise geringe Probandenzahl der Studien keine verbindlichen Aussagen zu. In dieser Übersichtsarbeit werden die Ergebnisse der wenigen Studien zu vegetarisch und vegan ernährten Kindern (< 12 Jahren) in Nordamerika und Europa zusammengefasst. Demnach lag die Zufuhr von Nahrungsenergie und Makronährstoffen vegetarischer und veganer Kinder meist näher an den Empfehlungen der Fachgesellschaften als die Ernährung gleichaltriger Mischkostkinder. Ebenso wiesen vegetarisch und vegan ernährte Kinder eine höhere Zufuhr von und bessere Versorgung mit verschiedenen Vitaminen und Mineralstoffen auf. Häufiger zeigten sich jedoch Defizite bei Vitamin B12, Zink, Kalzium, Eisen und Vitamin D. Das Wachstum und die Entwicklung vegetarisch und vegan ernährter Kinder entsprachen weitgehend den Referenzstandards, wobei sie dazu tendierten, leichter, schlanker und (< 5 Jahren) auch kleiner zu sein. Aufgrund der unzureichenden Studienlage besteht erheblicher Forschungsbedarf zu den Auswirkungen einer vegetarischen und veganen Ernährung im Kindesalter. PMID:27160086

  4. Restaurierung von Seen und Renaturierung von Seeufern

    NASA Astrophysics Data System (ADS)

    Grüneberg, Björn; Ostendorp, Wolfgang; Leßmann, Dieter; Wauer, Gerlinde; Nixdorf, Brigitte

    Süßwasserseen haben als ökosysteme und Lebensraum für Pflanzen und Tiere eine herausragende Bedeutung für die Artenvielfalt auf der Erde und prägen als Landschaftselemente unsere natürliche Umwelt. Seen fungieren als natürliche Stoffsenken, vor allem für Kohlenstoff und Nährstoffe, aber auch als Senken für in ihren Einzugsgebieten emittierte gelöste und feste Schadstoffe. Darüber hinaus ist Wasser eine wichtige Naturressource. Süßwasserseen stellen in den meisten Regionen der Erde lebenswichtige Quellen für die Versorgung mit Trinkwasser und tierischem Eiweiß (Fischfang) dar. Sie dienen als Wasserspeicher für die landwirtschaftliche und industrielle Nutzung. Auch für Erholungsaktivitäten des Menschen kommt ihnen eine große Bedeutung zu.

  5. Bewegungsapparat: Postcraniales Skelett und Muskulatur

    NASA Astrophysics Data System (ADS)

    Fischer, Martin S.

    Der Bewegungsapparat bestimmt die Form des Wirbeltierkörpers. So lässt sich z. B. aus der Gestalt eines Fisches auf seine bevorzugt e Schwimmweise schließen (S. 61). Bei den aquatisch en Schädeltieren dominiert die Fortbewegung mit axialem Antrieb; bei den meisten Tetrapoda findet sich eine Kombination aus axialem Antrieb und Bewegung durch Gliedmaßen. Selbst beim höchst spezialisierten Gang, der bipeden Bewegung des Menschen, sind Torsionsbewegungen des Rumpfes noch maßgeblich und bestimmen auch die Grundform des menschlichen Körpers (z. B. die Taille). Obwohl die verschiedenen Antriebsmechanismen eine funktionelle Einheit bilden, werden im Folgenden das Axialskelett sowie der Schulter- und Beckengürtel mit den zugehörigen Extremitäten getrennt besprochen.

  6. Kosmologie und Teilchenphysik.

    NASA Astrophysics Data System (ADS)

    Appenzeller, I.

    This book is a selection of 17 articles published in the journal "Spektrum der Wissenschaft". The original English versions of the papers were first published in "Scientific American". Contents: 1. Einführung (I. Appenzeller). 2. Sehr große Strukturen im Universum (J. O. Burns). 3. Die großräumigen Eigenbewegungen der Galaxien (A. Dressler). 4. Dunkle Materie im Universum (L. M. Krauss). 5. Der doppelte Beta-Zerfall (M. K. Moe, S. P. Rosen). 6. Quark-Lepton Familien (D. B. Cline). 7. Beschleunigerexperimente testen kosmologische Theorien (D. N. Schramm, G. Steigman). 8. Das Rätsel der kosmologischen Konstanten (L. Abbott). 9. Das Higgs-Boson (M. J. G. Veltman). 10. Die Suche nach dem Protonenzerfall (J. M. LoSecco, F. Reines, D. Sinclair). 11. Das inflationäre Universum (A. H. Guth, P. J. Steinhardt). 12. Die fünfte Dimension (E. Schmutzer). 13. Die verborgenen Dimensionen der Raumzeit (D. Z. Freedman, P. van Nieuwenhuizen). 14. Ist die Natur supersymmetrisch? (H. E. Haber, G. L. Kane). 15. Schwerkraft und Antimaterie (T. Goldman, R. J. Hughes, M. M. Nieto). 16. Superstrings (M. B. Green). 17. Kosmische Strings (A. Vilenkin).

  7. Postoperative endophthalmitis by Flavimonas oryzihabitans.

    PubMed

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

    2004-11-01

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

  8. Laparoscopic surgery complications: Postoperative peritonitis

    PubMed Central

    Drăghici, L; Drăghici, I; Ungureanu, A; Copăescu, C; Popescu, M; Dragomirescu, C

    2012-01-01

    Introduction: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient’s risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. Materials and methods: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of „Sf. Ioan” Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). Results:There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. Conclusions: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery. PMID:23049630

  9. Postoperative endophthalmitis by Flavimonas oryzihabitans.

    PubMed

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

    2004-11-01

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

  10. Postoperative imaging in femoroacetabular impingement.

    PubMed

    Dietrich, Tobias J; Dora, Claudio; Pfirrmann, Christian W A

    2013-07-01

    Femoroacetabular impingement (FAI) has been recognized as a common cause of pain, limited range of motion, and development of early osteoarthritis of the hip in adolescents and adults. Current surgical approaches include femoral osteochondroplasty, acetabular rim resection, and reattachment of torn labrum as either open surgical or arthroscopic techniques as well as periacetabular osteotomy. Conventional radiographs are routinely obtained in the postoperative setting. In addition, MRI serves for work-up in patients with persistent or recurrent groin pain after surgery. Inappropriate correction of the underlying femoral or acetabular osseous abnormality, insufficiency fractures of the femoral neck due to bone resection, intra-articular adhesions, ongoing joint degeneration including advanced cartilage damage, iatrogenic cartilage injury, retear of the labrum, rarely avascular necrosis of the femoral head, defects of the hip joint capsule, or heterotopic ossification might be observed after surgery for FAI. PMID:23787981

  11. Abdichtungen im Verbund mit Fliesen und Platten

    NASA Astrophysics Data System (ADS)

    Platts, Thomas

    Abdichtungen im Verbund mit Fliesen und Platten, im Folgenden auch als Verbundabdichtungen oder mit Kurzzeichen als AIV bezeichnet, haben sich in der Baupraxis insbesondere in Innenräumen wegen des vereinfachten konstruktiven Aufbaus gegenüber Bahnenabdichtungen nach DIN 18195-5 [14.1] in der Mehrzahl der Ausführungen durchgesetzt und bewährt. Sie können im Innen- und Außenbereich angeordnet werden und sind dadurch gekennzeichnet, dass die Nutzschicht in Boden- und Wandbereichen im Dünnbettverfahren unmittelbar auf die Abdichtung aufgebracht wird. Aufwändige Zwischenschichten oder Einbauteile wie armierter Putz, Telleranker etc. entfallen (Bild 14.1) und es lassen sich geringere Aufbauhöhen realisieren.

  12. Principles of postoperative anterior cruciate ligament rehabilitation.

    PubMed

    Saka, Tolga

    2014-09-18

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

  13. Principles of postoperative anterior cruciate ligament rehabilitation.

    PubMed

    Saka, Tolga

    2014-09-18

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

  14. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

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

  15. [The value of music in postoperative care].

    PubMed

    Kaufmann, M

    1999-05-20

    During the immediate postoperative period good monitoring, adequate analgesia and competent, comprehensive care are of paramount importance. The effect of music in the recovery room raised my interest as an additional "instrumentarium". It is my intent to motivate to take advantage of the many-fold uses of music in the postoperative phase.

  16. A Practical Guide to Postoperative Delirium.

    PubMed

    Beck, Justin L; Tucker, Phebe

    2015-01-01

    In conclusion, delirium is a common postoperative complication that especially impacts the elderly population. It contributes to a significant increase in morbidity, mortality, length of inpatient stay, and medical costs. Even with preventive efforts, many patients will develop postoperative delirium. While the gold standard treatment is to correct the underlying disorder, many therapies ranging from the use of antipsychotics to patient comfort measures are used to decrease the severity and duration of postoperative delirium. The most practical approach for physicians is continuous vigilance for the emergence of postoperative delirium. Movement toward increased use of multidisciplinary inpatient ward teams, early psychiatric consultation during postoperative delirium, larger clinical trials of prophylactic medications, and future research on delirium's pathogenesis will decrease complications of this common clinical problem. PMID:26638418

  17. Postoperative surgical complications of lymphadenohysterocolpectomy

    PubMed Central

    Marin, F; Pleşca, M; Bordea, CI; Voinea, SC; Burlănescu, I; Ichim, E; Jianu, CG; Nicolăescu, RR; Teodosie, MP; Maher, K; Blidaru, A

    2014-01-01

    Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. Methods and results Patients were divided according to the type of surgery performed as follows: for cervical cancer – group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% II).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% II) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer

  18. [Postoperative digestive fistulas. Etiopathogenic considerations].

    PubMed

    Munteanu, Iulia; Stefan, S; Sirbu-Boeti, Mirela; Popescu, R; Burcoveanu, Ioana; Topală, Roxana; Burcoveanu, C

    2009-01-01

    The digestive fistula is one of the most serious complications that might appear following different types of resectional digestive surgery. This condition still carries a considerable morbidity and mortality rate and therefore all surgical and ICU staff pay a great deal of attention and intensify their care to avoid the fatalities. The postoperative digestive fistulas, through their physiopathological and clinical complexity induce the disturbance of the biological equilibrium with vital consequences. The trend of the last decades is the increasing of digestive fistulas incidence with a variable mortality rate after different authors. A therapeutic algorithm is needed. The mortality rate due to digestive fistulas, two decades ago was, around 60%; at the present there is a decrease of the mortality rate, which is around 10%. The explanation is the introduction of the new methods of treatment such as lactic acid lavage aspiration for alkaline fistulas or total parenteral nutrition, continuous enteral nutrition and antiexocrine chemotherapy. A fistula is a communication between two epithelial or endothelial surfaces, lined by granulation tissue. It can be a life-threatening condition. PMID:21495307

  19. Clinical experimental studies of postoperative infusion analgesia.

    PubMed

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

    1983-01-01

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

  20. Physik gestern und heute Das Eiskalorimeter

    NASA Astrophysics Data System (ADS)

    Heering, P.

    2003-07-01

    Kalorimetrische Messungen gehören heute zum experimentellen Standardrepertoire im Bereich der Thermodynamik und der physikalischen Chemie. Das erste Gerät für derartige Messungen entwickelten Ende des 18. Jahrhunderts die französischen Wissenschaftler Antoine Laurent Lavoisier und Pierre Simon de Laplace.

  1. Postoperative ultrasonography of the musculoskeletal system

    PubMed Central

    Chun, Kyung Ah; Cho, Kil-Ho

    2015-01-01

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

  2. Early postoperative complications following liver transplantation.

    PubMed

    Mueller, Andrea R; Platz, Klaus-Peter; Kremer, Bernd

    2004-10-01

    Liver transplantation is a highly successful treatment for patients with end-stage liver disease and acute liver failure. However, serious postoperative complications can significantly compromise patient survival. Complications can be technical, medical, or immunological in nature. The risk of developing early postoperative complications is associated with the patient's preoperative condition, the quality of the donor liver, the quality of the donor and recipient procedure, initial graft function, and perioperative anaesthesiological and intensive care management. The patient's preoperative condition can include gastrointestinal bleeding, acute renal failure, a requirement for cathecholamines or mechanical ventilation, and prolonged encephalopathy for the most detrimental risk factors for developing early postoperative complications. The necessity for prolonged mechanical ventilation or the requirement for reintubation after transplantation can significantly increase the risk of developing pneumonia, sepsis, and multiple organ dysfunction. A decrease in infectious and other complications can be achieved by early postoperative enteral nutition, including the application of probiotics. PMID:15494284

  3. [New approach to postoperative delirium treatment].

    PubMed

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

    2015-01-01

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

  4. Foreign material in postoperative adhesions.

    PubMed Central

    Luijendijk, R W; de Lange, D C; Wauters, C C; Hop, W C; Duron, J J; Pailler, J L; Camprodon, B R; Holmdahl, L; van Geldorp, H J; Jeekel, J

    1996-01-01

    larger in patients with a history of multiple laparotomies, unoperated intra-abdominal inflammatory disease, and previous postoperative intra-abdominal complications, and when adhesions were already present at previous laparotomy. In recent adhesions, suture granulomas occurred in a large percentage. This suggests that the intra-abdominal presence of foreign material is an important cause of adhesion formation. Therefore intra-abdominal contamination with foreign material should be minimized. Images Figure 1. PMID:8604903

  5. Symmetriebrechung und Emergenz in der Kosmologie.

    NASA Astrophysics Data System (ADS)

    Mainzer, K.

    Seit der Antike wird der Aufbau des Universums mit einfachen und regulären (symmetrischen) Grundstrukturen verbunden. Diese Annahme liegt selbst noch den Standardmodellen der relativistischen Kosmologie zugrunde. Demgegenüber läßt sich die Emergenz neuer Strukturen von den Elementarteilchen über Moleküle bis zu den komplexen Systemen des Lebens als Symmetriebrechung verstehen. Symmetriebrechung und strukturelle Komplexität bestimmen die kosmische Evolution. Damit zeichnet sich ein fachübergreifendes Forschungsprogramm von Physik, Chemie und Biologie ab, in dem die Evolution des Universums untersucht werden kann.

  6. [Pain and postoperative analgesia after craniotomy].

    PubMed

    Verchère, E; Grenier, B

    2004-04-01

    Neurosurgery has for a long time been considered as a minimal painful surgery. This explains why there are few references in the literature concerning postoperative neurosurgical pain. Recent papers have demonstrated that even if postoperative pain is less important than in other specialities, such pain exists and should be taken care of. Rapid neurological recovery is now possible because of the progress in the surgical techniques and the introduction of new anaesthetic drugs. This implies a strict postoperative analgesic strategy in order to avoid both direct and indirect complications associated with pain. In this respect, the use of remifentanil or other techniques like target-controlled injection of opioids should absolutely be considered. In most cases, class I and II analgesics seem to provide optimal pain relief. However, for some patients, the use of an opioid may be required. PMID:15120790

  7. Recent Advances in Postoperative Pain Management

    PubMed Central

    Vadivelu, Nalini; Mitra, Sukanya; Narayan, Deepak

    2010-01-01

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

  8. Post-operative pulmonary complications after thoracotomy.

    PubMed

    Sengupta, Saikat

    2015-09-01

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

  9. Peppermint oil: a treatment for postoperative nausea.

    PubMed

    Tate, S

    1997-09-01

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

  10. Biomarkers of postoperative delirium and cognitive dysfunction

    PubMed Central

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

    2015-01-01

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

  11. VLAP: results immediately post-op

    NASA Astrophysics Data System (ADS)

    Cowles, Robert S.

    1996-05-01

    Visual laser ablation of the prostate (VLAP) has been shown to be as effective with fewer complications than TURP in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia. Questions have been raised about VLAP regarding prolonged irritative and obstructive voiding symptoms postoperatively. It is postulated that these symptoms are due to the slow slough of necrotic debris following VLAP. In an effort to improve upon the technique of VLAP, patients underwent lasing of the prostate in the routine manner (2, 4, 8, and 10 o'clock positions with sixty watts for sixty seconds) using Nd:YAG free beam energy. A bladder neck incision was then performed using a contact laser fiber. International prostate symptom score assessments were done preoperatively; one week and six weeks postoperatively. Post void residual urine volumes and prostate size were also evaluated. The findings indicate that symptom scores and post void residual urine volumes have significantly improved within ten days postoperatively using this technique.

  12. Satellitenbewegung, band III: Natiirliche und gesteuerte bewegung.

    NASA Astrophysics Data System (ADS)

    Jochim, E. F.

    2014-12-01

    Im dritten Band der Satellitenbewegung werden in fortlaufender Nummerierung einige für Untersuchungen der Bewegung der künstlichen Satelliten wichtige Grundlagen der Astrodynamik mit ausführlichen mathematischen Formelsystemen behandelt. Dazu zählen die unterschiedlichen Aspekte der Bewegung der natürlichen Himmelskörper, die Steuerung und Kontrolle von künstlichen Objekten, und insbesondere die für eine Satellitenbahnanalyse wichtigen physikalischen Beeinflussungen einer Satellitenbewegung. Mathematisch entscheidend ist die Wahl geeigneter Bahnparameter, die ein bestimmtes Bewegungsproblem widerspruchsfrei und singularitätenfrei zu behandeln gestatten. Für die Behandlung routinemäßiger Aufgabenstellungen der Satellitenbewegung, in erster Linie einer präzisen Bahnbestimmung und Bahnverbesserung, kann auf eine Fülle von lehrbuchartigen Monographien verwiesen werden, so dass diese Problematik in der vorliegenden Arbeit nur angedeutet werden soll.

  13. Simulation und virtuelle Realität

    NASA Astrophysics Data System (ADS)

    von Estorff, Otto; Markiewicz, Marian; Özkan, Ali; Zaleski, Olgierd; Blumrich, Reinhard; Genuit, Klaus; Fiebig, André

    Mit Hilfe akustischer Berechnungen ist es möglich, aufwendige Messungen an Fahrzeugprototypen deutlich zu reduzieren. Dieses Kapitel gibt einen kurzen Überblick über die wichtigsten derzeit verfügbaren Methoden. Dabei wird zunächst auf Elementverfahren, wie die Finite-Elemente-Methode (FEM) und die Boundary-Elemente-Methode (BEM), näher eingegangen. Während diese vor allem im tieffrequenten Bereich eingesetzt werden, kommen bei höheren Frequenzen vermehrt Verfahren zum Einsatz, die auf Energieformulierungen beruhen. Exemplarisch wird hier die Funktionsweise und der Einsatz der Statistischen-Energie-Analyse (SEA) erläutert. Anhand von repräsentativen Beispielen werden die Einsatzmöglichkeiten und Grenzen der verschiedenen Verfahren aufgezeigt, wobei vor allem auch auf Vergleiche zwischen Rechnung und Messung eingegangen wird.

  14. Hochschule fur Film und Fernsehen (Babelsberg).

    ERIC Educational Resources Information Center

    Neumann, Roland

    1992-01-01

    Describes the Hochschule fur Film und Fernsehen, an institution of higher education for the study of film and television production in Babelsberg, Germany (formerly the German Democratic Republic). Discusses the major reorientations in the school caused by Germany's reunification. (SR)

  15. Kosmische Katastrophen und der Ursprung der Religion.

    NASA Astrophysics Data System (ADS)

    Hoyle, F.

    This book is a German translation, by V. Delavre, from the English original "The origin of the Universe and the origin of religion", published in 1993. Contents: E. Sens: Die unterbrochene Musikstunde. Einleitung zur deutschen Ausgabe. C. Ryskamp: Einführung. R. N. Anshen: Vorwort. F. Hoyle: Kosmische Katastrophen und der Ursprung der Religion - Die Folgen der Respektabilität; Eiszeiten und Kometen; Die allgemeine Situation in den Nacheiszeiten; Kometen und der Ursprung der Religionen; Der Übergang zu Mittelalter und Neuzeit. Diskussionsbeiträge: Ruth Nanda Anshen, Freeman Dyson, Paul Oscar Kristeller, John Archibald Wheeler, James Schwartz, Roger Shinn, Milton Gatch, Philip Solomon, Norman Newell. F. Hoyle: Schlußwort. A. Tollmann: Nachwort zur deutschen Ausgabe.

  16. Pathogenesis of postoperative oral surgical pain.

    PubMed Central

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

    2003-01-01

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

  17. Postoperative global amnesia reversed with flumazenil.

    PubMed

    Rinehart, Joseph B; Baker, Brandee; Raphael, Darren

    2012-07-01

    Global postoperative amnesia (profound anterograde and retrograde amnesia) is rare and usually attributed to transient global amnesia-a poorly understood condition with no broadly accepted mechanism. We report an incident of probable transient global amnesia in a patient after endoscopic retrograde cholangiopancreatogram under general anesthesia, which was successfully treated with flumazenil. On the basis of the results of flumazenil administration in this and a previous case report, we would recommend a trial dose of 0.2 mg for cases of global postoperative amnesia, repeated if the first dose seems effective.

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

    PubMed Central

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

    2016-01-01

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

  19. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

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

    2015-01-01

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

  20. Postoperative sore throat: a systematic review.

    PubMed

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

    2016-06-01

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

  1. Postoperative sore throat: a systematic review.

    PubMed

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

    2016-06-01

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

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

    PubMed

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

    1983-06-01

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

  3. Management of pain in the postoperative neonate.

    PubMed

    Truog, R; Anand, K J

    1989-03-01

    Only recently has the use of anesthesia and analgesia become widely accepted in the newborn infant. This is largely a result of the overwhelming evidence that neonates have the neurologic substrate for the perception of pain and display characteristic behavioral, physiologic, metabolic, and hormonal responses to noxious stimuli. The management of postoperative pain in the surgical neonate begins in the operating room, where techniques can be chosen that will ease the transition into the postoperative period. For postoperative analgesia, the most widely used and effective agents are the narcotics morphine and fentanyl. They may be administered either intermittently or continuously, and with proper precautions may be given to both intubated and nonintubated newborns. Other medications for analgesia and sedation are not as well studied in the newborn, but chloral hydrate and the benzodiazepines are useful for sedation, and acetaminophen may be used for analgesia alone or for potentiating the effect of narcotics. In addition, a number of creative nonpharmacologic techniques are being developed and promise to further decrease the discomfort experienced by postoperative neonates.

  4. Postoperative nausea and vomiting following orthognathic surgery

    PubMed Central

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

    2015-01-01

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

  5. Postoperative adjuvant therapy of breast cancer. Oncology Overview

    SciTech Connect

    Not Available

    1984-12-01

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

  6. Tycho Brahe - Instrumentenbauer und Meister der Beobachtungstechnik

    NASA Astrophysics Data System (ADS)

    Wolfschmidt, Gudrun

    Vor der Erfindung des Fernrohrs war der dänische Astronom Tycho Brahe (1546 - 1601) der bedeutendste beobachtende Astronom. Von seinem Observatorium Uraniborg auf der - damals dänischen - Insel Hven ist heute noch der Grundriß erkennbar, von Stjerneborg sind die Fundamente erhalten, die Kuppeln in den 1950er Jahren ergänzt. In der Astronomie-Ausstellung im Deutschen Museum gibt es ein Modell der Sternwarte Uraniborg und der zugehörigen Instrumente (Maßstab 1:10); das größere Modell wurde dem Technischen Museum in Malmö geschenkt. Die Instrumente, die er in den Observatorien Uraniborg und Stjerneborg benutzte, sind nicht erhalten. Aber es gibt gute Beschreibungen der Instrumente (Halbkreis, Quadranten, Sextanten, Armillarsphären, Triquetrum, Himmelsglobus) in seinem Buch Astronomiae instauratae mechanica (Wandsbek 1598). Eine Nachbildung des großen hölzernen Quadranten kann man im Runden Turm in Kopenhagen sehen. Zwei Sextanten, hergestellt für Tycho um 1600 von Jost Bürgi und Erasmus Habermel, gibt es noch im Nationalmuseum für Technik in Prag. Ähnlichkeiten von Tychos Instrumenten mit Groß-Instrumenten aus dem islamischen Kulturkreis sind auffällig. Tycho Brahes Meßgeräte markieren einen großen Fortschritt in der Entwicklung astronomischer Instrumente und Meßtechniken und bilden die Grundlage für den weiteren Fortschritt der Positionsastronomie und der damit verbundenen Tabellenwerke. Die Nachwirkungen sind bis ins 17. und 18. Jahrhundert nachweisbar.

  7. Leitbilder und Handlungsstrategien für die Raumentwicklung in Deutschland. Entwicklungs-, Umsetzungs- und Fortschreibungsprozess der Bund-Länder-Strategie für Städte und Regionen

    NASA Astrophysics Data System (ADS)

    Issaoui, Mariam; Sinz, Manfred

    2010-09-01

    Die Ministerkonferenz für Raumordnung stellte im Mai 2010 fest, dass sich die „Leitbilder und Handlungsstrategien für die Raumentwicklung in Deutschland“ (2006) bewährt haben und bei der Gestaltung der räumlichen Entwicklung umgesetzt werden. Um die Leitbilder den sich verändernden wirtschaftlichen, sozialen und naturräumlichen Rahmenbedingungen anzupassen und die Erkenntnisse aus dem bisherigen Diskussions- und Umsetzungsprozess in Politik und Praxis einzubeziehen, sind sie zu ergänzen und weiterzuentwickeln. Im Mittelpunkt der Fortschreibung werden die Themen „Partnerschaften und Strategien für Stadtregionen und ländliche Räume“, „Mobilität und Logistik“ sowie „Klimaschutz und Energieversorgung“ stehen.

  8. [Pneumothorax revealed by postoperative computed tomography].

    PubMed

    Ikeda, Shizuka; Katori, Kiyoshi; Fujimoto, Minoru; Nitahara, Keiichi; Higa, Kazuo

    2005-11-01

    We report a case of pneumothorax revealed by postoperative computed tomography. A 39-year-old obese woman (height 153 cm, weight 70 kg) with fractures of the radius, ulna, clavicle, and femur in a traffic accident, was scheduled for osteosynthesis. Anesthesia was induced with thiopental and maintained with 50% nitrous oxide in oxygen and sevoflurane. The Spo2 decreased from 99% to 94% during the surgery. Bilateral chest sounds were symmetrical. The Spo2 increased to 100% after discontinuation of nitrous oxide. Pneumothorax was not evident on a postoperative chest X-ray, but computed tomography of the chest demonstrated right-sided pneumothorax. An ECG electrode had overlapped the fractured rib on the preoperative chest X-ray.

  9. Post-operative pulmonary complications after thoracotomy

    PubMed Central

    Sengupta, Saikat

    2015-01-01

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

  10. Die neue Kosmologie. Von Dunkelmaterie, GUTs und Superhaufen.

    NASA Astrophysics Data System (ADS)

    Cornell, J.

    This book is a German translation, by M. Röser, of the American original "Bubbles, voids, and bumps in time: the new cosmology", published 1989 (see 49.003.045). Contents: 1. Die Entdeckung des Weltalls: Eine Einleitung (A. P. Lightman). 2. Die Vermessung des Weltalls: Rotverschiebungen und Standardkerzen (R. P. Kirshner). 3. Die Kartierung des Weltalls: Scheiben und Blasen (M. J. Geller). 4. Die Bestimmung der Masse im Weltall: Dunkelmaterie und fehlende Masse (V. C. Rubin). 5. Der Beginn des Weltalls: Urknall und kosmische Inflation (A. H. Guth). 6. Die Ausweitung des Weltalls: Das Weltraumteleskop und Perspektiven für die nächsten 20 Jahre (J. E. Gunn).

  11. Postoperative epilepsy in patients undergoing craniotomy for glioblastoma multiforme.

    PubMed

    Telfeian, A E; Philips, M F; Crino, P B; Judy, K D

    2001-03-01

    Glioblastoma multiforme (GBM) has associated with it one of the poorest prognoses among brain tumors. Postoperative seizures and the side effects of anticonvulsants, routinely given for prophylactic purposes, add to patient morbidity. The primary goal of this study was to determine who, of those undergoing craniotomy for GBM resection, is at risk for epilepsy. We studied 72 consecutive patients who underwent craniotomy and palliative resection for GBM. Twenty-nine presented with seizures and 17 had postoperative seizures. All patients were treated with a postoperative anticonvulsant for at least six months; anticonvulsants were continued longer if there was a postoperative seizure. Patient factors examined for an association with risk for postoperative seizure included age, sex, tumor size, tumor location, adjuvant therapy, postoperative complications and history of preoperative seizures. The majority of patients with no prior seizure history and who seized postoperatively had their first seizure after withdrawal from their anticonvulsant medication. All, but one, of the patients with both pre- and postoperative seizures had their first postoperative seizure while still on anticonvulsants. Smaller tumor size and frontal resection were associated with an increased risk of postoperative seizures. Our data suggests that those who do not present with seizures and undergo GBM resection may still be prone to seize but more easily protected from postoperative seizures with anticonvulsant therapy than patients who present with seizures; resection of frontal tumors and smaller tumors seemed to indicate an increased risk for postoperative seizures. PMID:11370829

  12. Postoperative respiratory morbidity: identification and risk factors.

    PubMed

    Mitchell, C; Garrahy, P; Peake, P

    1982-04-01

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

  13. Intravitreal Daptomycin for Recalcitrant Postoperative Endophthalmitis

    PubMed Central

    Sim, Jennifer M.; Kapoor, Kapil G.; Wagner, Alan L.

    2016-01-01

    Purpose To report the first case to our knowledge of intravitreal daptomycin used to successfully treat culture-negative vancomycin resistant to exogenous endophthalmitis. Methods Case report with preoperative, intraoperative, and postoperative findings. Results A 63-year-old Caucasian male underwent routine pars plana vitrectomy with epiretinal membrane peeling. He developed acute postoperative endophthalmitis, and underwent vitreous tap and injection of intravitreal vancomycin/ceftazidime/dexamethasone. Gram stain showed Gram-positive cocci, but cultures were negative. His infection subsequently proved very recalcitrant and his treatment course involved pars plana vitrectomy with anterior chamber washout and repeat injection of antibiotics, followed by repeat intravitreal vancomycin and ceftazidime. Ultimately, a second vitrectomy with intravitreal daptomycin controlled his intraocular infection. On each occasion, cultures were negative. Conclusion This case suggests that vancomycin resistance should be considered in culture-negative postoperative endophthalmitis, and intravitreal daptomycin should be considered as an important treatment alternative. Although vancomycin resistance is fairly rare in endophthalmitis, acknowledgment of its increasing occurrence rate is critical for optimal management. PMID:27293409

  14. Zwischen Web 2.0, virtuellen Welten und Game-based Learning - Einsatzszenarien und Prototypen im Hochschulumfeld

    NASA Astrophysics Data System (ADS)

    Pongratz, Hans

    Web 2.0, virtuelle Welten und Game-based Learning werden als Allheilmittel moderner Wissensvermittlung an Hochschulen genannt. Dieser Artikel beschreibt nach einer Einführung in die Thematik Einsatzszenarien und Prototypen im Hochschulumfeld anhand ausgewählter Web 2.0-Dienste, der virtuellen Welt Second Life, eines an der TUM entwickelten Frameworks für Gamebased Learning Applikationen und eines Lernspiels. Diese werden anhand von konkreten Lehr- und Lernszenarien vorgestellt und anhand der bisherigen Erfahrungen in diesem Bereich kritisch beleuchtet.

  15. Wilhelm Julius Foerster und die "Vereinigung von Freunden der Astronomie und kosmischen Physik" (1891 bis 1914).

    NASA Astrophysics Data System (ADS)

    Tiemann, K.-H.

    Am 19. Mai 1891 wurde ins Leben gerufen die "Vereinigung von Freunden der Astronomie und der kosmischen Physik (nachfolg.: V.A.P.) - eine der beiden institutionellen Vorläufer der sich 1953 konstituierenden "Vereinigung der Sternfreunde".

  16. Gravitation und Kosmologie. Eine Einführung in die allgemeine Relativitätstheorie.

    NASA Astrophysics Data System (ADS)

    Sexl, R. U.; Urbantke, H. K.

    Contents: 1. Physikalische Grundlagen. 2. Riemannsche Geometrie. 3. Gravitationstheorie. 4. Experimentelle Tests. 5. Kosmologie. 6. Gravitationswellen. 7. Neue differentialgeometrische Methoden. 8. Sternbau und Gravitationskollaps. 9. Felder im Riemannschen Raum. 10. Gravitation und Feldtheorie. 11. Gravitation und Eichtheorie.

  17. Alvimopan, for Postoperative Ileus Following Bowel Resection

    PubMed Central

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

    2007-01-01

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

  18. Postoperative immunotherapy of murine C1300-neuroblastoma.

    PubMed

    Fowler, C L; Brooks, S P; Rossman, J E; Cooney, D R

    1990-02-01

    Low-dose cyclophosphamide (CY) is an immunomodulating agent that down-regulates T suppressor cell function. This study investigates postoperative immunotherapy with CY as an alternate treatment for advanced immunogenic tumors such as neuroblastoma that typically respond poorly to traditional high-dose chemotherapy. A/J mice with 1.5-cm subcutaneous C1300-neuroblastoma (C1300-NB) tumors were divided into the following treatment groups: I, untreated (n = 14); II, 85% tumor resection (n = 18); III, sham-operated (n = 18); IV, multiple-dose CY (n = 6); V, 85% resection and single-dose CY (n = 14); VI, 85% resection and multiple-dose CY (n = 14). CY (100 mg/kg, intraperitoneally) was given initially 24 hours post-operatively to groups IV, V, and VI. Groups IV and VI also received weekly maintenance doses of 25 mg/kg CY. Results showed significantly increased survival (log-rank test) in CY-treated groups (IV, V, VI) compared with control groups (I,II,III). Cures were observed only in groups receiving partial resection plus CY (V, 7%; VI, 29%). Although surgical debulking of tumor alone (II) did not enhance survival, the procedure normalized depressed total lymphocyte counts and the subpopulation of Lyt 2,3+ (T suppressor/cytolytic cells) in the immediate postoperative period during which immunotherapy with CY was instigated. This may have contributed to the success of CY immunotherapy. To characterize the tumor-host immune interaction, additional studies were performed. Results showed the following. (1) Mice cured by debulking plus CY (from groups V and VI) could not be successfully reimplanted with C1300-NB, demonstrating immunologic mediation by CY.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed

    Pogatzki-Zahn, E M; Meissner, W

    2015-10-01

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

  20. Postoperative pain management after supratentorial craniotomy.

    PubMed

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

    2002-04-01

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

  1. Reduction in postoperative endophthalmitis with intracameral cefuroxime.

    PubMed

    Myneni, J; Desai, S P; Jayamanne, D G R

    2013-08-01

    Postoperative endophthalmitis is an uncommon complication of cataract surgery with grave consequences. This report describes the trend of endophthalmitis in a district general hospital in England over eight years, and attempts made to modify this trend. An outbreak of endophthalmitis in 2007 led to a detailed investigation and subsequent changes in practice. Intracameral cefuroxime (ICC) was introduced in place of subconjunctival cefuroxime. Use of ICC in patients with 'penicillin allergy' was explored, found to be safe and resulted in a change of policy. This led to a four-fold reduction in the rate of endophthalmitis.

  2. Bladder exstrophy: current management and postoperative imaging.

    PubMed

    Pierre, Ketsia; Borer, Joseph; Phelps, Andrew; Chow, Jeanne S

    2014-07-01

    Bladder exstrophy is a rare malformation characterized by an infra-umbilical abdominal wall defect, incomplete closure of the bladder with mucosa continuous with the abdominal wall, epispadias, and alterations in the pelvic bones and muscles. It is part of the exstrophy-epispadias complex, with cloacal exstrophy on the severe and epispadias on the mild ends of the spectrum. Bladder exstrophy is the most common of these entities and is more common in boys. The goal of this paper is to describe common methods of repair and to provide an imaging review of the postoperative appearances. PMID:24939762

  3. Postoperative pain relief by demand analgesia.

    PubMed

    Peeters, M; Brugmans, J

    1980-01-01

    Postoperative pain relief is only apparently an easy task. A brief survey of literature investigating the discomfort experienced in the postoperative phase is all but encouraging. One can identify four basic problems in obtaining adequate results by delivery of analgesic drugs: a) the biological variability among individual patients, b) the unpredictable uptake of the drug administered intramuscularly, c) the time lag involved between request by the patient and the subsequent administration of a single dose and d) the lack of knowledge about the nature of the discomfort and its remedies. An alternative strategy introducing "On-Demand" analgesia administering prescribed doses at the right moment is presented and analysed a) as an operant conditioning process implementing a particular reinforcement schedule (behavioural sciences), as well as b) a negative feedback control loop that entrust the central judgement to the patient (system theory). Both approaches give insight into the results: the technique copes with biological variability; anticipating pain induced by fear disappears; the feedback strategy works well and patients adapt to a wide range in prescriptions; intermittent administration makes more efficient use of the analgesic; an optimal result is demonstrated in studies comparing on-demand analgesia with the normal IM-regime and epidural analgesia; continuity in pain relief can be obtained in routine clinical practice.

  4. [Onset and significance of postoperative bacteriuria].

    PubMed

    Riss, P; Schieder, K; Bartl, W

    1984-06-01

    In 52 patients an indwelling transurethral catheter was inserted after gynaecological surgery for 5 days; no patient received antibiotics. At the time of removal of the catheter on the 6th postoperative day and 2 days later (8th postoperative day) a urine culture was set up. At the time of removal of the catheter on the 6th day, 26/52 patients (50%) had significant bacteriuria greater than or equal to 10(5)/ml. In 11 out of the 26 patients with bacteriuria the urine cleared spontaneously within 2 days; on the other hand, 10/26 patients with a negative culture at the time of removal of the catheter had significant bacteriuria 2 days later. As a group these women also had delayed spontaneous onset of voiding and persistence of residual urine. Younger patients (less than 45 years) had significantly fewer bacteriurias on the 6th day than older patients. A positive urine culture at the time of removal of the catheter should be treated with antibiotics; a negative urine culture should be repeated whenever spontaneous voiding is delayed, when there is persistent residual urine, or when the clinical signs of urinary tract infection are present.

  5. [Postoperative management of hip and knee endoprostheses].

    PubMed

    Seitz, S; Rüther, W

    2012-10-01

    Rheumatoid arthritis is often accompanied by massive destruction of the smaller and larger joints even with early therapy using antirheumatic drugs. In these cases total joint arthroplasty is the only surgical option, especially for the knee and hip joint. Knowledge of the specific disease-related postoperative characteristics is a prerequisite for the successful treatment of patients with rheumatoid arthritis. As dislocation of the arthroplastic joint does not occur more often in rheumatoid arthritis, the risk of periprosthetic infection is increased due to the use of biologicals. Therefore, a perioperative optimization is obligatory. In order to facilitate independence in daily living physiotherapy in combination with aids such as arthritis crutches, gripping pliers or raised toilet seat need to be started as soon as possible after surgical treatment. To achieve this goal it is recommended to refer patients with inflammatory arthritis to inpatient rehabilitation facilities. With respect to the specific postoperative treatment after joint replacement the long-term results are comparable with those from patients with primary osteoarthritis.

  6. Herstellung von Chitosan und einige Anwendungen

    NASA Astrophysics Data System (ADS)

    Struszczyk, Marcin Henryk

    2001-05-01

    1. Die Deacetylierung von crabshell - Chitosan führte gleichzeitig zu einem drastischen Abfall der mittleren viscosimetrischen Molmasse ( Mv), insbesondere wenn die Temperatur und die Konzentration an NaOH erhöht werden. Diese Parameter beeinflussten jedoch nicht den Grad der Deacetylierung (DD). Wichtig ist jedoch die Quelle des Ausgangsmaterials: Chitin aus Pandalus borealis ist ein guter Rohstoff für die Herstellung von Chitosan mit niedrigem DD und gleichzeitig hoher mittlerer Mv, während Krill-Chitin (Euphausia superba) ein gutes Ausgangsmaterial zur Herstellung von Chitosan mit hohem DD und niedrigem Mv ist. Chitosan, das aus Insekten (Calliphora erythrocephala), unter milden Bedingungen (Temperatur: 100°C, NaOH-Konzentration: 40 %, Zeit: 1-2h ) hergestellt wurde, hatte die gleichen Eigenschaften hinsichtlich DD und Mv wie das aus Krill hergestellte Chitosan. Der Bedarf an Zeit, Energie und NaOH ist für die Herstellung von Insekten-Chitosan geringer als für crabshell-Chitosan vergleichbare Resultaten für DD und Mv. 2. Chitosan wurde durch den Schimmelpilz Aspergillus fumigatus zu Chitooligomeren fermentiert. Die Ausbeute beträgt 25%. Die Chitooligomere wurden mit Hilfe von HPLC und MALDI-TOF-Massenspektrmetrie identifiziert. Die Fermentationsmischung fördert die Immunität von Pflanzen gegen Bakterien und Virusinfektion. Die Zunahme der Immunität schwankt jedoch je nach System Pflanze-Pathogen. Die Fermentation von Chitosan durch Aspergillus fumigatus könnte eine schnelle und billige Methode zur Herstellung von Chitooligomeren mit guter Reinheit und Ausbeute sein. Eine partiell aufgereinigte Fermentationsmischung dieser Art könnte in der Landwirtschaft als Pathogeninhibitor genutzt werden. Durch kontrollierte Fermentation, die Chitooligomere in definierter Zusammensetzung (d.h. definierter Verteilung des Depolymerisationsgrades) liefert, könnte man zu Mischungen kommen, die für die jeweilige Anwendung eine optimale Bioaktivität besitzen. 3

  7. 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

  8. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study

    PubMed Central

    Chowdhury, Tumul; Prabhakar, Hemanshu; Bithal, Parmod K.; Schaller, Bernhard; Dash, Hari Hara

    2014-01-01

    Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. Materials and Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay) in patients undergoing transsphenoidal removal of pituitary tumors. Results: In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Conclusion: Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe. PMID:25191182

  9. Bemerkungen zur Relativitätstheorie und zu den Quanten

    NASA Astrophysics Data System (ADS)

    Bergmann, Peter G.

    Die theoretischen und experimentellen Grundlagen von Gravitations- und Quantenphysik, die Beziehung beider Theorien und die Bedeutung wesentlicher Begriffe, wie Observable, werden diskutiert.Translated AbstractRemarks on Relativity and on Quantum TheoryThe theoretical and experimental foundations of gravitation and quantum physics are discussed as well as the relation of these two theories and the role of basic notions like observables.

  10. Vom Urknall zum Zerfall. Die Welt zwischen Anfang und Ende.

    NASA Astrophysics Data System (ADS)

    Fritzsch, H.

    Contents: Der Tanz mit dem Ozean. Galaktische Landkarte. Das Maß der Dinge. Der würfelnde Gott der Quantenphysik. Geheimnisvolle Felder. Materie und Antimaterie. Quarks - Urstoff unserer Welt. Zerfallende Protonen und die Einheit der Physik. Der Zauberofen. Das überschaubare Universum. Das explodierende Universum. Nachhall der Schöpfung. Der achtfache Weg der kosmischen Entwicklung. Das Ende der Welt. Einheit in der Vielfalt. Das geistige Universum. Gott und das absurde Universum.

  11. [Clinical and functional considerations in some cases of postoperative endophthalmitis].

    PubMed

    Muşat, O; Toma, Oana; Cristescu, R; Coman, Corina; Asandi, R; Burcea, M

    2013-01-01

    We present 3 cases of postsurgery endophthalmitis, with good initial operatory technique, which were admitted in our hospital within variable time, to which a second surgery was performed, with good postoperative evolution, without any inflammatory signs and preserving the eye. We analyse the pre and post-operative treatment of endophthalmitis, but also the ways to prevent the appearance of this post-operative complication.

  12. [Clinical and functional considerations in some cases of postoperative endophthalmitis].

    PubMed

    Muşat, O; Marinescu, Oana; Cristescu, R; Coman, Corina; Asandi, R

    2012-01-01

    We present 3 cases of postsurgery endophthalmitis, with good initial operatory technique, which were admitted in our hospital within variable time, to which a second surgery was performed, with good postoperative evolution, without any inflamatory signs and preserving the eye. We analyse the pre and post-operative treatment of endophthalmitis, but also the ways to prevent the appearance of this post-operative complication.

  13. Single dose dipyrone for acute postoperative pain

    PubMed Central

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

    2014-01-01

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

  14. Novel pharmaceuticals in the management of postoperative pain.

    PubMed

    Palmer, Pamela

    2015-01-01

    Novel pharmaceutical advances in postoperative pain management include both non-opioid adjuvants as well as opioid analgesics. Optimizing postoperative analgesics includes improving onset of action, matching duration of analgesia to the setting of use, and minimizing adverse events. To improve on the current standard of care, the physicochemical properties of new analgesics and route of administration must be taken into consideration in order to achieve these three goals. Appropriately, patient satisfaction with postoperative pain is a key emphasis in hospital-focused patient satisfaction surveys, thereby focusing much-needed attention on improvement of care in the postoperative setting from both an analgesic efficacy and safety standpoint.

  15. Multiple postoperative intracerebral haematomas remote from the site of craniotomy.

    PubMed

    Rapanà, A; Lamaida, E; Pizza, V

    1998-08-01

    A postoperative haemorrhage is a common and serious complication of a neurosurgical procedure. It usually occurs at the site of the surgery, but on occasion a postoperative haematoma is found at a distance from the previous craniotomy. Multiple postoperative haemorrhages are extremely rare. We report the case of a 63-year-old woman, operated on for the removal of a supratentorial astrocytoma, who developed in the early post-operative period multiple bilateral intracerebral haematomas without involvement of the surgical bed. PMID:10070433

  16. Early postoperative complications following ostomy surgery: a review.

    PubMed

    Butler, Doris L

    2009-01-01

    This article reviews early postoperative complications in adults undergoing ostomy surgery. Whether the ostomy is the result of an emergent or elective procedure, the WOC nurse and staff nurses are responsible for monitoring and ensuring quality healthcare for the patient. Nevertheless, many patients undergoing ostomy surgery experience a complication during the early postoperative period. Early postoperative complications not only influence immediate postoperative care but may also impact quality of life for the person living with an ostomy. Keen assessment skills, early recognition of signs and symptoms of a complication, and prompt interventions are crucial to maintaining a viable stoma and a successful surgical outcome.

  17. Comprehensive Postoperative Management After Endoscopic Skull Base Surgery.

    PubMed

    Tien, Duc A; Stokken, Janalee K; Recinos, Pablo F; Woodard, Troy D; Sindwani, Raj

    2016-02-01

    To maximize outcomes from endoscopic skull base surgery, careful early postoperative management is critically important. Standardized postoperative regimens are lacking. The type of reconstruction and presence and type of cerebrospinal fluid leak dictate management. If a leak is encountered intraoperatively, patients should avoid maneuvers that increase intracranial pressures for at least 1 month. Early postoperative care focuses on minimizing and managing nasal crusting. This article reviews the evidence in the literature on postoperative management, complications, and quality of life after surgery, and outlines our experience in the management of patients after endoscopic skull base surgery.

  18. Das menschliche Gehör und Grundlagen der Psychoakustik

    NASA Astrophysics Data System (ADS)

    Genuit, Klaus; Sottek, Roland

    Das menschliche Gehör ist ein äußerst komplexes Empfangs- und Signalverarbeitungssystem. Es ist als Schallanalysator in Leistungsfähigkeit und Vielseitigkeit von technisch-analytischen Verfahren nach wie vor unerreicht. Die Signalverarbeitung läuft auf Grundlage komplexer Prozesse ab, die in ihrer Gesamtheit bislang nicht vollständig erfasst sind. Verschiedene Modelle zur gehörgerechten Zeit- und Frequenzanalyse ahmen jene komplexen Prozesse und Verarbeitungsmechanismen nach, die im menschlichen Gehör vollzogen werden.

  19. Ökologische Grundlagen und limitierende Faktoren der Renaturierung

    NASA Astrophysics Data System (ADS)

    Rosenthal, Gert; Eichberg, Carsten

    In den dicht besiedelten und agrarisch besonders intensiv genutzten Regionen Mittel- und Westeuropas ist seit Ende des Zweiten Weltkrieges ein fortschreitender Verlust an naturnahen ökosystemen mit hoher biologischer Vielfalt zu verzeichnen. Spätestens seit den 1970er-Jahren ist daher die Neuschaffung und Wiederherstellung gefährdeter Lebensräume und Biozönosen zunehmend in den Mittelpunkt von Naturschutzmaßnahmen gerückt (Bakker 1989, Muller et al. 1998, Bakker und Berendse 1999). Aufgrund fehlender wissenschaftlicher Grundlagen und praktischer Erfahrungen wurden Renaturierungsmaßnahmen anfangs fast durchweg nach dem trial and error-Prinzip durchgeführt. Im Vordergrund standen dabei zunächst die Wiederherstellung adäquater abiotischer Standortbedingungen sowie die Reorganisation traditioneller Nutzungsmanagements. Bei Ersterem ging es neben der Wiedervernässung entwässerter Feuchtgebiete (Pfadenhauer und Grootjans 1999) vor allem darum, Eutrophierungseffekte zu beseitigen und die Produktivität des Standortes auf das Niveau der Zielgemeinschaft zurückzuführen (Gough und Marrs 1990, Oomes et al. 1996, Snow et al. 1997, Tallowin et al. 1998).

  20. Hair Transplantation: Preventing Post-operative Oedema.

    PubMed

    Gholamali, Abbasi; Sepideh, Pojhan; Susan, Emami

    2010-05-01

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

  1. Postoperative pain relief and regional techniques.

    PubMed

    Reiz, S

    1984-01-01

    The methods of providing postoperative analgesia by regional anaesthetic techniques with local anaesthetics are outlined. For the use of epidural analgesia, the techniques of inserting an epidural catheter at any level of the spine must be familiar. The block should be regional, restricted to the area of pain and effective at all times after its institution with a minimum of side effects. Bupivacaine is at present the best local anaesthetic and can be administered either as intermittent injections with an interval of 1-2 hours or as a continuous infusion. A dose regimen for thoracic, abdominal, perineal and lower extremity pain is presented. Side effects of the epidural technique and ways to treat and avoid them are discussed. The intercostal nerve block for post-thoracotomy and upper abdominal pain is described with special reference to the recent development of the continuous technique with bupivacaine and the cryoanalgesia technique. PMID:6497310

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

    PubMed

    Melia, Kh; Kokaia, N; Manjgaladze, M

    2016-01-01

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

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

    PubMed

    Occella, P; Vivaldi, F

    2003-12-01

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

  4. Nonoperative and postoperative rehabilitation for glenohumeral instability.

    PubMed

    Wilk, Kevin E; Macrina, Leonard C

    2013-10-01

    The glenohumeral joint is an inherently unstable joint that relies on the interaction of the dynamic and static stabilizers to maintain stability. Disruption of this interplay or poor development of any of these factors may result in instability, pain, and a loss of function. Rehabilitation will vary based on the type of instability present and the key principles described. Whether a course of nonoperative rehabilitation is followed or the patient presents postoperatively, a comprehensive program designed to establish full ROM and balance capsular mobility, in addition to maximizing muscular strength, endurance, proprioception, dynamic stability, and neuromuscular control is essential. A functional approach to rehabilitation using movement patterns and sport-specific positions along with an interval sport program will allow a gradual return to athletics. The focus of the program should minimize the risk of recurrence and ensure that the patient can safely return to functional activities.

  5. Postoperative conversion disorder in a pediatric patient.

    PubMed

    Judge, Amy; Spielman, Fred

    2010-11-01

    According to the Diagnostic and Statistical Manual IV (DSM IV), conversion disorder is classified as a somatoform illness and defined as an alteration or loss of physical function because of the expression of an underlying psychological ailment. This condition, previously known as hysteria, hysterical neurosis, or conversion hysteria occurs rarely, with an incidence of 11-300 cases per 100,000 people (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edn. Washington, DC: American Psychiatric Association, 1994). Presentation after an anesthetic is exceptional. After thorough review of the literature, fewer than 20 cases have been documented, with only two instances in patients younger than 18 years of age after general anesthesia; both were mild in nature. We present a severe case of postoperative conversion disorder that developed upon emergence from anesthesia in a previously healthy 16-year-old girl following direct laryngoscopy with vocal fold injection.

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

    PubMed

    Melia, Kh; Kokaia, N; Manjgaladze, M

    2016-01-01

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

  7. Radiotherapy in the treatment of postoperative chylothorax

    PubMed Central

    2013-01-01

    Background Chylothorax is characterized by the presence of chyle in the pleural cavity. The healing rate of non-operative treatment varies enormously; the maximum success rate in series is 70%. We investigate the efficacy and outcomes of radiotherapy for postoperative chylothorax. Methods Chylothorax was identified based on the quantity and quality of the drainage fluid. Radiation was indicated if the daily chyle flow exceeded 450 ml after complete cessation of oral intake. Radiotherapy consisted of opposed isocentric portals to the mediastinum using 15 MV photon beams from a linear accelerator, a single dose of 1–1.5 Gy, and a maximum of five fractions per week. The radiation target area was the anatomical region between TH3 and TH10 depending on the localization of the resected lobe. The mean doses of the ionizing energy was 8.5 Gy ± 3.5 Gy. Results The median start date of the radiation was the fourth day after chylothorax diagnosis. The patients’ mediastinum was radiated an average of six times. Radiotherapy, in combination with dietary restrictions, was successful in all patients. The median time between the end of the radiation and the removal of the chest tube was one day. One patient underwent wound healing by secondary intention. The median time between the end of radiation and discharge was three days, and the overall hospital stay between the chylothorax diagnosis and discharge was 18 days (range: 11–30 days). After a follow-up of six months, no patient experienced chylothorax recurrence. Conclusions Our results suggest that radiotherapy in combination with dietary restriction in the treatment of postoperative chylothorax is very safe, rapid and successful. This novel interventional procedure can obviate repeat major thoracic surgery and shorten hospital stays and could be the first choice in the treatment of postthoracotomy chylothorax. PMID:23566741

  8. Nefopam and Ketamine Comparably Enhance Postoperative Analgesia

    PubMed Central

    Kapfer, Barbara; Alfonsi, Pascal; Guignard, Bruno; Sessler, Daniel I.; Chauvin, Marcel

    2005-01-01

    Summary Opioids alone sometimes provide insufficient postoperative analgesia. Co-administration of drugs may reduce opioid use and to improve opioid efficacy. We therefore tested the hypothesis that administration of ketamine or nefopam, to postoperative patients with pain only partly alleviated by morphine, limits the amount of subsequent opioid necessary to produce adequate analgesia. Patients (n=77) recovering from major surgery were given up to 9 mg intravenous morphine. Those still suffering from pain were randomly assigned to blinded administration of: 1) isotonic saline (Control, n=21); 2) ketamine 10 mg (Ketamine, n=22); or, 3) nefopam 20 mg (Nefopam, n=22). Three-mg morphine boluses were subsequently given at 5-minute intervals until adequate analgesia was obtained, or 60 minutes elapsed after the beginning of the study drug administration, or ventilation became insufficient (respiratory rate < 10 breath/minute or saturation by pulse oxymetery < 95%). Supplemental morphine (i.e., after test drug administration) requirements were significantly greater in the Control group [17 ± 10 (SD) mg] than in the Nefopam (10 ± 5 mg, P < 0.005) or Ketamine (9 ± 5 mg, P < 0.001) groups. Morphine titration was successful in all Ketamine and Nefopam patients, but failed in four Control patients (two from respiratory toxicity and two from persistent pain). Tachycardia and profuse sweating were more frequent in patients given nefopam and sedation was greater with ketamine; however, the incidence of other potential complications did not differ between groups. Implications We conclude that ketamine 10 mg and nefopam 20 mg comparably potentiate opioid analgesia, each reducing opioid need by approximately 40%. Ketamine administration was associated with sedation whereas nefopam produced tachycardia and sweating. However, none of the side effects was serious. Either drug can thus be used to potentiate opioid analgesia. PMID:15616073

  9. Supraleitung und Interkontinentalraketen „On-line computing“ zwischen Militär, Industrie und Wissenschaft

    NASA Astrophysics Data System (ADS)

    Knolle, Johannes; Joas, Christian

    Der zweite Weltkrieg und der Kalte Krieg veränderten nicht nur das Verhältnis zwischen Militär, Industrie und Wissenschaft, sondern auch die wissenschaftliche Praxis von Physikern und anderen Wissenschaftlern. In den 1950er Jahren stellte die Entwicklung von Interkontinentalraketen die Auftragnehmer des Militärs in der Industrie vor komplexe Fragestellungen, zu deren Lösung sie auf die Expertise von Wissenschaftlern angewiesen waren. Industrieunternehmen gründeten eigene Forschungseinheiten zur Lösung technischer und wissenschaftlicher Probleme.

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

    PubMed

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

    2014-08-01

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

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

    PubMed Central

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

    2014-01-01

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

  12. Darwin, Engels und die Rolle der Arbeit in der biologischen und kulturellen Evolution des Menschen

    NASA Astrophysics Data System (ADS)

    Reichholf, Josef H.

    Im Jahre 1876, 5 Jahre nach Erscheinen von Darwins Buch über die Evolution des Menschen und die sexuelle Selektion (Darwin 1871), veröffentlichte Friedrich Engels den berühmt gewordenen Essay "Anteil der Arbeit an der Menschwerdung des Affen“ (Engels 1876). Die Kernfrage darin lautet in Kurzform: Warum hat der Mensch eigentlich ein Bedürfnis nach Arbeit? Engels Antwort wird nachfolgend näher betrachtet und vom gegenwärtigen Kenntnisstand aus beurteilt. Wie sich zeigen wird, beantworten seine Überlegungen die Frage nicht wirklich. Sie ist weiterhin offen. Es können lediglich einige zusätzliche Anhaltspunkte zur Diskussion gestellt werden. Angesichts des drängenden Problems millionenfacher Arbeitslosigkeit und der Forderungen nach einem "Grundrecht auf Arbeit“ kommt den Überlegungen zum möglichen Ursprung des Bedürfnisses nach Arbeit mehr als nur akademisches Interesse zu.

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  16. Haptische Modellierung und Deformation einer Kugelzelle

    NASA Astrophysics Data System (ADS)

    Schippritt, Darius; Wiemann, Martin; Lipinski, Hans-Gerd

    Haptische Simulationsmodelle dienen in der Medizin in erster Linie dem Training operativer Eingriffe. Sie basieren zumeist auf physikalischen Gewebemodellen, welche eine sehr genaue Simulation der biomechanischen Eigenschaften des betreffenden Gewebes erlauben, aber gleichzeitig sehr rechenintensiv und damit zeitaufwändig in der Ausführung sind. Die menschliche Wahrnehmung kann allerdings auch eine ungenaue haptische Modellierung psychooptisch ausgleichen. Daher kann es sinnvoll sein, haptische Simulationen auch mit nicht vollständig physikalisch definierten Deformationsmodellen durchzuführen. Am Beispiel der haptischer Simulation einer in-vitro Fertilisation wird gezeigt, dass durch die Anwendung eines geometrischen Deformationsmodells eine künstliche Befruchtung unter realistischen experimentellen Bedingungen in Echtzeit haptisch simuliert und damit trainiert werden kann.

  17. Biochips und ihr Einsatz in der Lebensmittelanalytik

    NASA Astrophysics Data System (ADS)

    Huber, Ingrid; Zeltz, Patric

    Mit der Verbreitung des Begriffes "Biochip“ in den biotechnologischen Medien wurde Ende der 1990er-Jahre zunächst der Eindruck erweckt, dass die Computerelektronik in die molekularbiologischen Anwendungen eingestiegen ist [18]. In nur wenigen Jahren hat sich die Biochiptechnologie zu einem Verfahren entwickelt, das aus der molekularbiologischen Grundlagenforschung nicht mehr wegzudenken ist und über eine Vielzahl von Einsatzbereichen verfügt. Die Biochiptechnologie ermöglicht die Miniaturisierung von DNA-, RNA- bzw. Proteinanalytik in hochparallelen Formaten. Dieser hohe Parallelisierungsgrad ist einer der wesentlichen Vorteile dieser Technik gegenüber klassischen molekularbiologischen Methoden. Sie wird heutzutage vor allem in der Genomforschung eingesetzt, für Genexpressionsstudien, zum Screening von single nucleotide polymorphisms (SNPs), in der pharmakogenetischen Forschung sowie in der Erforschung von Erbkrankheiten und in der Krebsforschung [1, 7, 19]. Neben vielen weiteren Bereichen finden Biochips auch spezielle Anwendungen in der Lebensmittelanalytik.

  18. Postoperative infection in hand surgery. Cause, prevention, and treatment.

    PubMed

    Shapiro, D B

    1994-02-01

    The consequences of postoperative infection in hand surgery are fortunately uncommon but can lead to severe disability. This article reviews the pathogenesis of infections and the role of antibiotics, skin preparation, and surgical technique in the development and prevention of infection. The final sections discuss the role that different disease states and different types of surgery have on the risk of postoperative infection.

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

    PubMed

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

    2015-01-01

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

  20. Postoperative Imaging of the Knee: Meniscus, Cartilage, and Ligaments.

    PubMed

    Walz, Daniel M

    2016-09-01

    This article reviews the normal and abnormal postoperative imaging appearance of frequently performed surgical procedures of the meniscus, articular cartilage, and ligaments. Imaging algorithms and protocols are discussed with particular attention to MR imaging techniques. Attention is paid to surgical procedures and the expected postoperative appearance as well to commonly identified recurrent and residual disorders and surgical complications. PMID:27545429

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

    PubMed

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

    2015-07-01

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

  2. [One case of postoperative facial paralysis after first branchial fistula].

    PubMed

    Wang, Xia; Xu, Yaosheng

    2015-12-01

    Pus overflow from patent's fistula belew the left face near mandibular angle 2 years agowith a little pain. Symptoms relieved after oral antibiotics. This symptom frequently occurred in the past six months. Postoperative facial paralysis occurred after surgery, and recovered after treatment. It was diagnosed as the postoperative facial paralysis after first branchial fistula surgery.

  3. Elektronische Citizen Cards in Deutschland und Europa

    NASA Astrophysics Data System (ADS)

    Kowalski, Bernd

    Meine sehr geehrten Damen und Herren, der Bedarf an elektronischen Identitäten entsteht durch die wachsende Mobilität der Gesellschaft bei einem gleichzeitig steigenden Bedarf an Onlinepräsenz. Diese elektronischen Identitäten machen natürlich auch vor den staatlichen Ausweisen nicht halt, wie zum Beispiel dem Reisepass, aber auch dem Personalausweis und weiteren Ausweisdokumenten. Wobei es bei den staatlich herausgegebenen oder kontrollierten Ausweisen immer um zwei verschiedene Dinge geht: Einmal um die hoheitliche Funktion, wie zum Beispiel beim Reisepass. Hier geht es zum Beispiel darum, in einem Europa mit gefallenen Grenzen und bei freiem Reiseverkehr für alle Personen, die in diesem Raum wohnen, insbesondere auch im Schengener Raum, die Möglichkeit zu schaffen, auch künftig noch Personenkontrollen durchzuführen. Auch der Reiseverkehr über die europäischen Grenzen hinaus ist insofern ein Problem, da die Identitätenprüfung an den Grenzkontrollen immer schwieriger wird. Deswegen braucht man an dieser Stelle Möglichkeiten, um eine Personenüberprüfung durchzuführen, um feststellen zu können, dass diese Person auch zum Dokument gehört.

  4. Therapeutisches Management kutaner und genitaler Warzen.

    PubMed

    Ockenfels, Hans Michael

    2016-09-01

    Mindestens 10 % der Bevölkerung erkranken während ihres Lebens an einer Infektion mit humanen Papillomaviren (HPV), welche sich klinisch anhand der Ausbildung kutaner oder genitaler Warzen manifestiert. Obwohl Warzen ubiquitär sind, existieren keine definierten Behandlungen. Warzen zeigen, insbesondere in den ersten sechs Monaten, eine erhöhte Selbstheilungsrate. Dieser Umstand erschwert die Interpretation von Studien, da häufig Patienten mit Neuinfektionen zusammen mit Patienten mit Altinfektionen behandelt werden. Lokalisationen, Größe und Dicke der Warzen sind ebenfalls in den meisten Fällen nicht berücksichtigt. Ziel dieses Übersichtsartikels ist eine Analyse des vorliegenden Studienmaterials, unter der für den klinischen Alltag so wichtigen Berücksichtigung von Subtypen und Lokalisationen. Insbesondere die Abgrenzung zwischen frischen und chronisch-therapieresistenten Verrucae vulgares spiegelt sich in einem Therapiealgorithmus wider. Bei genitalen Warzen wird der Therapiealgorithmus deutlicher durch das Ausmaß der infizierten Fläche als durch das Alter der Warzen bestimmt. Bei immunkompetenten Personen muss es mit den hier aufgezeigten therapeutischen Methoden immer das Ziel sein, eine komplette Abheilung zu erzielen. PMID:27607029

  5. Postoperative inflammation after cataract surgery in patients with rheumatoid arthritis.

    PubMed

    Pahor, D; Pahor, A; Gracner, B

    2001-01-01

    The purpose of the present study was to assess the influence of preoperative activity of rheumatoid arthritis (RA) on early postoperative anterior chamber inflammation after phacoemulsification and intraocular lens implantation. Twenty-three eyes in 18 patients were included in our study. On the first postoperative day, anterior chamber inflammation was observed in 11 eyes (47.8%). Five days after surgery, we found postoperative inflammation only in 1 eye (4.3%). Keratic precipitates were observed in 1 eye (4.3%) on the second postoperative day. We found no correlation between the extent of anterior chamber inflammation and the preoperative activity of RA. Postoperative anterior chamber inflammation was also not associated with the medical management of RA.

  6. [Management of postoperative analgesia in patients after craniotomy].

    PubMed

    Imaev, A A; Dolmatova, E V; Lubnin, A Iu

    2013-01-01

    In a review paper, an analysis of publications in the world literature on the problem of acute postoperative pain in neurosurgical patients who underwent craniotomy is performed. Is shown that problem of acute postoperative pain in patients after craniotomy was underestimated for a long time. Mistakenly was thought that these patients do not experience any pain in the early postoperative period. Results of recent studies have shown that up to 80% of these patients may experience acute pain in the range from mild to severe. Unarrested postoperative pain could cause a number of serious secondary complications. This article demonstrates basic approaches to the prevention and treatment of acute postoperative pain in neurosurgical patients after craniotomy--first of all, the use of narcotic analgesics, NSAIDs, and other approaches. PMID:23866579

  7. Proximal row carpectomy with or without postoperative immobilisation.

    PubMed

    Jacobs, R; Degreef, I; De Smet, L

    2008-12-01

    Previously published reports have shown good results after proximal row carpectomy in all cases that had a postoperative immobilisation period from 1 to 4 weeks. Immobilisation is thought to be necessary because of the risk of postoperative subluxation of the carpus and for pain relief. There is, however, no evidence of its value. The results in 13 patients who underwent proximal row carpectomy without postoperative immobilisation were compared with those in 25 patients who underwent proximal row carpectomy with postoperative immobilisation for 4 weeks. After a mean follow-up period of 27 months, no significant differences were found for pain, range of motion or return to work between the two groups. We conclude that postoperative immobilisation is not necessary after proximal row carpectomy.

  8. Herstellung von Chitosan und einige Anwendungen

    NASA Astrophysics Data System (ADS)

    Struszczyk, Marcin Henryk

    2001-05-01

    1. Die Deacetylierung von crabshell - Chitosan führte gleichzeitig zu einem drastischen Abfall der mittleren viscosimetrischen Molmasse ( Mv), insbesondere wenn die Temperatur und die Konzentration an NaOH erhöht werden. Diese Parameter beeinflussten jedoch nicht den Grad der Deacetylierung (DD). Wichtig ist jedoch die Quelle des Ausgangsmaterials: Chitin aus Pandalus borealis ist ein guter Rohstoff für die Herstellung von Chitosan mit niedrigem DD und gleichzeitig hoher mittlerer Mv, während Krill-Chitin (Euphausia superba) ein gutes Ausgangsmaterial zur Herstellung von Chitosan mit hohem DD und niedrigem Mv ist. Chitosan, das aus Insekten (Calliphora erythrocephala), unter milden Bedingungen (Temperatur: 100°C, NaOH-Konzentration: 40 %, Zeit: 1-2h ) hergestellt wurde, hatte die gleichen Eigenschaften hinsichtlich DD und Mv wie das aus Krill hergestellte Chitosan. Der Bedarf an Zeit, Energie und NaOH ist für die Herstellung von Insekten-Chitosan geringer als für crabshell-Chitosan vergleichbare Resultaten für DD und Mv. 2. Chitosan wurde durch den Schimmelpilz Aspergillus fumigatus zu Chitooligomeren fermentiert. Die Ausbeute beträgt 25%. Die Chitooligomere wurden mit Hilfe von HPLC und MALDI-TOF-Massenspektrmetrie identifiziert. Die Fermentationsmischung fördert die Immunität von Pflanzen gegen Bakterien und Virusinfektion. Die Zunahme der Immunität schwankt jedoch je nach System Pflanze-Pathogen. Die Fermentation von Chitosan durch Aspergillus fumigatus könnte eine schnelle und billige Methode zur Herstellung von Chitooligomeren mit guter Reinheit und Ausbeute sein. Eine partiell aufgereinigte Fermentationsmischung dieser Art könnte in der Landwirtschaft als Pathogeninhibitor genutzt werden. Durch kontrollierte Fermentation, die Chitooligomere in definierter Zusammensetzung (d.h. definierter Verteilung des Depolymerisationsgrades) liefert, könnte man zu Mischungen kommen, die für die jeweilige Anwendung eine optimale Bioaktivität besitzen. 3

  9. Dorfentwicklung und Dorferneuerung . Die neuen Bundesländer

    NASA Astrophysics Data System (ADS)

    Bender, Oliver; Richter, Horst P.

    1997-03-01

    Das 1975 in Kraft getretene Bundesraumordnungsprogramm forderte, in allen Landesteilen angemessene und gleichwertige Lebensbedingungen herzustellen. Mit der Novellierung des Flurbereinigungsgesetzes 1976 bzw. dem Zukunftsinvestitionsprogramm 1977 bis 1980 startete die Dorfentwicklung/Dorferneuerung nicht zuletzt als Initiative zur Konjunkturbelebung im ländlichen Raum. Seit 1984 ist sie Bestandteil der von Bund und Ländern getragenen Gemeinschaftsaufgabe "Verbesserung der Agrarstruktur und des Küstenschutzes" (GAK) und liegt im Zuständigkeitsbereich der Landwirtschaftsministerien. Die Dorferneuerungsprogramme der Länder werden aus Mitteln der GAK, der EU und des Landes finanziert. Neben Ortssanierungen nach dem Städtebauförderungsgesetz bzw. Baugesetzbuch stellen sie das wichtigste Instrument zur Förderung von ländlichen Orten und Gemeinden dar. Nach der Vereinigung wurde das Dorferneuerungsrecht auf die neuen Bundesländer übertragen, indem man sich zunächst an den Regelungen der jeweiligen Partnerländer im Westen orientierte. Doch hatten sich die Dörfer in Ost- und Westdeutschland nach dem Zweiten Weltkrieg völlig unterschiedlich entwickelt, so dass sich im Osten ein erweiterter Handlungsbedarf zeigte. Für Fachleute aus Politik, Verwaltung, Wissenschaft und freien Planungsberufen, nicht zuletzt für angewandt arbeitende Geographen, stellten sich neue Herausforderungen.

  10. Equine surgical colic: risk factors for postoperative complications.

    PubMed

    French, N P; Smith, J; Edwards, G B; Proudman, C J

    2002-07-01

    The reason for undertaking this study was that postoperative complications of colic surgery lead to patient discomfort, prolonged hospitalisation and increased cost. Potential risk factors for the 6 most common postoperative complications (jugular thrombosis, ileus, re-laparotomy, wound suppuration, incisional herniation and colic) were evaluated using multivariable models. Jugular thrombosis was associated significantly with heart rate greater than 60 beats/min and with increased packed cell volume (PCV) at admission. The risk of postoperative ileus also increased with increasing PCV at admission and was higher in horses recovering from pedunculated lipoma obstruction. Incisional herniation was strongly associated with wound suppuration and with increasing heart rate at admission. The emergence of cardiovascular parameters as risk factors for several postoperative complications is consistent with the hypothesis that endotoxaemia is important in the development of these complications. Early referral of colic cases, prior to the development of severe endotoxaemic shock, may minimise the risk of some postoperative complications. Horses that have suffered epiploic foramen entrapment, are more than 4 times as likely to undergo re-laparotomy than other horses. Horses that have suffered postoperative ileus have a similarly increased risk of undergoing re-laparotomy. The risk of postoperative colic is significantly associated with horses recovering from large colon torsion (>360 degrees) and with having undergone re-laparotomy. Hazard ratios (with 95% confidence intervals) for these last two effects are 3.1 (1.7, 5.7) and 3.4 (1.9, 6.2), respectively. Knowledge of the risk factors for postoperative complications allows more accurate prognostication postoperatively and suggests ways in which the risk of postoperative complications can be minimised.

  11. Der neue Kosmos. Einführung in die Astronomie und Astrophysik

    NASA Astrophysics Data System (ADS)

    Unsöld, Albrecht; Baschek, Bodo

    Der neue Kosmos bietet in überschaubarem Umfang eine zusammenhängende Einführung in das Gesamtgebiet der Astronomie und Astrophysik. Aus den Bereichen: Klassische Astronomie und Planetensystem, Instrumente und Beobachtungsverfahren, Sonne und Sterne, Milchstraße und Galaxien, Kosmologie, Entstehung des Planetensystems, Entwicklung der Erde und des Lebens werden die Beobachtungsmethoden und die Ergebnisse astronomischer Forschung sowie deren theoretische Grundlagen und wechselseitigen Zusammenhänge vermittelt. Die aktualisierte 7. Auflage berücksichtigt den raschen Fortschritt astronomischer Forschung der letzten drei Jahre von unserem Planetensystem und den Entdeckungen zahlreicher Planeten bei anderen Sternen, über die fernsten Galaxien und Quasare bis zur Entwicklung der modernen Kosmologie.

  12. Renaturierung von subalpinen und alpinen Ökosystemen

    NASA Astrophysics Data System (ADS)

    Krautzer, B.; Klug, Brigitte

    Die große Vielfalt an alpinen und subalpinen Ökosystemen auf waldfreien Standorten stellt besonders hohe Anforderungen an Planung und Durchführung von Renaturierungsmaßnahmen. Zunehmende Meereshöhe, starke Hangneigungen und extreme klimatische Verhältnisse im Gebirge bedingen zudem seit jeher natürliche Erosionsprozesse. Die zahllosen menschlichen Aktivitäten der letzten Jahrzehnte, gepaart mit unzureichenden Begrünungsmaßnahmen, erhöhen dieses Risiko noch um ein Vielfaches: Geländekorrekturen im Zuge von Skipistenbauten, Almrevitalisierungen, Forst- und Almwegebauten, Maßnahmen zur Verbesserung der touristischen Infrastruktur oder Wildbach- und Lawinenverbauungen. Nur durch Verwendung von hochwertigem, dem Standort angepasstem Pflanzen-oder Saatgutmaterial in Kombination mit der passenden Begrünungstechnik kann dieser Bedrohung dauerhaft entgegengewirkt werden. Dabei sind folgende limitierende Faktoren besonders zu beachten.

  13. Self-care and postoperative dressing management.

    PubMed

    Dawn Hunt, Sharon

    2016-08-11

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

  14. Effect of suture material on postoperative astigmatism.

    PubMed

    Gimbel, H V; Raanan, M G; DeLuca, M

    1992-01-01

    Two hundred patients were enrolled in a randomized, prospective clinical trial comparing the use of 10-0 nylon, 10-0 polypropylene (Prolene), 11-0 polyester (Mersilene), and 10-0 polyethylene (Novafil) suture materials on the amount and decay curves of surgically induced astigmatism following intraocular lens (IOL) surgery. Patients with Mersilene and nylon sutures had the highest amounts of induced with-the-rule (WTR) cylinder (significantly more than Prolene) at one day after surgery. However, the WTR cylinder decayed rapidly for nylon during the first three months but more slowly for Mersilene because of its lack of stretchability. The Prolene group had the lowest level of induced WTR cylinder at one day, but against-the-rule (ATR) drift occurred, leaving cases with ATR astigmatism by a year. The nylon group had the second highest amount of induced WTR cylinder at one day, which had decayed to ATR cylinder by five months. Between one and two years postoperatively, the nylon group experienced a significant ATR shift. The amount of early induced WTR cylinder seemed to be related to the knot-tying technique and tissue gripping characteristics, whereas the shape of the decay curve was related to the material characteristics of the suture. PMID:1531234

  15. Pterygia: Single-fraction postoperative beta irradiation

    SciTech Connect

    Beyer, D.C. )

    1991-02-01

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

  16. Postoperative Acute Pulmonary Embolism Following Pulmonary Resections

    PubMed Central

    Shonyela, Felix Samuel; Liu, Bo; Jiao, Jia

    2015-01-01

    Postoperative acute pulmonary embolism after pulmonary resections is highly fatal complication. Many literatures have documented cancer to be the highest risk factor for acute pulmonary embolism after pulmonary resections. Early diagnosis of acute pulmonary embolism is highly recommended and computed tomographic pulmonary angiography is the gold standard in diagnosis of acute pulmonary embolism. Anticoagulants and thrombolytic therapy have shown a great success in treatment of acute pulmonary embolism. Surgical therapies (embolectomy and inferior vena cava filter replacement) proved to be lifesaving but many literatures favored medical therapy as the first choice. Prophylaxis pre and post operation is highly recommended, because there were statistical significant results in different studies which supported the use of prophylaxis in prevention of acute pulmonary embolism. Having reviewed satisfactory number of literatures, it is suggested that thoroughly preoperative assessment of patient conditions, determining their risk factors complicating to pulmonary embolism and the use of appropriate prophylaxis measures are the key options to the successful minimization or eradication of acute pulmonary embolism after lung resections. PMID:26354232

  17. Strahlen-und kinetische Waffen: Neue Waffentechniken und Rüstungskontrolle

    NASA Astrophysics Data System (ADS)

    Neuneck, Götz

    Laserstrahlen, Mikrowellen oder elektromagnetische Beschleuniger lassen sich nicht nur für zivile, sondern für militärische Zwecke einsetzen. Die Aufgabe einer vorbeugenden Rüstungskontrolle wäre es, diese wie andere künftige Waffentechnologien auf ihren destabilisierenden Charakter hin zu untersuchen und ihre Stationierung zu beschränken oder zu verhindern.

  18. [Preemptive analgesia for postoperative pain after frontotemporal craniotomy].

    PubMed

    Honnma, Toshimi; Imaizumi, Toshio; Chiba, Masahiko; Niwa, Jun

    2002-02-01

    Two thirds of patients suffer from moderate to severe pain after frontotemporal craniotomy. We think neurosurgeons must try to reduce the postoperative pain, which may induce postoperative hypertension, restlessness, and pathological pains. To investigate how preemptive analgesia effects postoperative pain, we assessed the pain in 20 consecutive patients who underwent neck clipping for non-ruptured cerebral aneurysms of anterior circulation systems by frontotemporal craniotomies. Ten patients underwent preemptive analgesia with four procedures (preemptive group) as follows, 1) oral administration of long-acting non-steroid anti inflammatory drug (NSAID, ampiroxicam) two hours before the surgical operation, 2) nerve blockades of the supra-orbital nerve and the infra-orbital nerve by bupivacaine, 3) local anesthesia of the scalp along the marker of a skin incision by xylocaine, 4) local anesthesia by bupivacaine along a skin incision after the skin closure. Ten patients of the control group underwent only procedure No. 3. Visual analog pain score (VAS) for postoperative pain 6, 12, and 24 hours, and 3, 5, 7, and 14 days after operation and NSAID administration for the pain were evaluated. Patients of the preemptive group had significantly less postoperative pain during the whole post-surgery period and required less administration of NSAID than the control group. Preemptive analgesia procedures No. 1, 2 and 4 reduced the postoperative pain and the total administration of NSAID. Postoperative pain may be reduced after other types of brain surgery, with proper nerve blocks like procedure No. 2, procedures No. 1, 3 and 4. PMID:11857941

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

    PubMed

    Nolli, M; Nicosia, F

    2000-09-01

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

  20. Postoperative hypercoagulability and deep-vein thrombosis after laparoscopic cholecystectomy.

    PubMed

    Caprini, J A; Arcelus, J I; Laubach, M; Size, G; Hoffman, K N; Coats, R W; Blattner, S

    1995-03-01

    Patients who undergo laparoscopic cholecystectomy (LC) are operated on under general anesthesia, in a reverse Trendelenburg position, with 12-15-mmHg pneumoperitoneum. All of these factors can induce venous stasis of the legs, which may lead to postoperative deep-vein thrombosis (DVT). The objectives of this study were to assess the degree of hypercoagulability and to determine the rate of postoperative DVT in a group of 100 patients in whom LC was completed. Whole-blood thrombelastography (TEG) and plasma-activated partial thromboplastin time (PTT) determination were carried out preoperatively and on the 1st postoperative day. All patients received pre-, intra-, and postoperative graduated compression stockings and sequential pneumatic compression devices until fully ambulatory. Twenty-six percent of the patients with a risk score > 4, or a post-operative TEG index > +5.0, received subcutaneous heparin (5,000 units b.i.d.), beginning in the postoperative period and continuing for 4 weeks as an outpatient. A complete venous duplex scan of both legs was performed on the 7th postoperative day, at the time of their office visit. Our results revealed significant postoperative hypercoagulability for the TEG index (P < 0.005) and for PTT (P < 0.05). One patient had an asymptomatic DVT (1%), and no side effects from the mechanical or pharmacological prophylaxis occurred in this series. These data suggest that the low incidence of thrombosis in the face of theoretical and laboratory evidence of postoperative hypercoagulability may reflect an effective prophylactic regime.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed

    Veney, Amy J

    2013-01-01

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

  2. Endocapsular cellulomonas as a cause of persistent postoperative endophthalmitis.

    PubMed

    Sharma, Shobha; Saffra, Norman A; Chinyadza, Tanyanyiwa; Ghitan, Monica; Chapnick, Edward K

    2008-01-01

    Sequestration of bacteria within the capsular fornices after cataract extraction with intraocular lens implantation can cause both acute and chronic inflammation. A case of persistent postoperative endophthalmitis caused by capsular sequestration of Cellulomonas is described. The patient underwent uncomplicated cataract extraction with intraocular lens implantation and subsequently developed acute postoperative endophthalmitis. Inflammation persisted despite several vitreous taps and the injection of intravitreal antibiotics. Definitive treatment required pars plana vitrectomy, intraocular lens explantation, capsular bag removal, and intravitreal and parenteral antibiotics. In patients with postoperative endophthalmitis, one must consider atypical organisms as the source and should consider explantation of the intraocular lens with capsular bag removal.

  3. Postoperative prevention of falls in older adults with fragility fractures.

    PubMed

    Demontiero, Oddom; Gunawardene, Piumali; Duque, Gustavo

    2014-05-01

    The postoperative period after correction of a fragility fracture is usually associated with functional deconditioning. This deconditioning is caused by multiple factors associated with a higher risk of falls during the immediate postoperative period and after discharge. Identification of risk and appropriate fall prevention interventions in these patients are pivotal. In this article, an overview is presented of the strategies to identify falls risk in postoperative patients after suffering a fragility fracture. Evidence is presented favoring targeted multicomponent intervention for falls prevention rather than a single intervention in fractured older patients at high risk of new falls and fractures.

  4. Incidence of postoperative deep vein thrombosis in the tropics.

    PubMed

    Orr, K B

    1973-06-01

    The author's experience in Vietnam in 1968 indicates a low incidence of deep vein thrombosis, pulmonary embolism, and coronary thrombosis as postoperative complications. Australian surgeons in Vietnam confirm these findings. The role of diet and/or nutrition is discounted since both of these in Vietnam are similar to Queensland, Australia, where postoperative deep vein complications have occurred at a rate similar to those in Britain and the U.S. It is hypothesized that climate in tropical areas may retard these types of postoperative complications. Further investigations will be necessary.

  5. Postoperative Morganella morganii endophthalmitis associated with subclinical urinary tract infection.

    PubMed

    Tsanaktsidis, Gina; Agarwal, Smita A; Maloof, Anthony J; Chandra, Jay; Mitchell, Paul

    2003-05-01

    We report a case of Morganella morganii acute endophthalmitis following clear corneal phacoemulsification cataract surgery in which a coincident asymptomatic chronic urinary tract infection was detected postoperatively. Morganella morganii is a gram-negative bacillus that inhabits the gastrointestinal tract and is part of the normal fecal flora. It is an opportunistic pathogen usually encountered in postoperative and nosocomial settings, causing urinary tract and wound infections. Chronic urinary tract infection may be a risk factor for postoperative endophthalmitis. A dipstick urinalysis before elective cataract surgery in elderly patients with a history of recurrent urinary tract infections may be considered.

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

    PubMed

    Faraoni, David; Van der Linden, Philippe

    2014-01-01

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

  7. Entwicklungsperspektiven von Social Software und dem Web 2.0

    NASA Astrophysics Data System (ADS)

    Raabe, Alexander

    Der Artikel beschäftigt sich zunächst mit dem derzeitigen und zukünftigen Einsatz von Social Software in Unternehmen. Nach dem großen Erfolg von Social Software im Web beginnen viele Unternehmen eigene Social Software-Initiativen zu entwickeln. Der Artikel zeigt die derzeit wahrgenommenen Einsatzmöglichkeiten von Social Software im Unternehmen auf, erörtert Erfolgsfaktoren für die Einführung und präsentiert mögliche Wege für die Zukunft. Nach der Diskussion des Spezialfalles Social Software in Unternehmen werden anschließend die globalen Trends und Zukunftsperspektiven des Web 2.0 in ihren technischen, wirtschaftlichen und sozialen Dimensionen dargestellt. Wie aus den besprochenen Haupttrends hervorgeht, wird die Masse an digital im Web verfügbaren Informationen stetig weiterwachsen. So stellt sich die Frage, wie es in Zukunft möglich sein wird, die Qualität der Informationssuche und der Wissensgenerierung zu verbessern. Mit dem Einsatz von semantischen Technologien im Web wird hier eine revolutionäre Möglichkeit geboten, Informationen zu filtern und intelligente, gewissermaßen verstehende" Anwendungen zu entwerfen. Auf dem Weg zu einem intelligenten Web werden sich das Semantic Web und Social Software annähern: Anwendungen wie Semantic Wikis, Semantic Weblogs, lightweight Semantic Web-Sprachen wie Microformats oder auch kommerzielle Angebote wie Freebase von Metaweb werden die ersten Vorzeichen einer dritten Generation des Webs sein.

  8. Darwinische Kulturtheorie - Evolutionistische und "evolutionistische`` Theorien sozialen Wandels

    NASA Astrophysics Data System (ADS)

    Antweiler, Christoph

    Evolutionistische Argumentationen außerhalb der Biologie sind weit verbreitet. Wenn sie vertreten werden, heißt das mitnichten, dass sie notwendigerweise von darwinischen Argumenten geprägt sind. Wenn man Evolution und Kultur aus explizit darwinischer Perspektive zusammen bringt, bedeutet das noch lange nicht unbedingt Soziobiologie. Und es bedeutet sicherlich nicht Sozialdarwinismus. Dieser Beitrag soll einen Überblick der so genannten evolutionären Ansätze bzw. evolutionistischen Ansätze zu menschlichen Gesellschaften bzw. Kulturen geben. Es soll gezeigt werden, was in den Ansätzen analytisch zu trennen ist und was synthetisch zusammen gehört. Mein Beitrag ist nicht wissenschaftsgeschichtlich angelegt, sondern systematisch ausgerichtet und hat zwei Schwerpunkte (Antweiler 2008; Antweiler 2009b). Zum einen geht es um kausale Zusammenhänge von organischer Evolution und gesellschaftlichem Wandel. Auf der anderen Seite werden Analogien zwischen biotischer und kultureller Evolution erläutert, die als spezifische Ähnlichkeiten dieser beiden als grundsätzlich verschieden gesehenen Prozesse aufgefasst werden. Dadurch wird die Frage aufgeworfen, ob die Evolution von Organismen einerseits und die Transformation von Gesellschaften bzw. Kulturen andererseits, spezielle Fälle eines allgemeinen Modells von Evolution darstellen.

  9. Das CARNOTsche Paradigma und seine erkenntnistheoretischen Implikationen

    NASA Astrophysics Data System (ADS)

    Schöpf, Hans-Georg

    Der vorliegende historisch-kritische Essay führt die Eigentümlichkeiten der klassischen phänomenologischen Thermodynamik auf das von CARNOT geschaffene Paradigma zurück und greift einige damit zusammenhängende Fragen auf.Translated AbstractCARNOT's Paradigm and its Epistemological ImplicationsThe present historic-critical essay traces the pecularities of classical phenomenological thermodynamics back to the paradigm, created by CARNOT, and takes up some questions to which this paradigm gives rise.

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

    PubMed

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

    2016-03-01

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

  11. Postoperative chronic subdural hematoma following craniotomy--four case reports.

    PubMed

    Takahashi, Y; Ohkura, A; Sugita, Y; Sugita, S; Miyagi, J; Shigemori, M

    1995-02-01

    Postoperative chronic subdural hematoma (CSH) following craniotomy developed in only four of 372 patients undergoing craniotomy for aneurysm surgery (1 patient) and brain tumor surgery (3 patients) between April, 1991 and November, 1993, an incidence of only 1.1%. There were three males and one female, aged from 32 to 66 years (mean 56 yrs). The period between craniotomy and development of CSH ranged from 3 to 5 months (mean 4.3 mos). Postoperative hematomas were located on the operative sides in three patients and the contralateral side in the other. Early postoperative computed tomographic scans found subdural fluid collection in all patients. Magnetic resonance images showed linear meningeal enhancement in all patients. Postoperative CSH may be caused by mixture of blood in subdural cerebrospinal fluid collection which persists due to reduced brain elasticity and wide subarachnoid membrane opening resulting in neomembrane formation and finally development of hematoma. PMID:7753312

  12. [Responsibilities of the resident in anesthesiology and postoperative care].

    PubMed

    Barrios Flores, L F

    2004-01-01

    Among medical specialties, anesthesiology/postoperative care has one of the highest rates of malpractice claims. This article treats the responsibilities of interns and residents in anesthesiology, their supervisors, and the institutions where they practice and receive training.

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

    PubMed

    Denisova, E V; Nazarov, V E

    2015-01-01

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

  14. Postoperative pancreatitis as a complication of biliary surgery.

    PubMed

    Ingram, D M; House, A K; Garcia-Webb, P

    1979-08-01

    Forty patients who underwent biliary surgery were investigated for postoperative pancreatic disturbance as measured by the amylase creatinine clearance ration (ACCR). Its relevance to preoperative pancreatitis, exploration of the common bile duct, and operative cholangiography were examined. The results suggested that a recent clinically proven episode of pancreatitis did not predispose to a postoperative recurrence following biliary surgery. Similarly, cholecystectomy alone did not produce a postoperative pancreatic disturbance. However, exploration of the common bile duct did frequently cause a postoperative elevated ACCR, and hence we recommend that duct exploration should be performed as carefully and as atraumatically as possible. The small number of patients who did not have operative cholangiograms prevented statistical evaluation of the effect of this procedure on the pancreas. However, information from elsewhere suggests that the plasma amylase level is not likely to be raised by cholangiography. PMID:291412

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

    MedlinePlus

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

  16. Postoperative patient falls on an orthopedic inpatient unit.

    PubMed

    Ackerman, Duncan B; Trousdale, Robert T; Bieber, Patti; Henely, Joan; Pagnano, Mark W; Berry, Daniel J

    2010-01-01

    We are not aware of any data looking specifically at inpatient falls in an orthopedic ward. We reviewed all postoperative orthopedic patients who fell during 2003 and 2005 on a single postoperative orthopedic unit. Seventy patients (1%) fell, resulting in 2.5 falls per 1000 musculoskeletal inpatient days. Most (n = 45, 64%) were bathroom related, were unassisted (n = 54, 77%), and occurred during the evening or night shift (n = 46, 66%). Thirteen (19%) patients acquired an injury as a consequence. Female sex (odds ratio [OR] = 1.9), patient age greater than 65 years (OR = 1.7), prolonged admission (OR = 1.7), and admission for primary or revision knee arthroplasty (OR = 5.0) were all significant risk factors for a postoperative inpatient fall. This information has provided us with some insight to direct the development of a fall prevention program specific to postoperative orthopedic patients.

  17. Pre- and postoperative electromyographic evaluations in the carpal tunnel syndrome.

    PubMed

    Schlagenhauff, R E; Glasauer, F E

    1971-09-01

    Twenty-five cases of carpal tunnel syndrome in 20 patients were evaluated preoperatively and postoperatively by electromyography. Clinical improvement resulted in all cases following decompression of the median nerve, and only in a few instances did mild symptoms persist. Distal motor conduction time im proved postoperatively in 24 cases studied, 19 of which returned to normal range. Most of the obvious improvement occurred within the first 3 months and further improvement could be observed as late as 36 months. Although no definite correlation could be established between the preoperative severity of the carpal tunnel syndrome and the postoperative clinical and electrical im provement, there was a definite evidence of better recovery in the younger age group. There was a greater range of improvement and a return closer to normal postoperatively in cases with severe preoperative distal latency. All cases ex amined after 24 months had reached normal values.

  18. Comparison of methods to facilitate postoperative bowel function.

    PubMed

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

    2009-01-01

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

  19. [Leben im Eismeer - Tauchuntersuchungen zur Biologie arktischer Meerespflanzen und Meerestiere

    PubMed

    Lippert; Karsten; Wiencke

    2000-01-01

    Die Maske wird nochmals auf Dichtigkeit überprüft, der Knoten der Sicherungsleine mit zwei halben Schlägen fixiert, dann rutscht die Taucherin von der Eiskante in das kalte Wasser. Eine halbe Stunde vergeht, bevor ihr Kopf wieder aus dem Eisloch auftaucht und sie ein großes Sammelnetz nach oben reicht, gefüllt mit verschiedenen Arten von Makroalgen. Obwohl noch große Flächen des Kongsfjordes im arktischen Spitzbergen zugefroren sind und das Festland von einer dicken Schneedecke bedeckt ist, hat unter Wasser in den Algenwäldern bereits der Sommer und damit die Saison der Meeresbiologen begonnen.

  20. Laparoscopic Surgery Can Reduce Postoperative Edema Compared with Open Surgery

    PubMed Central

    Guo, Dong; Gong, Jianfeng; Cao, Lei; Wei, Yao; Guo, Zhen

    2016-01-01

    Aim. The study aimed to investigate the impact of laparoscopic surgery and open surgery on postoperative edema in Crohn's disease. Methods. Patients who required enterectomy were divided into open group (Group O) and laparoscopic group (Group L). Edema was measured using bioelectrical impedance analysis preoperatively (PRE) and on postoperative day 3 (POD3) and postoperative day 5 (POD5). The postoperative edema was divided into slight edema and edema by an edema index, defined as the ratio of total extracellular water to total body water. Results. Patients who underwent laparoscopic surgery had better clinical outcomes and lower levels of inflammatory and stress markers. A total of 31 patients (26.05%) developed slight edema and 53 patients (44.54%) developed edema on POD3. More patients developed postoperative edema in Group O than in Group L on POD3 (p = 0.006). The value of the edema index of Group O was higher than that of Group L on POD3 and POD5 (0.402 ± 0.010 versus 0.397 ± 0.008, p = 0.001; 0.401 ± 0.009 versus 0.395 ± 0.007, p = 0.039, resp.). Conclusions. Compared with open surgery, laparoscopic surgery can reduce postoperative edema, which may contribute to the better outcomes of laparoscopic surgery over open surgery. PMID:27777583

  1. Diagnose und Therapie einer Depression im höheren Lebensalter – Einflüsse von Patienten- und Arztmerkmalen

    PubMed Central

    von dem Knesebeck, Olaf; Bönte, Markus; Siegrist, Johannes; Marceau, Lisa; Link, Carol; McKinlay, John

    2013-01-01

    Zusammenfassung Studienergebnissee aus dem englischsprachigen Raum zeigen, dass diagnostische und therapeutische Entscheidungen von Hausärzten bei der Versorgung von depressiven Patienten systematischen Einflüssen unterliegen, und dass sowohl Merkmale des Arztes als auch des Patienten unabhängig vom Krankheitsbild Einfluss auf diese Entscheidungen haben. In der vorliegenden Arbeit werden Ergebnisse einer deutschen Studie präsentiert, in der die Einflüsse von Patienten- und Arztmerkmalen auf diagnostische und therapeutische ärztliche Entscheidungen bei einer Depression untersucht wurden. Unter Anwendung eines faktoriellen Experimentaldesigns spielten professionelle Schauspieler in Videofilmen die Rolle von Patienten, die Symptome für eine depressive Erkrankung äußern. In den Videofilmen, die alle auf einem identischen Skript basieren, wurden systematisch die Patientenmerkmale Alter (55 vs. 75 Jahre), Geschlecht und sozialer Status (Hausmeister vs. Lehrer) variiert. Die randomisierte Ärztestichprobe wurde nach dem Arztgeschlecht und professioneller Erfahrung (< 5 vs. > 15 Jahre) geschichtet. Der Videofilm wurde insgesamt 128 niedergelassenen Ärzten für Allgemeinmedizin und hausärztlich tätigen Internisten in ihrer Praxis vorgespielt. Danach wurden die Ärzte zu unterschiedlichen Aspekten von Diagnose und Therapie befragt. Es wurde erhoben, ob der Arzt dem Patienten über das gezeigte Gespräch hinausgehende Fragen stellen würde, welche Diagnosen er für wahrscheinlich hält, wie sicher er sich mit seiner Diagnose ist, welche diagnostischen Tests er anordnen würde, ob er den Patienten überweisen würde oder ob er Medikamente verordnen oder ihm Empfehlungen zur Änderung seines Lebensstils geben würde. Die Ergebnisse weisen darauf hin, dass sowohl die Diagnose als auch die Therapie einer Depression durch niedergelassene Hausärzte in Deutschland nur geringfügig durch die untersuchten Merkmale der Patienten und der behandelnden Ärzte beeinflusst wird

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

    PubMed

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

    2016-04-01

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

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

    PubMed

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

    2016-04-01

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

  4. The Women of "Kabale und Liebe": A Teaching Approach

    ERIC Educational Resources Information Center

    Stephan, Naomi I.

    1976-01-01

    The three female characters in Schiller's "Kabale und Liebe" are analyzed. The article questions the value of using this play in a college curriculum because of the oppressive and unenlightened roles of the female characters. (TL)

  5. Konstruieren von Pkw-Karosserien: Grundlagen, Elemente und Baugruppen, Vorschriftenübersicht, Beispiele mit CATIA V4 und V5

    NASA Astrophysics Data System (ADS)

    Grabner, Jörg; Nothhaft, Richard

    Die Faszination, die vom Auto ausgeht, ist und bleibt ungebrochen. Entsprechend interessant ist es, sich vor dem Hintergrund konventioneller Konstruktionstechniken über die virtuelle Produktentwicklung von Pkw-Karosserien an modernen CAD-Arbeitsplätzen informieren zu können. Die Autoren führen in die Grundlagen ein und zeigen anhand von Beispielen und zahlreichen Abbildungen, wie mit dem System CATIA der Rohbau sowie die Ausstattung innen und au=C3=9Fen konstruiert werden. Darüber hinaus wird das so genannte "Package" an Beispielen beschrieben, also das Management und die Harmonisierung der Anforderungen an die Bauräume (z.

  6. Vasoactive modulators during and after craniotomy: relation to postoperative hypertension.

    PubMed

    Olsen, Karsten S; Pedersen, Carsten Boe; Madsen, Jørn Bo; Ravn, Lisbet I; Schifter, Søren

    2002-07-01

    Hypertension after craniotomy is frequent. To establish an association between vasoactive modulators and postoperative hypertension, we followed the arterial blood pressure and plasma concentrations of selected substances in patients undergoing craniotomy. Twelve consecutive patients scheduled for operation of a supratentorial brain tumor were anesthetized with thiopental, fentanyl, isoflurane, and pancuronium. None of the patients had a history of arterial hypertension or were hypertensive before the operation. Arterial blood pressure and heart rate measurements were obtained preoperatively, after incision, during closure, and four times in the 50-minute interval after stopping isoflurane. At the same time, plasma concentrations of norepinephrine, epinephrine, renin, aldosterone, atrial natriuretic peptide, endothelin, and cortisol were measured. Data are given as mean +/- SD (range). The postoperative concentrations of these substances were significantly higher than the baseline concentrations measured preoperatively. Six of the patients developed postoperative hypertension defined as a mean arterial pressure (MAP) > 20% more than the baseline MAP (group H), and six had normal blood pressure postoperatively (group N). The mean value of the maximal postoperative MAPs measured in groups H and N, respectively, was 118 +/- 16 mm Hg (range: 96-132) and 103 +/- 9 mm Hg (range: 92-115) (P =.01). Only renin levels were higher intraoperatively in group H when compared to group N. However, postoperative levels of catecholamines, aldosterone, renin, and endothelin levels were higher in group H patients. The results suggest that in addition to an increased discharge of the sympathetic system, activation of the renin-angiotensin aldosterone system may also play an important role in the development of postoperative hypertension after craniotomy. PMID:12172288

  7. Einstellung und Wissen von Lehramtsstudierenden zur Evolution - ein Vergleich zwischen Deutschland und der Türkei

    NASA Astrophysics Data System (ADS)

    Graf, Dittmar; Soran, Haluk

    Es wird eine Untersuchung vorgestellt, in der Wissen und Überzeugungen von Lehramtsstudierenden aller Fächer zum Thema Evolution an zwei Universitäten in Deutschland und der Türkei erhoben worden sind. Die Befragung wurde in Dortmund und in Ankara durchgeführt. Es stellte sich heraus, dass ausgeprägte Defizite im Verständnis der Evolutionsmechanismen herrschen. Viele Studierende, insbesondere aus der Türkei, sind nicht von der Faktizität der Evolution überzeugt. Dies gilt sowohl für Studierende mit Fach Biologie als auch für Studierende mit anderen Fächern. Näher untersucht worden sind die Faktoren, die die Überzeugungen zur Evolution beeinflussen können, was ja in Anbetracht der hohen Ablehnungsrate der Evolution von besonderem Interesse ist. Das Vertrauen in die Wissenschaft spielt hierbei eine besondere Rolle: Wer der Wissenschaft vertraut, ist auch eher von der Evolution überzeugt, als diejenigen, die skeptisch gegenüber der Wissenschaft sind.

  8. Physik gestern und heute Von der Metallstange zum Hochenergielaser

    NASA Astrophysics Data System (ADS)

    Heering, Peter

    2002-05-01

    Im Mai 1752 wurde in Marly bei Paris auf Anregung des amerikanischen Forschers und Politikers Benjamin Franklin erstmals die elektrische Natur des Blitzes nachgewiesen. Damals beschrieb Franklin auch eine technische Vorrichtung, die als Schutz von Gebäuden vor Blitzschlägen dienen sollte: den Blitzableiter. Diese aus heutiger Sicht scheinbar triviale Vorrichtung wurde aber keineswegs unmittelbar akzeptiert. Und bis heute ist die Forschung zum Schutz von Einrichtungen vor Blitzschlägen nicht abgeschlossen.

  9. Sticktechnologie für medizinische Textilien und Tissue Engineering

    NASA Astrophysics Data System (ADS)

    Karamuk, Erdal; Mayer, Jörg; Wintermantel, Erich

    Textile Strukturen werden in grossem Ausmass als medizinische Implantate eingesetzt, um Weich- und Hartgewebe zu unterstützen oder zu ersetzen. Im Tissue Engineering gewinnen sie an Bedeutung als scaffolds, um biologische Gewebe in vitro zu züchten für anschliessende Implantation oder extrakorporale Anwendungen. Textilien sind gewöhnlich anisotrope zweidimensionale Strukturen mit hoher Steifigkeit in der Ebene und geringer Biegesteifigkeit. Durch eine Vielzahl textiler Prozesse und durch entsprechende Wahl des Fasermaterials ist es möglich, Oberfläche, Porosität und mechanische Anisotropie in hohem Masse zu variieren. Wegen ihrer einzigartigen strukturellen und mechanischen Eigenschaften können faserbasierte Materialien in weitem Masse biologischem Gewebe nachgeahmt werden [1]. Gesticke erweitern das Feld von technischen und besonders medizinischen Textilien, denn sie vereinen sehr hohe strukturelle Variabilität mit der Möglichkeit, mechanische Eigenschaften in einem grossen Bereich einzustellen, um so die mechanischen Anforderungen des Empfängergewebes zu erfüllen (Abb. 42.1).

  10. Zahlen und Rechenvorgänge auf unterschiedlichen Abstraktionsniveaus

    NASA Astrophysics Data System (ADS)

    Rödler, Klaus

    "Das Verständnis geht langsam vor sich!" Diesen wichtigen Satz hörte ich bei einem Vortrag von Martin Lowsky. Auf die hier behandelte Fragestellung übertragen heißt das: Was eine Zahl ist und wie ich sie im Rechenvorgang einsetzen und interpretieren kann, das erschließt sich erst allmählich. Die Zahl des Rechenanfängers ist nicht dieselbe wie die des kompetenten Rechners und es ist nicht die Zahl des Lehrers oder der Lehrerin. Die Zahlen sind nur auf der Oberfläche der Worte und Zeichen gleich. Im Innern, im Verständnis, sind sie völlig verschieden! Ich glaube, dass die Missachtung dieser Divergenz dazu führt, dass manche Kinder in für den Lehrer und Lehrerin nicht nachvollziehbaren Routinen stecken bleiben, einfachste Informationen nicht wirklich integrieren. Die auf beiden Seiten wachsende Verunsicherung durch die nicht erkannte und daher nicht kommunizierbare Diskrepanz im inneren Zahlkonzept stört den allmählichen Aufbau strukturierter Zahlvorstellungen.

  11. S1-Leitlinie zur UV-Phototherapie und Photochemotherapie.

    PubMed

    Herzinger, Thomas; Berneburg, Mark; Ghoreschi, Kamran; Gollnick, Harald; Hölzle, Erhard; Hönigsmann, Herbert; Lehmann, Percy; Peters, Thorsten; Röcken, Martin; Scharffetter-Kochanek, Karin; Schwarz, Thomas; Simon, Jan; Tanew, Adrian; Weichenthal, Michael

    2016-08-01

    Die heilsame Wirkung des Sonnenlichts war teilweise schon im Altertum bekannt und fand in der zweiten Hälfte des 19. Jahrhunderts wieder zunehmend Beachtung. Den Beginn der modernen Phototherapien markiert die Entwicklung einer Apparatur zur ultravioletten Bestrahlung der Hauttuberkulose durch Finnsen zu Beginn des zwanzigsten Jahrhunderts. Zur Therapie von Hauterkrankungen finden beinahe ausschließlich die spektralen Bereiche unterhalb des sichtbaren Lichtes (ultraviolett) Anwendung. Seit den 1970er Jahren stehen zunehmend leistungsfähige künstliche Strahlenquellen bereit für die Therapie mit UVB, UVA und die Kombination von UVA mit Photosensibilisatoren (Photochemotherapie). Hohe strukturelle und prozedurale Qualitätsstandards sind unabdingbare Voraussetzung für die Durchführung einer gleichermaßen wirkungsvollen wie auch sicheren Phototherapie. Die Leitlinie formuliert den aktuellen Konsens führender Experten auf dem Gebiet der Phototherapie in Bezug auf die Indikationen für die jeweiligen Therapieverfahren, deren Gegenanzeigen und Nebenwirkungen und insbesondere für die Wahl der korrekten Dosis zu Beginn und im Verlauf einer Therapie sowie das Management von Nebenwirkungen. PMID:27509439

  12. One-Year Postoperative Resource Utilization in Sarcopenic Patients

    PubMed Central

    Kirk, Peter S.; Friedman, Jeffrey F.; Cron, David C.; Terjimanian, Michael N.; Wang, Stewart C.; Campbell, Darrell A.; Englesbe, Michael J.; Werner, Nicole L.

    2015-01-01

    Introduction It is well established that sarcopenic patients are at higher risk of postoperative complications and short-term healthcare utilization. Less well understood is how these patients fare over the long-term after surviving the immediate postoperative period. We explored costs over the first postoperative year among sarcopenic patients. Methods We identified 1,279 patients in the Michigan Surgical Quality Collaborative database who underwent inpatient elective surgery at a single institution from 2006 to 2011. Sarcopenia, defined by gender-stratified tertiles of lean psoas area, was determined from preoperative CT scans using validated analytic morphomics. Data were analyzed to assess sarcopenia’s relationship to costs, readmissions, discharge location, intensive care unit admissions, hospital length of stay, and mortality. Multivariate models adjusted for patient demographics and surgical risk factors. Results Sarcopenia was independently associated with increased adjusted costs at 30, 90, and 180 but not 365 days. The difference in adjusted postsurgical costs between sarcopenic and non-sarcopenic patients was $16,455 at 30 days and $14,093 at one year. Sarcopenic patients were more likely to be discharged somewhere other than home (p <0.001). Sarcopenia was not an independent predictor of increased readmission rates in the postsurgical year. Conclusion The effects of sarcopenia on healthcare costs are concentrated in the immediate postoperative period. It may be appropriate to allocate additional resources to sarcopenic patients in the perioperative setting to reduce the incidence of negative postoperative outcomes. PMID:25990695

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2015-01-01

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

  15. Postoperative headache after the lateral suboccipital approach: craniotomy versus craniectomy.

    PubMed

    Koperer, H; Deinsberger, W; Jödicke, A; Böker, D K

    1999-12-01

    The lateral suboccipital approach to the cerebellopontine angle is typically performed as a small craniectomy. Incisional pain and headache following cerebellopontine angle surgery have been reported. Adherence of the cervical muscles to the dura, which is richly innervated, with consequent traction has been suggested to be responsible for postoperative headache. Therefore, postoperative headache probably could be reduced by replacing the bone flap between the muscles and the dura. In a prospective non-randomized study this hypothesis was tested by comparing craniectomy and craniotomy. 40 patients underwent removal of an acoustic neuroma via the retrosigmoid approach. Patients with a history of migraine, with additional intracerebral tumors or recurrencies as well as patients who developed a CSF fistula postoperatively were excluded. 29 patients were eligible for further evaluation. 13 patients underwent a craniotomy, 16 patients a craniectomy. All patients were subject to a standardized telephone interview three months and one year after surgery. Comparing the craniotomy group to the craniectomy group no difference was observed regarding age, sex, tumor size and duration of operation. 3 months as well as 12 months postoperatively headache was significantly (p < 0.05) less frequent in the craniotomy group as compared to the craniectomy group. In conclusion, an osteoplastic craniotomy significantly reduces postoperative headache and is therefore highly recommended. PMID:10667820

  16. Dezocine Prevents Postoperative Hyperalgesia in Patients Undergoing Open Abdominal Surgery

    PubMed Central

    Yu, Fang; Zhou, Jie; Xia, Suyun; Xu, Huan; Wang, Xiangrui

    2015-01-01

    Objective. Postoperative hyperalgesia is very frequent and hard to treat. Dezocine is widely used and has a modulatory effect for thermal hyperalgesia in animal models. So, this study was designed to investigate the potential role of dezocine in decreasing postoperative hyperalgesia for patients undergoing open abdominal surgery. Methods. This is a randomized, double-blinded, and placebo-controlled trial. 50 patients for elective open gastrectomy were randomly allocated to either a true treatment group (0.15 mg/kg intravenous dezocine at the end of surgery) or a sham treatment group (equivalent volume of saline) in a 1 : 1 ratio. Patients were followed up for 48 hours postoperatively and pain threshold to Von Frey filaments, pain scores, PCIA consumption, rescue analgesics use, sedation score, and occurrence of postoperative nausea and vomiting were recorded. Results. Patients in the true treatment group experienced statistically significantly higher pain threshold on forearm and smaller extent of peri-incisional hyperalgesia than the sham treatment group. Rescue analgesic use, cumulative PCIA consumption, and pain scores were statistically significantly decreased in the true treatment group compared to the sham treatment group. Conclusions. Dezocine offers a significant antihyperalgesic and analgesic effect in patients undergoing elective open gastrectomy for up to 48 hours postoperatively. PMID:26170890

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  19. VDI-Richtlinien - mit Technischen Regeln Wirtschaftlichkeit erhöhen und Standards setzen

    NASA Astrophysics Data System (ADS)

    Mandelartz, Johannes

    Der Verein Deutscher Ingenieure e.V. (VDI) ist ein gemeinnütziger, wirtschaftlich und politisch unabhängiger, technisch-wissenschaftlicher Verein von Ingenieuren und Naturwissenschaftlern. Mit über 137 000 persönlich zugeordneten Mitgliedern ist er eine der größten Ingenieur-Vereinigungen Europas und gilt in Deutschland als führender Sprecher der Technik und der Ingenieure. 1856 gegründet, hat er viele für die Technik wesentliche Entwicklungen in Gang gesetzt, so im Bereich der technischen Überwachung, der technischen Regelsetzung und Normung, der Arbeitsstudien, im gewerblichen Rechtsschutz und im Patentwesen. Seit seiner Gründung sieht es der VDI als seine Aufgabe, "das Zusammenwirken aller geistiger Kräfte der Technik im Bewusstsein ethischer Verantwortung zu fördern“ und die Lebensmöglichkeiten aller Menschen durch Entwicklung und sinnvoller Anwendung technischer Mittel zu verbessern.

  20. Postoperative programmed muscle tension augmented osteotendinous junction repair.

    PubMed

    Wang, W; Chen, H H; Yang, X H; Xu, G; Chan, K M; Qin, L

    2007-08-01

    The postoperative programmed muscle tension induced by functional electrical stimulation (FES) was evaluated for its potential efficacy on acceleration of osteotendinous junction healing using an established partial patellectomy model in rabbits. After immobilization of the operated knee for 6 weeks, daily FES was applied to quadriceps muscles for 30 minutes per day and 5 days per week for 6 weeks in the treatment group and compared with the non-treatment control group at postoperative week 12 and 18, radiologically, histologically and biomechanically. Results showed that FES-induced muscle tension significantly increased new bone formation, bone mineral density, and fibrocartilage zone restoration in the osteotendinous healing interface. The failure load and ultimate strength of the repairing osteotendinous complex were also improved significantly with healing over time. In conclusion, the postoperative programmed FES-induced muscle tension was favorable for acceleration of osteotendinous junction repair and therefore recommended for clinical trails in orthopedic sports medicine and rehabilitation.

  1. Postoperative chronic pressure abnormalities in the vitreon study.

    PubMed

    Adile, S L; Peyman, G A; Greve, M D; Millsap, C M; Verma, L K; Wafapoor, H; Soheilian, M

    1994-01-01

    Perfluoroperhydrophenanthrene (Vitreon) was used as an intraoperative hydrokinetic retinal manipulator, followed by C3F8 or SF6 gases, silicone oil, or Vitreon as postoperative tamponading agents in 234 eyes. Two chronic intraoperative pressure abnormalities were defined: hypotony (5 mm Hg or less) and elevated intraocular pressure (IOP) (25 mm Hg or more at three or more postoperative visits). Postoperatively, 28 eyes (12%) had chronically elevated IOP, and 41 (18%) had chronic hypotony. There was no significant difference in the incidence of abnormal IOP among the groups of eyes in which the various tamponading agents had been used. In particular, the use of Vitreon as an intraoperative tool or as a short-term tamponade did not affect the incidence of chronic abnormal IOP any more than did the use of silicone oil, C3F8, or SF6 as tamponading agents.

  2. A new postoperative otoplasty dressing technique using cyanoacrylate tissue adhesives.

    PubMed

    Vetter, Miriam; Foehn, Matthias; Wedler, Volker

    2010-04-01

    There are many techniques for cosmetic surgery of the ears and also many different procedures for postoperative treatment. The postoperative dressing is described as important for a successful outcome. We present our method of postoperative dressing in the form of liquid bonding. Cyanoacrylate tissue adhesives as liquid bonding agents are used for fixation of the pinna at the mastoid area. After 10-14 days the bonding can be easily removed. No huge dressings, tapes, or plasters are necessary. The patients are satisfied with the light dressing; they do not feel ashamed to appear in public. We have found this dressing technique to be simple and economical, especially because of the use of the bonding for skin closure before. It can be used after otoplasty with an anterior or a posterior approach.

  3. [Postoperative refractory chylothorax which was improved by octreotide acetate].

    PubMed

    Gabe, Atsushi; Seki, Masahiro; Taira, Naohiro; Katsura, Morihiro; Ishida, Tomoki; Kang, Yukijya; Kubota, Tadao; Yamashiro, Toshimitsu; Uehara, Tetsuo; Sunagawa, Tohru; Ohkubo, Kazuaki

    2012-03-01

    A 77-year-old male with chronic hepatitis and liver cirrhosis underwent a right middle-lower lobectomy and lymph node dissection because of non-small cell carcinoma of the lung. On the 1st post-operative day (POD1), a large quantity of chylous pleural effusion was recognized after he initiated oral intake. The diagnosis was postoperative chylothorax. Conservative therapy including a medium chain tryglyceride diet and total parental nutrition were not effective. Considering of the patient's past history, we decided to continue conservative therapy using octreotide acetate on POD7. After administration of the octreotide acetate, the volume of chylous pleural effusion gradually decreased. The chest tube was removed on POD19. Octeotide acetate should be a choice for the conservative treatment of postoperative refractory chylothorax.

  4. Postoperative chronic pressure abnormalities in the vitreon study.

    PubMed

    Adile, S L; Peyman, G A; Greve, M D; Millsap, C M; Verma, L K; Wafapoor, H; Soheilian, M

    1994-01-01

    Perfluoroperhydrophenanthrene (Vitreon) was used as an intraoperative hydrokinetic retinal manipulator, followed by C3F8 or SF6 gases, silicone oil, or Vitreon as postoperative tamponading agents in 234 eyes. Two chronic intraoperative pressure abnormalities were defined: hypotony (5 mm Hg or less) and elevated intraocular pressure (IOP) (25 mm Hg or more at three or more postoperative visits). Postoperatively, 28 eyes (12%) had chronically elevated IOP, and 41 (18%) had chronic hypotony. There was no significant difference in the incidence of abnormal IOP among the groups of eyes in which the various tamponading agents had been used. In particular, the use of Vitreon as an intraoperative tool or as a short-term tamponade did not affect the incidence of chronic abnormal IOP any more than did the use of silicone oil, C3F8, or SF6 as tamponading agents. PMID:7830998

  5. Patient-controlled modalities for acute postoperative pain management.

    PubMed

    Miaskowski, Christine

    2005-08-01

    Although numerous clinical practice guidelines for pain management have been published throughout the last 12 years, inadequate pain relief remains a significant health care issue. Several patient-controlled analgesia (PCA) modalities are currently available for the treatment of acute postoperative pain, including intravenous (IV) PCA, epidural (PCEA), and oral PCA. Although PCEA and IV PCA are both commonly used modalities, IV PCA is considered the standard of care for postoperative pain management. Limitations of this modality do exist, however. Consequently, noninvasive PCA systems are under development to circumvent many of these limitations, including the fentanyl hydrochloride patient-controlled transdermal system (PCTS); (IONSYS Ortho-McNeil Pharmaceutical, Raritan, NJ) and a number of patient-controlled intranasal analgesia (PCINA) delivery systems. The objective of this article is to review the PCA modalities currently in use and to discuss those in development for the treatment of acute postoperative pain.

  6. Preoperative and postoperative hemostatic profiles of dogs undergoing ovariohysterectomy.

    PubMed

    Millis, D L; Hauptman, J G; Richter, M

    1992-10-01

    Hemostatic profiles were evaluated in 15 healthy dogs immediately before and 24 hours after celiotomy for routine ovariohysterectomy. Prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin degradation products, antithrombin III activity, platelet count, and hemogram were measured. There were no significant changes in prothrombin time, activated partial thromboplastin time, fibrin degradation products, antithrombin III activity, or platelet count. Fibrinogen concentration was significantly higher following surgery. Postoperative leukocyte differential counts were typical of stress leukograms, and were characterized by leukocytosis, neutrophilia, lymphopenia and eosinopenia. Mild decreases in packed cell volume, red blood cell count and hemoglobin concentration were consistent with minor blood loss during surgery or fluid retention and hemodilution postoperatively. It was concluded that celiotomy and routine ovariohysterectomy in healthy dogs did not alter hemostatic profiles 24 hours after surgery. Abnormal postoperative hemostatic profiles should not be attributed to surgery alone; other causes of abnormal hemostatic profiles should be investigated.

  7. Postoperative radiation of open head and neck wounds

    SciTech Connect

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

    1987-03-01

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

  8. Flurbiprofen axetil reduces postoperative sufentanil consumption and enhances postoperative analgesic effects in patients with colorectal cancer surgery.

    PubMed

    Lin, Xue; Zhang, Ruiqin; Xing, Jingchun; Gao, Xiaocui; Chang, Pan; Li, Wenzhi

    2014-01-01

    To investigate the effects of different strategies of flurbiprofen axetil (FA) administration on postoperative pain and sufentanil (SF) consumption after open colorectal cancer (CRC) surgery. Forty patients undergoing elective CRC resection were divided into two groups (n = 20 each). Patients in the F50+50 group received 50 mg of intravenous FA 30 min before skin incision and six hours after the first dose; patients in the F100 group received 100 mg of intravenous FA 30 min before skin incision. Perioperative plasma FA (CFA) and SF concentrations (CSF) were determined. Analgesic and sedative efficacy were evaluated using the visual analogue scale (VAS), Bruggman Comfort Scale (BCS), and Ramsay sedation scale. The time to the first PCIA trigger, the number of patients that pressed the PCIA trigger within 24 h after surgery, and the cumulative doses of SF consumption within 6 and 24 h after surgery were recorded. At postoperative 6 and 24 h, CFA was significantly higher, CSF was significantly lower, and the number of patients that pressed the PCIA trigger and the consumption of SF were significantly lower in the F50+50 group compared with the F100 group. At postoperative 4 h, VAS and BCS were significantly lower in the F50+50 group compared with the F100 group (P < 0.05). An administration strategy that maintains a relatively high plasma FA concentration at 6-24 h post-operatively may reduce postoperative inflammatory pain and SF-requirement in patients undergoing CRC resection.

  9. Flurbiprofen axetil reduces postoperative sufentanil consumption and enhances postoperative analgesic effects in patients with colorectal cancer surgery

    PubMed Central

    Lin, Xue; Zhang, Ruiqin; Xing, Jingchun; Gao, Xiaocui; Chang, Pan; Li, Wenzhi

    2014-01-01

    To investigate the effects of different strategies of flurbiprofen axetil (FA) administration on postoperative pain and sufentanil (SF) consumption after open colorectal cancer (CRC) surgery. Forty patients undergoing elective CRC resection were divided into two groups (n = 20 each). Patients in the F50+50 group received 50 mg of intravenous FA 30 min before skin incision and six hours after the first dose; patients in the F100 group received 100 mg of intravenous FA 30 min before skin incision. Perioperative plasma FA (CFA) and SF concentrations (CSF) were determined. Analgesic and sedative efficacy were evaluated using the visual analogue scale (VAS), Bruggman Comfort Scale (BCS), and Ramsay sedation scale. The time to the first PCIA trigger, the number of patients that pressed the PCIA trigger within 24 h after surgery, and the cumulative doses of SF consumption within 6 and 24 h after surgery were recorded. At postoperative 6 and 24 h, CFA was significantly higher, CSF was significantly lower, and the number of patients that pressed the PCIA trigger and the consumption of SF were significantly lower in the F50+50 group compared with the F100 group. At postoperative 4 h, VAS and BCS were significantly lower in the F50+50 group compared with the F100 group (P < 0.05). An administration strategy that maintains a relatively high plasma FA concentration at 6-24 h post-operatively may reduce postoperative inflammatory pain and SF-requirement in patients undergoing CRC resection. PMID:25663985

  10. [Systemic analgesia for postoperative pain management in the adult].

    PubMed

    Binhas, M; Marty, J

    2009-02-01

    Severe postsurgical pain contributes to prolonged hospital stay and is also believed to be a risk factor for the development of chronic pain. Locoregional anesthesia, which results in faster patient recovery with fewer side effects, is favored wherever feasible, but is not applicable to every patient. Systemic analgesics are the most widely used method for providing pain relief in the postoperative period. Improvements in postoperative systemic analgesia for pain management should be applied and predictive factors for severe postoperative pain should be anticipated in order to control pain while minimizing opioid side effects. Predictive factors for severe postoperative pain include severity of preoperative pain, prior use of opiates, female gender, non-laparoscopic surgery, and surgeries involving the knee and shoulder. Pre- and intraoperative use of small doses of ketamine has a preventive effect on postoperative pain. Multimodal or balanced analgesia (the combined use of various analgesic agents) such as NSAID/morphine, NSAID/nefopam, morphine/ketamine improves analgesia with morphine-sparing effects. Nausea and vomiting, the principle side effects of morphine, can be predicted using Apfel's simplified score; patients with a high Apfel score risk should receive preemptive antiemetic agents aimed at different receptor sites, such as preoperative dexamethasone and intraoperative droperidol. Droperidol can be combined with morphine for postoperative patient-controlled anesthesia (PCA). When PCA is used, dosage parameters should be adjusted every day based on pain evaluation. Patients with presurgical opioid requirements will require preoperative administration of their daily opioid maintenance dose before induction of anesthesia: PCA offers useful options for effective postsurgical analgesia using a basal rate equivalent to the patient's hourly oral usage plus bolus doses as required.

  11. Occurrence and causing stimuli of postoperative sensitivity in composite restorations.

    PubMed

    Auschill, Thorsten M; Koch, Christine A; Wolkewitz, Martin; Hellwig, Elmar; Arweiler, Nicole B

    2009-01-01

    Despite improvements in composite treatments over the past decade, postoperative sensitivity still remains a problem. Therefore, this clinical study evaluated the appearance of postoperative sensitivity after composite treatments and the stimuli that may have caused it. A total of 600 teeth in 231 patients was included in this study. All treatments were performed by dental students working under close supervision following standard procedures and using the bonding system Optibond FL and the nanofilled composite Ceram X. At baseline (visit 1), the restorations were grouped according to the following criteria: use of anesthesia, use of a rubber dam, indication for the restoration treatment, cavity class and clinical dimension of the cavity. After approximately two weeks (at visit 2), all the restorations were assessed and failure was defined if one of the following criteria occurred: a negative reaction to the vitality test, postoperative pain from masticatory forces or reported postoperative sensitivity by the patient. The reported postoperative sensitivity was specified with a visual analogue scale into hot/cold-sensitivity, sweet/soursensitivity, sharp/dull-sensitivity, spontaneous sensitivity and blistering/stinging-sensitivity. Failure was observed in 6% of the restorations. The statistical analysis showed that the clinical cavity depth turned out to be the only factor to have a significant influence on the appearance of postoperative sensitivity: caries profunda showed a four times higher risk of failure, while cavities with pulp exposure had a 14 times higher failure risk compared to restorations that were localized in the dentin. With regard to the type of sensitivity, no patients reported sensitivity to sweet/sour; most of them described their sensitivity as sharp/dull. PMID:19192831

  12. Risk Factors for Postoperative Hemorrhage After Partial Nephrectomy

    PubMed Central

    Jung, Saebin; Min, Gyeong Eun; Chung, Benjamin I.

    2014-01-01

    Purpose To evaluate the frequency and clinical characteristics of postoperative hemorrhage as a complication of partial nephrectomy. Materials and Methods The demographics, physical statistics, tumor size, R.E.N.A.L. nephrometry score, operative method, warm ischemic time, and presence of postoperative hemorrhage and its severity and method of intervention were examined in 300 partial nephrectomy patients in two medical centers (Stanford Medical Center and Kyung Hee University Medical Center) between March 2000 and March 2012. Results Of the 300 subjects, 13 (4.3%) experienced postoperative hemorrhage severe enough to require intervention more invasive than transfusion (Clavien grade III or higher). Univariate analysis of the bleeding and nonbleeding groups showed that whereas age, ischemic time, tumor size and stage, body mass index, American Society of Anesthesiologists class, and operative method did not differ significantly, the exophyticity (E) score was significantly higher for severe postoperative hemorrhage (p=0.04). However, multivariate analysis showed none of the factors to differ significantly. In most of the cases requiring intervention, selective embolization was sufficient, but in one case explorative laparotomy and nephrectomy were required. Clinical characteristics varied significantly among severe hemorrhage cases, with time of onset ranging from the first to the 30th postoperative day and symptoms presenting in a diverse manner, such as gross hematuria and pleuritic chest pain. Computed tomography and angiographic findings were consistent with either arteriovenous fistula or pseudoaneurysms. Conclusions Severe hemorrhage after partial nephrectomy is rare. Nonetheless, with the great variability in presenting symptoms and time of onset after surgery, surgeons should exercise great vigilance during the postoperative care of partial nephrectomy patients. PMID:24466392

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

    PubMed Central

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

    1999-01-01

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

  14. Post-operative diabetes insipidus after endoscopic transsphenoidal surgery.

    PubMed

    Schreckinger, Matthew; Walker, Blake; Knepper, Jordan; Hornyak, Mark; Hong, David; Kim, Jung-Min; Folbe, Adam; Guthikonda, Murali; Mittal, Sandeep; Szerlip, Nicholas J

    2013-12-01

    Diabetes insipidus (DI) after endoscopic transsphenoidal surgery (ETSS) can lead to increased morbidity, longer hospital stays, and increased medication requirements. Predicting which patients are at high risk for developing DI can help direct services to ensure adequate care and follow-up. The objective of this study was to review our institution's experience with ETSS and determine which clinical/laboratory variables are associated with DI in this patient population. The authors wanted to see if there was an easily determined single value that would help predict which patients develop DI. This represents the largest North American series of this type. We retrospectively reviewed the charts of patients who had undergone ETSS for resection of sellar and parasellar pathology between 2006 and 2011. We examined patient and tumor characteristics and their relationship to postoperative DI. Out of 172 endoscopic transsphenoidal surgeries, there were 15 cases of transient DI (8.7%) and 14 cases of permanent DI (8.1%). Statistically significant predictors of postoperative DI (p < 0.05) included tumor volume and histopathology (Rathke's cleft cyst and craniopharyngioma). Significant indicators of development of DI were postoperative serum sodium, preoperative to postoperative change in sodium level, and urine output prior to administration of 1-deamino-8-D-arginine vasopressin. An increase in serum sodium of ≥2.5 mmol/L is a positive marker of development of DI with 80% specificity, and a postoperative serum sodium of ≥145 mmol/L is a positive indicator with 98% specificity. Identifying perioperative risk factors and objective indicators of DI after ETSS will help physicians care for patients postoperatively. In this large series, we demonstrated that there were multiple perioperative risk factors for the development of DI. These findings, which are consistent with other reports from microscopic surgical series, will help identify patients at risk for diabetes insipidus

  15. [Hospital infection during postoperative intensive care (author's transl)].

    PubMed

    Kalmar, P; Horatz, K; Rodewald, G; Schassan, H H; Schassek, S

    1976-11-15

    Since 1970 all postoperative bacteriological findings recorded in surgical patients have been analyzed and compared with the postoperative course. There are also regular checks of bacterial invasion in the operating suites and in the intensive care units. By such means as systems of double lock for personnel and equipment, regular surface disinfection, frequent hand disinfection, cleaning of the respirators with antiseptics, etc., the authors have been able to reduce the incidence of hospital infection very drastically. These measures also almost eliminated cross-infections in patients on long-term ventilation and complications with long-term indwelling catheters.

  16. Thalidomide induces mucosal healing in postoperative Crohn disease endoscopic recurrence

    PubMed Central

    Hu, Huiqin; Wang, Xinying; Liu, Side

    2016-01-01

    Abstract Background: Thalidomide has been successful use in patients with refractory Crohn disease (CD) in recent years. Methods: We collected the data of a postoperative CD patient who was prescribed thalidomide to induce remission and reviewed the relevant literatures. Results: A 51-year-old female was diagnosed as CD after an urgent terminal intestinal resection and presented endoscopic recurrence despite the prophylactic treatment with azathioprine (AZA). Fortunately, she achieved mucosal healing (MH) at a low dose of thalidomide for 15 months. Conclusion: Thalidomide is effective to induce MH in the postoperative CD endoscopic recurrence. PMID:27603389

  17. Endoscopic Evaluation and Management of the Postoperative Crohn's Disease Patient.

    PubMed

    Hashash, Jana G; Binion, David G

    2016-10-01

    Approximately 70% of patients with Crohn's disease (CD) undergo surgical resection for the treatment of medically refractory disease or its complications. The sickest cohort of CD patients experience rapid postoperative relapse at the anastomotic site. Over the past 2 decades, the types of surgical anastomoses used in CD reconstruction have changed; end-to-side and end-to-end anastomoses have been surpassed by the more rapidly created side-to-side anastomoses. This article provides a review of the timing and purpose of endoscopic evaluation in postoperative CD patients and pragmatic information regarding interpretation of endoscopic findings at the different types of surgical anastomoses after ileocecal resection. PMID:27633596

  18. Delayed-onset postoperative endophthalmitis secondary to Exophiala.

    PubMed

    Quintero-Estades, Jose Alberto; Walter, Scott; Valenzuela, Felipe; Amescua, Guillermo

    2015-01-01

    Exophiala is a genus of slow-growing, melanin-producing, saprophytic fungi most commonly found in soil, faeces and decaying plant matter. It is an unusual fungal pathogen capable of causing a variety of ophthalmic manifestations, including keratitis, scleritis and endophthalmitis. In this report, we present a rare case of delayed-onset postoperative endophthalmitis confined to the anterior segment, secondary to Exophiala species. Previous reported cases of delayed-onset postoperative endophthalmitis have been treated medically, with suboptimal outcomes. Our experience supports the use of anterior segment surgery to clear the nidus of disease combined with intravitreal voriconazole to prevent recurrence of the infection. PMID:25691581

  19. [Intraoperative protective ventilation reduces postoperative pulmonary complications - PRO].

    PubMed

    Güldner, Andreas; Gama de Abreu, Marcelo

    2015-09-01

    Postoperative pulmonary complications add to higher mortality and morbidity. This risk could be lowered with intraoperative protective ventilation, especially with low tidal volumes. The application of PEEP and the use of recruitment maneuvers can enhance the lung function during surgery, but can also cause haemodynamic instability. In patients with open abdominal surgery and no lung damage or obesity, PEEP and recruitment maneuvers have no protective effect against postoperative pulmonary complications. It is still unclear, wether the use of intraoperative PEEP in other patient groups and during different surgery procedures is relevant for lung protection.

  20. [Treatment of postoperative impairment of gastrointestinal motility, cholangitis and pancreatitis].

    PubMed

    Schulze, T; Heidecke, C-D

    2015-06-01

    Although the mortality associated with major hepatopancreaticobiliary surgery has continuously decreased during the last decades, the morbidity of these procedures remains high. Functional disturbances of normal gastrointestinal motility as well as inflammation and infections of surgically treated organs are frequent complications resulting in considerably prolonged lengths of stay in hospital and increased healthcare costs. This review article highlights the therapeutic approaches and recent developments in the treatment of delayed gastric emptying, prolonged postoperative ileus, postoperative cholangitis and pancreatitis after hepatopancreaticobiliary surgery. Current practice is discussed on the basis of recent results in basic and clinical research, review articles, meta-analyses and guidelines. PMID:25986675

  1. Tolerance of gastric mucosal flap to postoperative irradiation

    SciTech Connect

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

    1991-05-01

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

  2. Nicolaus Copernicus Gesamtausgabe. Band VI/1. Documenta Copernicana: Briefe (Texte und Übersetzungen).

    NASA Astrophysics Data System (ADS)

    Kühne, A.

    Im Auftrage der Kommission für die Copernicus-Gesamtausgabe, herausgegeben von H. M. Nobis und M. Folkerts. Band VI/1 wurde bearbeitet von A. Kühne unter Mitarbeit von F. Boockmann und S. Kirschner und Verwendung der Vorarbeiten von H. M. Nobis.

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

    PubMed Central

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

    2014-01-01

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

  4. Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function.

    PubMed

    Rawal, N; Sjöstrand, U; Christoffersson, E; Dahlström, B; Arvill, A; Rydman, H

    1984-06-01

    In a randomized double-blind study of thirty grossly obese patients undergoing gastroplasty for weight reduction, the effects of intramuscular and epidural morphine were compared as regards analgesia, ambulation, gastrointestinal motility, early and late pulmonary function, duration of hospitalization, and occurrence of deep vein thrombosis in the postoperative period. The patients were operated on under thoracic epidural block combined with light endotracheal anesthesia. A six-grade scale was devised to quantify postoperative mobilization. A radioactive isotope method using 99mTc -plasmin was employed to detect postoperative deep vein thrombosis. For 14 hr after the first analgesic injection, respiratory frequency was noted every 15 min and arterial blood gases were measured hourly. Peak expiratory flow was recorded daily until the patient was discharged from hospital. Spirometry was performed the day before and the day after surgery. Plasma concentrations of morphine were measured after both intramuscular and epidural administration. Both intramuscular and epidural morphine gave effective analgesia, but the average dose of intramuscular morphine was up to seven times greater than that required by the epidural route. A larger number of patients receiving epidural morphine postoperatively were able to sit, stand, or walk unassisted within 6, 12, and 24 hr, respectively. Being alert and more mobile as a result of superior postoperative analgesia from epidural morphine, patients in this group benefited more from vigorous physiotherapy routine, which resulted in fewer pulmonary complications. Furthermore, earlier postoperative recovery of peak expiratory flow and bowel function presumably contributed to a significantly shorter hospitalization in patients receiving epidural morphine. There was no evidence of prolonged respiratory depression in this high-risk category of patients. The 99mTc -plasmin tests revealed no significant difference between the two groups.

  5. Ökophysik: Plaudereien über das Leben auf dem Land, im Wasser und in der Luft

    NASA Astrophysics Data System (ADS)

    Nachtigall, W.

    Prof. em. Dr. rer. nat. Werner Nachtigall, geb. 1934, war als Zoophysiologe und Biophysiker Leiter des Zoologischen Instituts der Universität des Saarlandes in Saarbrücken. In Forschung und Ausbildung hat er sich insbesondere mit Aspekten der Technischen Biologie und Bionik befasst und mit seinen Forschergruppen viele Basisdaten insbesondere zur Ökologie, Physiologie und Physik des Fliegens und Schwimmens aber auch zur Stabilität beispielsweise der Gräser erarbeitet. Lebewesen überraschen immer wieder durch ihre "Biodiversität", ihre hochspezifischen Ausgestaltungen und Anpassungen.

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

    PubMed Central

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

    2016-01-01

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

  7. Evaluation and management of the patient with postoperative facial paralysis.

    PubMed

    Hadlock, Tessa

    2012-05-01

    Postoperative facial paralysis comprises a spectrum of injuries ranging from mild, temporary weakness to severe, permanent paralysis, affecting as little as one muscle group to as much as the full hemiface. Herein is presented an introductory review of iatrogenic facial paralysis, from initial evaluation and decision making to the full range of conservative and operative management.

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

    PubMed

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

    2016-09-01

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

  9. Reducing the Risk of Postoperative Genital Complications in Male Adolescents

    ERIC Educational Resources Information Center

    Dossanova, ?ssem; Lozovoy, Vasiliy; Wood, Dan; ??nekenova, ?enzhekyz; Botabayeva, ?igul; Dossanov, Bolatbek; Lozovaya, Yelena; ?marov, ?algat

    2016-01-01

    The reproductive system of adolescents is exposed to a high risk of anomalies. In spite of the successes of surgical correction, the percentage of postoperative complications remains high. Special attention should be paid to circumcision, which is regarded as a religious tradition in many countries and carried out with sanitary violations. This…

  10. Laser Acupuncture for Postoperative Pain Management in Cats

    PubMed Central

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

    2015-01-01

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

  11. Transesophageal echocardiography in the postoperative child with an open sternum.

    PubMed

    Marcus, B; Wong, P C; Wells, W J; Lindesmith, G G; Starnes, V A

    1994-07-01

    We report the use of transesophageal echocardiography in 3 children whose sternums remained open for several days postoperatively. In these patients transesophageal echocardiography provided critical information when transthoracic echocardiography was ineffective due to limited acoustic windows. This report points out the application of transesophageal echocardiography in children with chest wall distortion. PMID:8037535

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

    PubMed

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

    2015-01-01

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

  13. Fentanyl Iontophoretic Transdermal System: A Review in Acute Postoperative Pain.

    PubMed

    Scott, Lesley J

    2016-04-01

    Fentanyl iontophoretic transdermal system (ITS) [Ionsys(®)] is indicated for the management of acute postoperative pain in adults requiring opioid analgesia in the hospital setting. This article reviews the clinical use of fentanyl ITS for postoperative pain management, and summarizes the pharmacology of fentanyl and the characteristics of the two-component fentanyl ITS (Ionsys(®)) device. In well-designed, multicentre clinical trials, fentanyl ITS was an effective and generally well tolerated method for managing acute postoperative pain in inpatients who had undergone major abdominal, thoracic or orthopaedic surgery. Overall, fentanyl ITS provided equivalent analgesic efficacy to that with morphine patient-controlled intravenous analgesia (PCIA), but was perceived to be more convenient/easier to use than morphine PCIA by patients, nurses and physical therapists. Patients receiving fentanyl ITS also had a greater ability to mobilize after surgery than patients receiving morphine PCIA. In addition, relative to morphine PCIA, fentanyl ITS offers advantages in terms of the noninvasive administrative route (i.e. transdermal needle-free administration), pre-programmed delivery (no risk of programming errors/incorrect dosing) and improved tolerability with regard to the overall incidence of opioid-related adverse events (ORAEs) and some individual ORAEs. Hence, fentanyl ITS is a useful option for the management of acute postoperative pain in adults requiring opioid analgesia in the hospital setting.

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

    PubMed Central

    Reena; Bandyopadhyay, Kasturi Hussain; Paul, Abhijit

    2016-01-01

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

  15. Determinants of adverse reaction following postoperative T-tube cholangiogram.

    PubMed Central

    Dellinger, E P; Kirshenbaum, G; Weinstein, M; Steer, M

    1980-01-01

    The incidence, nature, and mechanisms of adverse reaction following postoperative T-tube cholangiogram have received little attention in the medical literature. This paper presents the experience at one hospital over a 30-month period (1975--1977) covering 139 patients who had 170 cholangiograms. Factors examined included intraoperative and postoperative cultures of bile, the use of antibiotics prior to the performance of the cholangiogram, the technique of cholangiography, the interval between operation and cholangiogram. Eleven (6.5%) cholangiograms were followed by an adverse reaction. Two of these reactions were severe, manifested by signs of septic shock. The administration of antibiotics was not associated with a reduction in adverse reactions. The cholangiographic technique of gravity infusion of dye, which effectively limits the amount of pressure generated during the study, was associated with a significant reduction in adverse reactions. No severe reactions occurred following any study performed by the gravity technique. There was no significant correlation between the age of the patient or the number of days postoperative with adverse reaction. A review of the literature suggests that the mechanism for these severe reactions is cholangiovenous reflux. The avoidance of high intraductal pressures (above 25 cm of water) during the performance of postoperative T-tube cholangiogram should significantly reduce the incidence of adverse reactions. PMID:7369805

  16. Effect of intravascular cellular aggregate dissolution in postoperative patients.

    PubMed Central

    Dawidson, I; Barrett, J; Miller, E; Litwin, M S

    1975-01-01

    It was the purpose of this study to confirm whether the increase in packed cell (PC) viscosity that occurs in humans after elective surgery is accompanied by a decrease in total body O2 consumption as previously noted in animals, and further to define the effect of resolution of intravascular cellular aggregates (ICA) on these parameters. Thirty nine patients were studied. Total body O2 consumption was 76% of normal 6 hours postop, 81% of normal 24 hours postop and 87% of normal 48 hours postop. Twenty four hours after operation PC viscosity and increased markedly. Saline infusion had no significant effect on total body O2 consumption or PC viscosity, either pre- or postop, but WB viscosity decreased linearly in proportion in the drop in hematocrit. Resolution of ICA by dextran-40 infusion was associated with return of total body O2 consumption and PC viscosity to normal; a decrease in WB viscosity was disproportionately greater than would have been seen had the decrease been due solely to the drop in hematocrit. It is concluded that in humans surgical trauma causes an increase in PC viscosity and microcirculatory impairment as evidenced by a decrease in total body O2 consumption. Resolution of ICA by dextran-40 infusion reverses that detrimental changes. PMID:1190882

  17. [Ultrasonographic diagnosis and characteristic of postoperative accumulations of a liquid].

    PubMed

    Moshkivs'kyĭ, H Iu

    2010-09-01

    Ultrasonographic semiotics of extraorgan localized postoperative accumulations of a liquid occurring after performance of interventions on a liver was studied up. There was established the dependence of their localization on the operation kind. The differential diagnosis algorithm of some pathologic conditions (haematoma, biloma, seroma) was elaborated.

  18. Informationsqualität - Definitionen, Dimensionen und Begriffe

    NASA Astrophysics Data System (ADS)

    Rohweder, Jan Philipp; Kasten, Gerhard; Malzahn, Dirk; Piro, Andrea; Schmid, Joachim

    Die Verbesserung und Sicherstellung der Informationsqualität wird in immer mehr Unternehmen als eigenständige Managementaufgabe von großer Wichtigkeit begriffen. IQ-Management ist ein elementarer Baustein in Systemintegrationsprojekten. Aber auch in bestehenden Prozessen mit heterogenen Datenquellen und Informationsnutzern ist eine hohe Informationsqualität die Grundvoraussetzung für funktionierende betriebliche Abläufe. Voraussetzung für ein effektives IQ-Management ist die Bewertung der Informationsqualität [Lee et al. 2006, S. 13 und S. 27]. In vielen Unternehmen ist Informationsqualität nur ein gefühlter Wert. Die meisten Anwender bringen ein gewisses Misstrauen den Daten gegenüber zum Ausdruck, dies jedoch ohne genaue Angabe der Fehlerart und -häufigkeit. Nicht selten werden kostspielige Projekte angestoßen, um die Informationsqualität zu verbessern, ohne sich vor einer IQ-Maßnahme durch eine Analyse ein genaues Bild über die tatsächlichen Probleme zu verschaffen. Nur auf der Basis einer umfassenden Bewertung der Informationsqualität können die notwendigen Ressourcenentscheidungen herbeigeführt, Ziele gesetzt und der Erfolg des IQ-Management beurteilt werden.

  19. Herschel und die Zukunft der Fern-Infrarot-Astronomie

    NASA Astrophysics Data System (ADS)

    Linz, Hendrik

    2015-06-01

    Schon lange ist die beobachtende Astronomie den engen Grenzen des optisch Sichbaren entwachsen und hat fast alle Bereiche des elektromagnetischen Spektrums für sich dienstbar gemacht. Im sogenannten nahen und mittleren Infrarot (Wellenlängen zwischen 1-30 μm) sowie im Millimeter- und Radio-Regime (Wellenlängen zwischen 1 mm und 10 m) ist die Erdatmosphäre relativ gut durchlässig für elektromagnetische Signale oder hat zumindest eine Vielzahl von spektral begrenzten Transmissionsfenstern, die astronomische Beobachtungen zumindest von höheren Bergen aus möglich machen. Allerdings ist das sogenannte Ferne Infrarot (FIR, 30-300 μm Wellenlänge) von der Erde aus fast völlig unzugänglich für astronomische Beobachtungen. Selbst für die besten Beobachtungsplätze der Erde bleibt die atmosphärische Transmission durch die immense Wasserdampf- Absorption auf ein absolutes Minimum beschränkt. Jedoch erlaubt uns das FIR Zugang zu Informationen, die sehr nützlich sind für die astrophysikalische Forschung und komplementär zu anderen Wellenlängen-Bereichen.

  20. Messen, Kalibrieren, Eichen in der Radiologie: Prinzipien und Praxis

    NASA Astrophysics Data System (ADS)

    Wagner, Siegfried R.

    Nach einleitender Erläuterung der unterschiedlichen Meßbedingungen in der Strahlentherapie und im Strahlenschutz werden die metrologischen Probleme am Beispiel der Größenkategorie Äquivalentdosis diskutiert. Als spezielle Größen werden effektive Äquivalentdosis und Umgebungs-Äquivalentdosis eingeführt. Es wird gezeigt, wie richtiges Messen durch ein konsistentes System von Bauartanforderungen an Meßgeräte, durch Kalibrieren und durch Eichen gewährleistet werden kann. Die Bedeutung von Meßunsicherheiten und Fehlergrenzen wird erläutert und ihre Auswirkung auf die Interpretation von Meßergebnissen behandelt.Translated AbstractMeasurements, Calibration, Verification in Radiology: Principles and PracticeThe different measuring conditions in radiotherapy and in radiation protection are discussed in the introduction. Then, the metrological problems are discussed exemplarily with the dose equivalent as a category of quantity. Effective dose equivalent and ambient dose equivalent are introduced as special quantities. It is demonstrated, how correct measurements can be secured by a consistent system of instrument pattern requirements, by calibration and verification. The importance of uncertainties of measurements and of error limits is illustrated and their influence on the interpretation of the results of measurements is treated.

  1. [Effect of capnoperitoneum on postoperative carbon dioxide homeostasis].

    PubMed

    Blobner, M; Felber, A R; Hösl, P; Gögler, S; Schneck, H J; Jelen-Esselborn, S

    1994-11-01

    After laparoscopic cholecystectomy, carbon dioxide (CO2) must be exhaled after resorption from the abdominal cavity. There is controversy about the amount and relevance of postoperative CO2 resorption. Without continuous postoperative monitoring, after laparoscopic cholecystectomy a certain risk may consist in unnoticed hypercapnia due to CO2 resorption. Studies exist on the course of end-expiratory CO2 (Pe-CO2) alone over a longer postoperative period of time in extubated patients during spontaneous breathing. The goal of this prospective study was to investigate the amount of CO2 resorbed from the abdominal cavity in the postoperative period by means of CO2 metabolism. METHODS. After giving informed consent to the study, which was approved by the local ethics committee, 20 patients underwent laparoscopic cholecystectomy. All patients received general endotracheal anaesthesia. After induction, total IV anaesthesia was maintained using fentanyl, propofol, and atracurium. Patients were ventilated with oxygen in air (FiO2 0.4). The intra-abdominal pressure during the surgical procedure ranged from 12 to 14 mm Hg. Thirty minutes after releasing the capnoperitoneum (KP), CO2 elimination (VCO2), oxygen uptake (VO2), and respiratory quotient (RQ) were measured every minute for 1 h by indirect calorimetry using the metabolic monitor Deltatrac according to the principle of Canopy. Assuming an unchanged metabolism, the CO2 resorption (delta VCO2) at any given time (t) can be calculated from delta VCO2 (t) = VCO2 (t)-RQ(preop) VO2 (t). It was thus necessary to define the patient's metabolism on the day of operation. The first data were collected before surgery and after introduction of the arterial and venous cannulae for a 15-min period. Measuring point 0 was determined after exsufflation of the KP and emptying of the remaining CO2 via manual compression by the surgeon at the end of surgery. Patient's tracheas were extubated and metabolic monitoring started 30 min after

  2. Can reduction mammoplasty patients be promised a particular size postoperatively?

    PubMed

    Dal Cin, Arianna; Jeans, Elizabeth Rose

    2005-01-01

    This retrospective study used self-reported bra sizes, heights and weights pre- and postoperatively in patients who underwent reduction mammoplasty by one surgeon between 2001 and 2003. Preoperative data were collected on 91 patients. Postoperative data were collected from 69 respondents by telephone survey. Bra sizes were standardized according to cup size. In bra-making, the cup is the same size for decreasing cup letter size as the band size increases. The most common standardized cup size was seven, representing bra sizes 34 F, 36 E, 38 D, 40 C, etc. The range of preoperative cup sizes was five (34 D) to 17 (42 L). The mass of tissue removed from each breast was averaged for each patient and ranged from 147 g to 2453 g (mean 522 g). The average body mass index was 29.6 kg/m(2) preoperatively and 29.3 kg/m(2) postoperatively, with six patients reporting weight gain, 13 reporting weight loss and 50 reporting no change at all. Postoperative standardized cup sizes ranged from five (34 D) to 14 (44 H). The difference between pre- and postoperative cup size ranged from zero to eight as follows: for no cup size change (n=17), mean tissue removed per breast was 577.1 g; decrease by one cup size (n=23), 489.2 g; decrease by two cup sizes (n=25), 425.8 g. These data indicate that when self-reported data from patients are used, a plastic surgeon may find that as many as 25% report no change in bra size after reduction mammoplasty, even when more than 500 g of tissue is removed from each breast, which may adversely affect patients' satisfaction with the surgical results. Future studies will determine the cause of the apparent discrepancy between operative and self-reported results.

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

    PubMed Central

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

    2013-01-01

    Purpose While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ2 or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104–3.688; OR, 1.704; 95% CI, 1.03–2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365–7.289; OR, 1.55; 95% CI, 0.78–3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation. PMID:23845841

  4. Combined preoperative and postoperative immunotherapy for murine C1300 neuroblastoma.

    PubMed

    Fowler, C L; Brooks, S P; Rossman, J E; Cooney, D R

    1993-03-01

    Preoperative treatment of murine C1300-neuroblastoma (C1300) with triple immunotherapy using low-dose cyclophosphamide (CY), retinyl palmitate (RP), and interleukin-2 (IL2), followed by tumor resection leads to significant initial tumor control and prolonged survival. However, because long-term tumor recurrence is 67%, the efficacy of continued postoperative immunotherapy is now evaluated. Thirty-two A/J mice with 1 cm subcutaneous C1300 tumors were treated for 13 days with CY-100 mg/kg, intraperitoneally (IP), on day 2 of treatment then 25 mg/kg on day 9, RP-2500 IU IP 2 x/week, and IL2 1.6 x 10(5) U IP BID on days 4 to 9 and 11 to 13. On day 14, mice were divided into five treatment groups: (1) OP (operated-tumor resection, n = 6); (2) OP+CY (resection and postoperative CY, n = 7); (3) OP+CY+RP (resection and postoperative CY+RP, n = 7); (4) OP+CY+RP+IL2 (resection and postoperative CY+RP+IL2, n = 7); and (5) CY+RP+IL2 (continued CY+RP+IL2 with no resection, n = 5). Survival and postoperative tumor recurrence were followed for 60 days. The cure rates were group 1 33% (2/6), group 2 43% (3/7), group 3 29% (2/7), group 4 71% (5/7), and group 5 20% (1/5). After surgery, tumors that recurred did so in 8 to 22 days, with no statistical difference noted between groups. MHC class I antigenic expression of tumors resected on day 14 and recurrent tumors was determined with monoclonal antibodies and flow cytometry. In tumors resected on day 14, class I expression measured by mean fluorescence, was 374.8 +/- 27.40.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Portable single port 23-gauge vitrectomy in postoperative endophthalmitis

    PubMed Central

    Höhn, Fabian; Kretz, Florian TA; Sheth, Saumil; Natarajan, S; Singh, Pankaj; Koch, Frank H; Koss, Michael J

    2015-01-01

    Aim To evaluate the safety and effectiveness of the Intrector® for treating postoperative endophthalmitis. Materials and methods In a retrospective multicenter study, patients who received a single port 23-gauge core pars plana vitrectomy and isovolumetric injection of vancomycin, ceftazidime, and dexamethasone/amphotericin B using the Intrector® for postoperative endophthalmitis of intermediate severity (grade II or III vitreous inflammation and best-corrected visual acuity between hand movements and 0.3 logMAR [logarithm of the minimum angle of resolution]) were evaluated. Improvement in visual acuity, resolution of intraocular inflammation, the need for additional surgical procedures, and the development of complications were evaluated at a 1-month follow-up examination. Results Fifteen patients (mean age 55.6±7.2 years) underwent treatment with the Intrector®. The mean vitreous volume aspirated was 0.78±0.22 mL. The vitreous samples indicated positive microorganism culture results in six of the 15 cases, but the samples were positive when analyzed by real-time polymerase chain reaction in all cases (15/15). The mean best-corrected visual acuity improved significantly (P=0.01) from 0.88±0.29 (logMAR) to 0.32±0.28. Each patient demonstrated at least three lines of visual improvement. No additional medical or surgical interventions were required, and the complete resolution of intraocular inflammation was noted in all patients at the 1-month follow-up examination. No procedure-related complications were observed. Conclusion The Intrector® may be a safe and effective treatment option for infectious postoperative endophthalmitis. Larger studies comparing the outcomes of the Intrector® to the traditional treatments for postoperative endophthalmitis need to be conducted before its role in the treatment of postoperative endophthalmitis can be properly defined. PMID:26316685

  6. Gender Affects Early Postoperative Outcomes of Rotator Cuff Repair

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

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

    2013-08-01

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

  8. IQM-Reifegradmodell für die Bewertung und Verbesserung des Information Lifecycle Management Prozesses

    NASA Astrophysics Data System (ADS)

    Baškarada, Saša; Gebauer, Marcus; Koronios, Andy; Gao, Jing

    Heutige Organisationen produzieren und speichern mehr Informationen als je zuvor. Der resultierende Informationsüberfluss, zusammen mit einem Mangel an Qualitätssicherung für das Information Lifecycle Management, führt zu einem unsicheren Status der Informationsqualität in vielen Organisationen. Weiterhin hat sich herausgestellt, dass das Bewerten, Verbessern und Steuern der Informationsqualität ein offenkundig schwieriges Unterfangen ist. Dieses Kapitel stellt ein Modell zur Bewertung und Verbesserung der Information Quality Management Capability Maturity (IQM-Reifegrad) vor. Es wird ein Satz von Kriterien vorgestellt, der aus Literaturrecherche und Fallstudien abgeleitet wurde. Die Reifegradindikatoren werden validiert und in einem mehrstufigen Reifegradmodell durch eine Delphi-Studie gruppiert. Das abgeleitete IQM-Reifegradmodell hilft Organisationen ihre bestehenden Praktiken im IQM zu bewerten und potentielle Lücken und Verbesserungsstrategien zu ermitteln.

  9. Endoskopie, minimal invasive chirurgische und navigierte Verfahren in der Urologie

    NASA Astrophysics Data System (ADS)

    Grosse, Joachim; von Walter, Matthias; Jakse, Gerhard

    Betrachtet man die letzten 100 Jahre der Urologie in Deutschland seit Gründung ihrer Fachgesellschaft 1906 in Stuttgart, so sind sicherlich die letzten 25 Jahre von umfassenden Entwicklungen mit z. T. vollständigen Umwälzungen bisheriger Therapien und Methoden auf urologischen Fachgebiet gekennzeichnet. In erster Linie handelte es sich dabei um minimal invasive endoskopische Techniken wie perkutane Nierenchirurgie, Ureterorenoskopie, videoendoskopisch unterstütze transurethrale Elektroresektionen der Prostata und von Blasentumore sowie die Laparoskopie. Sie führten zu besseren operativen Ergebnissen und einer deutlichen Senkung der Morbidität der entsprechenden Behandlung urologischer Krankheitsbilder, mit der Konsequenz, dass einige bisher als Standard gültige offene Operationsverfahren abgelöst wurden.

  10. Terror mit Atomwaffen: reale Gefahr? Nukleare und Radiologische Waffen

    NASA Astrophysics Data System (ADS)

    Harigel, Gert G.

    2006-01-01

    Können Terroristen sich nukleare Massenvernichtungswaffen beschaffen? Dazu müssten sie ausreichende Mengen an waffenfähigem, spaltbarem Material stehlen. Selbst der Bau einer primitiven Atombombe erfordert einen hohen technischen Aufwand und Spezialisten. Wahrscheinlicher ist deshalb der Diebstahl einer kleinen taktischen Kernwaffe. Alternativ könnten Terroristen sich radioaktives Material aus zivilen Quellen beschaffen und daraus eine Schmutzige Bombe bauen. Eine solche radiologische Waffe wäre keine echte Massenvernichtungswaffe, doch ihre psychologische Wirkung könnte stark sein. Das macht sie für Terroristen attraktiv, weswegen diese Gefahr ernst genommen werden muss.

  11. Reflexionseigenschaften von Windenergieanlagen im Funkfeld von Funknavigations- und Radarsystemen

    NASA Astrophysics Data System (ADS)

    Sandmann, S.; Divanbeigi, S.; Garbe, H.

    2015-11-01

    Die hier behandelte Untersuchung befasst sich mit den Störungen des elektrischen Feldes einer Doppler Very High Frequency Omnidirectional Radio Range Navigationsanlage (DVOR) in der Gegenwart von Windenergieanlagen (WEA). Hierfür wird die Feldstärke auf 25 konzentrischen Kreisbahnen, sog. Orbit Flights verschiedener Höhen und mit verschiedenen Radien rund um die DVOR-Anlage numerisch simuliert. Insbesondere werden die Einflüsse diverser Parameter der WEA wie deren Anzahl, Position, Rotorwinkel, Turmhöhe und Rotordurchmesser auf die Feldverteilung herausgestellt, sowie die Anwendbarkeit der Simulationsmethode Physical Optics (PO) durch Vergleich der Simulationsergebnisse mit denen der Multi Level Fast Multipol Method (MLFMM) untersucht.

  12. Increased post-operative haemorrhage seen in adult coblation tonsillectomy.

    PubMed

    Noon, A P; Hargreaves, S

    2003-09-01

    Coblation is a new soft tissue surgical technique that is being used for tonsillectomy. Published results show a significant decrease in the amount of post-operative pain experienced by patients undergoing coblation tonsillectomy. There has been no published work to date on the incidence of post-operative haemorrhage. From August 2001 to November 2002 one surgeon performed 36 coblation tonsillectomies on adults. On another list he performed 29 by his standard method of dissection and bipolar coagulation. Retrospective analysis found a significant increase in the secondary haemorrhage rate in adult patients undergoing coblation tonsillectomy (22.2 vs. 3.4 per cent). At our department coblation tonsillectomy has been abandoned until further work into its safety has been published.

  13. Postoperative management of penetrating and nonpenetrating external filtering procedures.

    PubMed

    Bettin, Paolo

    2012-01-01

    Correct postoperative management is fundamental to prevent and treat complications and to optimize the success of filtering surgery: timely control visits and appropriate actions and prescriptions ensure the best outcomes, allow recovery from a number of untoward events, and can reestablish filtration when failure seems imminent. In contrast, a slack follow-up and wrong interventions or prescriptions can lead to failure of any surgery, no matter how accurately it had been carried out, sometimes jeopardizing vision and even the anatomy of the globe. The purpose of this review is to present a rational approach to postoperative follow-up and to synthetically describe how to prevent, recognize and address the most common complications of filtering surgery, pointing out the most common pitfalls in the management of the operated eye. PMID:22517173

  14. Pre and post-operative needs of patients with diabetes.

    PubMed

    Holt, Paula

    The incidence of diabetes is rising rapidly and individuals with the condition often have complex comorbidities, which may increase the need for surgical procedures such as amputation and cardiac, renal and eye surgery. Patients with diabetes undergoing surgery may have specific needs, particularly in relation to blood glucose control, and healthcare professionals need to be able to assess and manage these individuals to ensure optimum surgical outcomes. This article considers the potential effects of anaesthesia and surgery on blood glucose control. Diabetes-related complications, particularly signs and symptoms, and effects of these complications on patient safety during surgery are discussed. Specific pre and post-operative care of patients with type land type 2 diabetes is described, with reference to nil-by-mouth practices, blood glucose control, and post-operative infection and pain.

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

    PubMed Central

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

    1996-01-01

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

  16. Aspirin metabolism and efficacy in postoperative dental pain.

    PubMed Central

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

    1984-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. Postoperative hyperthermia of unknown origin treated with dantrolene sodium.

    PubMed

    Inada, Hirohito; Jinno, Shigeharu; Kohase, Hikaru; Fukayama, Haruhisa; Umino, Masahiro

    2005-01-01

    An 11-year-old girl was scheduled for alveolar cleft bone grafting with an iliac bone under general anesthesia. Anesthesia was performed with 70% nitrous oxide, 30% oxygen, and propofol. On the first and second postoperative day, persistent hyperthermia was observed. Because the administration of diclofenac sodium had not been effective for the hyperthermia, dantrolene sodium was given. Her body temperature gradually dropped and returned to normal level on the fifth postoperative day. The hyperthermia in the present case might have been caused by a rapidly elevated muscle metabolism in response to pain and stress after the propofol anesthesia. The oral administration of dantrolene sodium successfully lowered the patient's high body temperature. PMID:15859445

  19. [Postoperative handling in biliodigestive derivation by iatrogenic bile duct injury].

    PubMed

    Domínguez, I; Mercado, M A

    2008-01-01

    Bile duct injury is a severe complication related to cholecystectomy, impacting in the long-term quality of life and functional status. Bile duct repair is the first-line treatment for complex injuries. During short-term and long-term postoperative care, it is important to bear in mind the diagnostic tools, both laboratory and imaging, that will be useful to evaluate a possible surgical complication and to plan an adequate therapeutic strategy. In addition, post-surgical classification describes patients according to their complications and clinical course. In this review we describe the principal issues of postoperative care after bile duct repair, highlighting the diagnosis, severity classification and therapeutic approach of acute cholangitis.

  20. Patterns of postoperative pain medication prescribing after invasive dental procedures.

    PubMed

    Barasch, Andrei; Safford, Monika M; McNeal, Sandre F; Robinson, Michelle; Grant, Vivian S; Gilbert, Gregg H

    2011-01-01

    We investigated disparities in the prescription of analgesics following dental procedures that were expected to cause acute postoperative pain. Patients over the age of 19 years who had been treated by surgical and/or endodontic dental procedures were included in this study. We reviewed 900 consecutive charts and abstracted data on procedures, patients, and providers. We used chi-square and logistic regression models for analyses. There were 485 White subjects, 357 African American subjects included in this review; 81% of the African American and 78% of White patients received a postoperative narcotic prescription (p = .56). In multivariate regression models, patients over age 45 (p = .003), those with insurance that covered medication and those with preexisting pain (p = .004) were more likely to receive narcotic analgesics. Students prescribed more narcotics than residents (p = .001). No differences were found by race in prescribing analgesics.

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

    PubMed

    Panjganj, Donya; Bevan, Ann

    2016-06-01

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

  2. Percutaneous drainage of postoperative abdominal and pelvic lymphoceles.

    PubMed

    White, M; Mueller, P R; Ferrucci, J T; Butch, R J; Simeone, J F; Neff, C C; Yoder, I; Papanicolaou, N; Pfister, R C

    1985-11-01

    Eleven patients with postoperative abdominal and pelvic lymphoceles underwent percutaneous diagnostic and therapeutic intervention with either needle aspiration or catheter drainage. Although initial sonographic or CT examinations accurately identified these collections, definitive diagnosis required fluid sampling and laboratory analysis for confirmation. Seven pelvic and two retroperitoneal lymphoceles demonstrated a gross appearance and composition different from two lymphatic collections in the upper peritoneum. Nine patients underwent catheter drainage; two were managed by needle aspiration alone. Duration of catheter drainage was 4-120 days, substantially longer than is customary for standard fluid collections. Nine of 11 patients were cured by percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred. In another patient with persistent high-volume lymphatic output, sclerotherapy with tetracycline instillation was successful in rapidly closing the lymphatic fistula. Percutaneous drainage is a safe, effective procedure for drainage of postoperative lymphoceles.

  3. [Prevention of postoperative nausea and vomiting by lorazepam].

    PubMed

    Laraki, M; el Mouknia, M; Bouaguad, A; Idali, B; Benaguida, M

    1996-01-01

    This study was carried out to assess the efficacy of oral lorazepam on postoperative nausea and vomiting in patients undergoing thyroid surgery. Twenty-six patients were randomly assigned to two groups, and receiving orally, one hour before induction of anaesthesia, either 2.5 mg of lorazepam (n = 13) or a placebo (n = 13). Lorazepam reduced the incidence and especially the intensity of nausea. The incidence of vomiting in the lorazepam group was significantly lower than in the placebo group (14.5% vs 45%). The use of lorazepam for premedication thus reduces the incidence of postoperative nausea and vomiting. The advantages of this benzodiazepine are its ease of use, low cost and very low incidence of side effects. PMID:8760643

  4. Small Bowel Perforation as a Postoperative Complication from a Laminectomy.

    PubMed

    Krieger, Robert H; Wojcicki, Katherine M; Berry, Andrew C; Reuther, Warren L; McArthur, Kendrick D

    2015-01-01

    Chronic low back pain is one of the leading chief complaints affecting adults in the United States. As a result, this increases the percentage of patients that will eventually undergo surgical intervention to alleviate debilitating, chronic symptoms. A 37-year-old woman presented ten hours postoperatively after a lumbar laminectomy with an acute abdomen due to the extraordinarily rare complication of small bowel injury secondary to deep surgical penetration. PMID:26236534

  5. Acute post-operative rhinosinusitis following endonasal dacryocystorhinostomy

    PubMed Central

    Shams, P N; Selva, D

    2013-01-01

    Purpose To investigate the incidence and risk factors for acute rhinosinusitis (ARS) following endoscopic dacryocystorhinostomy (EnDCR). Methods Retrospective single-surgeon interventional case series, including 196 consecutive patients undergoing 203 endonasal DCR, with clinical and radiological evidence of nasolacrimal duct or common canalicular obstruction. Pre-operative lacrimal and sinonasal clinical assessment and imaging, intraoperative endoscopic video recording, and post-operative clinical and endoscopic findings were analysed for cases of ARS occurring within the first 4 weeks following DCR among patients with and without a past history of chronic rhinosinusitis (CRS). Surgical complications and outcomes at 12 months and management of ARS are reported. Results Three patients (1.5%) developed ARS within the first 5 post-operative days, none of which had experienced peri-operative complications and all had a past history of CRS. The rate of CRS in this cohort of 196 patients was 10.2% (n=20), of which 15% (n=3) developed ARS, although none had symptoms of CRS at the time of surgery; one had undergone previous sinus surgery. Presenting symptoms of ARS included facial pain, tenderness over the affected sinus, and nasal discharge; all patients responded to oral antibiotic therapy. Discussion The rate of ARS following EnDCR was 1.5%. In those with a prior history of CRS, it was 15% (P=0.009). ARS developed within the first post-operative week among patients with a past history of CRS, who were asymptomatic at the time of surgery, and responded to oral antibiotics. CRS may be a risk factor for the development of post-operative ARS. PMID:23846379

  6. [Control of postoperative vaginal sonographic findings following Shirodkar cerclage].

    PubMed

    Böhmer, S; Degenhardt, F; Unlü, C; Jagla, K; Bader, W

    1990-01-01

    Up to now postoperative control of the uterine cervix following cerclage was performed by bimanual palpation. Since clinical use of transvaginal sonography it is possible to get objective results about preoperative morphology of the cervix (exact cervical length, dilatation of the cervical canal and opening of internal and external os). Besides postoperative vaginal sonography following cerclage can ascertain lengthening and stabilization of the incompetent cervix and localize the ligature's position. 75 pregnant women between 15th and 30th week of gestation were examined using a 5-MHz vaginal sector scanner probe following Shirodkar cerclage to gain information about the residual cervical length and the distance from the surface of the ectocervix to the ligature's position within the anterior and posterior lip of the cervix. The mean postoperative cervical length was 3.75 cm (1.5 cm-6.5 cm). Compared to the preoperative average length of 3.0 cm (0.5 cm-5.0 cm) the cerclage resulted in an increase of about 25%. The average distance from the surface of the ectocervix to the ligature at anterior lip of the cervix was 1.85 cm, ranging from 0.9 cm to 2.6 cm. The mean value at the posterior lip was 1.56 cm, ranging from 0.8 cm to 2.0 cm. This study showed that the actual positions of ligatures after cerclage operations varied very much. Unsatisfying position can be an explanation why some preterm deliveries can not be prevented. Therefore it is recommended to control the position of the cerclage ligation postoperatively using transvaginal sonography. PMID:2198725

  7. Acute postoperative hydrocephalus following translabyrinthine craniotomy for acoustic neuroma resection.

    PubMed

    Roberson, J B; Brackmann, D E; Hitselberger, W E; House, J W; Lanman, T H

    1995-01-01

    Acute mental status changes following craniotomy for acoustic tumors demand prompt evaluation and treatment to avoid serious morbidity and mortality. Two cases of acute obstructive hydrocephalus complicating the postoperative period following translabyrinthine craniotomy are presented. Diagnosis is made with noncontrast computed tomography scanning. Treatment is rendered at the bedside with placement of a ventriculostomy. Diagnosis and management implications for acoustic tumor patients are discussed. PMID:17170940

  8. Acute Postoperative Hydrocephalus Following Translabyrinthine Craniotomy for Acoustic Neuroma Resection

    PubMed Central

    Roberson, Joseph B.; Brackmann, Derald E.; Hitselberger, William E.; House, John W.; Lanman, Todd H.

    1995-01-01

    Acute mental status changes following craniotomy for acoustic tumors demand prompt evaluation and treatment to avoid serious morbidity and mortality. Two cases of acute obstructive hydrocephalus complicating the postoperative period following translabyrinthine craniotomy are presented. Diagnosis is made with noncontrast computed tomography scanning. Treatment is rendered at the bedside with placement of a ventriculostomy. Diagnosis and management implications for acoustic tumor patients are discussed. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:17170940

  9. Postoperative infection of laparoscopic surgery wound due to Mycobacterium chelonae.

    PubMed

    Rajini, M; Prasad, S R; Reddy, R R; Bhat, R V; Vimala, K R

    2007-04-01

    We report a case of postoperative wound infection due to Mycobacterium chelonae. A 35-year-old woman presented with multiple erythematous nodules, plaques and discharging sinuses over the abdomen, 45 days after she had undergone laparoscopic ovarian cystectomy. The seropurulent discharge from the wound showed acid-fast bacilli on Ziehl- Neelsen stain and culture yielded Mycobacterium chelonae. The patient responded to clarithromycin and doxycycline. The source of infection was probably contaminated water or disinfectant solution used for sterilization of laparoscopic instruments.

  10. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

    PubMed Central

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

    2016-01-01

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

  11. Pulmonary artery stump thrombosis developed during the late postoperative period

    PubMed Central

    Kaya, Seyda Ors; Samancilar, Ozgur; Ceylan, Kenan Can

    2016-01-01

    A 73-year-old man underwent left pneumonectomy for squamous cell lung carcinoma 3 years ago. The postoperative and follow-up periods were uneventful. A thrombus was detected in the left pulmonary artery stump during the last chest computed tomography (CT) scan. Anticoagulant treatment was applied: intravenous heparin for 3 days followed by oral warfarin. The follow-up chest CT examination revealed regression in the size of the thrombus.

  12. Acute postoperative shingles after thoracic sympathectomy for hyperhidrosis.

    PubMed

    Massad, Malek G; Navarro, Rafael A; Rubeiz, Helene; Kpodonu, Jacques; Karol, Janet; Blacha, Mathew; Evans, Alexander

    2004-12-01

    Shingles secondary to reactivation of a previous varicella-zoster virus infection has been reported to develop within surgical wounds and after trauma. We report the case of a 17-year-old girl with history of chicken pox in childhood who had acute postoperative shingles develop along the T3-T4 dermatomes after thoracic sympathectomy for hyperhidrosis. The possible causes and precipitating factors are discussed. PMID:15561060

  13. [Subsyndromal delirium -- experience in psychiatry -- expectations for postoperative management].

    PubMed

    Brinkers, Michael; Pfau, Giselher; Gerth, Nico; Hachenberg, Thomas

    2014-07-01

    The phenomenon of delirium is well known since over 100 years. The anesthesiology has recognized that early detection and therapy results in significant improvement of postoperative clinical state of health of the patients. In the following article it will be discussed that it could be profitable to make a further step: threatening the subsyndromal delirium. Because there are only few experiences in anesthesiology, this thesis will be substantiated by datas from psychiatry.

  14. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

    PubMed Central

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

    2016-01-01

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

  15. Excessive Postoperative Fluid Administration in Infants with Gastroschisis.

    PubMed

    Bonasso, Patrick C; Lucke-Wold, Brandon; Hobbs, Gerald R; Vaughan, Richard A; Shorter, Nicholas A; Nakayama, Don K

    2016-08-01

    Careful fluid management is a cornerstone of neonatology because the cardiovascular, respiratory, and gastrointestinal systems in the newborn are sensitive to overhydration. Fluid management in gastroschisis is complicated by insensible fluid loss and postoperative third-space fluid shifts. Study of perioperative fluid management in gastroschisis is limited and has not undergone careful scrutiny. We reviewed perioperative fluid administration and urine output in all infants with gastroschisis over a 5-year period. Data included whether the patient underwent primary closure or staged repair, weight, and events during hospitalization (length of hospitalization and duration of gastric decompression, parenteral nutrition, and ventilator support). Paired t test gave statistical comparisons with significance at P < 0.05. From 2010 to 2014, 24 patients underwent abdominal closure, 17 had primary and 7 had staged closures. Fluid administration exceeded 100 mL/kg/d after primary closure, and was significantly higher (>150 mL/kg/d; P < 0.05) after staged closure on postoperative days 0 to 5. Postoperative urinary output exceeded 75 mL/kg/d for all patients, with higher volumes reaching 100 mL/kg/d after staged closure on postoperative days 4 to 6 (P < 0.05). Two patients died of sepsis. All survivors were discharged with intestinal continuity and gaining weight on oral feeding. Patients with gastroschisis received large volumes of fluid after operation despite similarly high urine output and positive daily fluid balances. The amounts of fluid administered after both primary and staged closure may be excessive and potentially deleterious. PMID:27657585

  16. Acute postoperative shingles after thoracic sympathectomy for hyperhidrosis.

    PubMed

    Massad, Malek G; Navarro, Rafael A; Rubeiz, Helene; Kpodonu, Jacques; Karol, Janet; Blacha, Mathew; Evans, Alexander

    2004-12-01

    Shingles secondary to reactivation of a previous varicella-zoster virus infection has been reported to develop within surgical wounds and after trauma. We report the case of a 17-year-old girl with history of chicken pox in childhood who had acute postoperative shingles develop along the T3-T4 dermatomes after thoracic sympathectomy for hyperhidrosis. The possible causes and precipitating factors are discussed.

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

    PubMed

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

    2015-01-01

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

  18. Experimental Model of Intervertebral Disk Mediated Postoperative Epidural Fibrosis

    PubMed Central

    Larionov, Sergey N.; Sorokovikov, V.A.; Erdyneyev, K.C.; Lepekhova, S.A.; Goldberg, O.A.

    2016-01-01

    Background Postoperative epidural fibrosis (EF) after lumbar discectomy is the most common and at the same time controversial issue. Purpose The etiology and pathogenesis creates a lot of discussion and selection of methods of treatment and prevention continues. Methods LIV laminectomy with dura mater (DM) exposition was done in 24 rats, and then, 0.3 ml of elements of suspension of autologous intervertebral disk was implicated on DM. As autologous intervertebral disk, we used the intervertebral disk from amputated tail. In all the animals, incisions were closed with 3/0 Vicryl. EF was examined. Fibroblast cell density was calculated in each field at ×40 magnification: Grade 1 - fewer than 100 fibroblasts in each field; Grade 2 - 100-150 fibroblasts in each field; Grade 3 - more than 150 fibroblasts in each field. Results Based on histological results, we confirmed our model of experiment. On the 30th day of evaluation, there were significant histological evidences of postoperative epidural adhesions in experimental animals, which included the obliteration of epidural space, the presence of adhesions in the dura and nerve roots, the restructuring of the yellow ligament, bone sclerosis, excessive appearance of fibrous tissue around the autologous intervertebral disk tissue that applied on the DM. Conclusion In our work, we describe a new experimental model, where the elements of autologous intervertebral disk play the role of inflammation trigger, which cause postoperative scar and EF. PMID:27647957

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

    PubMed

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

    2014-05-01

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

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

    PubMed

    Manias, Elizabeth; Bucknall, Tracey; Botti, Mari

    2005-03-01

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

  1. Experimental Model of Intervertebral Disk Mediated Postoperative Epidural Fibrosis

    PubMed Central

    Larionov, Sergey N.; Sorokovikov, V.A.; Erdyneyev, K.C.; Lepekhova, S.A.; Goldberg, O.A.

    2016-01-01

    Background Postoperative epidural fibrosis (EF) after lumbar discectomy is the most common and at the same time controversial issue. Purpose The etiology and pathogenesis creates a lot of discussion and selection of methods of treatment and prevention continues. Methods LIV laminectomy with dura mater (DM) exposition was done in 24 rats, and then, 0.3 ml of elements of suspension of autologous intervertebral disk was implicated on DM. As autologous intervertebral disk, we used the intervertebral disk from amputated tail. In all the animals, incisions were closed with 3/0 Vicryl. EF was examined. Fibroblast cell density was calculated in each field at ×40 magnification: Grade 1 - fewer than 100 fibroblasts in each field; Grade 2 - 100-150 fibroblasts in each field; Grade 3 - more than 150 fibroblasts in each field. Results Based on histological results, we confirmed our model of experiment. On the 30th day of evaluation, there were significant histological evidences of postoperative epidural adhesions in experimental animals, which included the obliteration of epidural space, the presence of adhesions in the dura and nerve roots, the restructuring of the yellow ligament, bone sclerosis, excessive appearance of fibrous tissue around the autologous intervertebral disk tissue that applied on the DM. Conclusion In our work, we describe a new experimental model, where the elements of autologous intervertebral disk play the role of inflammation trigger, which cause postoperative scar and EF.

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

    PubMed

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

    2016-09-01

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

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. Acute postoperative pain management: focus on iontophoretic transdermal fentanyl

    PubMed Central

    Mattia, Consalvo; Coluzzi, Flaminia

    2007-01-01

    Despite progress in the management of chronic pain, acute pain remains an issue for many postoperative patients. Although patient-controlled analgesia (PCA) has demonstrated efficacy and patient satisfaction, current techniques using intravenous (IV) administration present limitations, including the risk of programming errors and the potential to limit patient mobility due to pumps, lines, and tubing. The patient-controlled fentanyl hydrochloride (HCl) iontophoretic transdermal system (fentanyl ITS) was designed to address these concerns. Fentanyl ITS is an innovative, needle-free, self-contained drug-delivery system that uses iontophoretic technology to deliver fentanyl through the skin by application of a low-intensity electrical field. The results of several clinical studies are presented in this review. In three phase 3 placebo-controlled trials, fentanyl ITS was shown to be superior to placebo for the treatment of postoperative pain following major abdominal, orthopedic, and thoracic surgery. The results of one active-comparator phase 3 trial demonstrated comparable safety and efficacy with a standard morphine IV PCA dosing regimen, without significant difference in the side effect profile. Fentanyl ITS represents a safe, easy to use, non-invasive, and convenient alternative to current acute postoperative pain management modalities. PMID:18360612

  8. [Intestinal obstruction caused by postoperative adhesion. 79 cases].

    PubMed

    Dia, A; Fall, B; Thognon, P; Ndoye, A K; Sow, M L; Diop, A

    1991-12-01

    The intestinal post-operative bridle represents the third most important etiology of obstructions at the clinic of the University Hospital of Dakar, behind hernia strangulations and the volvulus of the digestive tube. Between 1970 and 1989, a retrospective study has led to a sample of 79 patients with post-operative bridle obstructions. The group was made of 47 women and 32 men between 17 and 84 years of age. Stomach ache was by far the most common functional symptomatology, followed by the stoppage of the transit and vomiting. In most cases palpation revealed the presence of tympanism. For almost all the patients, the abdomen without preparation revealed either a hydroaeric level or a diffuse grey area. The initial intervention concerned mainly gynecological affections or pathologies of appendicular type. The resection of the bridles was carried out in most cases. There were 10 deaths. The intestinal obstructions by post-operative bridles continue to be a surgical emergency still characterized by a high mortality rate. The late consultation of the patients, often received when presenting considerable visceral deficiency, is one of the main causes of the high rate of fatalities.

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

    PubMed Central

    Reddy B, Praveen

    2014-01-01

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

  10. Postoperative nosocomial infections among children with congenital heart disease

    PubMed Central

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

    2014-01-01

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

  11. Primary carcinoma of the gallbladder. Adjuvant postoperative external irradiation

    SciTech Connect

    Bosset, J.F.; Mantion, G.; Gillet, M.; Pelissier, E.; Boulenger, M.; Maingon, P.; Corbion, O.; Schraub, S. )

    1989-11-01

    Seven patients received the same postoperative (Postop) external-beam irradiation (NRT) after apparent complete removal of gallbladder carcinoma between August 1983 to February 1988. A dosage of 4600 cGy were delivered on a first volume (average treated volume 0.87 liters) corresponding to this of potentially locoregional disease, completed by a boost dose of 900 cGy on the gallbladder bed. Moderate acute side effects were seen in five patients; regressive dyspepsia in three and mean weight loss of 1.5 kg in three. The minimum follow-up is 5 months and the maximum is 58 months. Five patients are alive with no evidence of disease (NED) after 5, 9, 11, 31, and 58 months, respectively. One died at 12 months with local recurrence, liver metastasis, and peritoneal implants. Another one died at 26 months of abdominal recurrence. With regard to the natural history of this tumor, the dismal results obtained by surgery alone, and our preliminary data, we advocate Postop adjuvant XRT as a safe treatment.

  12. Postoperative nausea and vomiting: A simple yet complex problem

    PubMed Central

    Shaikh, Safiya Imtiaz; Nagarekha, D.; Hegade, Ganapati; Marutheesh, M.

    2016-01-01

    Postoperative nausea and vomiting (PONV) is one of the complex and significant problems in anesthesia practice, with growing trend toward ambulatory and day care surgeries. This review focuses on pathophysiology, pharmacological prophylaxis, and rescue therapy for PONV. We searched the Medline and PubMed database for articles published in English from 1991 to 2014 while writing this review using “postoperative nausea and vomiting, PONV, nausea-vomiting, PONV prophylaxis, and rescue” as keywords. PONV is influenced by multiple factors which are related to the patient, surgery, and pre-, intra-, and post-operative anesthesia factors. The risk of PONV can be assessed using a scoring system such as Apfel simplified scoring system which is based on four independent risk predictors. PONV prophylaxis is administered to patients with medium and high risks based on this scoring system. Newer drugs such as neurokinin-1 receptor antagonist (aprepitant) are used along with serotonin (5-hydroxytryptamine subtype 3) receptor antagonist, corticosteroids, anticholinergics, antihistaminics, and butyrophenones for PONV prophylaxis. Combination of drugs from different classes with different mechanism of action are administered for optimized efficacy in adults with moderate risk for PONV. Multimodal approach with combination of pharmacological and nonpharmacological prophylaxis along with interventions that reduce baseline risk is employed in patients with high PONV risk. PMID:27746521

  13. Effect of relaxation exercises on controlling postoperative pain.

    PubMed

    Topcu, Sacide Yildizeli; Findik, Ummu Yildiz

    2012-03-01

    This study examines the effect of relaxation exercises on controlling postoperative pain in patients who have undergone upper abdominal surgery. This is a cross-sectional and crossover study conducted on 60 patients who underwent upper abdominal surgery between October 2006 and June 2007, in the General Surgery Department, Health and Research Practice Center, Trakya University, Edirne, Turkey. We assessed the patients' pain levels before and after the relaxation exercises. Patients' personal information forms were used to collect data, and pain levels were determined using the verbal pain scale. We used the Wilcoxon T test, nonparametric Spearman correlation analysis, and nominal by interval eta analysis to assess the data, percentage, and frequency analyses. Pain levels were found to be reduced after the relaxation exercises compared with the levels before the relaxation exercises (z = -5.497; p < .001). Relaxation exercises, a nonpharmacologic method, are effective in reducing postoperative pain and should therefore be included in a regimen to control postoperative pain in patients who have undergone upper abdominal surgery.

  14. Hereditary vulnerabilities to post-operative cognitive dysfunction and dementia.

    PubMed

    Hogan, Kirk J

    2013-12-01

    In view of multiple prospective investigations reporting an incidence of 10% or greater in elderly patients after cardiac and non-cardiac procedures, it is surprising that no families, twins or even individual cases have been reported with persistent post-operative cognitive dysfunction (POCD) or post-operative dementia (POD) that is otherwise unexplained. As POCD and POD research has shifted in recent years from surgical and anesthetic variables to predictors of intrinsic, patient-specific susceptibility, a number of markers based on DNA sequence variation have been investigated. Nevertheless, no heritable, genomic indices of persistent POCD or post-operative dementia lasting 3 months or longer after surgery have been identified to date. The present manuscript surveys challenges confronting the search for markers of heritable vulnerability to POCD and POD, and proposes steps forward to be taken now, including the addition of surgical and anesthetic descriptors to ongoing longitudinal dementia protocols and randomized clinical trials (RCTs) comprising serial psychometric testing, and a fresh focus on phenotypes and genotypes shared between outliers with "extreme" POCD and POD traits.

  15. Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial - The PINOCCHIO trial

    PubMed Central

    2011-01-01

    Background Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient. We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. Methods/Design After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl. The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale) preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation. Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight) and to the preoperative score index

  16. Is immediate postoperative CA15.3 assay a predictive marker of early postoperative recurrence of carcinoma breast?

    PubMed

    Sarkar, Diptendra Kumar; Panda, Nilanjan; Biswas, Subikas; Saha, M L; Majumder, A

    2012-03-01

    Breast cancer is still an enigma. Systemic metastasis is an important prognostic factor. Tumour marker can predict occult systemic metastasis. To evaluate the immediate postoperative CA15.3 as predictor of early recurrence, a study was carried out in 48 patients of carcinoma breast in whom immediate postoperative marker level was done. In follow-up, recurrence was noted and relation with tumour size and stage done. Null hypothesis and 't' test were used for analysis. Relation of tumour size with marker is weak but strong relation exists between tumour stage with marker and recurrence with marker. CA15.3 predicts tumour load, can also predict occult residual/occult metastatic disease better than other prognostic markers which only predict tumour behaviour.

  17. Predicting postoperative visual outcomes in cataract patients with maculopathy

    PubMed Central

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

    2015-01-01

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

  18. Association between postoperative thromboembolism prophylaxis and complications following urological surgery

    PubMed Central

    CERRUTO, MARIA ANGELA; D'ELIA, CAROLINA; PICCOLI, MARCO; CACCIAMANI, GIOVANNI; DE MARCHI, DAVIDE; CORSI, PAOLO; DE MARCO, VINCENZO; CAVALLERI, STEFANO; ARTIBANI, WALTER

    2016-01-01

    Thromboembolism represents the most significant complication and cause of non-surgical mortality in major urological surgery. The aim of the present study was to assess the association between the type of pharmacological thromboembolism prophylaxis and the postoperative complication rate in a cohort of patients undergoing major urological surgery. All consecutive patients treated with major urological surgery between December 2011 and March 2013 were evaluated. For each patient, clinical and demographic data, as well as information on the post-surgical complications and the type of pharmacological thromboembolism prophylaxis, were collected. In total, 453 patients (mean age, 63.36±12.05 years) were recruited (43.5% for prostate surgery, 33.1% for renal surgery, 12.1% for bladder surgery and 11.3% for other surgery). Postoperative blood transfusions were required in 50 cases (11.0%). A total of 32 patients (7.1%) underwent re-intervention due to the occurrence of grade ≥3 complications, with a readmission rate of 2.0%. According to the Clavien-Dindo Classification, the complications were grade 1 in 36.0% of the cases, grade 2 in 19.4%, grade 3 in 6.0%, grade 4 in 2.0% and grade 5 (mortality) in 0.7%. Only 1 case of deep venous thrombosis not associated with pulmonary thromboembolism was observed. Univariate analyses showed a significant negative association (higher risk of complications) between the use of >4,000 IU enoxaparin as the thromboembolism prophylaxis and postoperative blood transfusion rate (P=0.045), re-intervention rate (P=0.001) and the occurrence of grade ≥3 complications (P<0.001). Multivariate analysis confirmed the significant association between the use of >4,000 IU enoxaparin and both re-intervention rate (P=0.013) and occurrence of grade ≥3 complications (P=0.002). High doses of enoxaparin (>4,000 IU) may lead to an increased risk of re-intervention and severe postoperative complications following major urological surgery. Randomised

  19. Incidence of postoperative epilepsy in children following subfrontal craniotomy for tumor.

    PubMed

    Wang, E C; Geyer, J R; Berger, M S

    1994-01-01

    Thirty-one children who underwent 36 subfrontal craniotomies were retrospectively studied to determine the incidence of postoperative epilepsy and the effectiveness of antiepileptic drugs for seizure prophylaxis. The incidence of postoperative epilepsy following a subfrontal craniotomy did not exceed 12% when examined at various time periods during a 3-year postoperative course. Antiepileptic drugs were not warranted to reduce the incidence of postoperative seizures after the 1-month postoperative period and should not be used for long-term prophylactic therapy in children following a subfrontal craniotomy. PMID:7803305

  20. Elektronenröhrenforschung nach 1945 Telefunkenforscher in Ost und West und das Scheitern des Konzepts der „Gnom-Röhren“ in Erfurt

    NASA Astrophysics Data System (ADS)

    Dörfel, Günter; Tobies, Renate

    Elektronenröhren standen wegen ihrer Rüstungsrelevanz nach Kriegsende unter dem Vorbehalt der Besatzungsmächte. Unter dem Druck eigener materieller Defizite erlaubte und initiierte die sowjetische Besatzungsmacht Entwicklungen dazu eher als die westlichen Alliierten. Daraus resultierten bemerkenswerte Innovationen und Vorsprünge im Gebiet von Miniaturröhren.

  1. Postoperative nausea and vomiting. A retrospective analysis in patients undergoing elective craniotomy.

    PubMed

    Fabling, J M; Gan, T J; Guy, J; Borel, C O; el-Moalem, H E; Warner, D S

    1997-10-01

    Nausea and vomiting are important complications after craniotomy, for which there are little published epidemiologic data. We retrospectively examined the incidence of postcraniotomy nausea and vomiting to define risk factors. Medical records from 199 adults undergoing elective craniotomy were identified. Data extracted from surgery and the initial 48 hours postoperatively included gender, age, supratentorial versus infratentorial craniotomy, type of anesthesia (general versus monitored anesthesia care), intraoperative fentanyl dose, duration of anesthesia, antiemetic administration intraoperatively and postoperatively, and incidence of postoperative nausea, emesis, and opioid use. Postoperative nausea was recorded in 99 patients (50%) and emesis in 78 patients (39%). Postoperative opioids were administered to 170 patients (85%). Antiemetics were given intraoperatively to 13 patients (7%) and postoperatively to 121 patients (61%). More women (61%) than men (37%) had nausea (P = 0.001); emesis (women = 46%; men = 31%, P = 0.03); and postoperative antiemetic use (women = 69%; men = 51%, P = 0.013). The incidence of postoperative nausea (P = 0.04) and vomiting (P = 0.06) was greater in patients having infratentorial surgery. Emesis was more frequent in younger patients (P = 0.03). Postoperative nausea and vomiting were independent of anesthetic duration, fentanyl dose, or postoperative opioid use and occurred with similar frequency after general anesthesia or monitored anesthesia care. We conclude that postoperative nausea and vomiting occur frequently after craniotomy. Infratentorial surgery, female gender, and younger age are significant risk factors for this complication. PMID:9339401

  2. Pre and post-operative treatments for prevention of atrial fibrillation after cardiac surgery.

    PubMed

    Orenes-Piñero, Esteban; Montoro-García, Silvia; Banerjee, Amitava; Valdés, Mariano; Lip, Gregory Y H; Marín, Francisco

    2012-11-01

    Post-operative atrial fibrillation (AF) occurs in up to 40% of cardiac surgery patients and represents the most common post-operative arrhythmic complication. Post-operative AF is associated with impaired cardiac hemodynamics, increased incidence of serious complications (e.g. heart failure, stroke), prolonged hospitalization and increased healthcare costs. Therefore, treatment of post-operative AF would decrease health-care costs during hospitalization and improve the prognosis of patients following cardiovascular surgery. Current consensus guidelines recommend β-blockers, amiodarone and sotalol for post-operative AF prophylaxis. However, new pharmacological agents have been associated with a reduction in post-operative AF frequency, including inhibition of the renin angiotensin aldosterone system (RAAS) using angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), statins, antioxidant agents, magnesium supplementation and antiarrhythmic drugs. The aim of this review is to analyse and determine the efficiency of existing therapies in the reduction of post-operative AF development.

  3. Comparison of Intraoperative C-Arm Fluoroscopy to Postoperative Radiographs in Operative Fracture Fixation.

    PubMed

    Horst, Taylor A; Mooney, James F; Hooker, Jennifer A; Barfield, William R; Glaser, John A

    2015-01-01

    The purpose of this study is to evaluate the differences between intraoperative C-arm images and postoperative plain film radiographs and the utility of each in assessing fracture fixation and determining postoperative management. Intraoperative and postoperative images with varying fracture types and locations were analyzed. C-arm images were compared to postoperative plain film radiographs for each treated fracture and reviewed by two orthopaedic surgeons. Image adequacy and quality for each radiograph were analyzed. The quality of reduction and fixation was also analyzed. Information was apparent on the postoperative radiographs, such that a reviewer felt that the postoperative treatment plan should change in 8.2% of cases. In the cases where treatment change was recommended, fracture gap, rotation, and angulation were found to be the strongest predictors. The ability of intraoperative and postoperative images to reflect fracture gap, rotation, and angulation may vary between images.

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

    PubMed

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

    2016-08-01

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

  5. Rückwärtsintegration - Zu den Verhältnissen Gymnasium, Hochschule und Arbeitswelt

    NASA Astrophysics Data System (ADS)

    Schmid, Gerhard; Heppner, Winfried; Focht, Eva

    In seiner 2007 erschienen Sammlung von Vorträgen und Essays beschäftigt sich Wolfgang Frühwald, mit der Frage "Wieviel Wissen brauchen wir?“ [1] Die Kernproblematik moderner Wissenschaft und Forschung sieht der Autor, emeritierter Ordinarius für Neuere Deutsche Literaturwissenschaft und von 1992 bis 1997 Präsident der Deutschen Forschungsgemeinschaft, einerseits in der zunehmenden Spezialisierung der Wissenschaftsbereiche, andererseits in der Gefahr der Abkoppelung der Naturwissenschaften von den Geisteswissenschaften. Wiederholt plädiert er dafür, über der rasanten Entwicklung beispielsweise in der Biologie und Physik, die historische, gesellschaftliche und besonders die ethische Dimension der Forschung nicht zu übersehen und fordert eine übergeordnete Theorie der Wissenschaft, die nur im Dialog zwischen den einzelnen Fachgebieten zu entwickeln sei.

  6. Post-operative rehabilitation and nutrition in osteoarthritis

    PubMed Central

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

    2016-01-01

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

  7. Magnesium and Ketamine Gargle and Postoperative Sore Throat

    PubMed Central

    Teymourian, Houman; Mohajerani, Seyed Amir; Farahbod, Alireza

    2015-01-01

    Background: Postoperative sore throat is one of the most common complications after endotracheal intubation. Both Ketamine and magnesium can block N-methyl-D-aspartic acid (NMDA) receptors and provide central and local analgesia. Objectives: To compare the effect of magnesium sulfate and ketamine gargle on the incidence and severity of postoperative sore throat. Patients and Methods: A total of 100 patients candidate for emergency acute appendicitis surgery were enrolled in the study. Patients in ketamine group received ketamine gargle (0.5 mg/kg) and magnesium group received magnesium sulfate gargle (20 mg/kg up to 30 mL dextrose water 20%) 15 minutes before the operation. Patient complaint of postoperative sore throat, and its severity measured by visual analogue scale (VAS) were recorded at baseline in recovery room, and then 2, 4, and 24 hours after operation. Results: There were no significant differences between age, sex, and body mass index (BMI) between two groups of patients. Hemodynamics of patients, including blood pressure, respiratory rate, oxygen saturation %, and conscious state were not significantly different (P > 0.05). Number of patients with sore throat were significantly lower in magnesium group compared to ketamine group at 2 (P = 0.032), 4 (P = 0.02), and 24 hours (P = 0.01) after the operation. Sore throat pain score (VAS) was significantly lower in magnesium group compared to ketamine group at 2 (P = 0.019), 4 (P = 0.028), and 24 hours (P = 0.014) after the operation. Conclusions: Magnesium at low dose decreases sore throat and pain severity more effectively compared to ketamine gargle. PMID:26161316

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

    PubMed

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

    2016-08-01

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

  9. Postoperative wound infections after a proctectomy—Patient experiences

    PubMed Central

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

    2016-01-01

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

  10. Hepatic resection is associated with reduced postoperative opioid requirement

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  12. Corpus callosum involvement and postoperative outcomes of patients with gliomas.

    PubMed

    Chen, Ko-Ting; Wu, Tai-Wei Erich; Chuang, Chi-Cheng; Hsu, Yung-Hsin; Hsu, Peng-Wei; Huang, Yin-Cheng; Lin, Tzu-Kang; Chang, Chen-Nen; Lee, Shih-Tseng; Wu, Chieh-Tsai; Tseng, Chen-Kan; Wang, Chun-Chieh; Pai, Ping-Ching; Wei, Kuo-Chen; Chen, Pin-Yuan

    2015-09-01

    Corpus callosum involvement is associated with poorer survival in high grade glioma (HGG), but the prognostic value in low grade glioma (LGG) is unclear. To determine the prognostic impact of corpus callosum involvement on progression free survival (PFS) and overall survival (OS) in HGG and LGG, the records of 233 glioma patients treated from 2008 to 2011 were retrospectively reviewed. Preoperative magnetic resonance (MR) images were used to identify corpus callosum involvement. Age, sex, preoperative Karnofsky performance scale, postoperative Eastern Cooperative Oncology Group (ECOG) score and extent of resection (EOR) were evaluated with respect to PFS and OS. The incidence of corpus callosum involvement was similar among HGG (14 %) and LGG (14.5 %). Univariate analysis revealed that PFS and OS were significantly shorter in both WHO grade II and grade IV glioma with corpus callosum involvement (both, p < 0.05). Multivariate analysis showed that grade II glioma with corpus callosum involvement have shorter PFS (p = 0.03), while EOR, instead of corpus callosum involvement (p = 0.16), was an independent factor associated with PFS in grade IV glioma (p < 0.05). Corpus callosum involvement was no longer significantly associated with OS after adjusting age, gender, EOR, preoperative and postoperative performance status (p = 0.16, 0.17 and 0.56 in grade II, III and IV gliomas, respectively). Corpus callosum involvement happened in both LGG and HGG, and is associated with lower EOR and higher postoperative ECOG score both in LGG and HGG. Corpus callosum involvement tends to be an independent prognostic factor for PFS in LGG, but not for OS in LGG or in HGG.

  13. Quality of postoperative pain management in American versus European institutions.

    PubMed

    Chapman, C Richard; Stevens, Duncan A; Lipman, Arthur G

    2013-12-01

    Management of postoperative pain remains an important clinical problem throughout the world. Using the PAIN-OUT acute pain registry database to examine perioperative pain management in orthopedic surgery patients, we compared patient-reported outcomes (PROs) in a pooled sample obtained from four American hospitals (N = 473) with PROs in a pooled sample of 20 European institutions (N = 8799). Most American hospitals consistently assess acute pain in surgical patients due to Joint Commission accreditation guidelines. Therefore, we hypothesized that this practice would create a climate of clinical staff sensitivity to patients' pain and a greater readiness to intervene when pain is higher than one would find in Europe as a whole. American institutions might then provide better control of postoperative pain after orthopedic surgery than European institutions. Because of the large sample sizes, our analyses focused on effect size rather than statistical significance. Evaluation of the pain PROs revealed that European patients reported much lower Worst Pain on the first day after orthopedic surgery than American patients. The mean Worst Pain (± SD) for Europeans was 5.4 (2.5) but for Americans the mean was 7.4 (2.7), p < .0001, a large effect size. Europeans also reported significantly less emotional discomfort, less interference of pain with activity and lower Least Pain. Nonetheless, 98.3% of American patients received opioids on the ward on the first postoperative day compared to 70.2% of European patients, and 41.1% received regional analgesia on the ward while 15.9% of European patients received regional analgesia (both small effect sizes). Overall, the results are clear in demonstrating much better pain control in the ensemble of European countries as compared to the United States. PMID:24143928

  14. Post-operative rehabilitation and nutrition in osteoarthritis.

    PubMed

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

    2014-01-01

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

  15. Hepatic resection is associated with reduced postoperative opioid requirement

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  17. Idea on prevention from postoperative intraorbital hematoma in orbital surgery.

    PubMed

    Lee, D G

    2014-01-01

    The retrobulbar hematoma is a rare complication after orbital surgery. Despite of its rareness, the retrobulbar hematoma may be disastrous to the patient's vision (Chen et al. in J Craniofac Surg 20:963--967, 2009). Since 2007, I have applied the combined use of a scalp vein set and a vacuumed blood sampling bottle in all of the orbital surgeries. In my study, I achieved a good result, and I will introduce this simple method as one of alternatives for the prevention from the postoperative intraorbital hematoma including the retrobulbar hematoma. PMID:24533408

  18. [Pre- and postoperative complaints in women with total hysterectomy].

    PubMed

    Rha, J G; Lee, J H

    1973-01-01

    A study was conducted at St. Mary's Hospital in Seoul, Korea, to determine levels of complaints before and after total hysterectomy. 113 women who underwent the operation from January 1968 to June 1972 were questioned as to medical, mental, and sexual complaints both pre- and postoperative. The total number of complaints decreased from 35.2% before to 30.2% after the operation. Each category of complaint decreased following the operation. Pelvic inflammatory disease and myom ata complaint rates decreased significantly. High rates of depression were common following the operation. PMID:12307215

  19. [Introduction on postoperative nutritional support in neonatal cardiac surgery].

    PubMed

    Oeschger, Vanesa Verónica; Mazza, Carmen Silvia; Araujo, María Beatriz; Sauré, Carola

    2014-10-01

    Malnutrition is common in newborn patients after cardiac surgery, because of the low metabolic reserves, increased energy expenditure caused by the injury, and reduced or delayed nutritional support they receive, as well as their inability to metabolize the nutrients administered. It is important to achieve appropriate nutrition; a better metabolic response after surgery has a significant impact on length of stay, wound healing, susceptibility to infections and surgical outcome. This guideline intended to establish the practical foundation for parenteral and enteral nutritional support in the newborn with cardiac surgery, considering water restriction, optimizing macro and micronutrients required in the postoperative time.

  20. Management strategies to reduce risk of postoperative infections

    PubMed Central

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

    2013-01-01

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

  1. Single dose oral flurbiprofen for acute postoperative pain in adults

    PubMed Central

    Sultan, Asquad; McQuay, Henry J; Moore, R Andrew; Derry, Sheena

    2014-01-01

    Background Flurbiprofen is a non-selective non-steroidal anti-inflammatory drug (NSAID), related to ibuprofen and naproxen, used to treat acute and chronic painful conditions. There is no systematic review of its use in acute postoperative pain. Objectives To assess efficacy, duration of action, and associated adverse events of single dose oral flurbiprofen in acute postoperative pain in adults. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to January 2009. Selection criteria Randomised, double blind, placebo-controlled trials of single dose orally administered flurbiprofen in adults with moderate to severe acute postoperative pain. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Pain relief or pain intensity data were extracted and converted into the dichotomous outcome of number of participants with at least 50% pain relief over 4 to 6 hours, from which relative risk (RR) and number needed to treat to benefit (NNT) were calculated. Numbers of participants using rescue medication over specified time periods, and time to use of rescue medication, were sought as additional measures of efficacy. Information on adverse events and withdrawals were collected. Main results Eleven studies compared flurbiprofen (699 participants) with placebo (362 participants) in studies lasting 6 to 12 hours. Studies were of adequate reporting quality, and most participants had pain following dental extractions. The dose of flurbiprofen used was 25 mg to 100 mg, with most information for 50 mg and 100 mg. The NNT for at least 50% pain relief over 4 to 6 hours for flurbiprofen 50 mg compared with placebo (692 participants) was 2.7 (2.3 to 3.3) and for 100 mg (416 participants) it was 2.5 (2.0 to 3.1). With flurbiprofen 50 mg and 100 mg 65% to 70% of participants experienced at least 50% pain relief, compared with 25% to 30% with placebo. Rescue medication was used by 25

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

    PubMed Central

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

    2016-01-01

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

  3. [Postoperative opacification of posterior chamber intraocular lenses - a review].

    PubMed

    Schmidbauer, J M; Werner, L; Apple, D J; Pandey, S K; Izak, A M; Trivedi, R H; Macky, T A; Auffarth, G U; Peng, Q; Arthur, S N; Escobar-Gomez, M; Ma, L; Vargas, L G

    2001-09-01

    Postoperative opacification of intraocular lenses (IOLs) is a very unpleasant complication for the ophthalmic surgeon and the patient. We report on our experiences with opacification of different foldable IOL designs and rigid poly (methyl methacrylate) (PMMA) posterior chamber lenses.1. Snowflake degeneration of PMMA IOLs: This condition is an unanticipated and surprising late postoperative finding 8 to 15 years after implantation. In our opinion, this complication is probably not related to the PMMA biomaterial itself, but rather it appears to represent a manufacturing problem that has affected a selected, albeit large number of lenses manufactured in the 1980s-mid 1990s.2. Degeneration of UV absorber material and calcium deposits within the optic of hydrophilic IOLs: Two years postoperatively degenerations of UV absorber material and calcium deposits within the optic of single piece hydrophilic acrylic lenses SC60B-OUV manufactured by MDR (Medical developmental research Inc. Clearwater FL, USA) can occur. Although the precise mechanism is not fully known, it was assumed that these opacifications are due to premature aging of the UV blocking agent incorporated in the lens biomaterial and calcification.3. Calcification on the surface of the Bausch & Lomb Hydroviewtrade mark IOLs: Twelve to 15 months postoperatively granular surface calcifications in Hydroviewtrade mark IOLs occured. The mechanism is not fully understood. According to Bausch and Lomb studies, part of the components of the packaging contained silicone, which may have come off the packaging onto the lens optic, where it then appears to be a catalyst for calcium precipitation. The manufacturer has correlated a change in packaging with the appearance of the opacification. The manufacturer now believes that this problem has been solved. However, final verification will require a careful 1 - 2 years clinical study.4. Glistenings in the hydrophobic acrylic AcrySoftrade mark IOLs: The time frame of

  4. Percutaneous endoscopic gastrostomy for postoperative rehabilitation after maxillofacial tumor surgery.

    PubMed

    Koehler, J; Buhl, K

    1991-02-01

    Despite the progress made in tumor and reconstructive surgery of the maxillofacial region, postoperative problems, such as malnutrition and dysfunction of the oral-oesophageal tract are still encountered. Nutrition via a nasogastric tube often complicates the rehabilitation process of these patients. Percutaneous endoscopic gastronomy (PEG), as opposed to nasogastral feeding, is presented. The technique, possible long-term complications, and the easy usage of the mechanical pump system, are presented. In our study of 40 patients, PEG, objectively, proved useful for functional, esthetic, practical, economical, and psychological reasons.

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

    PubMed

    Tevis, Sarah E; Kennedy, Gregory D

    2016-09-01

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

  6. The Evaluation of Postoperative Patients with Ulcerative Colitis.

    PubMed

    Shen, Bo

    2016-10-01

    Restorative proctocolectomy with ileal pouch-anal anastomosis has become the standard surgical treatment modality for patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Normally staged pouch surgery is performed. Endoscopy plays an important role in postoperative monitoring of disease status and delivery of therapy, if necessary. Therefore, ileal pouch surgery significantly alters bowel anatomy, with new organ structures being created. Endoscopy of the altered bowel includes the evaluation of end ileostomy, Hartmann pouch or diverted rectum, loop ileostomy, diverted pouch, and pouchoscopy. Each segment of the bowel has unique landmarks. PMID:27633595

  7. Observing posterior capsule lens haptics in living postoperative eyes.

    PubMed

    Miyake, K

    1984-08-01

    The cycloscope, an aid for observing the ciliary body, was used to study lens haptic fixation in 100 living eyes (200 haptics). Although the whole aspect of the lens could be viewed in only about 20 haptics (10%), in 102 haptics (51%), judgment about whether fixation was in or out of the bag could be made based on the relationship of the visible part of the lens haptic and the surrounding tissues. Thus, the method was found to be useful in studying the fixation mechanism of posterior chamber lens haptics in living postoperative eyes. Two cases of J-loop posterior chamber lens implantation studied by cycloscopy are reported.

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

    PubMed Central

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

    2016-01-01

    Background Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on the same side of a brain lesion. Case report We describe a rare case of postoperative ipsilateral hemiballism in a patient who underwent pituitary adenoma resection and experienced a right internal cerebral artery territory infarct. We review the literature on hemichorea hemiballismus (HCHB) and explore various mechanisms for its occurrence. Discussion Only three cases of ipsilateral hemiballism have been described, and the exact pathophysiology remains unknown. A dominant left hemisphere with corpus callosal connections to the right basal ganglia is the most probable explanation for this unusual event. PMID:27127720

  9. [Correction of arterial hypoxemia during early postoperative period].

    PubMed

    Levité, E M; Bobrinskaia, I G; Uklonskiĭ, A N

    2003-01-01

    The article is dedicated to investigating the reasons of development of hypoxemia during the early postoperative period when the patient is switched to an unassisted air breathing. It was established that hypoxemia develops, after abdominal operations with a multi-component total anesthesia, in 68% of patients, although there is a recovery of adequate ventilation of the lungs, and it is related with an insufficient anesthesia, which results in an increased volume of expiratory closure. Epidural anesthesia prevents an increase in the closure volume and development of hypoxemia.

  10. Treatment of postoperative sciatic nerve palsy after total hip arthroplasty for postoperative acetabular fracture: A case report.

    PubMed

    Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko; Morohashi, Itaru

    2016-11-01

    Acetabular fracture is usually treated with osteosynthesis. However, in the case of an intra-articular fracture, osteosynthesis can result in arthropathy of the hip joint and poor long-term results, hence, total hip arthroplasty is required. However, in total hip arthroplasty for postoperative acetabular fracture, sciatic nerve palsy tends to develop more commonly than after primary total hip arthroplasty. This is a case report of a 57-year-old Japanese male who had internal skeletal fixation for a left acetabular fracture that had occurred 2 years earlier. One year later, he developed coxarthrosis and severe pain of the hip joint and total hip arthroplasty was performed. After the second surgery, he experienced pain along the distribution of the sciatic nerve and weakness of the muscles innervated by the peroneal nerve, indicating sciatic nerve palsy. We performed a third operation, and divided adhesions around the sciatic nerve. Postoperatively, the anterior hip joint pain and the buttocks pain when the hip was flexed were improved. Abduction of the fifth toe was also improved. However, the footdrop and sensory disturbance were not improved. A year after the third operation, sensory disturbance was slightly improved but the footdrop was not improved. We believe the sciatic nerve palsy developed when we dislocated the hip joint as the sciatic nerve was excessively extended as the hip joint flexed and internally rotated. Sciatic nerve adhesion can occur easily in total hip replacement for postoperative acetabular fracture; hence, adhesiotomy should be conducted before performing hip dislocation to prevent injury caused by nerve tension. The patient agreed that the details of this case could be submitted for publication. The work has been reported in line with the CARE criteria and cite. PMID:27672438

  11. Population Pharmacokinetics of Vancomycin in Postoperative Neurosurgical Patients.

    PubMed

    Li, Xingang; Wu, Yuanxing; Sun, Shusen; Mei, Shenghui; Wang, Jiaqing; Wang, Qiang; Zhao, Zhigang

    2015-11-01

    Neurosurgical procedures may damage the blood-brain barrier to allow more vancomycin distribution into the cerebrospinal fluid (CSF) from blood after intravenous administration. However, a large intersubject variability in CSF vancomycin concentration was observed. We aimed to develop a population pharmacokinetic model to guide vancomycin dosing in patients after neurosurgical operation. Blood and CSF samples were collected and determined from postoperative neurosurgical patients after vancomycin administration. A three-compartment (central, peripheral, and CSF) model was proposed to characterize the pharmacokinetics of vancomycin. A nonlinear mixed-effects modeling approach was applied to fit the blood and CSF data simultaneously. The covariate analysis found that the CSF albumin level was strongly associated with the clearance between central and CSF compartment. Visual predictive check indicated that the proposed population pharmacokinetic model agrees well with the observed vancomycin concentrations. Individualized vancomycin dosage regimens could be developed for postoperative neurosurgical patients with different CSF albumin levels through model simulations. The CSF albumin level is a determinant of CSF vancomycin concentration.

  12. The importance of communication in the management of postoperative pain.

    PubMed

    Sugai, Daniel Y; Deptula, Peter L; Parsa, Alan A; Don Parsa, Fereydoun

    2013-06-01

    This study investigates the importance of communication in surgery and how delivering preoperative patient education can lead to better health outcomes postoperatively, via promoting tolerable pain scores and minimizing the use of narcotics after surgery. Patients who underwent outpatient surgery were randomly divided into groups to compare the pain scores of those who received preoperative patient education, the experimental group, and those who did not receive any form of patient education, the control group. Two weeks before surgery, the experimental group subjects received oral and written forms of patient education consisting of how the body responds to pain, and how endorphins cause natural analgesia. Moreover, patients were educated on the negative effects narcotics have on endorphin production and activity, as well as mechanisms of non-opioid analgesics. Of the 69 patients in the experimental group, 90% declined a prescription for hydrocodone after receiving preoperative education two weeks prior to surgery. The control group consisted of 66 patients who did not receive preoperative patient education and 100% filled their hydrocodone prescriptions. Patients in both groups were offered and received gabapentin and celecoxib preoperatively for prophylaxis of postoperative pain unless they declined. The control groups were found to have average pain scores significantly greater (P <.05) than the experimental groups and also a significantly longer (P <.005) duration of pain. This study illustrates the power of patient education via oral, written and visual communication, which can serve as an effective means to minimize narcotic analgesia after surgery. PMID:23795326

  13. Outcome of postoperative intratumoral bleomycin injection for cystic craniopharyngioma.

    PubMed Central

    Park, Dong Hyuk; Park, Jung Yul; Kim, Joo Han; Chung, Yong Gu; Lee, Hoon Kap; Lee, Ki Chan; Suh, Jung Keun

    2002-01-01

    Total excision is a treatment of choice in preventing the relapse of craniopharyngioma, but for tumors involving an extensive area, it is often associated with an increased risk of complications. We have performed a partial or subtotal tumor removal followed by repeated injection of bleomycin into the remaining tumor through a subcutaneous reservoir as postoperative adjuvant therapy. A retrospective review of clinical, radiological, and surgical data was performed for 10 patients (5 males and 5 females; age, 3-65 yr; follow-up duration, 12-79 months) with cystic craniopharyngiomas. The measurements of lactate dehydrogenase (LDH) level at each aspiration were performed. The shrinkage and/or stabilization of tumor was initially noted in all cases. The recurrence of tumor was seen in 4 cases (40%). The decreased or increased level of LDH was interpreted as tumor shrinkage or recurrence, respectively. The transient toxic reactions were observed in 3 patients (30%). Our study demonstrates that postoperative bleo-mycin injection for cystic craniopharyngioma, although does not appear to eradicate the tumor, decreases and stabilizes the tumor size, when used as an adjuvant therapy in young patients. PMID:11961313

  14. [Prevention and control of postoperative anastomotic leak after colorectal anastomosis].

    PubMed

    Zheng, Peng; Xu, Jianmin

    2016-04-01

    Anastomotic leak is a major complication after colorectal resection. Risk factors for anastomotic leak include patient and disease related factors, preoperative factors(e.g. use of neoadjuvant chemoradiation and mechanical bowel preparation), intraoperative factors(e.g. anastomotic techniques, performing of water injection test, preventive colostomy, and surgical procedures, etc; postoperative factors, such as postoperative medication use, etc. Early diagnosis of anastomotic fistula is crucial, which can be made by combining laboratory examination with imaging examination or take the prediction and diagnosis model as reference. Once diagnosed, anastomotic leak should be managed immediately according to individual status and severity of disease. As for intraperitoneal anastomosis, no matter whether the bowel lack of blood supply or not, original anastomosis should be removed and terminal loop ileumstomy should be created. As for extraperitoneal anastomosis(mainly low rectal anastomosis), adequate drainage and terminal loop ileumstomy can be considered when anastomosis is slightly cracked or invisible due to adhesion. When anastomosis is severely cracked or blood supply is too limited, however, we must disconnect the original anastomotic and create a proximal colostomy.

  15. Battery of behavioral tests in mice to study postoperative delirium

    PubMed Central

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R.; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  16. Key to Prevention of Bradycardia: Be Relax Postoperatively

    PubMed Central

    Chowdhury, Tumul; Schaller, Bernhard

    2016-01-01

    Abstract Hypotension and bradycardia are commonly observed after the spinal anesthesia and various mechanisms have been postulated for these hemodynamic changes. A middle-aged otherwise healthy male Caucasian patient developed several episodes of bradycardia postoperatively after the umbilical hernia repair under subarachnoid block (SAB) while trying to lean forward and move his legs. Episodes were aborted when patient was advised to relax in supine position. The common mechanism of bradycardia and hypotension under SAB is postulated as sympathetic blockade, decrease venous return, and parasympathetic over-dominance leading to a decrease in right arterial pressure and pressure in the great veins as they enter the right atrium. But over time, the parasympathetic inhibition is usually withdrawn first, leading to the risk of severe bradycardia that is probably favored by the reverse Trendelenburg position as described in our case. Postoperative severe hemodynamic changes can occur even under stable spinal anesthesia; however, can be prevented by vigilant monitoring and simple maneuver which includes maintenance of relax posture on the bed. PMID:27258501

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

    PubMed

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

    1992-10-01

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

  18. The effects of early postoperative radiation on vascularized bone grafts

    SciTech Connect

    Evans, H.B.; Brown, S.; Hurst, L.N. )

    1991-06-01

    The effects of early postoperative radiation were assessed in free nonvascularized and free vascularized rib grafts in the canine model. The mandibles of one-half of the dogs were exposed to a cobalt 60 radiation dose of 4080 cGy over a 4-week period, starting 2 weeks postoperatively. The patency of vascularized grafts was confirmed with bone scintigraphy. Histological studies, including ultraviolet microscopy with trifluorochrome labeling, and histomorphometric analyses were performed. Osteocytes persist within the cortex of the vascularized nonradiated grafts to a much greater extent than in nonvascularized, nonradiated grafts. Cortical osteocytes do not persist in either vascularized or nonvascularized grafts subjected to radiation. New bone formation is significantly retarded in radiated grafts compared with nonradiated grafts. Periosteum and endosteum remained viable in the radiated vascularized grafts, producing both bone union and increased bone turnover, neither of which were evident to any significant extent in nonvascularized grafts. Bone union was achieved in vascularized and non-vascularized nonradiated bone. In the radiated group of dogs, union was only seen in the vascularized bone grafts.

  19. Managing the stiff elbow: operative, nonoperative, and postoperative techniques.

    PubMed

    Dávila, Sylvia A; Johnston-Jones, Karen

    2006-01-01

    Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture. PMID:16713873

  20. Battery of behavioral tests in mice to study postoperative delirium.

    PubMed

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  1. Convergent Validity of Three Methods for Measuring Postoperative Complications

    PubMed Central

    Fritz, Bradley A.; Escallier, Krisztina E.; Abdallah, Arbi Ben; Oberhaus, Jordan; Becker, Jennifer; Geczi, Kristin; McKinnon, Sherry; Helsten, Dan L.; Sharma, Anshuman; Wildes, Troy S.; Avidan, Michael S.

    2016-01-01

    Background Anesthesiologists need tools to accurately track postoperative outcomes. The accuracy of patient report in identifying a wide variety of postoperative complications after diverse surgical procedures has not previously been investigated. Methods In this cohort study, 1,578 adult surgical patients completed a survey at least 30 days after their procedure asking if they had experienced any of 18 complications while in the hospital after surgery. Patient responses were compared to the results of an automated electronic chart review and (for a random subset of 750 patients) to a manual chart review. Results from automated chart review were also compared to those from manual chart review. Forty-two randomly selected patients were contacted by telephone to explore reasons for discrepancies between patient report and manual chart review. Results Comparisons between patient report, automated chart review, and manual chart review demonstrated poor-to-moderate positive agreement (range, 0 to 58%) and excellent negative agreement (range, 82 to 100%). Discordance between patient report and manual chart review was frequently explicable by patients reporting events that happened outside the time period of interest. Conclusions Patient report can provide information about subjective experiences or events that happen after hospital discharge, but often yields different results from chart review for specific in-hospital complications. Effective in-hospital communication with patients and thoughtful survey design may increase the quality of patient-reported complication data. PMID:27028469

  2. Single dose oral paracetamol (acetaminophen) for postoperative pain in adults

    PubMed Central

    Toms, Laurence; McQuay, Henry J; Derry, Sheena; Moore, R Andrew

    2014-01-01

    Background This is an updated version of the original Cochrane review published in Issue 1, 2004 - this original review had been split from a previous title on ‘Single dose paracetamol (acetaminophen) with and without codeine for postoperative pain’. The last version of this review concluded that paracetamol is an effective analgesic for postoperative pain, but additional trials have since been published. This review sought to evaluate the efficacy and safety of paracetamol using current data, and to compare the findings with other analgesics evaluated in the same way. Objectives To assess the efficacy of single dose oral paracetamol for the treatment of acute postoperative pain. Search methods We searched The Cochrane Library, MEDLINE, EMBASE, the Oxford Pain Relief Database and reference lists of articles to update an existing version of the review in July 2008. Selection criteria Randomised, double-blind, placebo-controlled clinical trials of paracetamol for acute postoperative pain in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Area under the “pain relief versus time” curve was used to derive the proportion of participants with paracetamol or placebo experiencing at least 50% pain relief over four to six hours, using validated equations. Number-needed-to-treat-to-benefit (NNT) was calculated, with 95% confidence intervals (CI). The proportion of participants using rescue analgesia over a specified time period, and time to use, were sought as measures of duration of analgesia. Information on adverse events and withdrawals was also collected. Main results Fifty-one studies, with 5762 participants, were included: 3277 participants were treated with a single oral dose of paracetamol and 2425 with placebo. About half of participants treated with paracetamol at standard doses achieved at least 50% pain relief over four to six hours, compared with about 20% treated with placebo. NNTs for at

  3. Effect of both preoperative andpostoperative cryoceutical treatment on hemostasis and postoperative pain following total knee arthroplasty

    PubMed Central

    Desteli, Engin Eren; Imren, Yunus; Aydın, Nuri

    2015-01-01

    Aim: We aimed to evaluate the hemostatic effects and the clinical outcomes of preoperative and postoperative cryoceutical treatment (C-tx) following total knee arthroplasty. Patients and method: 42 patients received C-tx both preoperatively, and postoperatively. In the control group, 45 patients did not receive any C-tx. Amount of bloody drainage and verbal rating pain scores were noted. Results: We found significant difference in both the preoperative and postoperative hemoglobin levels and blood drainage (P<0.001). However, there was no significant difference in the average verbally rated pain scores (P>0.05). Conclusion: C-tx performed preoperatively and postoperatively for total knee arthroplasty is effective in decreasing perioperative and postoperative hemorrhage. However, it had no superior effect on the control of postoperative pain. PMID:26770547

  4. Predictive images of postoperative levator resection outcome using image processing software

    PubMed Central

    Mawatari, Yuki; Fukushima, Mikiko

    2016-01-01

    Purpose This study aims to evaluate the efficacy of processed images to predict postoperative appearance following levator resection. Methods Analysis involved 109 eyes from 65 patients with blepharoptosis who underwent advancement of levator aponeurosis and Müller’s muscle complex (levator resection). Predictive images were prepared from preoperative photographs using the image processing software (Adobe Photoshop®). Images of selected eyes were digitally enlarged in an appropriate manner and shown to patients prior to surgery. Results Approximately 1 month postoperatively, we surveyed our patients using questionnaires. Fifty-six patients (89.2%) were satisfied with their postoperative appearances, and 55 patients (84.8%) positively responded to the usefulness of processed images to predict postoperative appearance. Conclusion Showing processed images that predict postoperative appearance to patients prior to blepharoptosis surgery can be useful for those patients concerned with their postoperative appearance. This approach may serve as a useful tool to simulate blepharoptosis surgery. PMID:27757008

  5. Congenital Cataract: Progress in Surgical Treatment and Postoperative Recovery of Visual Function.

    PubMed

    Wang, Mingyue; Xiao, Wei

    2015-03-01

    Congenital cataract is a common cause of childhood low vision or blindness worldwide. Early surgery should be performed in sensitive vision development period to avoid vision deprivation in cases of strabismus and nystagmus development. Postoperative recovery of visual function is of great significance for these patients and should include proper postoperative aphakia correction by the application of a contact lens and secondary implantation of an intraocular lens (IOL). Patients should receive amblyopic training after surgery to improve their postoperative visual acuity. Although recent advances in surgery techniques and materials have brought better postoperative visual acuity and less complications, a few postoperative complications can still hamper vision condition and vision development, including posterior capsule opacification and secondary glaucoma. Surgery in early infancy are risk factors for these two complications. Life-long follow-up is essential for these patients. Further study will continue to address the surgery timing issue and methods that prevent postoperative complications. PMID:26390798

  6. Assessment of the amylase--creatinine clearance ratio in postoperative patients.

    PubMed

    Leckie, P A; Ferreira, P; Debas, H T

    1980-08-01

    The value of the amylase--creatinine clearance ratio (ACCR) in the diagnosis of postoperative pancreatitis was prospectively assessed. In 77 patients undergoing operations known to have a significant incidence of postoperative pancreatitis (gastric, biliary or pancreatic) i.e. "high risk" group, the ACCR was abnormally elevated postoperatively in 36 patients (47%). However, overt clinical pancreatitis occurred in only eight patients (10%). In 60 other patients undergoing nonabdominal operations (orthiipedic, head and neck, varicose vein surgery etc.) i.e. "low risk" group, the ACCR was abnormally elevated postoperatively in 23 patients (38%). No patient in this group developed clinical pancreatitis. We conclude, therefore, the ACCR is often abnormally elevated nonspecifically following any type of surgery, and cannot be used as evidence of postoperative pancreatitis. These data do suggest, however, that a normal ACCR, especially on successive daily determinations, might help to exclude the diagnosis of postoperative pancreatitis.

  7. Assessment of the amylase--creatinine clearance ratio in postoperative patients.

    PubMed

    Leckie, P A; Ferreira, P; Debas, H T

    1980-08-01

    The value of the amylase--creatinine clearance ratio (ACCR) in the diagnosis of postoperative pancreatitis was prospectively assessed. In 77 patients undergoing operations known to have a significant incidence of postoperative pancreatitis (gastric, biliary or pancreatic) i.e. "high risk" group, the ACCR was abnormally elevated postoperatively in 36 patients (47%). However, overt clinical pancreatitis occurred in only eight patients (10%). In 60 other patients undergoing nonabdominal operations (orthiipedic, head and neck, varicose vein surgery etc.) i.e. "low risk" group, the ACCR was abnormally elevated postoperatively in 23 patients (38%). No patient in this group developed clinical pancreatitis. We conclude, therefore, the ACCR is often abnormally elevated nonspecifically following any type of surgery, and cannot be used as evidence of postoperative pancreatitis. These data do suggest, however, that a normal ACCR, especially on successive daily determinations, might help to exclude the diagnosis of postoperative pancreatitis. PMID:6157370

  8. Factors predisposing to postoperative complications related to wisdom tooth surgery among university students.

    PubMed

    Muhonen, A; Ventä, I; Ylipaavalniemi, P

    1997-07-01

    In a retrospective study among 550 Helsinki University students 20 to 30 years old, factors predisposing to postoperative complications from removal of lower jaw wisdom teeth were evaluated. Patient records and panoramic tomograms covering the period from 1990 to 1993 were examined; 50 patients (9.1%) had postoperative complications after removal of a wisdom tooth. The most common complications were alveolar osteitis (2.9%), postoperative infection (2.6%), postoperative bleeding (1.5%), and dysesthesia of the lower lip or tongue (1.1%). Factors associated with increased postoperative complications were mesiohorizontal position of the tooth, deep impaction of the tooth, and use of oral contraceptives. Before patients undergo surgery for removal of wisdom teeth, those who use oral contraceptives or have difficult tooth impactions should be informed about the increased possibility of postoperative complications. PMID:9248241

  9. Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility.

    PubMed Central

    Watters, J M; Kirkpatrick, S M; Norris, S B; Shamji, F M; Wells, G A

    1997-01-01

    OBJECTIVE: The authors set out to determine whether immediate enteral feeding minimizes early postoperative decreases in handgrip and respiratory muscle strength. SUMMARY BACKGROUND DATA: Muscle strength decreases considerably after major surgical procedures. Enteral feeding has been shown to restore strength rapidly in other clinical settings. METHODS: A randomized, controlled, nonblinded clinical trial was conducted in patients undergoing esophagectomy or pancreatoduodenectomy who received immediate postoperative enteral feeding via jejunostomy (fed, n = 13), or no enteral feeding during the first 6 postoperative days (unfed, n = 15). Handgrip strength, vital capacity, forced expiratory volume in one second (FEV1), and maximal inspiratory pressure (MIP) were measured before surgery and on postoperative days 2, 4, and 6. Fatigue and vigor were evaluated before surgery and on postoperative day 6. Mobility was assessed daily after surgery using a standardized descriptive scale. Postoperative urine biochemistry was evaluated in daily 24-hour collections. RESULTS: Postoperative vital capacity (p < 0.05) and FEV1 (p = 0.07) were consistently lower (18%-29%) in the fed group than in the unfed group, whereas grip strength and maximal inspiratory pressure were not significantly different. Postoperative mobility also was lower in the fed patients (p < 0.05) and tended to recover less rapidly (p = 0.07). Fatigue increased and vigor decreased after surgery (both p < or = 0.001), but changes were similar in the fed and unfed groups. Intensive care unit and postoperative hospital stay did not differ between groups. CONCLUSIONS: Immediate postoperative jejunal feeding was associated with impaired respiratory mechanics and postoperative mobility and did not influence the loss of muscle strength or the increase in fatigue, which occurred after major surgery. Immediate postoperative enteral feeding should not be routine in well-nourished patients at low risk of nutrition

  10. Entwicklung und methodische Verbesserung der Arbeitssicherheit in der Instandhaltung

    NASA Astrophysics Data System (ADS)

    Galinski, Marek

    Die Hüttenwerke Krupp Mannesmann gehören zu den führenden Stahlherstellern in Europa. Die Instandhaltung ist einerseits den Anlagen vor Ort zugeordnet, andererseits gibt es für werksweite bzw. spezielle Themen eine zentrale Instandhaltung. Die im Folgenden beschriebenen Methoden wurden für das gesamte Unternehmen entwickelt, jedoch je nach Organisationseinheit unterschiedlich adaptiert und unterschiedlich intensiv verfolgt. Die zentrale Instandhaltung hat insbesondere in den letzten 12 Jahren der Arbeitssicherheit einen hohen Stellenwert beigemessen, und hervorragende Ergebnisse erzielt. So ist die Unfallhäufigkeit in der zentralen Instandhaltung von ca. 30 anzeigepflichtigen Unfällen pro eine Million verfahrener Stunden vor ca. 15 Jahren auf Null in 2007 gesunken! In 2008 konnte dieses hervorragende Ergebnis gehalten werden. Zwei Jahre unfallfrei! Wer hätte das vor 15 Jahren gedacht? Der Schwerpunkt des Beitrags liegt auf der Erläuterung der Ansatzpunkte mit denen dieses Ergebnis erreicht wurde und der Darstellung der Methoden incl. der Anpassung an die veränderten Ansatzpunkte in den betroffenen Bereichen. Die beschriebenen Methoden sind in der zentralen Instandhaltung so angewendet worden.

  11. Probiotic use in preventing postoperative infection in liver transplant patients

    PubMed Central

    Chen, Jim; Wu, Jinshan; Chalson, Helen; Merigan, Lynn; Mitchell, Andrew

    2013-01-01

    Background Although liver transplantation has been widely practised, post-operative bacterial infection is still a frequent complication which contributed to an increased risk of fatality. There were studies on preoperative use of probiotics for liver transplant patients and acquired reduction in postoperative sepsis and wound infection, but the relevant clinical experience with pre- and probiotics is still limited. Objectives This study is to assess fibre and probiotic use aimed at preventing bacterial sepsis and wound complications in patients undergoing liver transplantation. Study methods There were a total of sixty-seven adult patients scheduled for liver transplantation were included in a public teaching hospital. From January to December 2011, 34 continuous patients following liver transplantation were put on fibre + probiotics. In retrospectively, from January to December 2010, 33 continuous patients were collected as a control group and they were only received fibre post operation. The incidence of bacterial infections was compared in patients receiving either fibre and lactobacillus or fibre only. Statistical analysis was performed using SPSS 15. The t test, fisher’s and chi- square test was used to compare discrete variables. Results In summary, in the analysis of 67 liver transplant recipients, 8.8% group A patients developed infections compared to 30.3% group B patients. The difference between groups A and B was statistically significant in both cases. In addition, the duration of antibiotic therapy was significantly shorter in the lactobacillus-group. Wound infection was the most frequent infections and enterococci the most frequently isolated bacteria. Fibre and lactobacilli were well tolerated in most cases. The operating time, amount of intra- and post-operatively transfused units of blood, fresh frozen plasma and albumin did not differ significantly between the groups. Conclusions Combined fibre and probiotics could lower the incidence of

  12. Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

    PubMed Central

    Shin, Young-Hee; Jeong, Hee-Joon

    2015-01-01

    Background Postoperative delirium is a frequent complication in elderly patients undergoing major abdominal surgery and is associated with a poor outcome. We compared postoperative delirium in elderly patients following laparoscopic gastrectomy (LG) versus open gastrectomy (OG). Methods In total, 130 patients aged ≥ 65 years with gastric cancer undergoing LG and OG were enrolled prospectively. Postoperative delirium and cognitive status were assessed daily using the Confusion Assessment Method (CAM) and Mini-Mental Status Examination (MMSE), respectively, for 3 days postoperatively. For CAM-positive patients, delirium severity was then assessed using the Delirium Index (DI). Results In total, 123 subjects (LG, n = 60; OG, n = 63) were included in the analysis. In both groups, the overall incidences of postoperative delirium were similar: 31.6% (19/60) in the LG group and 41.2% (26/63) in the OG group. When considering only those with delirium, the severity, expressed as the highest DI score, was similar between the groups. A decline in cognitive function (reduction in MMSE ≥ 2 points from baseline) during 3 days postoperatively was observed in 23 patients in the LG group (38.3%) and 27 patients in the OG group (42.9%) (P = 0.744). In both groups, postoperative cognitive decline was significantly associated with postoperative delirium (P < 0.001). Conclusions We found that, compared with traditional open gastrectomy, laparoscopic gastrectomy did not reduce either postoperative delirium or cognitive decline in elderly patients with gastric cancer. PMID:26257851

  13. Physik gestern und heute: Fragwürdiges beim Millikan-Versuch

    NASA Astrophysics Data System (ADS)

    Heering, Peter

    2006-09-01

    Robert A. Millikan erhielt 1923 als erster amerikanischer Physiker den Nobelpreis für Physik. Geehrt wurde er für seine Präzisionsmessungen zum Photoeffekt und zur experimentellen Bestimmung der elektrischen Elementarladung. Millikans Experimente zur Elementarladung sind auch heute noch ein Standardthema im schulischen Physikunterricht, gleichzeitig werfen sie aber eine Reihe von wissenschaftstheoretischen und ethisch relevanten Fragen auf.

  14. Quantenphysik und Gravitation Äquivalenzprinzip gilt auch für Quantenobjekte

    NASA Astrophysics Data System (ADS)

    Fray, Sebastian; Hänsch, Theodor W.; Weitz, Martin

    2005-03-01

    Gravitationstheorie und die Quantentheorie zu einer gemeinsamen Theorie vereinheitlichen, das ist eines der ungelösten Probleme der modernen Physik. Garchinger und Tübinger Wissenschaftler haben nun das Äquivalenzprinzip, einen Eckstein der Gravitationstheorie, mit der Methode der Atominterferometrie, die sich der quantenmechanischen Natur von Atomen bedient, überprüft.

  15. Blick in das kalte Weltall. Protosterne, Staubscheiben und schwarze Löcher.

    NASA Astrophysics Data System (ADS)

    Mezger, P. G.

    Contents: 1. Radioastronomie: Ein neues Fenster ins Weltall öffnet sich. Die Entwicklung der Radioastronomie. Vom Anfang der Welt: Der Urknall. Die Milchstraße und ihr infrarotes Bild. Sterne und interstellare Materie. Die Suche nach den Protosternen. Der Zentralbereich der Milchstraße. Im Zentrum der Milchstraße: Ein schwarzes Loch mit einer Akkretionsscheibe? 2. Der Wissenschaftsbetrieb.

  16. [COPD und Klangtherapie: Pilotstudie zur Wirksamkeit einer Behandlung mit Körpertambura bei COPD-Patienten].

    PubMed

    Hartwig, Bernhard; Schmidt, Stefan; Hartwig, Isabella

    2016-01-01

    Hintergrund: Erkrankungen der Atemorgane treten mit steigendem Alter öfter auf, nehmen weltweit zu und sind häufige Ursachen für Morbidität und Mortalität. In dieser Pilotstudie wurde der Frage nachgegangen, ob eine einmalige 10-minütige Behandlung mit einer Körpertambura eine signifikante und effektive Verbesserung der Lungenfunktion von Patienten mit chronisch-obstruktiver Lungenerkrankung (COPD; GOLD-Stadium A oder B) erbringen kann. Patienten und Methoden: 54 Probanden konnten je zur Hälfte in eine Behandlungsgruppe (Körpertambura) und eine aktive Kontrollgruppe (Atemtherapie) randomisiert werden. Eine Bestimmung der Lungenfunktionsmessparameter «Einsekundenkapazität» (FEV1) und «inspiratorische Vitalkapazität» (IVC) zu den Zeitpunkten T1 (Baseline), T2 (direkt nach Behandlung) und als Follow-up etwa 3 Wochen nach T1 (T3). Ergebnisse: Die Behandlungsgruppe zeigte sich der Kontrollgruppe in beiden Werten signifikant überlegen. Die Zeit-×-Gruppe-Interaktion (Varianzanalyse) ergab p = 0,001 (FEV1) bzw. p = 0,04 (IVC). Die Behandlungsgruppe zeigte bei beiden Werten eine Verbesserung von klinischer Relevanz. Schlussfolgerung: Diese Ergebnisse zeigen, dass die Klangbehandlung mittels einer Körpertambura - neben den schulmedizinischen, leitliniengerechten Therapien - eine zusätzliche, nebenwirkungsarme, aber durchaus klinisch wirksame Option für die Behandlung von COPD-Patienten darstellen kann, um deren Lebensqualität zu stabilisieren und zu verbessern. PMID:27606616

  17. Inflammation Induced by Perfluorocarbon Liquid: Intra- and Postoperative Use

    PubMed Central

    Figueroa, Marta S.; Casas, Diego Ruiz

    2014-01-01

    Perfluorocarbon liquids (PFCLs) are useful and safe surgical tools in vitreoretinal surgery. The use of PFCL as a tamponade has been controversial due to the corneal toxicity, retinal infiltration, and inflammatory reaction in experimental studies. Several authors have studied in humans the anatomical and functional outcome and adverse effects of perfluorocarbon liquids used as short-, medium-, and long-term tamponade. PFCLs develop dispersion a few days after injection and droplets may move into the anterior chamber and cause corneal endothelial damage. When PFCLs are used as postoperative tamponades for more than one week, a foreign-body inflammatory reaction is observed in up to 30% of cases but such a reaction does not induce PVR, and it resolves after removal of PFCLs. Although most clinical studies have found no signs of retinal toxicity such as progressive visual acuity deterioration or macular anatomical changes, few performed ERG or retinal histological analysis. PMID:24783224

  18. Postoperative Submandibular Gland Swelling following Craniotomy under General Anesthesia.

    PubMed

    Nakanishi, Haruka; Tono, Tetsuya; Ibusuki, Shoichiro

    2015-01-01

    Objective. Reporting of a rare case of postoperative submandibular gland swelling following craniotomy. Case Report. A 33-year-old male underwent resection for a brain tumor under general anesthesia. The tumor was resected via a retrosigmoid suboccipital approach and the patient was placed in a lateral position with his face down and turned to the right. Slight swelling of the right submandibular gland was observed just after the surgery. Seven hours after surgery, edematous change around the submandibular gland worsened and he required emergent reintubation due to airway compromise. The cause of submandibular gland swelling seemed to be an obstruction of the salivary duct due to surgical positioning. Conclusion. Once submandibular swelling and edematous change around the submandibular gland occur, they can worsen and compromise the air way within several hours after operation. Adequate precaution must be taken for any predisposing skull-base surgery that requires strong cervical rotation and flexion. PMID:26697254

  19. Postoperative Submandibular Gland Swelling following Craniotomy under General Anesthesia

    PubMed Central

    Nakanishi, Haruka; Tono, Tetsuya; Ibusuki, Shoichiro

    2015-01-01

    Objective. Reporting of a rare case of postoperative submandibular gland swelling following craniotomy. Case Report. A 33-year-old male underwent resection for a brain tumor under general anesthesia. The tumor was resected via a retrosigmoid suboccipital approach and the patient was placed in a lateral position with his face down and turned to the right. Slight swelling of the right submandibular gland was observed just after the surgery. Seven hours after surgery, edematous change around the submandibular gland worsened and he required emergent reintubation due to airway compromise. The cause of submandibular gland swelling seemed to be an obstruction of the salivary duct due to surgical positioning. Conclusion. Once submandibular swelling and edematous change around the submandibular gland occur, they can worsen and compromise the air way within several hours after operation. Adequate precaution must be taken for any predisposing skull-base surgery that requires strong cervical rotation and flexion. PMID:26697254

  20. Intracameral cefuroxime: prophylaxis of postoperative endophthalmitis after cataract surgery.

    PubMed

    Keating, Gillian M

    2013-02-01

    Results of the landmark European Society of Cataract and Refractive Surgeons trial and additional prospective and retrospective studies support the use of intracameral cefuroxime in the prophylaxis of endophthalmitis following cataract surgery. Prophylaxis with intracameral cefuroxime at the recommended dose appears to be well tolerated in patients undergoing cataract surgery. However, off-label use of intracameral cefuroxime usually requires a two-step dilution process with the potential for dilution errors, and there are also concerns regarding the risk of contamination. Aprokam® (intracameral cefuroxime) has been approved in the EU for the prophylaxis of postoperative endophthalmitis after cataract surgery. After reconstitution of Aprokam®, no further dilution is required and each vial is only indicated for single-patient use; this has the potential to reduce the risk of both dilution errors and contamination.

  1. Quality of sleep in postoperative surgical oncologic patients.

    PubMed

    Barichello, Elizabeth; Sawada, Namie Okino; Sonobe, Helena Megumi; Zago, Márcia Maria Fontão

    2009-01-01

    This study aimed to evaluate surgical-oncologic patients' quality of sleep through the Pittsburgh Sleep Quality Index (PSQI) questionnaire. It is an exploratory study with transversal-observational design, in 46 postoperative head & neck and urology cancer patients. The PSQI questionnaire was used to evaluate the subjective quality of sleep and the occurrence of sleep disorders. Six PSQI components were statistically significant and 78.3% of the interviewees had impaired subjective quality of sleep. Among factors leading to sleep disorders we point out: taking too long to fall asleep; waking up in the middle of the night; getting up to go to the bathroom and napping during the day. This study is expected to sensitize the nursing team regarding the need to investigate quality of sleep and causes of its disorders in cancer survivors for an effective course of action. PMID:19820854

  2. A Minimally Invasive Approach for Postoperative Pancreatic Fistula

    SciTech Connect

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

    2003-11-15

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

  3. Delayed aortic rupture resulting from postoperative superficial sternal wound infection

    PubMed Central

    Kim, Su Wan; Chang, Jee Won

    2016-01-01

    While deep sternal wound infection (DSWI) after cardiac surgery is a significant contributor to patient morbidity and mortality, superficial sternal wound infection (SSWI) mostly has a benign course. We report a mortality case of aortic rupture resulting from SSWI after cardiac surgery. A 50-year-old male underwent an aortic valve replacement (AVR). Three months after the valve operation, he presented with severe dyspnea, which had never before been observed, and chest computed tomography revealed an ascending aortic rupture with large hematoma compressing the main pulmonary artery. We performed an emergent operation for aortic rupture that possibly originated from the SSWI. Postoperatively, the patient died of hypovolemic shock due to recurrent aortic rupture despite efforts to resuscitate him. PMID:27499988

  4. POSTOP: Postbuckled open-stiffener optimum panels, user's manual

    NASA Technical Reports Server (NTRS)

    Biggers, S. B.; Dickson, J. N.

    1984-01-01

    The computer program POSTOP developed to serve as an aid in the analysis and sizing of stiffened composite panels that may be loaded in the postbuckling regime, is intended for the preliminary design of metal or composite panels with open-section stiffeners, subjected to multiple combined biaxial compression (or tension), shear and normal pressure load cases. Longitudinal compression, however, is assumed to be the dominant loading. Temperature, initial bow eccentricity and load eccentricity effects are included. The panel geometry is assumed to be repetitive over several bays in the longitudinal (stiffener) direction as well as in the transverse direction. Analytical routines are included to compute panel stiffnesses, strains, local and panel buckling loads, and skin/stiffener interface stresses. The resulting program is applicable to stiffened panels as commonly used in fuselage, wing, or empennage structures. The capabilities and limitations of the code are described. Instructions required to use the program and several example problems are included.

  5. [A severe late tonsillar hemorrhage 2 months postoperatively].

    PubMed

    Swoboda, H; Welleschik, B

    1988-08-01

    Tonsilloadenoidectomy performed on an 8-year old girl, in the course of which heavy bleeding from the left niche was staunched by suture ligation, was complicated from the 7th day onwards by severe haemorrhages at intervals from 5 to 25 days, causing life-threatening hypovolaemia. Haemorrhages started mostly in the early morning hours and ceased spontaneously. Revision of the left niche was undertaken shortly after the 5th bleeding two months postoperatively. After removal of the almost completely restituted mucosal covering, spreading of a haemosiderinstained canal released a massive pulsating haemorrhage which was controlled by ligation of the external carotid artery and suturing of the tonsillar bed. As the origin of the haemorrhage, an arterial lesion either by tonsil enucleation or by suture ligation is discussed. Attention is drawn to the possibility that certain branches of the external carotid artery may be positioned very close to the inferior half of the tonsil. PMID:3210878

  6. [Pleural hernia of an esophageal graft--late postoperative complication].

    PubMed

    Grabowski, K; Lewandowski, A; Moroń, K; Strutyńska-Karpińska, M; Błaszczuk, J; Machała, R

    1997-01-01

    Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

  7. [Therapeutic use of amiodarone against postoperative fibrillation after cardiac surgery].

    PubMed

    Osawa, Hisayoshi; Muraki, Satoshi; Sakurada, Taku; Kawaharada, Nobuyoshi; Sasaki, Jun; Araki, Eiji; Nakashima, Shinji

    2014-05-01

    We investigated the effect of amiodarone (AMD) administered intravenously for the treatment of post-operative atrial fibrillation( POAF) after cardiac surgery. After rapid administration of 150 mg for 10 minutes, AMD was administered in 1.0 mg per minute for 6 hours followed by 0.5 mg per minute for 18 hours. AMD was then administered orally 200 mg per day for 1 or 2 weeks. Twenty-five cases were enrolled from January 2010 to June 2013. In 18 cases(72%), the patients were successfully defibrillated by this protocol. In the other 7 cases, the patients required electrical defibrillation, but in 1 patient developed chronic atrial fibrillation. It was thought that AMD could be a choice for POAF.

  8. Postoperative adjuvant radiotherapy for patients with gastric adenocarcinoma.

    PubMed

    Lim, Do Hoon

    2012-12-01

    In gastric adenocarcinoma, high rates of loco-regional recurrences have been reported even after complete resection, and various studies have been tried to find the role of postoperative adjuvant therapy. Among them, Intergroup 0116 trial was a landmark trial, and demonstrated the definite survival benefit in adjuvant chemoradiotherapy, compared with surgery alone. However, the INT 0116 trial had major limitation for global acceptance of the INT 0116 regimen as an adjuvant treatment modality because of the limited lymph node dissection. Lately, several randomized studies that were performed to patients with D2-dissected gastric cancer were published. This review summarizes the data about patterns of failure after surgical resection and the earlier prospective studies, including INT 0116 study. Author will introduce the latest studies, including ARTIST trial and discuss whether external beam radiotherapy should be applied to patients receiving extended lymph node dissection and adjuvant chemotherapy. PMID:23346491

  9. Postoperative management of heart failure in pediatric patients.

    PubMed

    Yuerek, Mahsun; Rossano, Joseph W; Mascio, Christopher E; Shaddy, Robert E

    2016-01-01

    Low cardiac output syndrome (LCOS) is a well-described entity occurring in 25-65% of pediatric patients undergoing open-heart surgery. With judicious intensive care management of LCOS, most patients have an uncomplicated postoperative course, and within 24 h after cardiopulmonary bypass, the cardiac function returns back to baseline. Some patients have severe forms of LCOS not responsive to medical management alone, requiring temporary mechanical circulatory support to prevent end-organ injury and to decrease myocardial stress and oxygen demand. Occasionally, cardiac function does not recover and heart transplantation is necessary. Long-term mechanical circulatory support devices are used as a bridge to transplantation because of limited availability of donor hearts. Experience in usage of continuous flow ventricular assist devices in the pediatric population is increasing. PMID:26560361

  10. Postoperative glucose metabolism in patients with gastrointestinal malignancy.

    PubMed

    Copeland, G P; Leinster, S J; Davis, J C; Hipkin, L H

    1988-12-01

    Patients with gastrointestinal malignancy demonstrate impaired postoperative glucose disposal (17.5 +/- 1.4 mumol/kg min vs 28.9 +/- 2.5 mumol/kg min; P less than 0.001) and a reduced insulin response, during steady state hyperglycaemia, when compared with control. Analysis of glucose disposal when compared with insulin concentration suggested insulin resistance as a factor in the causation of impaired glucose disposal. In the control group both glucose disposal and insulin response demonstrated a negative correlation with malnutrition score (as assessed by a 13 factor, three grade scoring system), whereas in the cancer group only the insulin response was related to malnutrition score. However, the insulin response in the cancer group was quantitatively different from control subjects. The possible clinical implications of these findings are discussed.

  11. Postoperative complications due to a retained surgical sponge.

    PubMed

    Sarda, A K; Pandey, D; Neogi, S; Dhir, U

    2007-06-01

    Retained surgical sponge or glossypiboma is a relatively common occurrence; however, surgeons may not report these events for fear of litigation and adverse publicity. We report postoperative complications in three cases due to retained surgical sponges. The first case, a 26-year-old woman, presented with gastric outlet obstruction due to the sponge obstructing the pyloric canal three weeks following cholecystectomy, which was completely relieved following endoscopical removal of the sponge. The second case, a 32-year-old woman, presented with repeated attacks of intestinal obstruction following cholecystectomy and tubal ligation and was treated with surgical removal of the sponge. The third patient, a 40-year-old woman, presented with features of colonic obstruction following hysterectomy. Colonoscopy revealed a partial migration of the sponge through the colonic wall and on laparotomy, she was found to have multiple internal fistulae between the small and large intestines, all occurring around the inflammation caused by the retained sponge.

  12. [Postoperatively Diagnosed Pulmonary Actinomycosis;Report of Three Cases].

    PubMed

    Ishida, Hisao; Murasawa, Masaki; Yoshizawa, Masatoshi; Hoshino, Taiki; Hanawa, Takeshi; Kuwabara, Masayoshi

    2015-09-01

    Three cases of pulmonary actinomycosis have been postoperatively diagnosed in our hospital in the past 3 years. All the cases were preoperatively difficult to differentiate from lung cancer, and all were diagnosed in men. One of the patients was diagnosed on the basis of clinical symptoms, while the other 2 patients were diagnosed during the treatment and follow-up of other diseases. On radiological examination, 2 patients showed mass-like shadows, and the 3rd showed a cavitary lesion; fluorodeoxyglucose (FDG) -positron emission tomography showed high FDG accumulation in all the patients. One of the patients was pathologically suspected with lung cancer on transbronchial lung biopsy. Right upper lobectomy was performed in 2 patients, and right lower lobectomy in 1. One of the patients who underwent right upper lobectomy, also received chest wall resection because of the perioperative finding of chest wall invasion of lung cancer. Clinically, all the cases were preoperatively diagnosed as lung cancer. PMID:26329633

  13. The challenge of post-operative peritonitis after gastrointestinal surgery.

    PubMed

    Sartelli, Massimo; Griffiths, Ewen A; Nestori, Maurizio

    2015-12-01

    Post-operative peritonitis (PP) is a life-threatening hospital-acquired intra-abdominal infection with high rates of mortality. Diffuse PP remains a challenge for surgeons. Prognosis and outcome of patients are directly related to early diagnosis and prompt intervention. The diagnosis of PP may be difficult because there are no specific clinical signs and laboratory tests to reject or confirm the diagnosis. Atypical clinical features may be responsible for a delay in reoperation. An early diagnosis and prompt treatment is crucial to prevent the development of organ failure and improve the outcome of the patients with PP. The cornerstones in the management of patients with PP are early hemodynamic support, prompt source control and adequate antimicrobial therapy.

  14. Postoperative management of heart failure in pediatric patients.

    PubMed

    Yuerek, Mahsun; Rossano, Joseph W; Mascio, Christopher E; Shaddy, Robert E

    2016-01-01

    Low cardiac output syndrome (LCOS) is a well-described entity occurring in 25-65% of pediatric patients undergoing open-heart surgery. With judicious intensive care management of LCOS, most patients have an uncomplicated postoperative course, and within 24 h after cardiopulmonary bypass, the cardiac function returns back to baseline. Some patients have severe forms of LCOS not responsive to medical management alone, requiring temporary mechanical circulatory support to prevent end-organ injury and to decrease myocardial stress and oxygen demand. Occasionally, cardiac function does not recover and heart transplantation is necessary. Long-term mechanical circulatory support devices are used as a bridge to transplantation because of limited availability of donor hearts. Experience in usage of continuous flow ventricular assist devices in the pediatric population is increasing.

  15. Postoperative epidural opioid analgesia: what are the choices?

    PubMed

    de Leon-Casasola, O A; Lema, M J

    1996-10-01

    The administration of hydrophilic opioids via a continuous infusion results in selective spinal analgesia with a low incidence of side effects. Lipophilic opioids may also be associated with spinal effects. However, the doses required to produce postoperative analgesia also produce plasma concentrations within the MEAC. Thus, in clinical practice it may not be possible to limit epidural doses of lipophilic opioids to those associated with spinal analgesia. Regardless of the mechanism of action, epidural administration of lipophilic opioids may offer no clinical advantages over the IV route. Notwithstanding, epidural administration of small doses of lipophilic opioids in combination with local anesthetics may offer significant clinical advantages over systemic administration of opioids alone. Dose-ranging studies will be necessary to determine the ideal concentrations of opioids and local anesthetics, as well as the ratios of the two drugs to obtain optimal analgesia with minimal incidence of side effects.

  16. Major postoperative complications and survival for colon cancer elderly patients

    PubMed Central

    2012-01-01

    Background Increased life expectancy has led to elevating the mean age of the patients at the time of diagnosis of colon cancer and subsequent treatment. Differences in complication rates and outcome between elderly and younger patients have been investigated. Methods We retrospectively analysed a database containing the information of patients who underwent surgery for stage I-III colorectal cancer from January 2004 to January 2012 at our institution and compared demographic, cancer-related, and outcomes data of 235 elderly patients with 211 patients ≤65 years old. Results Intraoperative complications did not differ between young and old patients whereas some differences have been found in postoperative and late complications: elderly patients suffered more by ileus (P = 0.024), peritonitis or septic shock (P = 0.017), pelvic abscess (P = 0.028), wound infection (P = 0.031), and incisional/port herniation (P = 0.012) compared with younger patients. Moreover, elderly patients suffered by systemic complications such as cardiovascular (4.7% vs. 1.4%, P = 0.049), renal (4.7% vs. 0.5%, P = 0.006), and respiratory (10.6% vs. 5.2%, P = 0.036). The multivariate analysis assessing the odds of having a complication revealed that older age (Odd Ratio [OR] 2.75, 95% Confidential Interval [CI]: 1.67-4.52) and open surgery (OR 1.63, 95% CI: 1.01-2.62) are significantly and independently associated with having a complication. Conclusions In our series, elderly patients have presented a slight higher incidence of comorbidities that may affect the incidence rates of postoperative complications. These results have implications in increasing the hospital stay as well as a higher rate of death. PMID:23173563

  17. Postoperative retention of urine: a prospective urodynamic study.

    PubMed Central

    Anderson, J B; Grant, J B

    1991-01-01

    OBJECTIVE--To investigate the cause of post-operative retention of urine in elderly men. DESIGN--Prospective study. SETTING--Northern General Hospital, Sheffield. PATIENTS--32 consecutive men (median age 73, range 55-85) referred to the urology department who were unable to pass urine either within 48 hours after operation and required catheterisation (23) or after removal of a catheter inserted at the initial operation (nine). INTERVENTION--Intermittent self catheterisation. MAIN OUTCOME MEASURES--Urological investigation by medium fill and voiding cystometry within four weeks after operation, and minimum follow up three months thereafter. RESULTS--6 patients resumed normal voiding before urodynamic assessment, three proceeded straight to prostatectomy, and one was unfit for self catheterisation. Of 22 men who underwent urodynamic investigation, only five had bladder outflow obstruction, who subsequently had successful prostatectomy; 15 showed either a low pressure-low flow system (seven) or complete detrusor failure (eight) and two showed pelvic parasympathetic nerve damage. With intermittent self catheterisation spontaneous voiding returned in all but one man within a median of 8 weeks (range 6-32 weeks). Recovery of bladder function took significantly longer in men with detrusor failure than in those with an underactive bladder (median 10 weeks (range 6-32 weeks) v median 8 weeks (range 6-8 weeks); p = 0.05). Three months later all patients had re-established their own normal voiding pattern with minimal residual urine on ultrasonography and satisfactory flow rates. CONCLUSIONS--Postoperative urinary retention in elderly men is not an indication for prostatectomy; a normal pattern of micturition can be re-established by intermittent self catheterisation in most men. PMID:1709058

  18. Effect of Pregabalin and Dexamethasone on Postoperative Analgesia after Septoplasty

    PubMed Central

    Demirhan, Abdullah; Akkaya, Akcan; Tekelioglu, Umit Yasar; Apuhan, Tayfun; Bilgi, Murat; Yurttas, Veysel; Bayir, Hakan; Yildiz, Isa; Gok, Uzeyir; Kocoglu, Hasan

    2014-01-01

    Objectives. The aim of this study was to explore effect of a combination of pregabalin and dexamethasone on pain control after septoplasty operations. Methods. In this study, 90 patients who were scheduled for septoplasty under general anesthesia were randomly assigned into groups that received either placebo (Group C), pregabalin (Group P), or pregabalin and dexamethasone (Group PD). Preoperatively, patients received either pregabalin 300 mg one hour before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain treatment included tramadol and diclofenac sodium 30 minutes before the end of the operation. Numeric rating scale (NRS) for pain assessment, side effects, and consumption of tramadol, pethidine, and ondansetron were recorded. Results. The median NRS score at the postoperative 0 and the 2nd h was significantly higher in Group C than in Group P and Group PD (P ≤ 0.004 for both). The 24 h tramadol and pethidine, consumptions were significantly reduced in Groups P and PD compared to Group C (P < 0.001 and P < 0.001). The incidence of blurred vision was significantly higher in Group PD compared to Group C within both 0–2 h and 0–24 h periods (P = 0.002 and P < 0.001, resp.). Conclusions. We conclude that administration of 300 mg pregabalin preoperatively may be an adequate choice for pain control after septoplasty. Addition of dexamethasone does not significantly reduce pain in these patients. PMID:24876957

  19. Preventive Effect of Tamsulosin on Postoperative Urinary Retention

    PubMed Central

    Mohammadi-Fallah, Mohammadreza; Tayyebi-Azar, Ali

    2012-01-01

    Purpose To investigate the prophylactic effect of Tamsulosin, a super-selective alpha-1a adrenergic blocking agent, on the development of urinary retention in men undergoing elective inguinal herniorrhaphy. Materials and Methods From May 2010 through November 2011, a total of 80 males who underwent elective inguinal herniorrhaphy in a university hospital were included in this study. Patients were randomly assigned to one of two groups. In group one (control), the patients were given two doses of placebo orally, 6 hours before surgery and 6 to 12 hours after surgery. Patients in group two were given 0.4 mg of Tamsulosin orally in the same manner as the placebo. All patients were closely followed for 24 hours post-operatively, and any voiding difficulties or urinary retention was recorded. Results There were 40 patients in group one (control group) and 40 patients in group two (Tamsulosin group). The patients' mean age was 64 years. In group one, 6 patients and in group two, 1 patient required catheterization. Thus, 15% of patients in group I and 2.5% of patients in group II had urinary retention. The difference in the requirement for catheterization was statistically significant (p=0.04). The technique of herniorrhaphy, the side of the body in which the hernia was located, the type of anesthesia, the duration of the surgery, and the severity of pre-operative urinary symptoms had no significant effect on the incidence of urinary retention. Conclusions The use of perioperative Tamsulosin represents an effective strategy to reduce the risk of post-operative urinary retention following inguinal herniorrhaphy. PMID:22741052

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

    PubMed Central

    Geller, Elizabeth J

    2014-01-01

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

  1. PEarly Postoperative Emergency Department Care of Abdominal Transplant Recipients1

    PubMed Central

    McElroy, Lisa M.; Schmidt, Kathryn A.; Richards, Christopher T.; Lapin, Brittany; Abecassis, Michael M.; Holl, Jane L.; Adams, James; Ladner, Daniela P.

    2015-01-01

    Background Research on post-transplant care has predominantly focused on predictors of readmission with little attention to emergency department (ED) visits. The goal of this study was to describe early postoperative ED care of transplant recipients. Methods A secondary database analysis of adult patients who underwent abdominal organ transplantation between January 1, 2008 and December 31, 2013 and sought ED care within one year post-transplantation was conducted. Survival was compared using the Kaplan-Meier method with log-rank test. Cox proportional hazards regression analysis was performed to adjust for pertinent covariates. Results A total of 1,900 abdominal organ transplants were performed during the study period. Of these, 37% (N=711) transplant recipients sought care in the ED (1,343 total visits) with 1.89 mean ED visits per recipient. Of recipients seen in the ED, 58% received a kidney transplant and 28% received a liver transplant, with 45% of recipients presenting within the first 60 postoperative days. The most common chief complaints were gastroenterological (17%) and abnormal laboratory values or vital signs (17%). In total, 74% of recipients were readmitted and 50% of admitted patients were discharged in less than 24 hours. Transplant recipients with ED visits had lower 3-year graft (81% vs. 87%; p<0.001) and patient (89% vs. 93%; p=0.002) survival. Conclusion Transplant recipients have a high frequency of ED visits in the first post-transplantation year and high rates of subsequent hospital admission. Further investigation is needed to understand what drives recipient presentation to the ED and create care models that achieve the best outcomes. PMID:26050012

  2. Movement, Function, Pain, and Postoperative Edema in Axillary Web Syndrome

    PubMed Central

    Blaes, Anne H.; Haddad, Tuffia C.; Hunter, David W.; Hirsch, Alan T.; Ludewig, Paula M.

    2015-01-01

    Background Axillary web syndrome (AWS) is a condition that may develop following breast cancer surgery and that presents as a palpable axillary cord of tissue. Objective The purposes of this study were: (1) to determine the clinical characteristics of AWS related to movement, function, pain, and postoperative edema and (2) to define the incidence of and risk factors for AWS within the first 3 months following breast cancer surgery. Design This was a prospective cohort study with a repeated-measures design. Methods Women who underwent breast cancer surgery with sentinel node biopsy or axillary lymph node dissection (N=36) were assessed for AWS, shoulder range of motion, function, pain, and postoperative edema (using girth measurements, bioimpedance, and tissue dielectric constant) at 2, 4, and 12 weeks. Demographic characteristics were used for risk analysis. Results Seventeen women (47.2%) developed AWS, and AWS persisted in 10 participants (27.8%) at 12 weeks. Abduction range of motion was significantly lower in the AWS group compared with the non-AWS group at 2 and 4 weeks. There were no differences between groups in measurements of function, pain, or edema at any time point. Trunk edema measured by dielectric constant was present in both groups, with an incidence of 55%. Multivariate analysis determined lower body mass index as being significantly associated with AWS (odds ratio=0.86; 95% confidence interval=0.74, 1.00). Limitations Limitations included a short follow-up time and a small sample size. Conclusion Axillary web syndrome is prevalent following breast/axilla surgery for early-stage breast cancer and may persist beyond 12 weeks. The early consequences include movement restriction, but the long-term effects of persistent AWS cords are yet unknown. Low body mass index is considered a risk factor for AWS. PMID:25977305

  3. Avoiding Opioids and Their Harmful Side Effects in the Postoperative Patient: Exogenous Opioids, Endogenous Endorphins, Wellness, Mood, and Their Relation to Postoperative Pain.

    PubMed

    Stephan, Bradley C; Parsa, Fereydoun D

    2016-03-01

    Prescribed opioids are routinely used for many postoperative patients. However, these medications have daunting adverse effects on the body's innate pain management system--the action of the beta-endorphins. The prescribed opioids not only severely impair the function of the mu-opioid receptors, but also inhibit the release of beta-endorphin. This is unfortunate, because beta-endorphin appears to be a much more potent agonist of the mu-opioid receptor than opioids. In addition, beta-endorphin indirectly elevates dopamine, a neurotransmitter related to feelings of euphoria. Therefore, by prescribing opioids, practitioners may inadvertently prolong and increase the overall intensity of the postoperative patients' pain as well as herald anhedonia. This article highlights the relationships between prescribed (exogenous) opioids, beta-endorphins, mu-opioid receptors, wellness, mood, and postoperative pain. The role of patient education, opioid alternatives, and additional recommendations regarding pain control in the postoperative patient are also discussed. PMID:27011886

  4. Avoiding Opioids and Their Harmful Side Effects in the Postoperative Patient: Exogenous Opioids, Endogenous Endorphins, Wellness, Mood, and Their Relation to Postoperative Pain

    PubMed Central

    Parsa, Fereydoun D

    2016-01-01

    Prescribed opioids are routinely used for many postoperative patients. However, these medications have daunting adverse effects on the body's innate pain management system - the action of the beta-endorphins. The prescribed opioids not only severely impair the function of the mu-opioid receptors, but also inhibit the release of beta-endorphin. This is unfortunate, because beta-endorphin appears to be a much more potent agonist of the mu-opioid receptor than opioids. In addition, beta-endorphin indirectly elevates dopamine, a neurotransmitter related to feelings of euphoria. Therefore, by prescribing opioids, practitioners may inadvertently prolong and increase the overall intensity of the postoperative patients' pain as well as herald anhedonia. This article highlights the relationships between prescribed (exogenous) opioids, beta-endorphins, mu-opioid receptors, wellness, mood, and postoperative pain. The role of patient education, opioid alternatives, and additional recommendations regarding pain control in the postoperative patient are also discussed. PMID:27011886

  5. Local anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a randomized trial.

    PubMed

    Sanchez, Barry; Waxman, Kenneth; Tatevossian, Raymond; Gamberdella, Marla; Read, Bruce

    2004-11-01

    Pain after an open inguinal hernia repair may be significant. In fact, some surgeons feel that the pain after open repair justifies a laparoscopic approach. The purpose of this study was to determine if the use of local anesthetic infusion pumps would reduce postoperative pain after open inguinal hernia repair. We performed a prospective, double-blind randomized study of 45 open plug and patch inguinal hernia repairs. Patients were randomized to receive either 0.25 per cent bupivicaine or saline solution via an elastomeric infusion pump (ON-Q) for 48 hours, at 2 cc/h. The catheters were placed in the subcutaneous tissue and removed on postoperative day 3. Both groups were prescribed hydrocodone to use in the postoperative period at the prescribed dosage as needed for pain. Interviews were conducted on postoperative days 3 and 7, and patient's questionnaires, including pain scores, amount of pain medicine used, and any complications, were collected accordingly. During the first 5 postoperative days, postoperative pain was assessed using a visual analog scale. Twenty-three repairs were randomized to the bupivicaine group and 22 repairs randomized to the placebo group. In the bupivicaine group, there was a significant decrease in postoperative pain on postoperative days 2 through 5 with P values <0.05. This significant difference continued through postoperative day 5, 2 days after the infusion pumps were removed. Patients who had bupivicaine instilled in their infusion pump had statistically significant lower subjective pain scores on postoperative days 2 through 5. This significant difference continued even after the infusion pumps were removed. Local anesthetic infusion pumps significantly decreased the amount of early postoperative pain. Pain relief persisted for 2 days after catheter and pump removal. PMID:15586515

  6. Postoperative hospital course of patients with history of severe psychiatric illness.

    PubMed

    Solomon, S; McCartney, J R; Saravay, S M; Katz, E

    1987-09-01

    The postoperative hospital course of 54 patients with a past history of psychiatric illness was studied through chart review. Both chronic schizophrenics and chronic depressives tolerated surgical procedures well, without any unusual difficulties or exacerbation of psychiatric illness. They represented no management problems. Patients with acute, severe upset in the preoperative period (regardless of diagnosis) presented most of the management problems postoperatively. PMID:3678811

  7. Self-Reported, Structured Measures of Recovery to Detect Postoperative Morbidity

    PubMed Central

    Anetsberger, Aida; Blobner, Manfred; Krautheim, Veronika; Umgelter, Katrin; Schmid, Sebastian; Jungwirth, Bettina

    2015-01-01

    Previous studies have focused on postoperative anaesthetic visit as a tool for measuring postoperative recovery or patient’s satisfaction. Whether it could also improve timely recognition of complications has not been studied yet. Aim of our study was to assess pathological findings in physical examination requiring further intervention during postoperative visit and to explore whether a self-administered version of the Quality of Recovery (QoR)-9 score, compared to a detailed medical history, can act as a screening tool for identification of patients who show a low risk to develop postoperative complications. This observational study included 918 patients recovering from various types of non-cardiac surgery and anaesthesia. The postoperative visit implied three steps: measuring the QoR-9 score, a structured medical history and a physical examination. QoR-9-score showed a comparable negative predictive value (0.93 vs. 0.92) and a higher sensitivity of finding at least one pathological examination than a detailed medical history (0.92 vs. 0.81 respectively). At least one postoperative pathological examination finding was observed in 23.7% of the patients. Our approach presents a strategy on screening postoperative patients in order to identify patients whose examination and consequent treatment should be intensified. In further studies the question could be addressed whether the postoperative visit may help to reduce complications and mortality after surgery. PMID:26207620

  8. Self-Reported, Structured Measures of Recovery to Detect Postoperative Morbidity.

    PubMed

    Anetsberger, Aida; Blobner, Manfred; Krautheim, Veronika; Umgelter, Katrin; Schmid, Sebastian; Jungwirth, Bettina

    2015-01-01

    Previous studies have focused on postoperative anaesthetic visit as a tool for measuring postoperative recovery or patient's satisfaction. Whether it could also improve timely recognition of complications has not been studied yet. Aim of our study was to assess pathological findings in physical examination requiring further intervention during postoperative visit and to explore whether a self-administered version of the Quality of Recovery (QoR)-9 score, compared to a detailed medical history, can act as a screening tool for identification of patients who show a low risk to develop postoperative complications. This observational study included 918 patients recovering from various types of non-cardiac surgery and anaesthesia. The postoperative visit implied three steps: measuring the QoR-9 score, a structured medical history and a physical examination. QoR-9-score showed a comparable negative predictive value (0.93 vs. 0.92) and a higher sensitivity of finding at least one pathological examination than a detailed medical history (0.92 vs. 0.81 respectively). At least one postoperative pathological examination finding was observed in 23.7% of the patients. Our approach presents a strategy on screening postoperative patients in order to identify patients whose examination and consequent treatment should be intensified. In further studies the question could be addressed whether the postoperative visit may help to reduce complications and mortality after surgery.

  9. [General principles of clinical and therapeutic management in postoperative external enteral fistulas].

    PubMed

    Munteanu, Iulia; Stefan, S; Burcoveanu, C; Pădureanu, S; Bulat, C

    2008-01-01

    Postoperative enterocutaneous fistulas represent a frequent complication in the emergency or cancerous digestive surgery. As to the high level of mortality and morbidity caused by this type of postoperative complication (4%), efforts are made to establish the principles of therapeutic management, on the purpose of decreasing these indicators and thus lowering the prolonged hospitalisation afferent costs. PMID:20201248

  10. Nursing postoperative visit as a quality indicator for surgical patient care.

    PubMed

    Silva, R; Martins, M M; Jardim, H G

    2016-06-01

    The postoperative visit as a quality indicator for surgical patient care, demands some consideration from perioperative nurses. We evaluated the nursing perioperative interventions on postoperative visits, and adjusted them to the needs of the patients with postoperative pain. Our study indicated that 73% of patients visited didn't have postoperative pain whereas 27% had pain. The pain is aggravated when the patient is mobilised, one of the most common signs and symptoms being gastrointestinal changes. Pharmacological and non-pharmacological measures were used in pain management. The results showed that the percentage of patients with postoperative visits needs to be improved. We aim to have high quality perioperative nursing interventions which raise levels of patient satisfaction. PMID:27498440

  11. A Retrospective Analysis of the Management of Postoperative Discitis: A Single Institutional Experience

    PubMed Central

    Lakshmi, K.

    2015-01-01

    Study Design Retrospective study. Purpose The aim of the study was to study the impact and outcome of conservative management and surgical intervention in cases of postoperative discitis. Overview of Literature Postoperative discitis is a rare but often misdiagnosed cause of failed back syndrome. There is paucity of literature regarding management guidelines of postoperative discitis. Methods The study was carried out over a period of 6 years. Eighteen patients with postoperative discitis were included in the study. Results Conservative management with antibiotics, analgesics and bed rest were started in all the study cases. Posterior transpedicular fixation after re-exploration debridement and curettage of disc space granulation tissue was conducted in five patients in whom conservative management failed. Conclusions Early diagnosis and appropriate management is the key to effective treatment of postoperative discitis. Conservative management leads to excellent results in majority of cases. Surgical intervention with posterior interbody fusion and debridement is helpful when conservative treatment fails. PMID:26240715

  12. Postoperative discal cyst: An unusual complication after microendoscopic discectomy in teenagers.

    PubMed

    Jha, Subash C; Tonogai, Ichiro; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Goda, Yuichiro; Abe, Mitsunobu; Nagamachi, Akihiro; Fukuta, Shoji; Sairyo, Koichi

    2016-02-01

    Various complications after microendoscopic discectomy (MED) are well known, but postoperative discal cyst is a unique and relatively unknown complication. Here, we report on two teenage patients who presented with postoperative discal cyst after MED for herniated nucleus pulposus (HNP), which resolved after conservative treatment. The patients were diagnosed with HNP at L4-5 and L5-S1 based on MRI and then treated by MED. Postoperative discal cyst was diagnosed on MRI after recurrence of symptoms. Both patients were managed conservatively. T2-weighted MRI demonstrated hyperintense collections adjacent to the operated intervertebral disc level, which were communicating with the corresponding disc annulus. Because the clinical symptoms were relatively mild, the patients were managed conservatively; both made a complete clinical recovery with radiological evidence of improvement. Postoperative discal cyst is a relatively unknown complication after MED for HNP. Surgeons should be aware of this postoperative complication when operating on young individuals with HNP. PMID:26781537

  13. Dexmedetomidine in Postoperative Analgesia in Patients Undergoing Hysterectomy

    PubMed Central

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

    2015-01-01

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

  14. [Trans and postoperative myocardial infarct in heart surgery].

    PubMed

    Rotberg, T; Macías, R; Correa-Suárez, R; Luna, P; Malo, R

    1976-01-01

    1. A study was made of 34 cases (33%) of myocardial infarction trans and immediately postoperative which occurred in 11,210 surgical interventions with and without extracorporeal circulation. 2. This presents a statistical relation of the frequency of myocardial infarction in realtion to the heart disease acquired with or without extracorporeal circulation with the mitral, aortic, and double prosthesis of the mitral and aortic valves. A correlation was also made with the ischemic heart disease subjected to revascularization. The same analysis was carried out in the congenital heart disease with or without extracorporeal circulation. 3. In all cases the antecedents, precipitating factors, and the clinical picture were studied and in 12 cases the necropsy was analized. The principal finding was transmural myocardial infarction with electrocardiographic proof and serial enzymes. 4. The group was divided into two sub-groups; Group "A" with acute myocardial infarction transoperative, and Group "B" with acute myocardial infarction in the first eight postoperative days. The electrical and mechanical complications were analized. 5. A correlation was made of the causes of mortality related to the type of congenital or acquired heart disease with or without extracorporeal circulation. 6. The frequency of this entity was studied with the total time of aortic clamping, and the complications such as the low cardiac output syndrome, rupture of the wall, aneurysms, acute pulmonary edema, and with the disturbances of rhythm and conduction. 7. The presence of 33.3% of normal coronaries in these of necropsy was emphasized. 8. The importance of the coronary profile of this group in relation to the consequences of a stress from anesthesia, surgery, extracorporeal circulation, and aortic clamping is mentioned. 9. The diagnostic parameters such as arterial hypotension with or without the low cardiac output syndrome, enzyme levels, and the action of the potassium ion are mentioned. 10

  15. [Experimental analysis of postoperative early recurrence of liver cancer].

    PubMed

    Namieno, T

    1989-09-01

    The author suspected that the high incidence of early recurrence after macroscopically curative operation in human liver cancers correlated with the production of liver regeneration factor which was induced following partial hepatectomy (PH). The author therefore analyzed whether PH enhanced the growth of liver cancers or not, and the relevant mechanism involved, using rats subcutaneously injected with hepatocellular carcinoma (KDH-8, AH-66) cells. Primarily, it proved that PH significantly enhanced the growth of liver cancers injected in rats. The effect of this enhancement of liver cancer growth appeared as an abrupt increase in tumor volume within 24 hours following PH, which fact was supported by the mitotic indices of the hepatocellular carcinoma (KDH-8) cells. However PH did not affect rats injected with mammary carcinoma (SST-2) cells without estrogen receptor (E2R) or fibrosarcoma (KMT-75) cells. Secondly, based on this result, the author tried to analyze the mechanism of enhanced growth of liver cancers following PH, from the standpoints of; changes in postoperative immunity, expression of cytosol E2R in liver cancer cells or liver regeneration factor, using KDH-8 cells. The changes in postoperative immunity (NK-activity and Blastogenesis) did not correlate with the changes in liver cancer growth. Although serum estradiol (E2) increased significantly after PH, E2R was not detected in the KDH-8 cells used in this experiment. Serum was obtained from healthy rats 24 hours after PH, and 20 mg of serum, as calculated from total protein, was eluted into 50 fractions by high liquid chromatography (column; TSK G3000 SW). When the author examined which fractions stimulated both the growth of primarily cultivated hepatocytes and KDH-8 cells, only the fraction Fr. 30, the molecular weight of which was about 100 Kd, enhanced both. Furthermore, the author performed an in vivo assay to determine the number of days needed for tumor appearance: PHs were carried out 2

  16. Effect of body mass index on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing percutaneous nephrolithotomy

    PubMed Central

    Shohab, Durre; Ayub, Ramsha; Alam, Muhammad Umar; Butt, Amna; Sheikh, Sanam; Assad, Salman; Akhter, Saeed

    2015-01-01

    Objective To compare the effect of body mass index (BMI) on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing percutaneous nephrolithotomy (PCNL) by comparing three BMI groups. Material and methods This is a retrospective analysis of 129 patients who underwent PCNL from January 2010 to August 2013. All the patients underwent PCNL by a standard technique. The patients were divided into three groups: patients having a BMI ≤24 kg/m2 were included in the normal group, those having a BMI of 24.1–30.0 kg/m2 were included in the overweight group, and those having a BMI >30 kg/m2 were included in the obese group. Three groups were compared for operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement. Results A total of 129 patients including 44 females and 85 males were included with a mean age of 45.00±1.44 years. The mean age in the normal group was 43.29±1.69 years, 47.08±1.29 years in the overweight group, and 43.61±1.25 years in the obese group. The mean stone size in the normal group was 25.46±8.92 mm, 28.01±8.40 mm in the overweight group, and 26.84±7.41 mm in the obese group. Our results showed no statistically significant difference with respect to mean operative time, mean hospital stay, and stone clearance in the normal, obese, and overweight patients undergoing PCNL. Postoperative complications and analgesia requirement were also similar in all the three groups. Conclusion There was no effect of BMI on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing PCNL. PCNL is a safe and effective procedure for the removal of renal stones in obese patients. PMID:26623145

  17. Postoperative irradiation in malignant epithelial tumors of the parotid

    SciTech Connect

    McNaney, D.; McNeese, M.D.; Guillamondegui, O.M.; Fletcher, G.H.; Oswald, M.J.

    1983-09-01

    From 1954 through 1979, 77 patients with malignant tumors of the parotid gland were referred from the Department of Head and Neck Surgery for postoperative irradiation. The analysis has been made by grouping the patients according to the estimated amount of disease left after the surgical procedure and by the histological types. There were no local failures in the low-grade tumors, and there were 6 in the 63 patients with high-grade tumors. With gross residual disease or potential residual disease the patients received slightly higher doses than those without. Although there were only 6 failures in the various histological types, there was perhaps a trend to more failures in the adenocarcinomas. There was no difference in the failure rates in patients having had a total resection of the facial nerve or partial resection or no resection. The preferred treatment has been a combination of 20 MeV photons and 18 MeV electrons. Five neck failures were essentially a result of lack of electrive irradiation of the neck. Severe complications appeared only in the patients irradiated either for gross residual disease or excision of a recurrence with a high risk of widespread microscopic residual disease.

  18. POSTOPERATIVE PAIN: MANAGEMENT AND DOCUMENTATION BY IRANIAN NURSES

    PubMed Central

    Rafati, Foozieh; Soltaninejad, Maryam; Aflatoonian, Mohamad Reza; Mashayekhi, Fatemeh

    2016-01-01

    Background: Pain is one of the most common symptoms experienced by patients after surgeries. Inadequate postoperative pain management is an international problem and the need to improve its management is well documented. The aim of the study was to assess nursing reports related to the patients’ pain intensity and quality, concomitant symptoms, use of scales in pain assessment, and compliance with the national guideline after surgery. Methods: This study was a retrospective cohort; samples were nurse records of patients who had elective surgery. Result: Only 6% of the patients’ pain records included pain intensity which was not measured with standard scales. More than half of all injections were opioid analgesic which is in contrast to the guidelines of the Iranian Ministry of Health. Pain assessment was higher in women and by nurses with more than 15 years of working experience. Conclusion: to conclude, the patients’ pain was not assessed properly in terms of intensity, quality, and associated symptoms. Therefore, training and motivating nurses is very important in this context and should be incorporated in nurses’ academic and continuous educational courses. PMID:27047265

  19. Post-operative atrial fibrillation: a maze of mechanisms

    PubMed Central

    Maesen, Bart; Nijs, Jan; Maessen, Jos; Allessie, Maurits; Schotten, Ulrich

    2012-01-01

    Post-operative atrial fibrillation (POAF) is one of the most frequent complications of cardiac surgery and an important predictor of patient morbidity as well as of prolonged hospitalization. It significantly increases costs for hospitalization. Insights into the pathophysiological factors causing POAF have been provided by both experimental and clinical investigations and show that POAF is ‘multi-factorial’. Facilitating factors in the mechanism of the arrhythmia can be classified as acute factors caused by the surgical intervention and chronic factors related to structural heart disease and ageing of the heart. Furthermore, some proarrhythmic mechanisms specifically occur in the setting of POAF. For example, inflammation and beta-adrenergic activation have been shown to play a prominent role in POAF, while these mechanisms are less important in non-surgical AF. More recently, it has been shown that atrial fibrosis and the presence of an electrophysiological substrate capable of maintaining AF also promote the arrhythmia, indicating that POAF has some proarrhythmic mechanisms in common with other forms of AF. The clinical setting of POAF offers numerous opportunities to study its mechanisms. During cardiac surgery, biopsies can be taken and detailed electrophysiological measurements can be performed. Furthermore, the specific time course of POAF, with the delayed onset and the transient character of the arrhythmia, also provides important insight into its mechanisms. This review discusses the mechanistic interaction between predisposing factors and the electrophysiological mechanisms resulting in POAF and their therapeutic implications. PMID:21821851

  20. Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty

    PubMed Central

    Bertrand, L. A.; Elliott, S. P.; Breyer, B. N.; Erickson, B. A.

    2015-01-01

    Excision with primary anastomosis (EPA) urethroplasty is generally the preferred method for short strictures in the bulbar urethra, given its high success rate and low complication rate compared to other surgical interventions. Bleeding is a presumed risk factor for any surgical procedure but perioperative hemorrhage after an EPA requiring hospitalization and/or reintervention is unreported with no known consensus on the best course for management. Through our experience with three separate cases of significant postoperative urethral hemorrhage after EPA, we developed an algorithm for treatment beginning with conservative management and progressing through endoscopic and open techniques, as well as consideration of embolization by interventional radiology. All the three of these cases were managed successfully though they did require multiple interventions. We theorize that younger patients with more robust corpus spongiosum and more vigorous spontaneous erections, patients that have undergone fewer prior urethral procedures and therefore have more prominent vasculature, and those patients managed with a two-layer closure of the ventral urethra without ligation of the transected bulbar arteries are at a higher risk for this complication. PMID:26635991

  1. Effect of chlorhexidine scrub on postoperative bacterial counts.

    PubMed

    Dahl, J; Wheeler, B; Mukherjee, D

    1990-05-01

    Chlorhexidine surgical scrub was left on the surgeon's hands in 50 orthopedic and vascular surgical procedures to determine whether the number of bacteria on the hands could be decreased postoperatively. After a standard 5-minute scrub, one hand was randomly rinsed prior to gloving; the other was lightly patted with a sterile towel, leaving some foam on the hand. The surgeon then gloved and performed the procedure in the usual manner. After the operation, both hands were immersed in a tryptic soy broth for 30 seconds. The broth was then cultured for bacterial species and number. Cases in which glove puncture occurred were not cultured. The results were analyzed using the Wilcoxon signed-rank test. There were fewer bacterial colonies isolated from the hand coated with chlorhexidine scrub versus the other; this difference was statistically significant (p less than 0.005). There also seemed to be a trend towards higher bacterial counts after longer operations; however, the difference was not significant. Neither surgeon noted any evidence of dermatitis during the study. These results suggest that leaving chlorhexidine scrub on the hands during surgery can lead to lower bacterial counts on the surgeon's hands and less chance of wound contamination should glove puncture occur.

  2. The impact of opioid-induced hyperalgesia for postoperative pain.

    PubMed

    Koppert, Wolfgang; Schmelz, Martin

    2007-03-01

    Clinical evidence suggests that--besides their well known analgesic activity - opioids can increase rather than decrease sensitivity to noxious stimuli. Based on the observation that opioids can activate pain inhibitory and pain facilitatory systems, this pain hypersensitivity has been attributed to a relative predominance of pronociceptive mechanisms. Acute receptor desensitization via uncoupling of the receptor from G-proteins, upregulation of the cAMP pathway, activation of the N-methyl-D-aspartate (NMDA)-receptor system, as well as descending facilitation, have been proposed as potential mechanisms underlying opioid-induced hyperalgesia. Numerous reports exist demonstrating that opioid-induced hyperalgesia is observed both in animal and human experimental models. Brief exposures to micro-receptor agonists induce long-lasting hyperalgesic effects for days in rodents, and also in humans large-doses of intraoperative micro-receptor agonists were found to increase postoperative pain and morphine consumption. Furthermore, the prolonged use of opioids in patients is often associated with a requirement for increasing doses and the development of abnormal pain. Successful strategies that may decrease or prevent opioid-induced hyperalgesia include the concomitant administration of drugs like NMDA-antagonists, alpha2-agonists, or non-steroidal anti-inflammatory drugs (NSAIDs), opioid rotation or combinations of opioids with different receptor/selectivity.

  3. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting

    PubMed Central

    Horn, Charles C.; Wallisch, William J.; Homanics, Gregg E.; Williams, John P.

    2013-01-01

    Clinical research shows that postoperative nausea and vomiting (PONV) is caused primarily by the use of inhalational anesthesia and opioid analgesics. PONV is also increased by several risk predictors, including a young age, female sex, lack of smoking, and a history of motion sickness. Genetic studies are beginning to shed light on the variability in patient experiences of PONV by assessing polymorphisms of gene targets known to play roles in emesis (serotonin type 3, 5-HT3; opioid; muscarinic; and dopamine type 2, D2, receptors) and the metabolism of antiemetic drugs (e.g., ondansetron). Significant numbers of clinical trials have produced valuable information on pharmacological targets important for controlling PONV (e.g., 5-HT3 and D2), leading to the current multi-modal approach to inhibit multiple sites in this complex neural system. Despite these significant advances, there is still a lack of fundamental knowledge of the mechanisms that drive the hindbrain central pattern generator (emesis) and forebrain pathways (nausea) that produce PONV, particularly the responses to inhalational anesthesia. This gap in knowledge has limited the development of novel effective therapies of PONV. The current review presents the state of knowledge on the biological mechanisms responsible for PONV, summarizing both preclinical and clinical evidence. Finally, potential ways to advance the research of PONV and more recent developments on the study of postdischarge nausea and vomiting (PDNV) are discussed. PMID:24495419

  4. Risk Factors for Postoperative Retention After Hemorrhoidectomy: A Cohort Study.

    PubMed

    Qi-Ming, Xue; Jue-Ying, Xiang; Ben-Hui, Chen; Jing, Wu; Ning, Li

    2015-01-01

    The objective of this study was to identify the risk factors for urinary retention after hemorrhoidectomy. With the approval of West China Hospital of Sichuan University Ethics Board, data were abstracted from 961 charts of patients who underwent hemorrhoidectomy from January 1, 2009, to June 30, 2011. The outcome was urinary retention in the first 24 hours after surgery. Risk factors were identified using multivariable logistic regression, and they were expressed as odds ratios or 95% confidence intervals. The overall urinary retention rate was 14.8% (n = 142). Significant risk factors associated with postoperative urinary retention included female gender, anesthesia methods, severity of hemorrhoid, a large amount of intravenous fluid administered perioperatively, and length of hospital stay. Logistic regression analysis revealed that female gender (odds ratio, 2.607; p < .01), sacral anesthesia (odds ratio, 2.481; p = .02), more than 3 hemorrhoids resected (odds ratio, 2.658; p < .01), hemorrhoids having 4 degrees of severity (odds ratio, 3.101; p < .01), intravenous fluids > 700 ml (odds ratio, 1.597; p = .02), and length of stay more than 7 days (odds ratio, 1.852; p < .01) were significant predictors of urinary retention post-hemorrhoidectomy.

  5. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting.

    PubMed

    Horn, Charles C; Wallisch, William J; Homanics, Gregg E; Williams, John P

    2014-01-01

    Clinical research shows that postoperative nausea and vomiting (PONV) is caused primarily by the use of inhalational anesthesia and opioid analgesics. PONV is also increased by several risk predictors, including a young age, female sex, lack of smoking, and a history of motion sickness. Genetic studies are beginning to shed light on the variability in patient experiences of PONV by assessing polymorphisms of gene targets known to play roles in emesis (serotonin type 3, 5-HT3; opioid; muscarinic; and dopamine type 2, D2, receptors) and the metabolism of antiemetic drugs (e.g., ondansetron). Significant numbers of clinical trials have produced valuable information on pharmacological targets important for controlling PONV (e.g., 5-HT3 and D2), leading to the current multi-modal approach to inhibit multiple sites in this complex neural system. Despite these significant advances, there is still a lack of fundamental knowledge of the mechanisms that drive the hindbrain central pattern generator (emesis) and forebrain pathways (nausea) that produce PONV, particularly the responses to inhalational anesthesia. This gap in knowledge has limited the development of novel effective therapies of PONV. The current review presents the state of knowledge on the biological mechanisms responsible for PONV, summarizing both preclinical and clinical evidence. Finally, potential ways to advance the research of PONV and more recent developments on the study of postdischarge nausea and vomiting (PDNV) are discussed.

  6. Radionuclide studies in postoperative evaluation of the Fontan procedure

    SciTech Connect

    Brendel, A.J.; Wynchank, S.; Choussat, A.; Barat, J.L.; Deville, C.; Ducassou, D.; Fontan, F.

    1984-10-01

    Radionuclide studies were performed on 12 patients who had had a Fontan operation for cyanotic congenital heart disease, six of whom had undergone a prior palliative Glenn procedure. The patients without prior Glenn anastomoses were studied by radionuclide first-pass angiocardiography, using a right antecubital vein injection of /sup 99m/Tc pertechnetate. The patients with Glenn anastomoses required two injections, one by femoral vein to study the Fontan procedure, using bolus injection of /sup 99m/Tc pertechnetate or microspheres, and the second by right anetcubital vein to study the Glenn anastomosis and right lung, using a bolus of microspheres. Noninvasive radionuclide methods seem to be dependable in the postoperative evaluation of patients after the Fontan procedure. First-pass angiocardiography is most helpful in evaluating the dynamics and distribution of blood flow, especially the right atrial output, and gated blood-pool scintigraphy offers a better evaluation of right atrial and left ventricular contraction, so both supply complementary information.

  7. [Effect of local anesthetics on the postoperative inflammatory response].

    PubMed

    Beloeil, H; Mazoit, J-X

    2009-03-01

    Current knowledge suggests that peripheral inflammation following surgery activates and sensitizes both peripheral and central nervous system. These phenomena involved in the maintenance of the inflammatory response lead to hypersensibility, hyperalgesia and allodynia. Hyperalgesia participates in the general experience of postoperative pain and ALo in the development of chronic pain. A correlation between the ability of treatments to reduce areas of hypersensitivity surrounding the wound after surgery and their ability to reduce the incidence of chronic pain has been shown. For a long time, local anaesthetics have been used for their capacity to block nociceptive input. They can ALo modulate the inflammatory response following a surgical trauma. By inhibiting the nervous conductivity at the site of the trauma, local anesthetics attenuate the sensitization of the nervous system and therefore the inflammatory phenomena. They ALo exert intrinsic anti-inflammatory properties by modulating the local and systemic liberation of inflammatory mediators. The mechanisms involved are not clearly elucidated. Local, systemic, and spinal inflammatory mechanisms may be influenced by local anesthetics through multiple different mechanisms. The therapeutic implications of effects of local anesthetics on local, systemic, and spinal inflammatory responses merit further study. PMID:19297121

  8. Adhesion barrier reduces postoperative adhesions after cardiac surgery.

    PubMed

    Kaneko, Yukihiro; Hirata, Yasutaka; Achiwa, Ikuya; Morishita, Hiroyuki; Soto, Hajime; Kobayahsi, Jotaro

    2012-06-01

    Reoperation in cardiac surgery is associated with increased risk due to surgical adhesions. Application of a bioresorbable material could theoretically reduce adhesions and allow later development of a free dissection plane for cardiac reoperation. Twenty-one patients in whom a bioresorbable hyaluronic acid-carboxymethylcellulose adhesion barrier had been applied in a preceding surgery underwent reoperations, while 23 patients underwent reoperations during the same period without a prior adhesion barrier. Blinded observers graded the tenacity of the adhesions from surgical video recordings of the reoperations. No excessive bleeding requiring wound reexploration, mediastinal infection, or other complication attributable to the adhesion barrier occurred. Multiple regression analysis showed that shorter duration of the preceding surgery, non-use of cardiopulmonary bypass in the preceding surgery, and use of the adhesion barrier were significantly associated with less tenacious surgical adhesions. The use of a bioresorbable material in cardiac surgery reduced postoperative adhesions, facilitated reoperation, and did not promote complications. The use of adhesion barrier is recommended in planned staged procedures and those in which future reoperation is likely.

  9. 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

  10. Effect of preoperative suggestion on postoperative gastrointestinal motility.

    PubMed Central

    Disbrow, E A; Bennett, H L; Owings, J T

    1993-01-01

    Autonomic behavior is subject to direct suggestion. We found that patients undergoing major operations benefit more from instruction than from information and reassurance. We compared the return of intestinal function after intra-abdominal operations in 2 groups of patients: the suggestion group received specific instructions for the early return of gastrointestinal motility, and the control group received an equal-length interview offering reassurance and nonspecific instructions. The suggestion group had a significantly shorter average time to the return of intestinal motility, 2.6 versus 4.1 days. Time to discharge was 6.5 versus 8.1 days. Covariates including duration of operation, amount of intraoperative bowel manipulation, and amount of postoperative narcotics were also examined using the statistical model analysis of covariance. An average savings of $1,200 per patient resulted from this simple 5-minute intervention. In summary, the use of specific physiologically active suggestions given preoperatively in a beleivable manner can reduce the morbidity associated with an intra-abdominal operation by reducing the duration of ileus. PMID:8342264

  11. A Targeted Swallow Screen for the Detection of Postoperative Dysphagia.

    PubMed

    Gee, Erica; Lancaster, Elizabeth; Meltzer, Jospeh; Mendelsohn, Abie H; Benharash, Peyman

    2015-10-01

    Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. A simple and sensitive screening test to identify patients requiring objective dysphagia evaluation is presently lacking. In this study, we evaluated the efficacy of a novel targeted swallow screen evaluation. This was a prospective trial involving all adult patients who underwent elective cardiac surgery with cardiopulmonary bypass at our institution over an 8-week period. Within 24 hours of extubation and before the initiation of oral intake, all postsurgical patients were evaluated using the targeted swallow screen. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. During the study, 50 postcardiac surgery patients were screened. Fifteen (30%) failed the targeted swallow screen, and ten of the fifteen (66%) failed the subsequent fiberoptic endoscopic evaluation of swallowing exam and were confirmed to have dysphagia. The screening test had 100 per cent sensitivity for detecting dysphagia in our patient population, and a specificity of 87.5 per cent. The overall incidence of dysphagia was 20 per cent. We have shown that a targeted swallow evaluation can efficiently screen patients during the postcardiac surgery period. Furthermore, we have shown that the true incidence of dysphagia after cardiac surgery is significantly higher than previously recognized in literature.

  12. The sensitivity of radiography of the postoperative stomach

    SciTech Connect

    Ott, D.J.; Munitz, H.A.; Gelfand, D.W.; Lane, T.G.; Wu, W.C.

    1982-09-01

    The results of radiology and endoscopy were compared in 140 patients who had undergone gastric surgery for ulcer disease. Of 74 patients who were examined with single-contrast radiography, 37 had abnormalities that were demonstrated endoscopically. The radiographic sensitivities in these patients were: gastritis 2/22 (9%); ulcer 3/5 (60%); obstruction 8/8 (100%); and miscellaneous abnormalities 2/2 (100%). The predictive accuracy of a diagnois of ulcer was 38%. Of the 66 patients who were examined with double-contrast radiography, 33 abnormalities were found with endoscopy. The radiographic sensitivities were: gastritis 3/13 (23%); ulcer 7/10 (70%); obstruction 4/4 (100%); and miscellaneous abnormalities 6/6 (100%). The predictive accuracy of a diagnosis of ulcer was 44%. Radiology appears to be unreliable in diagnosing gastritis and recurrent ulceration in the post-operation stomach. The double-contrast technique does not offer significant improvement over the single-contrast method in evaluating these postoperative problems.

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

    SciTech Connect

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

    2013-10-15

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

  14. Validation of sensor for postoperative positioning with intraocular gas

    PubMed Central

    Brodie, Frank L; Woo, Kelly Y; Balakrishna, Ashwin; Choo, Hyuck; Grubbs, Robert H

    2016-01-01

    Purpose Surgical repair of retinal attachment or macular hole frequently requires intraocular gas. This necessitates specific postoperative positioning to improve outcomes and avoid complications. However, patients struggle with correct positioning. We have developed a novel sensor to detect the position of the gas bubble in the eye and provide feedback to patients in real time. In this paper, we determine the specificity and sensitivity of our sensor in vitro using a model eye. Methods We assessed the reliability of our sensor to detect when a gas bubble has deviated off a model retinal break in a model eye. Various bubble sizes representing the intraocular kinetics of sulfur hexafluoride gas and varying degrees of deviation from the correct position were tested using the sensor attached to a mannequin head with a model eye. Results We recorded 36 data points. The sensor acted appropriately in 33 (91.7%) of them. The sensor triggered the alarm every time the bubble deviated off the break (n=15, sensitivity =100%). However, it triggered the alarm (falsely) 3/21 times when the bubble was correctly positioned over the retinal break (specificity =86%). Conclusion Our device shows excellent sensitivity (100%) and specificity (86%) in detecting whether intraocular gas is tamponading a retinal break in a model eye. PMID:27307698

  15. Incidences of frostbite in arthroscopic knee surgery postoperative cryotherapy rehabilitation.

    PubMed

    McGuire, David A; Hendricks, Stephen D

    2006-10-01

    A retrospective study of 4 cases of frostbite was undertaken to examine causes and to identify related contributory behaviors and circumstances. These patients underwent various surgical interventions before the onset of frostbite during similar postoperative care regimens. Surgical procedures included some of the following in each patient: lateral retinacular release, vastus medialis oblique muscle advancement, partial medial meniscectomy, chondromalacia patella, trochlea, medial and lateral femoral condyle debridement, lateral retinaculum release, and excision of medial plica. The mechanism of onset, development, and sites of frostbite were uniform in all patients. In every case, the sites were located in the area on top of the patella including some adjacent regions depending on the size of each injury. Frostbite locations were correlated with the part of the cryotherapy cold cuff device located on top of the patellar region. This cuff portion was originally designed to accommodate surgical trauma induced during autogenous bone-tendon-bone graft harvest in anterior cruciate ligament reconstruction surgery. Locating cryotherapy over this region assisted in minimizing pain and effusion for patients subsequent to distal patella bone plug harvest trauma. However, the requirement for use of the pad in the patella area for patients not undergoing anterior cruciate ligament reconstruction with autograft was found to be unnecessary and was the primary cause of frostbite in the cases presented here.

  16. Postoperative deep venous thrombosis in Japan. Incidence and prophylaxis

    SciTech Connect

    Inada, K.; Shirai, N.; Hayashi, M.; Matsumoto, K.; Hirose, M.

    1983-06-01

    The incidence of postoperative deep venous thrombosis was investigated using the iodine-125-fibrinogen method in 256 patients undergoing major surgery. Deep venous thrombosis was found in 49 patients (15.3 percent), and nonfatal pulmonary embolism developed in one of seven patients in whom the thrombus extended to the popliteal vein. The same investigation was performed in 110 patients who wore a graduated compression stocking on one leg, with the other leg serving as a control. Deep venous thrombosis was found in 4 of 110 stockinged legs (3.6 percent) and in 16 of 110 control legs (14.5 percent). The incidence of deep venous thrombosis decreased significantly in patients who wore the stocking. An increase in femoral venous flow velocity was found in the stockinged legs by the Doppler method. The mean velocity of venous return by xenon-133 clearance was significantly greater in the stockinged legs than in the control legs. These findings were considered to support the efficacy of graduated compression stockings for the prevention of deep venous thrombosis.

  17. Is postoperative encephalopathy with choreoathetosis an acquired form of neuroacanthocytosis?

    PubMed

    Popkirov, Stoyan; Schlegel, Uwe; Skodda, Sabine

    2016-04-01

    Postoperative encephalopathy with choreoathetosis ("postpump chorea") is a rare complication of open-heart surgery and, in particular, the employment of a cardiopulmonary bypass pump. It almost exclusively occurs in young children. While risk factors and the underlying histopathology have been identified, the pathogenesis of postpump chorea, crucially, remains largely unknown. Transient cerebral hypoperfusion associated with cardiopulmonary bypass is considered a likely candidate mechanism, but the evidence is insufficient and inconclusive. It is hypothesized in this article, that postpump chorea may be caused by mechanical trauma to red blood cells and resulting acanthocytosis. These dysfunctional erythrocytes could then lead to damage to the globus pallidus and disease development akin to that presumed in neuroacanthocytosis. In patients with neuroacanthocytosis an association between acanthocytosis and basal ganglia pathology has been suggested. To test the mechanism hypothesized here, the effects of cardiopulmonary bypass on erythrocyte morphology and function could be systematically tested in children undergoing cardiac surgery. Ideally, the extent of erythrocyte damage could be correlated with the risk of developing postpump chorea. Finally, if the proposed hypothesis is supported by empirical findings, efforts to reduce blood cell damage during extracorporeal circulation in children might prevent this devastating complication. PMID:26968902

  18. Consensus guidelines for the management of postoperative nausea and vomiting.

    PubMed

    Gan, Tong J; Diemunsch, Pierre; Habib, Ashraf S; Kovac, Anthony; Kranke, Peter; Meyer, Tricia A; Watcha, Mehernoor; Chung, Frances; Angus, Shane; Apfel, Christian C; Bergese, Sergio D; Candiotti, Keith A; Chan, Matthew Tv; Davis, Peter J; Hooper, Vallire D; Lagoo-Deenadayalan, Sandhya; Myles, Paul; Nezat, Greg; Philip, Beverly K; Tramèr, Martin R

    2014-01-01

    The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.

  19. Hybrid technique for postoperative ventral hernias – own experience

    PubMed Central

    Okniński, Tomasz; Pawlak, Jacek

    2015-01-01

    Introduction There are many techniques which may be involved in abdominal hernia repair, from classical to tension-free. Treatment of complicated hernias has undergone evolution. Many surgeons consider the laparoscopic method as a method of choice for incisional hernia repair. Sometimes miniinvasive repair of complicated hernia is not so easy to perform. We are convinced that selected patients may benefit from combined open and laparoscopic techniques. Aim To present the operating technique and early results of treatment of 15 patients operated on using the 3 hybrid technique. Material and methods Fifteen patients suffering from recurrent incisional hernias underwent the hybrid technique for their repair between June 2012 and April 2015. The hybrid technique was performed using synthetic meshes in 14 cases and a biological implant in 1 case. Results The early postoperative period was uncomplicated in all cases. Within a maximum follow-up period of 32 months, two deep wound infections were observed. Conclusions The hybrid technique may be used in patients with recurrent incisional hernias. PMID:26865889

  20. Kernschmelze Der nachhaltige Einfluss von Nuklearwaffen auf Politik und Wirtschaft

    NASA Astrophysics Data System (ADS)

    Greiner, Bernd

    "Was sollen wir von einer Kultur halten, der die Ethik stets als wesentliches Element des menschlichen Lebens galt, die aber - außer in fachlicher oder spieltheoretischer Terminologie - nicht in der Lage war, über die Möglichkeit zu sprechen, nahezu alle Menschen zu töten?" Der Fragesteller gehört zu den berühmtesten Physikern des 20. Jahrhunderts und zu den nach wie vor Umstrittensten. über ihn wurde in den 1960er Jahren ein international viel beachtetes Theaterstück geschrieben, vor wenigen Jahren gar eine Oper.

  1. Was leistet ein Sportler? Kraft, Leistung und Energie im Muskel

    NASA Astrophysics Data System (ADS)

    Thaller, Sigrid; Mathelitsch, Leopold

    2006-01-01

    Der Leistungsbegriff ist im Sport weiter gefasst als in der Physik. In beiden Fällen liegt der Fokus jedoch auf einer pro Zeiteinheit erfolgten Energieumsetzung. Allerdings gibt die rein physikalische Leistung nicht immer Auskunft über den Energieumsatz der Muskeln. Die Muskelkraft hängt von der Kontraktionsgeschwindigkeit des Muskels ab. Ein Muskel verhält sich also anders als eine Feder. Für den Hochleistungssport müssen die Energieumsätze der Muskeln durch spezielle Trainings- und Nahrungsprogramme optimiert werden.

  2. Zu einer inhaltsorientierten Theorie des Lernens und Lehrens der biologischen Evolution

    NASA Astrophysics Data System (ADS)

    Wallin, Anita

    Der Zweck dieser Studie (zwecks Überblick siehe dazu Abb. 9.1) war zu untersuchen, wie die Schüler der Sekundarstufe II ein Verständnis von der Theorie der biologischen Evolution entwickeln. Vom Ausgangspunkt "Vorurteile der Schüler“ ausgehend wurden Unterrichtssequenzen entwickelt und drei verschiedene Lernexperimente in einem zyklischen Prozess durchgeführt. Das Wissen der Schüler wurde vor, während und nach den Unterrichtssequenzen mit Hilfe von schriftlichen Tests, Interviews und Diskussionsrunden in kleinen Gruppen abgefragt. Etwa 80 % der Schüler hatten vor dem Unterricht alternative Vorstellungen von Evolution, und in dem Nachfolgetest erreichten circa 75 % ein wissenschaftliches Niveau. Die Argumentation der Schüler in den verschiedenen Tests wurde sorgfältig unter Rücksichtnahme auf Vorurteile, der konzeptionellen Struktur der Theorie der Evolution und den Zielen des Unterrichts analysiert. Daraus konnten Einsichten in solche Anforderungen an Lehren und Lernen gewonnen werden, die Herausforderungen an Schüler und Lehrer darstellen, wenn sie anfangen, evolutionäre Biologie zu lernen oder zu lehren. Ein wichtiges Ergebnis war, dass das Verständnis existierender Variation in einer Population der Schlüssel zum Verständnis von natürlicher Selektion ist. Die Ergebnisse sind in einer inhaltsorientierten Theorie zusammengefasst, welche aus drei verschiedenen Aspekten besteht: 1) den inhaltsspezifischen Aspekten, die einzigartig für jedes wissenschaftliche Feld sind; 2) den Aspekten, die die Natur der Wissenschaft betreffen; und 3) den allgemeinen Aspekten. Diese Theorie kann in neuen Experimenten getestet und weiter entwickelt werden.

  3. Charakterisierung von Sulfotransferasen im Gastrointestinaltrakt von Mensch und Ratte und Aktivierung von Promutagenen in V79-Zellen, die eine intestinale Form (1B1) des Menschen und der Ratte exprimieren

    NASA Astrophysics Data System (ADS)

    Teubner, Wera

    2001-05-01

    Die Ausstattung der gastrointestinalen Mukosa des Menschen und der Ratte mit Sulfotransferasen wurde mit Hilfe von Immunodetektion und Enzymaktivitätsmessungen untersucht. In Proben aus Colon und Rektum von 39 Personen wurden die Formen h1A1, h1A3 und h1B1 identifiziert, wobei in einer weiteren Probe, die als einzige von einem an Colitis Ulcerosa erkrankten Patienten stammte, keine Sulfotransferasen nachgewiesen werden konnten. Bei der Immunblot-Analyse war das Expressionsmuster der einzelnen Formen in allen Proben ähnlich. In wenigen Proben waren die relativen Signalintensitäten der h1A1 und der h1B1 um die Hälfte erniedrigt. Der Gehalt von SULT an zytosolischem Protein zeigte einen bis zu 8 - 10fachen Unterschied, er betrug jedoch bei zwei Dritteln der Proben zwischen 0,15 und 0,3 (h1A1 und h1A3) bzw. 0,6 und 0,8 Promille (h1B1). Die Variation konnte nicht auf Alter, Geschlecht oder Krankheitsbild der Patienten zurückgeführt werden. Auch der für die allelischen Varianten der h1A1 beschriebene Effekt auf die Enzymaktiviät bzw. Stabilität konnte in der Menge an immunreaktivem Protein nicht in diesem Ausma detektiert werden. Die Allelhäufigkeit von h1A1*R und h1A1*H war gegenüber der gesunden Bevölkerung nicht verändert. In den sieben Proben aus dem Dünndarm (Coecum, viermal Ileum, Jejunum) konnten zusätzlich die Formen h1E1 und h2A1 identifiziert werden. Ein möglicherweise der Form h1C1 entsprechendes Protein wurde im Magen detektiert. Im Vergleich zum Menschen war die Expression in der Ratte stärker auf die Leber konzentriert. Während beim Menschen in allen untersuchten Abschnitten Sulfotransferasen in Mengen detektiert wurden, die in zwei Fällen (h1B1 und h1A3) sogar den Gehalt in der Leber überstiegen, beschränkte sich die Expression in der Ratte auf im Vergleich zur Leber geringe Mengen im Magen und Dickdarm. Nachgewiesen wurden die r1B1, r1A1 sowie eine nicht identifizierte Form von 35kD, bei der es sich vermutlich um die r1C2 handelt. Im

  4. Der Kalte Krieg in der Peripherie Griechische Physiker und Atomenergie nach dem Zweiten Weltkrieg

    NASA Astrophysics Data System (ADS)

    Vlahakis, George N.

    Die vorliegende Arbeit analysiert Ansichten griechischer Physiker zur Atomenergie und deren mögliche Anwendung nach dem Zweiten Weltkrieg, insbesondere während des Kalten Kriegs. Einerseits werden Ansichten von Physik- Professoren griechischer Universitäten präsentiert - beispielsweise von Dimitrios Hondros, der Student von Arnold Sommerfeld und Mitarbeiter von Peter Debye in München war, und andererseits wird die Politik der griechischen Regierung für die Etablierung eines Forschungsinstitutes diskutiert, das der Entwicklung der Atomenergie dienen sollte; ebenfalls wird eine öffentliche Meinungsumfrage zu diesen Thema, die in den Tageszeitungen der damaligen Zeit präsentiert wurde, diskutiert.

  5. Chaos für die Schule!: Nichtlinearität und Strukturbildung

    NASA Astrophysics Data System (ADS)

    Nordmeier, Volkhard; Schlichting, Hans Joachim

    2003-01-01

    Modellsysteme können Schülern die Grundlagen der nichtlinearen Physik anschaulich vermitteln. Sie schlagen so einen Bogen von der Schulphysik zur aktuellen Forschung. Ein solches Modellsystem ist das chaotische Wasserrad, das Lehrer auf einfache Weise für den Schulunterricht nachbauen können. Im Wesentlichen steuert der Zufluss des Wassers das Verhalten des Wasserrads. Wächst er, so durchläuft das Rad von der geordneten, gleichförmigen Drehung bis zum Chaos verschiedene Phasen von Bewegungsfiguren. Das Experiment kann grundlegende Modelle und Begriffe der Chaostheorie demonstrieren: lokale und globale Bifurkationen und verschiedene Übergänge ins Chaos.

  6. Das Prinzip Bewegung - Herz und Gehirn als Metaphern des menschlichen Lebens

    NASA Astrophysics Data System (ADS)

    Otis, Laura

    In diesem Jahr, in dem wir Charles Darwins gedenken, möchte ich etwas riskieren und eine Frage erörtern, die für die Literatur ebenso wie für die Biologie zentral ist: Was ist das Leben? Die Antwort auf diese Frage finden wir nicht in der Bibliothek und nicht im Labor, zumindest nicht an diesen erkenntnisproduzierenden Stellen allein. Als Literaturwissenschaftlerin und ehemalige Naturwissenschaftlerin glaube ich, dass wir das Leben nur verstehen werden, wenn wir seinen Wirkungen überall nachforschen, inklusive in der Literatur.

  7. Von Donuts und Zucker: Mit Neutronen biologische Makromoleküle erforschen

    NASA Astrophysics Data System (ADS)

    May, Roland P.

    2003-05-01

    Für die Erforschung von Biomolekülen bieten Neutronen einzigartige Eigenschaften. Vor allem ihre unterschiedliche Wechselwirkung mit dem natürlichen Wasserstoff und seinem schweren Isotop Deuterium ermöglicht tiefe Einblicke in Struktur, Funktion und Dynamik von Proteinen, Nukleinsäuren und Biomembranen. Bei vielen Fragestellungen zur Strukturaufklärung gibt es kaum oder keine Alternative zum Neutron. Das Institut Laue-Langevin trägt Bahnbrechendes zum Erfolg der Neutronen-Methoden in der Biologie bei.

  8. Role of Ketamine in Acute Postoperative Pain Management: A Narrative Review

    PubMed Central

    Radvansky, Brian M.; Shah, Khushbu; Parikh, Anant; Sifonios, Anthony N.; Le, Vanny; Eloy, Jean D.

    2015-01-01

    Objectives. The objective of this narrative review was to examine the usage of ketamine as a postoperative analgesic agent across a wide variety of surgeries. Design. A literature search was performed using the phrases “ketamine” and “postoperative pain.” The authors analyzed the studies that involved testing ketamine's effectiveness at controlling postoperative pain. Effectiveness was assessed through various outcomes such as the amount of opiate consumption, visual analog scale (VAS) pain scores, and persistent postoperative pain at long-term follow-up. Results. While many different administration protocols were evaluated, delivering ketamine both as a pre- or perioperative bolus and postoperative infusion for up to 48 hours appeared to be the most effective. These effects are dose-dependent. However, a number of studies analyzed showed no benefit in using ketamine versus placebo for controlling postoperative pain. While ketamine is a safe and well-tolerated drug, it does have adverse effects, and there are concerns for possible neurotoxicity and effects on memory. Conclusions. In a number of limited situations, ketamine has shown some efficacy in controlling postoperative pain and decreasing opioid consumption. More randomized controlled trials are necessary to determine the surgical procedures and administrations (i.e., intravenous, epidural) that ketamine is best suited for. PMID:26495312

  9. Are Hyoid Bone and Tongue the Risk Factors Contributing to Postoperative Relapse for Mandibular Prognathism?

    PubMed Central

    Tseng, Yu-Chuan; Lai, Steven; Lee, Huey-Er; Chen, Ker-Kong; Chen, Chun-Ming

    2016-01-01

    Objective. The purpose of this study was to investigate postoperative stability and the correlation between hyoid, tongue, and mandible position following surgery for mandibular prognathism. Materials and Methods. Thirty-seven patients, treated for mandibular prognathism using intraoral vertical ramus osteotomy (IVRO), were evaluated cephalometrically. A set of four standardized lateral cephalograms were obtained from each subject preoperatively (T1), immediately postoperatively (T2), six weeks to three months postoperatively (T3), and more than one year postoperatively (T4). The Student t-tests, the Pearson correlation coefficient, and the multiple linear regression were used for statistical analysis. Results. Immediately after surgery, menton (Me) setback was 12.8 mm, hyoid (H) setback was 4.9 mm, and vallecula epiglottica (V) setback was 5.8 mm. The postoperative stability significantly correlated (r = −0.512, p < 0.01) with the amount of setback. The hyoid bone and tongue did not have significant effects on postoperative stability. Multiple linear regression model (R2 = 0.2658, p < 0.05) showed predictability: Horizontal Relapse Me (T4-T2) = −6.406 − 0.488Me (T2-T1) + 0.069H (T2-T1) − 0.0619V (T2-T1). Conclusion. Mandibular setback surgery may push the hyoid and tongue significantly backward, but this did not correlate with mandibular relapse. Postoperative stability significantly correlated with the amount of mandibular setback. PMID:27042664

  10. Relationship between Frontal Gap and Postoperative Stability in the Treatment of Mandibular Prognathism

    PubMed Central

    Tseng, Yu-Chuan; Hsu, Kun-Jung; Wu, Ju-Hui

    2016-01-01

    Objectives. To investigate the correlation between frontal gaps and skeletal stability after intraoral vertical ramus osteotomy (IVRO) for correction of mandibular prognathism. Materials and Methods. Thirty-three patients with frontal gaps after IVRO-based mandibular prognathism correction were included. Three lateral and frontal cephalometric radiographs were obtained: preoperatively (T1), immediately postoperatively (T2), and 2 years postoperatively (T3). Two linear measurements (menton [Me] and frontal gap) were compared from T1 to T3 (T21: immediate surgical changes; T32: postoperative stability; T31: 2-year surgical change). Data were analyzed using Pearson's correlation coefficient and multiple linear regression. Results. The T21 mean surgical horizontal change in the Me position was 12.4 ± 4.23 mm. Vertically, the mean downward Me movement was 0.6 ± 1.73 mm. The mean frontal gaps were 4.7 ± 2.68 mm and 4 ± 2.48 mm in the right and left gonial regions, respectively. Postoperative stability (T32) significantly correlated with the amount of setback. Frontal gaps did not have a significant effect on postoperative stability. However, multiple regression model (R2 = 0.341, P = 0.017) showed value predictability, especially in the amount of setback. Conclusion. Frontal gaps occur after IVRO but have no significant effect on long-term postoperative skeletal stability. The primary risk factor for postoperative relapse remains the amount of mandibular setback. PMID:27774457

  11. Postoperative pain in treatment of spontaneous pneumothorax with limited two-port thoracoscopy

    PubMed Central

    Lin, Fengwu; Zhang, Chuan; Zhang, Qiang; Dang, Dan; Zhao, Yan

    2014-01-01

    Objectives: To investigate effects of the limited two-port video assisted thoracic surgery on treatment of spontaneous pneumothorax. Methods: A retrospective analysis of 96 patients with spontaneous pneumothorax who underwent video assisted thoracic surgery was conducted in the present study, in which 23 cases underwent the limited two-port video assisted thoracic surgery while 73 cases treated with the standard three-port video assisted thoracic surgery or the standard two-port video assisted thoracic surgery. The mean operation time, mean intraoperative blood loss and average postoperative hospital stay, average postoperative chest tube duration and postoperative pain rating were analyzed. Results: There was no statistical difference existed in the mean operation time, mean intraoperative blood loss, average postoperative hospital stay, average postoperative chest tube duration between the two groups (P>0.05). However, the postoperative pain in the limited two-port video assisted thoracic surgery group was significantly lower than that of the traditional video assisted thoracic surgery group. Conclusion: Compared with that of the standard three-port video assisted thoracic surgery or the standard two- port video assisted thoracic surgery, there is better cosmetic effect, and lower grade postoperative pain in the limited two-port video assisted thoracic surgery. PMID:25097502

  12. Effects of ketoprofen for prevention of postoperative cognitive dysfunction in aged rats.

    PubMed

    Kawano, Takashi; Takahashi, Tetsuya; Iwata, Hideki; Morikawa, Akihiro; Imori, Satoko; Waki, Sayaka; Tamura, Takahiko; Yamazaki, Fumimoto; Eguchi, Satoru; Kumagai, Naoko; Yokoyama, Masataka

    2014-12-01

    Postoperative cognitive dysfunction is a common geriatric complication that may be associated with increased mortality. Here, we investigated the effects of postoperative analgesia with ketoprofen on cognitive functions in aged animals and compared its effectiveness to morphine. Rats were randomly allocated to one of four groups: isoflurane anesthesia without surgery (group C), isoflurane anesthesia with laparotomy (group IL), and isoflurane anesthesia with laparotomy plus postoperative analgesia with ketoprofen or morphine. There was no difference in postoperative locomotor activity among groups. In group IL, postoperative pain levels assessed by the Rat Grimace Scale significantly increased until 8 h after surgery, which was similarly inhibited by both ketoprofen and morphine. Cognitive function was assessed using radial arm maze testing for 12 consecutive days from postoperative day 3. Results showed that the number of memory errors in group IL were significantly higher than those in goup C. However, both ketoprofen and morphine could attenuate the increase in memory errors following surgery to a similar degree. Conversely, ketoprofen showed no effect on cognitive function in the nonsurgical rats that did not experience pain. Our findings suggest that postoperative analgesia with ketoprofen can prevent the development of surgery-associated memory deficits via its pain-relieving effects.

  13. Proficiency of eye drop instillation in postoperative cataract patients in Ghana

    PubMed Central

    Liu, Yang; Murdoch, Amanda; Bassett, Ken; Dharamsi, Shafik

    2013-01-01

    Objective The purpose of the study was to evaluate the efficacy of postoperative instruction on proficiency of eye drop instillation following cataract surgery, and to determine whether such proficiency correlates with the prevalence and/or duration of irritation and pain experienced in operated eyes. Design This was a prospective, nonrandomized control trial with an educational intervention conducted via a single eye clinic in Accra, Ghana. Participants The 218 subjects who completed the study were postoperative cataract surgery patients whose surgery had been funded by the nongovernmental organization Unite for Sight. Methods Patients were evaluated on their ability to administer eye drops correctly on their first attempt on postoperative day one. If unsuccessful, patients were given an educational session that consisted of verbal instructions and an educational video. Both groups (successful and unsuccessful) on the first postoperative day were tested again for proficiency on postoperative day 30. The baseline group was evaluated only on postoperative day 30 and consisted of 36 patients. Results Of the 133 patients who received the educational session on eye drop instillation, 112 (84%) exhibited proficiency on postoperative day 30 as compared with 29 of 49 patients (59%) who did not receive the intervention. Additionally, there were fewer reports of pain and irritation following cataract extraction in the patients who received the educational session. Conclusion This study supports the efficacy of patient education in improving proficiency in eye drop instillation and in reducing pain and irritation following cataract extraction surgeries. PMID:24194638

  14. Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis

    PubMed Central

    Arumugam, Sudha; Lau, Christine SM; Chamberlain, Ronald S

    2016-01-01

    Objectives Effective postoperative pain management is crucial in the care of surgical patients. Opioids, which are commonly used in managing postoperative pain, have a potential for tolerance and addiction, along with sedating side effects. Gabapentin’s use as a multimodal analgesic regimen to treat neuropathic pain has been documented as having favorable side effects. This meta-analysis examined the use of preoperative gabapentin and its impact on postoperative opioid consumption. Materials and methods A comprehensive literature search was conducted to identify randomized control trials that evaluated preoperative gabapentin on postoperative opioid consumption. The outcomes of interest were cumulative opioid consumption following the surgery and the incidence of vomiting, somnolence, and nausea. Results A total of 1,793 patients involved in 17 randomized control trials formed the final analysis for this study. Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference −1.35, 95% confidence interval [CI]: −1.96 to −0.73; P<0.001). There was a significant reduction in morphine, fentanyl, and tramadol consumption (P<0.05). While a significant increase in postoperative somnolence incidence was observed (relative risk 1.30, 95% CI: 1.10–1.54, P<0.05), there were no significant effects on postoperative vomiting and nausea. Conclusion The administration of preoperative gabapentin reduced the consumption of opioids during the initial 24 hours following surgery. The reduction in postoperative opioids with preoperative gabapentin increased postoperative somnolence, but no significant differences were observed in nausea and vomiting incidences. The results from this study demonstrate that gabapentin is more beneficial in mastectomy and spinal, abdominal, and thyroid surgeries. Gabapentin is an effective analgesic adjunct, and clinicians should consider its use in multimodal treatment

  15. Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis

    PubMed Central

    Arumugam, Sudha; Lau, Christine SM; Chamberlain, Ronald S

    2016-01-01

    Objectives Effective postoperative pain management is crucial in the care of surgical patients. Opioids, which are commonly used in managing postoperative pain, have a potential for tolerance and addiction, along with sedating side effects. Gabapentin’s use as a multimodal analgesic regimen to treat neuropathic pain has been documented as having favorable side effects. This meta-analysis examined the use of preoperative gabapentin and its impact on postoperative opioid consumption. Materials and methods A comprehensive literature search was conducted to identify randomized control trials that evaluated preoperative gabapentin on postoperative opioid consumption. The outcomes of interest were cumulative opioid consumption following the surgery and the incidence of vomiting, somnolence, and nausea. Results A total of 1,793 patients involved in 17 randomized control trials formed the final analysis for this study. Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference −1.35, 95% confidence interval [CI]: −1.96 to −0.73; P<0.001). There was a significant reduction in morphine, fentanyl, and tramadol consumption (P<0.05). While a significant increase in postoperative somnolence incidence was observed (relative risk 1.30, 95% CI: 1.10–1.54, P<0.05), there were no significant effects on postoperative vomiting and nausea. Conclusion The administration of preoperative gabapentin reduced the consumption of opioids during the initial 24 hours following surgery. The reduction in postoperative opioids with preoperative gabapentin increased postoperative somnolence, but no significant differences were observed in nausea and vomiting incidences. The results from this study demonstrate that gabapentin is more beneficial in mastectomy and spinal, abdominal, and thyroid surgeries. Gabapentin is an effective analgesic adjunct, and clinicians should consider its use in multimodal treatment

  16. The method of early postoperative alimentation by needle-catheter jejunostomy.

    PubMed

    Bodoky, G; Harsányi, L

    1989-01-01

    It is well established that the nutritional state greatly influences tolerance during the operation. Authors present a new procedure for the early postoperative enteral alimentation having not been used in Hungary so far. Twelve hours after operation, a pump-operated, gradually increasing amount of oligopeptide food-preparation and concentrate is introduced continuously into the second jejunal loop intraoperatively. Using this method, a caloric intake of 9572 kJ can be achieved already from the fourth postoperative day onwards. Based on our experience gained from 32 patients, the method can be recommended for an up-to-date postoperative enteral alimentation.

  17. [Relaparotomy and programmed sanation of the abdominal cavity in treatment of early postoperative complications].

    PubMed

    Trofymov, P S; Shestopalov, D V; Karakursakov, N E; Kysliakov, V V; Tatarchuk, P O

    2014-08-01

    The structure and causes of postoperative complications occurrence, necessitating early relaparotomy conduction through last 5 yrs and 30 yrs ago, were analyzed. The complications rate almost did not change, but their structure--essentially. The occurrence rate for eventration, adhesive ileus, relaparotomy performance for abdominal cavity abscess have had lowered significantly due to introduction of a new operative technologies and prophylactic measures. The lowering of lethality after relaparotomy is caused by improvement of the complications diagnosis, timely performance of reoperations, application of laparostomy in the treatment of postoperative peritonitis, what have permitted to govern a postoperative period course.

  18. Effect of Tributyrin on Electrical Activity in the Small Intestine during Early Postoperative Period.

    PubMed

    Tropskaya, N S; Kislyakova, E A; Popova, T S

    2015-12-01

    The effect of enteral administration of tributyrin on electrical activity in the upper segments of the small intestine was examined in rats on the model of postoperative ileus. This postoperative state is characterized with pronounced and long-term disturbances in generation of migrating myoelectric complex of the small intestine. The enteral administration of tributyrin in the early postoperative period aimed to suppress the non-adrenergic non-cholinergic influences and activation of the cholinergic anti-inflammatory pathways is an effective procedure to normalize the migrating myoelectric complex and therefore the coordinated propulsive peristalsis in the small intestine.

  19. Adaptive and regulatory mechanisms in aged rats with postoperative cognitive dysfunction

    PubMed Central

    Bi, Yanlin; Liu, Shuyun; Yu, Xinjuan; Wang, Mingshan; Wang, Yuelan

    2014-01-01

    Inflammation may play a role in postoperative cognitive dysfunction. 5′ Adenosine monophosphate-activated protein kinase, nuclear factor-kappa B, interleukin-1β, and tumor necrosis factor-α are involved in inflammation. Therefore, these inflammatory mediators may be involved in postoperative cognitive dysfunction. Western immunoblot analysis revealed 5′ adenosine monophosphate-activated protein kinase and nuclear factor-kappa B in the hippocampus of aged rats were increased 1–7 days after splenectomy. Moreover, interleukin-1β and tumor necrosis factor-α were upregulated and gradually decreased. Therefore, these inflammatory mediators may participate in the splenectomy model of postoperative cognitive dysfunction in aged rats. PMID:25206851

  20. [Relaparotomy and programmed sanation of abdominal cavity in treatment of early postoperative complications].

    PubMed

    2014-08-01

    The structure and causes of postoperative complications occurrence, necessitating early relaparotomy conduction through last 5 yrs and 30 yrs ago, were analyzed. The complications rate almost did not change, but their structure--essentially. The occurrence rate for eventration, adhesive ileus, relaparotomy performance for abdominal cavity abscess have had lowered significantly due to introduction of a new operative technologies and prophylactic measures. The lowering of lethality after relaparotomy is caused by improvement of the complications diagnosis, timely performance of reoperations, application of laparostomy in the treatment of postoperative peritonitis, what have permitted to govern a postoperative period course.

  1. [MORPHOMETRIC AND HISTOLOGICAL CHANGES OF TISSUES IN PATIENTS, WHO UNDERWENT OPERATIONS FOR POSTOPERATIVE ABDOMINAL HERNIAS].

    PubMed

    Brek, O O

    2015-05-01

    The impact of hernioplasty on postoperative morphometric and histological changes in tissues of patients, suffering postoperative abdominal hernias (POAH), was studied. For POAH 135 patients were operated, in 85 of them (the main group)--combined methods of hernial gate plasty in accordance to procedures proposed, and in 50 (control group)--classical methods of hernial gate were applied. The most favorable course of the wound process of the inflammatory, changes reduction and stabilization of the tissues reaction on implant already on the 7th postoperative day was noted after application of a sub lay method in original modification.

  2. Suchmaschinen und Informationsqualität: Status quo, Problemfelder, Entwicklungstendenzen

    NASA Astrophysics Data System (ADS)

    Maaß, Christian; Gräfe, Gernot

    Das Thema Informationsqualität wird in den vorangegangenen Beiträgen umfangreich betrachtet. Die dabei geführte Diskussion zielt vordergründig auf organisatorische Dimensionen der Datenqualität, die strukturierte Datenanalyse oder Datenmanagementprozesse im Unternehmen ab. Dabei liegt ein Großteil der zur Unterstützung von Entscheidungsprozessen herangezogenen Informationen in Datenbanksystemen bzw. in einem Data Warehouse vor. Auf Basis verschiedener Analysetools (z. B. Online-Analytical-Processing) lassen sich diese Informationen dann systematisch auswerten. Allerdings können Entscheidungen nicht allein aufgrund der unternehmensintern vorliegenden Informationen getroffen werden. Vielmehr gilt es auch die aus der Unternehmensumwelt relevanten Informationen zu verarbeiten, die zum Teil über das Internet zugänglich sind. Im Gegensatz zu unternehmensinternen Datenbanksystemen handelt es sich beim Internet um ein schwach strukturiertes und offenes Netzwerk, weshalb die im Unternehmenskontext eingesetzten Analysetools kaum weiterhelfen, um Informationen mit hoher Qualität herauszufiltern. In dieser Situation spielen Suchmaschinen eine wichtige Rolle, um Informationen zu identifizieren und anhand verschiedener Kriterien in Form einer Suchergebnisseite zu sortieren.

  3. Organization of the und R chromosome region in maize

    SciTech Connect

    Kermicle, J.

    1989-07-01

    Maize is highly polymorphic in pattern of anthocyanin pigmentation. That portion of the total variation which is attributable to one gene is revealed when alleles from various sources are incorporated into a standard line by backcrossing before comparison under uniform environments. The variation associated with such collections of {und R} alleles is discontinuous, suggesting the presence of discrete units of function. Alleles comprising more than one such element constitute an allelic complex or gene family. An objective of the early years of investigation under this grant was to work out the arrangement of genic elements in such allelic complexes. Elements in a complex are identified by independent mutation and separability by recombination, the latter serving also to order them in the chromosome. Alleles having from one to three elements each were represented among five accessions of the colored-seed, colored-plant class ({und R-r}). Nine different genic elements were identified. This line of inquiry has been de-emphasized in recent years in deference to investigating the organization of individual genic elements. We have focused on a set of readily distinguished elements that were identified or produced in the analysis of allelic complexes. 7 refs., 1 tab.

  4. Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis

    PubMed Central

    Liu, Feng‐Hsuan; Kuo, Sheng‐Fong; Hsueh, Chuen; Chao, Tzu‐Chieh

    2015-01-01

    Background and Objectives : The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis. Methods : The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow‐up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra‐thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis. Results : Compared with the intra‐thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease‐specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow‐up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors. Conclusions : In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra‐thyroid tumor group. J. Surg. Oncol. 2015 111:149–154. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc. PMID:26175314

  5. PRE- AND POSTOPERATIVE IN BARIATRIC SURGERY: SOME BIOCHEMICAL CHANGES

    PubMed Central

    TEDESCO, Amanda Kaseker; BIAZOTTO, Rafaela; GEBARA, Telma Souza e Silva; CAMBI, Maria Paula Carlini; BARETTA, Giorgio Alfredo Pedroso

    2016-01-01

    ABSTRACT Background: The bariatric surgery may cause some nutritional deficiencies. Aim: To compare the serum levels of biochemical markers, in iimmediate post-surgical patients who were submitted to bariatric surgery. Methods: Non-concurrent prospective cross-sectional study. The analysis investigated data in medical charts of pre-surgical and immediate post-surgical patients who were submitted to bariatric surgery, focusing total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C reactive protein, vitamin B12 levels, folic acid, homocysteine values, iron and serum calcium at the referred period. Results: Twenty-nine patients of both genders were evaluated. It was observed weight loss from 108.53 kg to 78.69 kg after the procedure. The variable LDL-c had a significant difference, decreasing approximately 30.3 mg/dl after the surgery. The vitamin B12 serum average levels went from 341.9 pg/ml to 667.2 pg/ml. The triglycerides values were in a range of 129.6 mg/dl-173.3 mg/dl, and 81.9 mg/dl-105.3 mg/dl at the pre- and postoperative respectively. CRP levels fall demonstrated reduction of inflammatory activity. The variable homocysteine was tested in a paired manner and it did not show a significant changing before or after, although it showed a strong correlation with LDL cholesterol. Conclusion: Eligible patients to bariatric surgery frequently present pre-nutritional deficiencies, having increased post-surgical risks when they don´t follow an appropriate nutritional follow-up. PMID:27683780

  6. Predictors of Postoperative Aftercare Attrition among Gastric Bypass Patients

    PubMed Central

    Khorgami, Zhamak; Zhang, Chi; Messiah, Sarah E

    2015-01-01

    Background: Poor adherence to post-bariatric surgery aftercare continues to challenge surgical practices. The objective of this study was to identify factors that predict poor aftercare attendance among patients who underwent Roux-en-Y Gastric Bypass (RYGB) surgery. Method: A retrospective medical chart review of patients who underwent RYGB from 2002 to 2011 was conducted. Patients with four visits or more in the first 2 years (>50%) were categorized as “acceptable follow-up” and with ≤50% as “poor follow-up.” Demographics, presurgical body mass index (BMI), and comorbidities were compared using multivariate analysis. Results: Out of 2,658 patients, 1,092 (41.1%) had acceptable follow-up. Preoperative factors that predicted acceptable follow-up included female gender (odds ratio [OR] 1.41 [95% confidence interval (CI) 1.15–1.72]), older age (OR 1.03 [95% CI 1.03–1.04]), higher BMI at surgery (OR 1.02 [95% CI 1.01–1.03]), and Hispanic ethnicity (OR 1.40 [95% CI 1.15–1.72]). Conversely, presence of diabetes mellitus (OR 0.58 [95% CI 0.39–0.88]), hypertension (OR 0.53 [95% CI 0.39–0.72]), and obstructive sleep apnea (OR 0.39 [95% CI 0.26–0.57]) predicted less adherence to RYGB aftercare. Conclusion: These findings suggest RYGB patients' age, gender, ethnicity, preoperative BMI, and certain comorbidities should be considered to maximize postoperative aftercare attendance. PMID:26155436

  7. Effect of Previous Gastrectomy on the Performance of Postoperative Colonoscopy

    PubMed Central

    Kim, Sunghwan; Choi, Jeongmin; Kim, Tae Han; Suh, Yun-Suhk; Im, Jong Pil; Lee, Hyuk-Joon; Kim, Sang Gyun; Jeong, Seung-Yong; Kim, Joo Sung; Yang, Han-Kwang

    2016-01-01

    Purpose The purpose of this study was to determine the effect of a prior gastrectomy on the difficulty of subsequent colonoscopy, and to identify the surgical factors related to difficult colonoscopies. Materials and Methods Patients with a prior gastrectomy who had undergone a colonoscopy between 2011 and 2014 (n=482) were matched (1:6) to patients with no history of gastrectomy (n=2,892). Cecal insertion time, intubation failure, and bowel clearance score were compared between the gastrectomy and control groups, as was a newly generated comprehensive parameter for a difficult/incomplete colonoscopy (cecal intubation failure, cecal insertion time >12.9 minutes, or very poor bowel preparation scale). Surgical factors including surgical approach, extent of gastrectomy, extent of lymph node dissection, and reconstruction type, were analyzed to identify risk factors for colonoscopy performance. Results A history of gastrectomy was associated with prolonged cecal insertion time (8.7±6.4 vs. 9.7±6.5 minutes; P=0.002), an increased intubation failure rate (0.1% vs. 1.9%; P<0.001), and a poor bowel preparation rate (24.7 vs. 29.0; P=0.047). Age and total gastrectomy (vs. partial gastrectomy) were found to be independent risk factors for increased insertion time, which slowly increased throughout the postoperative duration (0.35 min/yr). Total gastrectomy was the only independent risk factor for the comprehensive parameter of difficult/incomplete colonoscopy. Conclusions History of gastrectomy is related to difficult/incomplete colonoscopy performance, especially in cases of total gastrectomy. In any case, it may be that a pre-operative colonoscopy is desirable in selected patients scheduled for gastrectomy; however, it should be performed by an expert endoscopist each time. PMID:27752394

  8. Unplanned Reoperations in Neurosurgical Patients Due to Postoperative Bleeding

    PubMed Central

    Zheng, Xin-Rui; Chen, Tao; Yang, Yue-Fan; Rao, Wei; Wang, Guan-Ying; Zhang, Shan-Hong; Fei, Zhou

    2015-01-01

    Abstract The aim of this study is to investigate the incidence of unplanned reoperations from all causes due to bleeding in neurosurgical patients. The medical records of patients who received neurosurgical procedures at our hospital were retrospectively reviewed and data of patients who received reoperations were extracted and summarized. A literature review was conducted of the Medline, Cochrane, EMBASE, and Google Scholar databases up to November 2013. The main outcome measure was the rate of unplanned reoperations due to bleeding. At our hospital, 68 patients with a mean age of 41.5 ± 21.5 years (range, 7 months to 76 years) received an unplanned reoperation. More than 70% of the patients were older than 18 years, 64.7% were males, and 94.1% had cranial surgery. Almost 60% of the patients received >1 blood transfusion (58.8%) after the first surgery. Of the 68 patients, 35 (51.5%) received a second operation due to bleeding. Univariate logistic regression analysis only showed that an increasing time interval between the first and second surgery was associated with a decreased chance of the reoperation being performed due to bleeding (odds ratio [OR] = 0.843, 95% confidence interval [CI]: 0.720–0.987; P = .033). Of 229 studies identified, 5 retrospective reports with a total of 1375 patients were included in the analysis. The rate of reoperations for bleeding in the 5 studies ranged from 4.2% to 31.5%. Employing measures to reduce postoperative bleeding may help reduce the rate of unplanned neurosurgical reoperations. PMID:26061301

  9. Therapeutic suggestion has not effect on postoperative morphine requirements.

    PubMed

    van der Laan, W H; van Leeuwen, B L; Sebel, P S; Winograd, E; Baumann, P; Bonke, B

    1996-01-01

    This study was designed to confirm the effect of therapeutic intraoperative auditory suggestion on recovery from anesthesia, to establish the effect of preoperative suggestion, and to assess implicit memory for intraoperative information using an indirect memory task. Sixty consenting unpremedicated patients scheduled for elective gynecologic surgery were randomly divided into three equal groups: Group 1 received a tape of therapeutic suggestions preoperatively, and the story of Robinson Crusoe intraoperatively; Group 2 heard the story of Peter Pan preoperatively and therapeutic suggestions intraoperatively; Group 3 heard the Crusoe story preoperatively and the Peter Pan story intraoperatively. A standardized anesthetic technique was used with fentanyl, propofol, isoflurane, and nitrous oxide. After surgery, all patients received patient-controlled analgesia (PCA) with a standardized regimen. In the 24 h postsurgery, morphine use was recorded every 6 h and at 24 h an indirect memory test (free association) was used to test for memory of the stories. Anxiety scores were measured before surgery and at 6 and 24 h postsurgery. There were no significant differences between groups for postoperative morphine use, pain or nausea scores, anxiety scores, or days spent in hospital after surgery. Seven of 20 patients who heard the Pan story intraoperative gave a positive association with the word "Hook," whereas 2 of 20 who did not hear the story gave such an association. Indirect memory for the Pan story was established using confidence interval (CI) analysis. (The 95% CI for difference in proportion did not include zero). No indirect memory for the Crusoe story could be demonstrated. This study did not confirm previous work which suggested that positive therapeutic auditory suggestions, played intraoperatively, reduced PCA morphine requirements. In contrast, a positive implicit memory effect was found for a story presented intraoperatively.

  10. Elektrische Phänomene des Körpers und ihre Detektion

    NASA Astrophysics Data System (ADS)

    Bolz, Armin; Kikillus, Nicole; Moor, Claudius

    Im menschlichen Körper verfügen sowohl Nerven- als auch Muskelzellen über die Eigenschaft, intra- und extrazelluläre Ionenkonzentrationen zu verschieben und damit die Potenzialverteilung in ihrer Umgebung zu beeinflussen. Über unterschiedliche Synchronisationsverfahren sind makroskopische Zellverbände zusätzlich in der Lage, koordiniert ihre Felder zu verändern und somit auch signifikante, an der Körperoberfläche messbare elektrische Signale zu erzeugen. Das vorliegende Kapitel beschreibt zunächst die elektrophysiologischen Grundlagen elektrischer Signale des menschlichen Körpers, die Synchronisationsmechanismen und die daraus entstehenden Felder, insbesondere das Elektrokardiogramm (EKG), das Elektroenzephalogramm (EEG) sowie das Elektromyogramm (EMG). Im Anschluss daran werden die wesentlichen Grundlagen der Messtechnik zur Erfassung bioelektrischer Phänomene erläutert. Einige Beispielapplikationen runden diesen Beitrag ab.

  11. Modulare LDAP-Server-, -Protokoll und - Funktionserweiterungen am Beispiel von OpenLDAP

    NASA Astrophysics Data System (ADS)

    Pluta, Daniel

    In diesem Artikel wird ein Standardisierungsvorschlag für eine LDAP-Protokollerweiterung und deren Referenzimplementierung in Form einer modularen Erweiterung für die LDAP-Software-Suite des OpenLDAPProjektes vorgestellt. Nach einer Einführung in und einem Überblick über die wichtigsten OpenLDAP-Komponenten stellen wir unseren Lösungsansatz vor und gehen auf seine technischen Details ein. Ziel dieses Overlays ist die Implementierung einer neuen Funktionalität, die vom LDAP-Protokoll bisher nicht vorgesehen ist: Der Umfang der Suchergebnismenge soll serverseitig, dezentral und in der Granularität ganzer Objekte in Abhängigkeit von der aktuellen Serverzeit (konfigurierbar) eingeschränkt werden.

  12. Kosteneffiziente Honbearbeitung durch intelligente und flexible Verknüpfung von autarken Honzentren

    NASA Astrophysics Data System (ADS)

    Roth, Günther

    Die Planungsabteilungen in der Automobilindustrie werden vor immer größere Herausforderungen gestsellt. Der zur Verfügung stehende Zeitraum zu einer seriensicheren Umsetzung der entwicklungs- und produktionstechnischen Forderungen wird von Projekt zu Projekt kürzer. Aufgrund des hohen Wettbewerbsdrucks und daraus resultierenden erforderlichen Kostenoptimierungen, die schnelleren Timeto-market-und Innovationszyklen und die vermeintlich zur Kundenbindung erforderlichen, kaum mehr überschaubaren Diversifizierungen in den Modellpaletten lassen den Planungshorizont immer kürzer werden. Die zu beschaffenden Fertigungsanlagen sollen aber in den nächsten 8-12 Jahren all die Varianten produzieren können, die heute nur teilweise oder noch gar nicht bekannt sind.

  13. Jahre Entwicklung der Instandhaltung - von der ausfallorientierten Instandhaltung zum gemeinsamen TPM und RCM

    NASA Astrophysics Data System (ADS)

    Iske, Friedhelm

    Zur Einleitung meines Beitrages möchte ich von einem Gespräch mit einem Mitarbeiter berichten, das ich als junger Vorgesetzter einer Instandhaltungsgruppe 1988 führte. Der engagierte Mitarbeiter feierte damals sein vierzigjähriges Dienstjubiläum und war stolz auf das von ihm Geleistete sowie auf den besonderen Einsatz seiner Altersgruppe, die nach dem Zweiten Weltkrieg das Werk wieder aufgebaut hatte. Auf meine Frage, was denn damals die erste Aufgabe in der Firma war, bekam ich kurz und knapp und mit einer Selbstverständlichkeit die selbstbewusste Antwort: "Unser Pferd füttern und mit dem Pferd die innerbetrieblichen Transporte erledigen“. Als junger, technisch orientierter Vorgesetzter war ich über diese Antwort sehr überrascht. Gedanklich weit entfernt war die Vorstellung, dass in der Vergangenheit Transporte mit einem Pferd erledigt wurden.

  14. Perioperative ketorolac tromethamine and postoperative hemorrhage in cases of tonsillectomy and adenoidectomy.

    PubMed

    Gallagher, J E; Blauth, J; Fornadley, J A

    1995-06-01

    The charts of 258 patients undergoing tonsillectomy with or without adenoidectomy between June 1991 and June 1993 were reviewed. One hundred sixty-nine of these patients received ketorolac tromethamine during the perioperative period as a nonnarcotic alternative for postoperative pain management. The incidence of postoperative hemorrhage among patients who received ketorolac tromethamine was 10.1%, compared to 2.2% in those patients who received narcotic analgesia only. The average time to adequate oral intake and discharge was evaluated. Ketorolac appeared to moderately decrease the time to adequate oral intake. The use of ketorolac did not significantly alter the time to discharge. The increased incidence of postoperative hemorrhage in patients receiving ketorolac should be considered before this medication is used in the perioperative period. The risk/benefit ratio of ketorolac use as a postoperative analgesic may be better demonstrated in a prospective study.

  15. Xylitol Gum Chewing to Achieve Early Postoperative Restoration of Bowel Motility After Laparoscopic Surgery.

    PubMed

    Gong, Yunhui; Zhang, Qianwen; Qiao, Lin; Lv, Donghao; Ruan, Jiaying; Chen, Hongqin; Gong, Junming; Shi, Gang

    2015-08-01

    Our objective was to evaluate the effects of postoperative xylitol gum chewing on gastrointestinal functional recovery after laparoscopy. Altogether, 120 patients undergoing elective gynecologic laparoscopy were randomly divided into 2 groups of 60 each (final numbers: 53 controls, 56 patients). Controls underwent a routine postoperative regimen. Starting 6 hour after surgery, study patients chewed mint-flavored, sugarless xylitol gum until flatus occurred thrice a day. Other postoperative management was routine. First bowel sounds, first flatus, first bowel movement, and discharge times were recorded. Symptoms included abdominal distension, nausea, and vomiting. First flatus and first bowel sounds occurred significantly (P<0.001) earlier in the study patients. No significant differences were found for first defecation time, hospitalization duration, or mild/severe intestinal obstruction (all P>0.05). Thus, xylitol gum chewing after laparoscopy can effectively shorten the time to first flatus and helps with postoperative gastrointestinal functional recovery. It is simple, convenient, and well tolerated. PMID:26121546

  16. [Administration of Perfalgan (paracetamol) for postoperative analgesia in obstetrics and gynaecology].

    PubMed

    Tablov, B; Popov, I; Tablov, V; Radev, R

    2005-01-01

    The aim of our study is to determine the quality of postoperative analgesia by using of Perfalgan (injectable paracetamol)--alone or in combination with other analgesics for different operations in obstetric and gynecology. We have evaluated 60 women, divided into four groups each one of 15 according to the kind of surgical intervention: section cesarean, laparoscopy, laparohysterectomy or cystectomy. The effect of administered Perfalgan over postoperative pain was estimated by different objective and subjective parameters after standard general anesthesia. As a result of our study we consider that postoperative analgesia with Perfalgan is suitable enough after section cesarean and laparoscopy. As a component of multimodal analgesic combination it gives a good quality of postoperative pain relief in condition of laparohysterectomy or cystectomy. It is very important that this is without any adverse effects. PMID:16544723

  17. Postoperative elevation of amylase/creatinine clearance ratio in patients without pancreatitis.

    PubMed

    Gross, J B; Levitt, M D

    1979-09-01

    An elevated CAm/CCr ratio has been used as evidence for the frequent occurrence of acute pancreatitis in the postoperative period. We measured CAm/CCr pre and postoperatively in 28 patients undergoing extraperitoneal surgical procedures. None of the patients had clinical evidence of pancreatitis, although 2 of the 28 patients had elevated CAm/CCr ratios preoperatively. Mean CAm/CCr rose from a preoperative level of 2.3 +/- 0.3% (1 SE) to 3.2 +/- 0.3% on the first postoperative day (P less than 0.001). Of the 26 patients with normal preoperative CAm/CCr, 12% (3 of 26) developed a clearly abnormal ratio and 12% (3 of 26) developed borderline elevated values. An elevated CAm/CCr appears to be a nonspecific postoperative finding and cannot be used as evidence of acute pancreatitis during this period.

  18. Xylitol Gum Chewing to Achieve Early Postoperative Restoration of Bowel Motility After Laparoscopic Surgery.

    PubMed

    Gong, Yunhui; Zhang, Qianwen; Qiao, Lin; Lv, Donghao; Ruan, Jiaying; Chen, Hongqin; Gong, Junming; Shi, Gang

    2015-08-01

    Our objective was to evaluate the effects of postoperative xylitol gum chewing on gastrointestinal functional recovery after laparoscopy. Altogether, 120 patients undergoing elective gynecologic laparoscopy were randomly divided into 2 groups of 60 each (final numbers: 53 controls, 56 patients). Controls underwent a routine postoperative regimen. Starting 6 hour after surgery, study patients chewed mint-flavored, sugarless xylitol gum until flatus occurred thrice a day. Other postoperative management was routine. First bowel sounds, first flatus, first bowel movement, and discharge times were recorded. Symptoms included abdominal distension, nausea, and vomiting. First flatus and first bowel sounds occurred significantly (P<0.001) earlier in the study patients. No significant differences were found for first defecation time, hospitalization duration, or mild/severe intestinal obstruction (all P>0.05). Thus, xylitol gum chewing after laparoscopy can effectively shorten the time to first flatus and helps with postoperative gastrointestinal functional recovery. It is simple, convenient, and well tolerated.

  19. Does postoperative ventilation have an effect on the integrity of the anastomosis in repaired oesophageal atresia?

    PubMed

    Beasley, S W

    1999-04-01

    Several authors have claimed that the use of postoperative ventilation or graded withdrawal of respiratory support reduces the incidence of anastomotic complications after repair of oesophageal atresia, particularly where the gap between the oesophageal ends has been extensive or where the anastomosis has been constructed under tension. Careful review of their data reveals little objective evidence to either support or refute this contention. Many institutions are achieving low leakage rates following oesophageal anastomosis in oesophageal atresia, but to date there has been no controlled study to show that the use of neck flexion, muscle paralysis, intubation and assisted ventilation postoperatively influences the integrity of the anastomosis. The sequence of observations that led to the presumed relationship between postoperative ventilation and oesophageal leak is reviewed. It would appear that the effect of postoperative ventilation and paralysis on the oesophageal anastomosis is yet to be determined. PMID:10365344

  20. Anesthetic Routines: The Anesthesiologist's Role in GI Recovery and Postoperative Ileus

    PubMed Central

    Leslie, John B.; Viscusi, Eugene R.; Pergolizzi, Joseph V.; Panchal, Sunil J.

    2011-01-01

    All patients undergoing bowel resection experience postoperative ileus, a transient cessation of bowel motility that prevents effective transit of intestinal contents or tolerance of oral intake, to varying degrees. An anesthesiologist plays a critical role, not only in the initiation of surgical anesthesia, but also with the selection and transition to effective postoperative analgesia regimens. Attempts to reduce the duration of postoperative ileus have prompted the study of various preoperative, perioperative, and postoperative regimens to facilitate gastrointestinal recovery. These include modifiable variables such as epidural anesthesia and analgesia, opioid-sparing anesthesia and analgesia, fluid restriction, colloid versus crystalloid combinations, prokinetic drugs, and use of the new peripherally acting mu-opioid receptor (PAM-OR) antagonists. Review and appropriate adaptation of these multiple modifiable interventions by anesthesiologists and their surgical colleagues will facilitate implementation of a best-practice management routine for bowel resection procedures that will benefit the patient and the healthcare system. PMID:21991449

  1. Pre-Operative Assessment and Post-Operative Care in Elective Shoulder Surgery

    PubMed Central

    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. PMID:24093051

  2. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    PubMed Central

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  3. Fish Oil and Post-Operative Atrial Fibrillation – Results of the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation (OPERA) Trial

    PubMed Central

    Mozaffarian, Dariush; Marchioli, Roberto; Macchia, Alejandro; Silletta, Maria G.; Ferrazzi, Paolo; Gardner, Timothy J.; Latini, Roberto; Libby, Peter; Lombardi, Federico; O’Gara, Patrick T.; Page, Richard L.; Tavazzi, Luigi; Tognoni, Gianni

    2013-01-01

    Context Post-operative atrial fibrillation/flutter (AF) is one of the most common complications of cardiac surgery and significantly increases morbidity and healthcare utilization. A few small trials have evaluated whether long-chain n-3-polyunsaturated fatty acids (PUFA) reduce post-op AF, with mixed results. Objective To determine whether peri-operative n-3-PUFA supplementation reduces post-op AF. Design Randomized, double-blind, placebo-controlled, multinational, clinical trial. Patients A total of 1,516 patients scheduled for cardiac surgery across 28 centers in the US, Italy, and Argentina, enrolled between Aug 2010 and Jun 2012. Inclusion criteria were broad; the main exclusions were regular use of fish oil or absence of sinus rhythm at enrollment. Forty-eight percent of screened patients and 94% of eligible patients were enrolled. Intervention Patients were randomized to receive fish oil (1 g capsules containing ≥840 mg n-3-PUFA as ethyl esters) or placebo, with pre-operative loading of 10g over 3-5 days (or 8g over 2 days) followed post-operatively by 2g/d until hospital discharge or post-op day10, whichever first. Main Outcome Measures The primary endpoint was occurrence of post-op AF >30 sec. We also evaluated post-op AF lasting >1hr, resulting in symptoms, or treated with cardioversion; other secondary post-op AF endpoints; other tachyarrhythmias; hospital utilization; and major adverse cardiovascular events, 30-day mortality, bleeding, and other adverse events. All endpoints and analyses plans were prespecified. Results At enrollment, mean±SD age was 64±13 years, 72.2% were male, and 51.8% had planned valvular surgery. The primary endpoint occurred in 233 (30.7%) and 227 (30.0%) patients assigned to placebo and n-3-PUFA, respectively (OR=0.96, 95%CI=0.77-1.20; P=0.74). None of the secondary endpoints were significantly different, including post-op AF that was sustained, symptomatic, or treated (n=231 [30.5%] vs. n=224 [29.6%], P=0.70) or number of

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

    PubMed Central

    Divekar, Abhay A

    2016-01-01

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

  5. Effects of Flurbiprofen on CRP, TNF-α, IL-6, and Postoperative Pain of Thoracotomy

    PubMed Central

    Esme, Hidir; Kesli, Recep; Apiliogullari, Burhan; Duran, Ferdane Melike; Yoldas, Banu

    2011-01-01

    Objective: The aims of this study were to evaluate serum levels of acute phase reactants, such as CRP and cytokines (TNF-α and IL-6) in patients who have undergone thoracotomy and to investigate the effects of flurbiprofen on postoperative inflammatory response. Methods: Forty patients undergoing posterolateral thoracotomy were randomly divided into 2 groups of 20 each. Control group received tramadol (4 x 100 mg) intravenously for four days, and flurbiprofen group received both tramadol (4 x 100 mg) and flurbiprofen (2 x 100 mg). Blood samples were collected before surgery and at the 3th and 168th hours after surgical procedure to measure serum CRP, IL-6, and TNF-α. Pain visual analog scales were recorded daily during the first four postoperative days. Spirometric measurement of forced expiratory volume in the first second (FEV 1) was done before and four days after the operation. Results: The serum CRP, IL-6, and TNF-α levels in both groups increased significantly at 3th hour after thoracotomy. Serum TNF-α levels did not differ significantly between the groups at postoperative 4th day. However, IL-6 and CRP were significantly lower in flurbiprofen group than in control group at the same day (p<0.05). Visual analog scale was significantly lower in flurbiprofen group at 6th, 12th, 48th, 72th, and 96th hours postoperatively (p<0.05). The patients receiving flurbiprofen had higher FEV 1 values when compared with control group at postoperative 4th day. Conclusions: Patients undergoing thoracotomy showed reduced postoperative pain, mean additional analgesic consumption, and serum IL-6 and CRP levels, when flurbiprofen was added to systemic analgesic therapy. Analgesia with anti-inflammatory drug may contribute to the attenuation of the postoperative inflammatory response and prevent postoperative pain in patients undergoing thoracotomy. PMID:21448308

  6. Postoperative cerebral myiasis: A rare cause of wound dehiscence in developing countries

    PubMed Central

    Navarro, Juliano N.; Alves, Raphael V.

    2016-01-01

    Background: Cerebral myiasis is a rare parasitic disease, especially in postoperative neurological surgery. Case Description: We report a case of postoperative myiasis in a patient who underwent a craniotomy for resection of metastatic melanoma, evolving with wound dehiscence due to myiasis in the operative wound. Conclusion: Myiasis infestation should be a differential diagnosis of surgical wound dehiscence, particularly when the classic signs of inflammation are not present and computed tomography of the brain shows signs suggestive of this disease entity. PMID:27413581

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

    PubMed Central

    Divekar, Abhay A

    2016-01-01

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

  8. Endoscopy-based management decreases the risk of postoperative recurrences in Crohn’s disease

    PubMed Central

    Boucher, Anne-Laure; Pereira, Bruno; Decousus, Stéphanie; Goutte, Marion; Goutorbe, Felix; Dubois, Anne; Gagniere, Johan; Borderon, Corinne; Joubert, Juliette; Pezet, Denis; Dapoigny, Michel; Déchelotte, Pierre J; Bommelaer, Gilles; Buisson, Anthony

    2016-01-01

    AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence. METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn’s disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy. RESULTS: From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence (HR = 0.30, 95%CI: 0.13-0.70, P = 0.006). CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation. PMID:27275099

  9. Prograde dilatation with Tucker bougies: a technique for managing postoperative rectal strictures.

    PubMed

    Gamliel, Z; Wesson, D

    1991-11-01

    Postoperative rectal stricture is an occasional complication of abdominoperineal pull-through and low anterior resection of the rectum. Although the causes and pathogenesis of this phenomenon are poorly understood, various techniques for stricture dilatation have been described. In this article, we present two cases of severe postoperative rectal strictures that were not amenable to conventional methods of dilatation but were successfully managed by a technique of dilatation using Tucker bougies without general anesthesia.

  10. Post-operative negative pressure pulmonary oedema in an athletic male.

    PubMed

    Stewart, Sarah K; Johnston, A McD

    2013-03-01

    A case of post-operative negative pressure pulmonary oedema in a young, athletic male is reported. We discuss this rare but life-threatening condition and its aetiology, and review the published literature. Military health care providers need to be aware of this condition as young fit personnel may be at increased risk of developing negative pressure pulmonary oedema in the post-operative period.

  11. Magnesium Versus Bupivacaine Infiltration in Controlling Postoperative Pain in Inguinal Hernia Repair

    PubMed Central

    Razavi, Seyed Sajad; Peyvandi, Hasan; Badrkhani Jam, Ali Reza; Safari, Farhad; Teymourian, Houman; Mohajerani, Seyed Amir

    2015-01-01

    Background: Postoperative pain is one of the most common problems after hernia repair. Decrease in postoperative pain accelerates functional recovery, decreases duration of hospital stay and postoperative morbidity. Objectives: To compare postoperative analgesic effect of infiltration of magnesium versus bupivacaine into incision of inguinal hernia repair. Patients and Methods: In a double blind clinical trial, 80 patients’ candidates for elective inguinal hernia repair were enrolled. Right before closure of incision, in Bupivacaine group 5 mL Bupivacaine 0.5% added to 5 mL normal saline and in Magnesium group, 10 mL Magnesium sulfate 20% was infused subcutaneously. Pain score was measured using numeric rating score (NRS) at 1, 3, 6, 12 and 24 hours postoperatively. If NRS was above 3, 1 mg morphine was administered as rescue analgesic until patient felt comfortable or NRS < 3. Results: Postoperative pain scores at 1 and 3 hours were not significantly different between bupivacaine and magnesium groups (P = 0.21, 0.224; respectively). However, at 6 (P = 0.003), 12 (P = 0.028) and 24 (P = 0.022) hours postoperative, pain score (NRS) was significantly lower in bupivacaine group. Number of patients needed at least 1 dose of rescue morphine (P = 0.001), mean number of episodes asked for morphine during next 24 hours (P = 0.001) and total dose of morphine requirement (P = 0.01) were significantly lower in bupivacaine group. Conclusions: Magnesium infiltration did not decrease total dose and number of episodes needed for morphine rescue analgesic. Bupivacaine infiltration into surgical site was more effective than magnesium sulfate infiltration in postoperative pain control. PMID:26705525

  12. COX-2 dependent inflammation increases spinal Fos expression during rodent postoperative ileus

    PubMed Central

    Kreiss, C; Birder, L A; Kiss, S; VanBibber, M M; Bauer, A J

    2003-01-01

    Background and aims: Cyclooxygenase 2 (COX-2) and prostaglandins (PGs) participate in the pathogenesis of inflammatory postoperative ileus. We sought to determine whether the emerging neuronal modulator COX-2 plays a significant role in primary afferent activation during postoperative ileus using spinal Fos expression as a marker. Methods: Rats, and COX-2+/+ and COX-2−/− mice underwent simple intestinal manipulation. The effect of intestinal manipulation on Fos immunoreactivity (IR) in the L5-S1 spinal cord, in situ circumference, and postoperative leucocytic infiltrate of the intestinal muscularis was measured. Postoperative PGE2 production was measured in peritoneal lavage fluid. The dependence of these parameters on COX-2 was studied in pharmacological (DFU, Merck- Frosst, selective COX-2 inhibitor) and genetic (COX-2−/− mice) models. Results: Postoperative Fos IR increased 3.7-fold in rats and 2.2-fold in mice. Both muscularis leucocytic infiltrate and the circumference of the muscularis increased significantly in rats and COX-2+/+ mice postoperatively, indicating dilating ileus. Surgical manipulation markedly increased PGE2 levels in the peritoneal cavity. DFU pretreatment and the genetic absence of COX-2−/− prevented dilating ileus, and leucocytic infiltrate was diminished by 40% with DFU and by 54% in COX-2−/− mice. DFU reversed postsurgical intra- abdominal PGE2 levels to normal. Fos IR after intestinal manipulation was attenuated by approximately 50% in DFU treated rats and in COX-2−/− mice. Conclusions: Postoperatively, small bowel manipulation causes a significant and prolonged increase in spinal Fos expression, suggesting prolonged primary afferent activation. COX-2 plays a key role in this response. This activation of primary afferents may subsequently initiate inhibitory motor reflexes to the gut, contributing to postoperative ileus. PMID:12631664

  13. Schönheit und andere Provokationen - Eine neue evolutionsbiologische Theorie der Kunst

    NASA Astrophysics Data System (ADS)

    Junker, Thomas

    Die Evolution hat viele spektakuläre Phänomene hervorgebracht - von der Eleganz des Vogelflugs über die gigantischen Körper der Dinosaurier und die farbenprächtige Vielfalt der Korallenriffe bis hin zu ihrem jüngsten Geniestreich - der menschlichen Kunst. Die schönen Künste - Malerei, Bildhauerei und Architektur, Theater, Tanz, Oper und Filmkunst, Musik und Literatur - Produkte der Evolution? Diese Vorstellung mutet vielen Menschen fremd an, aber wie könnte es anders sein? Denn wenn Charles Darwin recht hat, dann sind nicht nur die körperlichen Merkmale der Menschen als Antworten auf die Erfordernisse des Lebens entstanden, sondern auch ihre geistigen Fähigkeiten und Verhaltensweisen. Im Jahr 1859 hatte er auf den letzten Seiten seines berühmten Buches über die Entstehung der Arten eine kühne Prophezeiung gemacht: Durch die Evolutionstheorie werde es "zu einer bemerkenswerten Revolution in der Naturwissenschaft kommen […]. Die Psychologie wird auf die neue Grundlage gestellt, dass jede geistige Kraft und Fähigkeit notwendigerweise durch graduelle Übergänge erworben wird“ (Darwin 1859, S. 484, 488; Junker 2008).

  14. [Comparison of contact and immersion techniques of ultrasound biometry in terms of target postoperative refraction].

    PubMed

    Hrebcová, J; Skorkovská, S; Vasků, A

    2009-07-01

    The success of cataract surgery in terms of the postoperative refractive result depends on the calculation of optimal intraocular lens (IOL) power. The accuracy of preoperative measurements (keratometry, biometry) is of a great importance due to the increasing patients' demands on final refractive results. The purpose of this study was to compare the accuracy of contact and immersion techniques of A - scan ultrasound biometry in terms of target postoperative refraction while using the SRK/T formula. The accuracy of the applied biometric techniques was compared by means of the postoperative spherical equivalent (SE). The prospective longitudinal study included 111 non-paired eyes, and the preoperative biometry was performed by means of an OcuScan ultrasound machine (Alcon).The contact technique was used in 48 eyes whereas the immersion technique was employed in 63 eyes.The mean SE in the group measured by the contact technique was -0.13 D, compared to 0.25 D in the group with the applied immersion technique. No statistically significant difference was found in postoperative spherical equivalents while using both biometric techniques (p > 0.1). In this study the choice of a biometric technique had therefore no influence on the predicted postoperative refraction. The results have indicated that the biometric techniques (contact and immersion) are interchangeable in terms of postoperative refractive results.

  15. Effect of different adhesive strategies on the post-operative sensitivity of class I composite restorations

    PubMed Central

    Sancakli, Hande Sar; Yildiz, Esra; Bayrak, Isil; Ozel, Sevda

    2014-01-01

    Objective: To evaluate the post-operative sensitivity of occlusal restorations using different dentin adhesives performed by an undergraduate and a post-doctorate dentist. Materials and Methods: One hundred and eighty-eight molar occlusal restorations were placed in 39 patients (ages between 18 and 30) using 3 different kind of adhesive systems; Optibond FL (OBF), Clearfil Protect Bond (CPB), and iBond (IB) by a post-doctorate dentist or a fifth-year dental student according to the manufacturers’ instructions. Post-operative sensitivity to cold and air was evaluated using a Visual Analog Scale (VAS) after 24 hours, 30, 90, and 180 days. Data were analyzed using the Mann-Whitney U and Friedman tests (P < 0.05). Results: Post-operative sensitivity scores for OBF and CPB were higher for the dental student (P < 0.05), while IB scores did not differ statistical significantly according to the operator (P > 0.05). Conclusion: Operator skill and experience appears to play a role in determining the outcome of post-operative sensitivity of multi-step adhesive systems although the post-operative sensitivity was low. It is suggested that the less experienced clinicians (rather than experienced clinicians) should better use the self-etching dentin bonding systems with reduced application steps to minimize the potential risk of post-operative sensitivity of dental adhesives. PMID:24966741

  16. Safety of liposome extended-release bupivacaine for postoperative pain control

    PubMed Central

    Portillo, Juan; Kamar, Nawal; Melibary, Somayah; Quevedo, Eduardo; Bergese, Sergio

    2014-01-01

    Background: Ideal postoperative pain management requires a multidisciplinary approach in combination with a variety of dosage regimens. Approximately 21–30% of patients experience moderate to severe pain in the postoperative period, which may have a significant impact on recovery rate, standard of living, psychological health, and postoperative complications. Objective: Analysis of the incidence and characterization of reported adverse effects with DepoFoam bupivacaine compared to conventional bupivacaine or placebo. Methods: A systematic review of prospective studies on the use of DepoFoam versus bupivacaine or placebo was performed in order to answer the clinically relevant question: is DepoFoam a safer formulation in place of bupivacaine single injection or continuous local infusion techniques for postoperative pain management? Inclusion criteria required randomized, controlled, double-blind trials in patients 18 years old or older, single dose used for postoperative pain control, and a primary procedure performed. Results: Six studies fitted the inclusion criteria for analysis, DepoFoam bupivacaine used in therapeutic doses was well-tolerated, had a higher safety margin, and showed a favorable safety profile compared to bupivacaine and control groups. Conclusion: Extended drug delivery system DepoFoam bupivacaine is a promising drug formulation that may significantly improve postoperative care and pain control in surgical patients. PMID:24817851

  17. Postoperative complications following TECA-LBO in the dog and cat.

    PubMed

    Spivack, Rebecca E; Elkins, A Derrell; Moore, George E; Lantz, Gary C

    2013-01-01

    The medical records for 133 total ear canal ablations combined with lateral bulla osteotomies (TECA-LBOs) performed on 82 dogs (121 ears) and 11 cats (12 ears) between 2004 and 2010 were reviewed to determine if the duration of preoperative clinical signs was associated with the incidence of postoperative facial nerve injury and Horner's syndrome. Other perioperative complications, such as a head tilt, nystagmus, incisional drainage, draining tracts, hearing loss, as well as bacterial culture results, were noted. Postoperative facial nerve paresis occurred in 36 of 133 ears (27.1%), and paralysis occurred in 29 of 133 ears (21.8%), with no significant difference between species. Thus, postoperative facial nerve deficits occurred in 48.9% of ears. The median duration of clinically evident temporary facial nerve deficits was 2 wk for dogs and 4 wk for cats. Dogs had a significantly longer duration of preoperative clinical signs and were less likely than cats to have a mass in the ear canal. Dogs were less likely to have residual (> 1 yr) postoperative facial nerve deficits. The incidence of postoperative Horner's syndrome was significantly higher in cats than dogs. The duration of preoperative clinical signs of ear disease was not associated with postoperative facial nerve deficits.

  18. Postoperative Adverse Outcomes in Patients With Asthma: A Nationwide Population-based Cohort Study.

    PubMed

    Lin, Chao-Shun; Chang, Chuen-Chau; Yeh, Chun-Chieh; Chung, Chi-Li; Chen, Ta-Liang; Liao, Chien-Chang

    2016-01-01

    Outcome after surgery in patients with asthma remains unknown. The purpose of this study is to investigate postoperative major complications and mortality in surgical patients with asthma.Using reimbursement claims from the Taiwan National Health Insurance Research Database, the authors identified 24,109 surgical patients with preoperative asthma and 24,109 nonasthma patients undergoing major surgeries using matching procedure with propensity score by sociodemographics, coexisting medical conditions, and surgical characteristics. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day postoperative complications and mortality associated with asthma were analyzed in the multivariate logistic regressions.Asthma increased postoperative pneumonia (OR 1.48; 95% CI 1.34-1.64), septicemia (OR 1.11; 95% CI 1.02-1.21), and urinary tract infection (OR 1.17; 95% CI 1.09-1.26). Preoperative emergency care for asthma was significantly associated with postoperative 30-day in-hospital mortality, with an OR of 1.84 (95% CI 1.11-3.04). Preoperative emergency service, hospitalizations, admission to intensive care unit, and systemic use of corticosteroids for asthma were also associated with higher postoperative complication rates for asthmatic patients.Postoperative complications and mortality were significantly increased in asthmatic patients. We suggest urgent efforts to revise protocols for asthma patients' perioperative care.

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

    PubMed Central

    Robleda, Gemma; Sillero-Sillero, Amalia; Puig, Teresa; Gich, Ignasi; Baños, Josep-E

    2014-01-01

    OBJECTIVES: to analyze the relationship between preoperative emotional state and the prevalence and intensity of postoperative pain and to explore predictors of postoperative pain. METHOD: observational retrospective study undertaken among 127 adult patients of orthopedic and trauma surgery. Postoperative pain was assessed with the verbal numeric scale and with five variables of emotional state: anxiety, sweating, stress, fear, and crying. The Chi-squared test, Student's t test or ANOVA and a multivariate logistic regression analysis were used for the statistical analysis. RESULTS: the prevalence of immediate postoperative pain was 28%. Anxiety was the most common emotional factor (72%) and a predictive risk factor for moderate to severe postoperative pain (OR: 4.60, 95% CI 1.38 to 15.3, p<0.05, AUC: 0.72, 95% CI: 0.62 to 0.83). Age exerted a protective effect (OR 0.96, 95% CI: 0.94-0.99, p<0.01). CONCLUSION: preoperative anxiety and age are predictors of postoperative pain in patients undergoing orthopedic and trauma surgery. PMID:25493674

  20. Is Early Enteral Nutrition Better for Postoperative Course in Esophageal Cancer Patients?

    PubMed Central

    Kobayashi, Kazuaki; Koyama, Yu; Kosugi, Shin-ichi; Ishikawa, Takashi; Sakamoto, Kaoru; Ichikawa, Hiroshi; Wakai, Toshifumi

    2013-01-01

    We retrospectively examined esophageal cancer patients who received enteral nutrition (EN) to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN) were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Group E showed fewer days for the first fecal passage (p < 0.01), lesser dose of postoperative albumin infusion (p < 0.01), less use of TPN (p < 0.01), and shorter duration of SIRS (p < 0.01). However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation. PMID:24067386