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Sample records for patients undergoing cesarean

  1. The incidence of significant fetomaternal hemorrhage in patients undergoing cesarean section.

    PubMed

    Feldman, N; Skoll, A; Sibai, B

    1990-09-01

    To determine the incidence of fetomaternal hemorrhage in patients undergoing cesarean section, Kleihauer-Betke tests were performed in the immediate postoperative period on 199 parturients. Some degree of hemorrhage was detected in 18.5% of patients, with 2.5% demonstrating greater than 30 ml of fetal blood. Comparison of groups on the basis of indication for cesarean delivery revealed no difference in rates of fetal hemorrhage. Because patients with greater than 30 ml of fetal blood would not be adequately protected from Rh sensitization by the standard 300 micrograms dose of Rh immune globulin, we recommend screening all Rh-negative patients undergoing cesarean section for the presence of significant fetomaternal hemorrhage.

  2. Comparison of postoperative analgesic effect of tramadol and bupivacaine subcutaneous infiltration in patients undergoing cesarean section.

    PubMed

    Behdad, Shekoufeh; Sekhavat, Leila; Ayatollahi, Vida; Meshkat, Fatemah; Mortazavi, Abulghasem

    2013-03-01

    Cesarean section is associated with significant postoperative pain. The aim of this study was to evaluate the effects of tramadol versus bupivacaine administration at wound closure on postoperative pain relief in patients undergoing cesarean section. Sixty women undergoing cesarean deliveries were randomly assigned to receive either 10 mL of bupivacaine 0.5% (n = 30) or 50 mg of tramadol in 10 mL of normal saline (n = 30), both as local wound infiltration prior to skin closure at the end of operation. Postoperative pain was evaluated with a visual analogue scale (VAS: 0-10) at 1, 2 and 6 hours after operation. Time to first analgesic administration and analgesic consumption in 24 hours after operation were recorded and compared between the two groups. Data were analyzed by SPSS software version 15 and p < 0.05 was considered significant. The VAS score did not differ significantly between the two groups at 1 and 2 hours after cesarean section, but it was higher in bupivacaine group than tramadol group 6 hours after operation (p < 0.05; Fisher exact test). Postoperative consumption of analgesic was higher in bupivacaine group than tramadol group but the difference was not significant (p > 0.05; Fisher exact test). No side effects were reported in either group. This study showed that subcutaneous administration of tramadol provided analgesic effect equal to bupivacaine with longer pain relief after cesarean section.

  3. Effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia

    PubMed Central

    Senapathi, Tjokorda Gde Agung; Widnyana, I Made Gede; Wiryana, Made; Aribawa, I Gusti Ngurah Mahaalit; Aryabiantara, I Wayan; Hartawan, I Gusti Agung Gede Utara; Sinardja, I Ketut; Suarjaya, I Putu Pramana; Nada, I Ketut Wibawa; Jaya, AA Gde Putra Semara

    2016-01-01

    Purpose Cesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia. Patients and methods Thirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18). Ketamine 0.3 mg/kg (KET group) or NaCl 0.9% (NS group) was administered intravenously before the administration of spinal anesthesia. C-reactive protein (CRP) and neutrophil levels were measured preoperatively and postoperatively. Results Elevation of CRP stress response was lower in the KET group and significantly different (P≤0.05) from that in the NS group. Neutrophil level was elevated in both the groups and hence not significantly different from each other (P>0.05). Postoperative visual analog scale pain score was not significantly different between the two groups (P>0.05), but there was a statistically significant (P≤0.05) positive and weak correlation between visual analog scale and CRP level postoperatively. Conclusion Low-dose intravenous ketamine effectively attenuates the CRP stress response in patients undergoing emergency cesarean section with spinal anesthesia. PMID:27703393

  4. Anesthetic management of a patient with multiple sclerosis undergoing cesarean section with low dose epidural bupivacaine

    PubMed Central

    Sethi, Sameer; Kapil, Sonia

    2014-01-01

    A 32-year-old Indian female 38 weeks pregnant, with a history of multiple sclerosis since 2008 was admitted in obstetric ward for safe confinement. She had a history of diminution of vision in both eyes and limb weakness, relapsing – remitting type with movement-induced muscle spasms, in all the four limbs. Her symptoms were usually diplopia, difficulty in vision and ataxic gait. Sh was then treated with methylprednisolone. She was on oral dimethyl fumarate trial, which was stopped at the beginning of pregnancy. Presently, she was completely asymptomatic. Epidural anesthesia with an indwelling catheter was administered with 15 ml of 0.25% bupivacaine in 5 ml increments. A total of 3 mg of epidural morphine was given for post-operative analgesia. The surgery evolved without any intercurrences and patient was discharged from the hospital 72 h after surgery without worsening of her symptoms. We report a safe anesthetic management of a patient with MS undergoing cesarean section with low dose epidural bupivacaine with the addition of morphine for post-operative analgesia. PMID:25191198

  5. Efficacy of intravenous paracetamol on pressor response in patients undergoing cesarean section under general anesthesia

    PubMed Central

    Kashif, Sanum; Hamid, Mohammad

    2016-01-01

    Background and Aims: Profound hemodynamic alterations due to stress and pain during endotracheal intubation may cause deleterious effects. The purpose of this study was to evaluate the effect of intravenous (IV) paracetamol on hemodynamic changes due to endotracheal intubation during cesarean section under general anesthesia. Material and Methods: Random allocation of one hundred and ten patients in two groups (Group A - placebo and Group B - paracetamol), was achieved as per computer generated table. The placebo (normal saline) and paracetamol solutions looked identical as both were available in 100 ml piggy bags and were labeled as study drug. Infusion of the drug was given 1 h before surgery. Two baseline readings of heart rate, systolic blood pressure (BP), diastolic BP and mean BP were recorded before induction, and these readings were repeated during intubation. Detrimental effect on neonate was evaluated by Apgar score measured at 1 and 5 min after birth. Results: There were no significant demographic differences found between the two groups. Hemodyamic changes during intubation also did not differ between the two groups. Conclusion: Administration of IV paracetamol 1 h before cesarean section has no significant effect in preventing hemodynamic changes at the time of endotracheal intubation. PMID:27275051

  6. The Effects of Diclofenac Suppository and Intravenous Acetaminophen and their Combination on the Severity of Postoperative Pain in Patients Undergoing Spinal Anaesthesia During Cesarean Section

    PubMed Central

    Niaki, Alireza Seyedi; Jafari, Seyed Yaghoub; Yousefi, Zahra; Aryaie, Mohammad

    2016-01-01

    Introduction The main tasks of postoperative care are postoperative pain and complications control which play an important role in accelerating the recovery of patient’s general condition. Aim This study was performed in order to compare the effects of diclofenac suppository, intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia for cesarean section in Sayyad Shirazi teaching Hospital, Gorgon, Iran. Materials and Methods This was a double-blind clinical trial on 90 patients undergoing cesarean section. The patients were randomly divided into three groups, group A: 100 mg diclofenac suppository, group B: 1000 mg intravenous acetaminophen, group C: 100 mg diclofenac suppository and 500 mg intravenous acetaminophen. The same spinal anaesthesia circumstances were applied for all the participants. At the end of surgery, pain severity was assessed according to VAS scale at different times. Data were then analysed by SPSS 18 statistical software. Results The mean age of participants was (28.27±6.07). There was significant difference between the mean pain scores of the three groups before the intervention (p=0.018), which was considered as co-variate. This difference was more notable between the combination of acetaminophen – diclofenac group and diclofenac alone. After the intervention, significant difference was observed in mean pain severity between acetaminophen group and the combination group and also between diclofenac and the combination group. During the study, the least mean pain severity was found in the combination group and the highest was observed in the diclofenac group. Conclusion Results of this study indicates a significant effect of concomitant use of intravenous acetaminophen and diclofenac suppository on pain severity reduction and reducing the need for repeated doses of narcotics and prolonging the postoperative analgesia.

  7. The Effects of Diclofenac Suppository and Intravenous Acetaminophen and their Combination on the Severity of Postoperative Pain in Patients Undergoing Spinal Anaesthesia During Cesarean Section

    PubMed Central

    Niaki, Alireza Seyedi; Jafari, Seyed Yaghoub; Yousefi, Zahra; Aryaie, Mohammad

    2016-01-01

    Introduction The main tasks of postoperative care are postoperative pain and complications control which play an important role in accelerating the recovery of patient’s general condition. Aim This study was performed in order to compare the effects of diclofenac suppository, intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia for cesarean section in Sayyad Shirazi teaching Hospital, Gorgon, Iran. Materials and Methods This was a double-blind clinical trial on 90 patients undergoing cesarean section. The patients were randomly divided into three groups, group A: 100 mg diclofenac suppository, group B: 1000 mg intravenous acetaminophen, group C: 100 mg diclofenac suppository and 500 mg intravenous acetaminophen. The same spinal anaesthesia circumstances were applied for all the participants. At the end of surgery, pain severity was assessed according to VAS scale at different times. Data were then analysed by SPSS 18 statistical software. Results The mean age of participants was (28.27±6.07). There was significant difference between the mean pain scores of the three groups before the intervention (p=0.018), which was considered as co-variate. This difference was more notable between the combination of acetaminophen – diclofenac group and diclofenac alone. After the intervention, significant difference was observed in mean pain severity between acetaminophen group and the combination group and also between diclofenac and the combination group. During the study, the least mean pain severity was found in the combination group and the highest was observed in the diclofenac group. Conclusion Results of this study indicates a significant effect of concomitant use of intravenous acetaminophen and diclofenac suppository on pain severity reduction and reducing the need for repeated doses of narcotics and prolonging the postoperative analgesia. PMID:27630929

  8. Misrecognition of need: Women’s experiences of and explanations for undergoing cesarean delivery

    PubMed Central

    Tully, Kristin P.; Ball, Helen L.

    2013-01-01

    International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women’s accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed ‘on request.’ The categorization of cesareans into ‘emergency’ and ‘elective’ did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of ‘choice.’ The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from ‘prolonged’ labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the ‘too posh to push’ label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the ‘need’ for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack

  9. Trial of labor in previous cesarean section patients, excluding classical cesarean sections.

    PubMed

    Stovall, T G; Shaver, D C; Solomon, S K; Anderson, G D

    1987-11-01

    The American College of Obstetricians and Gynecologists has supported the concept of a trial of labor in patients with a previous lower uterine transverse cesarean section, and its safety is generally accepted. The purpose of this report was to present the results of a year-long, prospective study in which the indications for trial of labor were liberalized. Only patients with a previous classical incision or "T" incision on the uterus were excluded. Two hundred seventy-two patients elected to undergo a trial of labor. Vaginal delivery occurred in 216 patients (76.5%). Oxytocin was used as needed, and epidural anesthesia was used in all patients who requested it. One uterine rupture occurred in a patient with a single lower transverse scar. The results of this study suggest that a trial of labor is a safe alternative for patients with a previous single or multiple lower uterine transverse incision or a lower uterine vertical incision. In addition, the use of epidural anesthesia and oxytocin appears safe in patients undergoing a trial of labor. PMID:3658277

  10. [Bupivacaine-induced Anaphylaxis in a Parturient Undergoing Cesarean Section].

    PubMed

    Iwasaki, Mitsuo; Tachibana, Kazuya; Mitsuda, Nobuaki; Kinouchi, Keiko

    2015-02-01

    We describe a case of anaphylaxis that occurred in a 33-year-old gravida 1, para 1 term woman scheduled for cesarean delivery for breech presentation. Her past history was unremarkable except for orciprenaline allergy. Spinal anesthesia was performed at L3-4 using 2.5 ml of 0.5% hyperbaric bupivacaine and 0.1 mg morphine. Seven minutes after spinal anesthesia, she complained of hoarseness and difficulty in breathing and 3 minutes later, blood pressure decreased to 76/51 mmHg, and oxygen saturation to 87% with supplemental oxygen. Skin flushing was noted in the face and trunk of the body and anaphylaxis was diagnosed. She was treated with a rapid intravenous infusion and iv administration of phenylephrine (total dose 0.4 mg), ephedrine (total dose 25 mg), hydrocortisone and famotidine. Cesarean section was started 23 minutes after spinal anesthesia when blood pressure and oxygen saturation recovered. A male infant was delivered (18 minutes after the onset of anaphylactic event) with Apgar scores of 2 and 5 at 1 and 5 min, respectively and resuscitated with mask ventilation. Umbilical artery blood gas analysis revealed pH 6.85, base excess -20.3 mmol x l (-1) and lactate 109 mg x dl (-1). The mother was discharged from the hospital on the 6th postoperative day. The baby's electroencephalogram, however, demonstrated a pattern consistent with mild hypoxic-ischemic encephalopathy. Lymphocyte stimulation test revealed that she was allergic to bupivacaine. If maternal hypotension persists, i.m. or i.v. adrenaline should be administered immediately because maternal hypotension and hypoxemia may cause significant fetal morbidity and mortality and prompt cesarean section should be considered. PMID:26121818

  11. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery.

    PubMed

    Landon, Mark B

    2010-08-01

    Uterine rupture is the most serious complication for women undergoing trial of labor (TOL) after prior cesarean delivery. While rates of uterine rupture vary significantly according to a variety of clinically associated risk factors, the absolute risk for this complication ranges between 0.5 and 4 percent. Previous vaginal delivery and prior successful vaginal birth after cesarean delivery confer the lowest risk of rupture on women attempting TOL. In contrast, multiple prior cesareans, short interpregnancy interval, single layer uterine closure, prior preterm cesarean, labor induction and augmentation have all been suggested in some studies as factors which may increase the rate of uterine rupture. While considering these risk factors is important in counseling women regarding childbirth following cesarean delivery, the infrequency of uterine rupture coupled with relatively weak associations for most risk factors has prevented the development of an accurate prediction tool for uterine rupture. Preliminary studies suggest that sonographic evaluation of the uterine scar may hold some promise for identifying women at risk.

  12. Management of Pregnant Patients Who Refuse Medically Indicated Cesarean Delivery

    PubMed Central

    Deshpande, Neha A; Oxford, Corrina M

    2012-01-01

    The doctrine of informed refusal may become difficult to adhere to in obstetric practice, especially in situations in which the fetus’s life is at risk. One rare yet potentially problematic situation of informed refusal is the case of a pregnant woman who refuses to undergo a medically indicated cesarean delivery that would ensure the well-being of her fetus. Although some would argue that patient autonomy takes precedence and the woman’s informed refusal should be respected, others would argue that beneficence, justice, and doing no harm to the viable fetus should ethically overrule the refusal of a surgery. This article explores the profound conflict between maternal autonomy and the rights of the fetus, provides a framework to address when the two diverge, and poses suggestions for how providers can better navigate this dilemma. PMID:23483714

  13. Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia

    PubMed Central

    Chia, Yuan-Yi; Lo, Yuan; Chen, Yan-Bo; Liu, Chun-Peng; Huang, Wei-Chun; Wen, Chun-Hsien

    2016-01-01

    Abstract To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17–1.34). CD with EA might increase the risk of subsequent chronic LBP. PMID:27100449

  14. Use of methergine for the prevention of postoperative endometritis in non-elective cesarean section patients.

    PubMed Central

    Dweck, M F; Lynch, C M; Spellacy, W N

    2000-01-01

    OBJECTIVE: Methergine increases constriction of uterine musculature which may facilitate sloughing of endometrial debris, close uterine vessels, and prevent post-cesarean endometritis. The objective of this study was to evaluate the efficacy of methergine in preventing endometritis in patients undergoing non-elective cesarean section delivery. METHODS: Eighty patients undergoing non-elective cesarean section were enrolled in a prospective randomized clinical trial of methergine (41) versus no methergine (39) administration during the postpartum period. The hospital records were abstracted after discharge to compare the postpartum course. RESULTS: There were no significant demographic differences between the two groups. The women receiving methergine had a significant reduction in the rate of postoperative endometritis (10% vs. 36%, P < 0.005). In addition, the mean postoperative hemoglobin was significantly higher in the methergine treated group (P < 0.001). CONCLUSIONS: The use of methergine postpartum in women undergoing non-elective cesarean sections significantly reduces the incidence of postoperative endometritis and blood loss. PMID:10968597

  15. Obstetric outcome of patients with more than one previous cesarean section.

    PubMed

    Novas, J; Myers, S A; Gleicher, N

    1989-02-01

    Records of patients with more than one previous cesarean section were reviewed for a 1-year period. Of 69 such pregnancies, 36 underwent trial of labor in concurrence with an ongoing departmental cesarean section reduction initiative; 80% culminated in vaginal delivery. Twenty of these 69 patients had three or more previous cesarean sections; 9 underwent trial of labor, with 8 subsequent vaginal deliveries. The vaginal delivery rate after more than one previous cesarean section was no different from that of patients with only one previous cesarean section. We conclude that trial of labor in patients with more than one previous cesarean section did not result in a deleterious outcome. Our findings suggest that a trial of labor after more than one previous cesarean section delivery can safely be allowed. Guidelines can be identical to those already established for patients with only one previous cesarean section.

  16. Is non-directive counseling for patient choice cesarean delivery ethically justified?

    PubMed

    Kalish, Robin B; McCullough, Laurence B; Chervenak, Frank A

    2007-01-01

    The current controversy concerning patient choice cesarean delivery potentially affects all women of child-bearing age and the physicians who care for them. The purpose of this paper is to address three salient issues within the patient choice cesarean delivery controversy. First, is performing patient choice cesarean delivery consistent with good professional medical practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? And, third, should patient choice cesarean delivery be routinely offered to all pregnant women?

  17. Patient Counseling and Preferences for Elective Repeat Cesarean Delivery.

    PubMed

    Folsom, Susan; Esplin, M Sean; Edmunds, Sean; Metz, Torri D; Jackson, G Marc; Porter, T Flint; Varner, Michael W

    2016-04-01

    Objective We sought to identify factors influencing a woman's decision to have an elective repeat cesarean delivery (ERCD) versus vaginal birth after cesarean (VBAC). Methods and Materials A prospective study at two academic medical centers of women with one prior cesarean, and no contraindication to a trial of labor, delivered by ERCD from October 2013 to June 2014. Participants completed anonymous surveys during their delivery hospitalization. Counseling was considered adequate if women reported being counseled, recalled being quoted a VBAC success probability, and this probability was within 20% of that derived from an established VBAC success prediction model. Participants were also asked why they chose ERCD. Results Of 68 participants, only 8 (11.8%) had adequate counseling. Of those with inadequate counseling, 21.7% did not recall being counseled, 63.3% were not quoted a chance of success, and 60.0% had more than a 20% discrepancy between their recalled and predicted success rates. Eighteen women were calculated to have more than 70% chance of successful VBAC. Of these, 16 (88.9%) were not adequately counseled. Conclusion Most women were inadequately counseled about delivery options. The most important factors influencing the choice of ERCD over VBAC were patient preferences, risk for fetal injury, and perceived physician preference. PMID:27308098

  18. Managing anesthesia for cesarean section in obese patients: current perspectives.

    PubMed

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  19. Managing anesthesia for cesarean section in obese patients: current perspectives

    PubMed Central

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  20. [Temperature changes and thermoregulatory responses during epidural anesthesia in women undergoing cesarean delivery].

    PubMed

    Negishi, C; Ozaki, M; Suzuki, H; Ohno, T

    1996-05-01

    Eleven healthy pregnant women were studied to determine temperature changes after induction of epidural anesthesia during cesarean delivery. Epidural anesthesia was induced by 2% lidocaine 15-20 ml (T 5 level) at 25 degrees C ambient temperature. Tympanic membrane and skin surface temperature, skin-temperature gradients (forearm-fingerchip, calf-toe), thermal perception (1-10 scale VAS) and the presence or absence of shivering were measured. Sixty minutes after induction, tympanic temperature decreased for 0.52 +/- 0.26 degrees C and average skin temperature increased for 0.56 +/- 0.17 degrees C. Central hypothermia and shivering did not produce a cold sensation. Temperature gradients of upper limb increased to 2.0 +/- 3.7 degrees C (50 minutes after induction) and the lower limbs decreased to -1.4 +/- 0.55 degrees C (30 minutes after induction). Shivering occurred in 3 patients. We conclude that epidural anesthesia impaired thermoregulatory control and induced redistribution hypothermia as in nonpregnant individuals.

  1. Spinal anesthesia for cesarean section in a patient with systemic sclerosis associated interstitial lung disease: a case report

    PubMed Central

    Cho, Sooyoung

    2016-01-01

    Systemic sclerosis or scleroderma is a rare autoimmune disorder characterized by excessive fibrosis and, vasculopathy, with multiorgan involvement. Anesthetic considerations in patients with systemic sclerosis must take into account the degree of organ dysfunction as well as airway management. Regional anesthesia is a preferable alternative to general anesthesia despite the reports of prolonged sensory block. Spinal anesthesia in patients with systemic sclerosis has been reported for only one patients undergoing cesarean section. Concurrent systemic sclerosis and pregnancy raise many obstetric and anesthetic considerations. We describe the case of a pregnant patient with systemic sclerosis who had a history of dyspnea and interstitial lung disease. The cesarean section was performed uneventfully under spinal anesthesia. PMID:27482321

  2. Spinal anesthesia for cesarean section in a patient with systemic sclerosis associated interstitial lung disease: a case report.

    PubMed

    Lee, Guie Yong; Cho, Sooyoung

    2016-08-01

    Systemic sclerosis or scleroderma is a rare autoimmune disorder characterized by excessive fibrosis and, vasculopathy, with multiorgan involvement. Anesthetic considerations in patients with systemic sclerosis must take into account the degree of organ dysfunction as well as airway management. Regional anesthesia is a preferable alternative to general anesthesia despite the reports of prolonged sensory block. Spinal anesthesia in patients with systemic sclerosis has been reported for only one patients undergoing cesarean section. Concurrent systemic sclerosis and pregnancy raise many obstetric and anesthetic considerations. We describe the case of a pregnant patient with systemic sclerosis who had a history of dyspnea and interstitial lung disease. The cesarean section was performed uneventfully under spinal anesthesia. PMID:27482321

  3. The Cesarean Catastrophe

    PubMed Central

    Lothian, Judith A.

    2006-01-01

    The cesarean rate has reached an all-time high at 29.1% of all births in the United States. In this column, the risks inherent in cesareans are discussed within the context of the current climate of “intervention-intensive” labor and birth, forced cesareans, the precipitate decrease in vaginal births after cesarean, and the alarming increase in primary cesarean, including “patient-choice” cesareans. Strategies to increase women's confidence and to promote, protect, and support normal birth are discussed as ways to decrease the cesarean rate. PMID:17322943

  4. Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients

    PubMed Central

    Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

    2015-01-01

    Purpose The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. Methods We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Results Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01). Conclusion Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance. PMID:26263014

  5. Randomized Controlled Trial Evaluating Dialkylcarbamoyl Chloride Impregnated Dressings for the Prevention of Surgical Site Infections in Adult Women Undergoing Cesarean Section

    PubMed Central

    Bizoń, Magdalena; Cendrowski, Krzysztof; Sawicki, Włodzimierz

    2016-01-01

    Abstract Background: Surgical site infections (SSI) occur in 1.8%–9.2% of women undergoing cesarean section (CS) and lead to greater morbidity rates and increased treatment costs. The aim of the study was to evaluate the efficacy and cost-effectiveness of dialkylcarbamoyl chloride (DACC) impregnated dressings to prevent SSI in women subject to CS. Methods: Randomized, controlled trial was conducted at the Mazovian Bródno Hospital, a tertiary care center performing approximately 1300 deliveries per year, between June 2014 and April 2015. Patients were randomly allocated to receive either DACC impregnated dressing or standard surgical dressing (SSD) following skin closure. In order to analyze cost-effectiveness of the selected dressings in the group of patients who developed SSI, the costs of ambulatory visits, additional hospitalization, nursing care, and systemic antibiotic therapy were assessed. Independent risk factors for SSI were determined by multivariable logistic regression. Results: Five hundred and forty-three women undergoing elective or emergency CS were enrolled. The SSI rates in the DACC and SSD groups were 1.8% and 5.2%, respectively (p = 0.04). The total cost of SSI prophylaxis and treatment was greater in the control group as compared with the study group (5775 EUR vs. 1065 EUR, respectively). Independent risk factors for SSI included higher pre-pregnancy body mass index (adjusted odds ratio [aOR] = 1.08; [95% confidence interval [CI]: 1.0–1.2]; p < 0.05), smoking in pregnancy (aOR = 5.34; [95% CI: 1.6–15.4]; p < 0.01), and SSD application (aOR = 2.94; [95% CI: 1.1–9.3]; p < 0.05). Conclusion: The study confirmed the efficacy and cost-effectiveness of DACC impregnated dressings in SSI prevention among women undergoing CS. PMID:26891115

  6. Vaginal birth after cesarean section: an update on physician trends and patient perceptions.

    PubMed

    Penso, C

    1994-10-01

    The increased number of women having a vaginal birth after a cesarean section can be attributed to changing physician trends. Women eligible for vaginal birth after cesarean section include those with previous low vertical incisions, multiple previous incisions and even unknown scars, regardless of the method of closure or previous indication. Limited data suggest that in carefully selected women a current twin gestation, breech presentation, or the presence of fetal macrosomia are not contraindications for a trial of labor, in the presence of a uterine scar. Changing trends in the management of labor may also contribute to an increase in successful trial of labor with the use of oxytocin for the induction or augmentation of labor, the administration of epidural anesthesia for pain relief, and the instillation of prostaglandin E2 gel for cervical ripening. External cephalic version and amnioinfusion may also be reasonable alternatives in appropriately selected cases. Despite the documented safety and success of vaginal birth after cesarean section, and the lack of increased morbidity of failed trial of labor, 50% of women who are eligible for vaginal birth after cesarean section will decline an attempt, even after extensive counseling and encouragement. Patient resistance, largely attributed to the fear and inconvenience of labor, is still a major deterrent to a further rise in vaginal birth after cesarean section rates.

  7. Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia: A Nationwide Population-Based Retrospective Cohort Study.

    PubMed

    Chia, Yuan-Yi; Lo, Yuan; Chen, Yan-Bo; Liu, Chun-Peng; Huang, Wei-Chun; Wen, Chun-Hsien

    2016-04-01

    To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17-1.34). CD with EA might increase the risk of subsequent chronic LBP.

  8. Medical Management of Patients Undergoing Dentoalveolar Surgery.

    PubMed

    Abramowicz, Shelly; Roser, Steven M

    2015-08-01

    The oral and maxillofacial surgeon (OMS) should have an understanding of common medical comorbidities. This understanding allows for risk stratification and thus prevention of potential problems. Remaining knowledgeable regarding diseases, diagnosis, treatment strategies, and pharmacology ultimately improves patient care. This article provides an update on some of the most common medical diseases for the patient undergoing dentoalveolar surgery.

  9. Continuous measurement of cardiac output with the electrical velocimetry method in patients under spinal anesthesia for cesarean delivery.

    PubMed

    Liu, Yanhong; Pian-Smith, May C M; Leffert, Lisa R; Minehart, Rebecca D; Torri, Andrea; Coté, Charles; Kacmarek, Robert M; Jiang, Yandong

    2015-10-01

    In this study, we aimed to continuously measure cardiac output (CO) with the electrical velocimetry (EV) method and characterize the hemodynamic profile of patients undergoing spinal anesthesia for elective cesarean delivery (CD), and to discuss the potential benefit of using real time CO monitoring to guide patient management. Forty-two patients scheduled for elective CD under spinal anesthesia were enrolled in this observational study. A non-invasive CO monitor incorporating the electrical velocimetry algorithm, ICON(®) (Cardiotronic(®), La Jolla, California, USA), was used to measure CO and stroke volume (SV) continuously. Peripheral venous pressure was measured intermittently at pre-defined time points. Systemic vascular resistance was calculated retrospectively after completion of the study. Hemodynamic changes at pre-defined time points and caused by phenylephrine administration were analyzed. Hypotension (MAP reduction more than 20% from baseline values) occurred in 71.1% of patients after spinal anesthesia, while the coinstantaneous CO was increased ≥20% from baseline in the majority of patients (76.3%) at the same time. Significant increase in CO took place at 3-2 min before the administration of phenylephrine bolus. Treatment of hypotension with phenylephrine was associated with significant decrease in CO. Continuous CO monitoring with EV enables clinicians to determine CO and SV changes prior to onset of hypotension and to better understand patients' hemodynamics. It is an important addition to the current monitoring. The benefit of routinely using this technique remains to be determined in term of the patient outcomes. PMID:25510959

  10. Pregnancy, Delivery, and Neonatal Outcomes of In Vitro Fertilization-Embryo Transfer in Patient with Previous Cesarean Scar.

    PubMed

    Zhang, Ningyuan; Chen, Hua; Xu, Zhipeng; Wang, Bin; Sun, Haixiang; Hu, Yali

    2016-01-01

    BACKGROUND What role should previous cesarean section play in affecting clinical pregnancy outcomes and avoiding the complications of in vitro fertilization? In this article, we focus on elective single-embryo transfer (eSET) versus double-embryo transfer (DET) and assess the clinical efficacy and safety of eSET in patients who have a previous cesarean scar. MATERIAL AND METHODS The pregnancy, delivery, and neonatal outcomes of 130 patients who had a previous cesarean scar and received in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. The number of transferred embryos was chosen depending on patients' desire after acknowledging all benefits and risks, including eSET (eSET group, n=56) and DET (DET group, n=74). A total of 101 patients with previous vaginal delivery receiving IVF-ET in the same period were included as a control group. RESULTS The pregnancy rates, multiple birth rates, abortion rates, ectopic pregnancy rates, gestational age at delivery, preterm birth rates, neonatal birth weight, and take-home baby rates were similar between the previous cesarean section group and the previous vaginal delivery group. A previous cesarean section scar did not affect embryo implantation and pregnancy outcomes in IVF. In the eSET and DET groups of previous cesarean section patients, the embryo implantation rates, pregnancy rates, abortion rates, and take-home baby rates were similar. However, the rate of multiple pregnancies reached 50% in the DET group, which led to more preterm births and lower birth weight. CONCLUSIONS Elective single-embryo transfer is a well-accepted strategy to avoid multiple pregnancies and improve the obstetric and neonatal outcomes of singleton pregnancy in IVF patients with a previous cesarean section. PMID:27636504

  11. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury

    PubMed Central

    Tawfik, Mohamed Mohamed; Badran, Basma Abed; Eisa, Ahmed Amin; Barakat, Rafik Ibrahim

    2015-01-01

    The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby. PMID:25829914

  12. Pregnancy, Delivery, and Neonatal Outcomes of In Vitro Fertilization-Embryo Transfer in Patient with Previous Cesarean Scar

    PubMed Central

    Zhang, Ningyuan; Chen, Hua; Xu, Zhipeng; Wang, Bin; Sun, Haixiang; Hu, Yali

    2016-01-01

    Background What role should previous cesarean section play in affecting clinical pregnancy outcomes and avoiding the complications of in vitro fertilization? In this article, we focus on elective single-embryo transfer (eSET) versus double-embryo transfer (DET) and assess the clinical efficacy and safety of eSET in patients who have a previous cesarean scar. Material/Methods The pregnancy, delivery, and neonatal outcomes of 130 patients who had a previous cesarean scar and received in vitro fertilization-embryo transfer (IVF-ET) were retrospectively analyzed. The number of transferred embryos was chosen depending on patients’ desire after acknowledging all benefits and risks, including eSET (eSET group, n=56) and DET (DET group, n=74). A total of 101 patients with previous vaginal delivery receiving IVF-ET in the same period were included as a control group. Results The pregnancy rates, multiple birth rates, abortion rates, ectopic pregnancy rates, gestational age at delivery, preterm birth rates, neonatal birth weight, and take-home baby rates were similar between the previous cesarean section group and the previous vaginal delivery group. A previous cesarean section scar did not affect embryo implantation and pregnancy outcomes in IVF. In the eSET and DET groups of previous cesarean section patients, the embryo implantation rates, pregnancy rates, abortion rates, and take-home baby rates were similar. However, the rate of multiple pregnancies reached 50% in the DET group, which led to more preterm births and lower birth weight. Conclusions Elective single-embryo transfer is a well-accepted strategy to avoid multiple pregnancies and improve the obstetric and neonatal outcomes of singleton pregnancy in IVF patients with a previous cesarean section. PMID:27636504

  13. Anesthetic management of patient with Sjogren's syndrome who underwent cesarean section: a case report

    PubMed Central

    Kim, Na Eun; Lee, Jae Hyuk; Lee, Jun Yong

    2016-01-01

    Sjogren's syndrome is one of the most common autoimmune disorders and has a female predominance. Maternal circulating autoantibodies such as anti-Ro/SSA and anti-La/SSB antibodies can cause congenital heart block of fetus, and in severe case, emergency pacemaker implantation may be needed for neonate. Therefore, it is very important to understand maternal and fetal condition and pay attention to the status of the neonate during delivery. In this paper, we present a case of patient with Sjogren's syndrome who underwent cesarean section under spinal anesthesia. PMID:27274376

  14. Anesthetic management of patient with Sjogren's syndrome who underwent cesarean section: a case report.

    PubMed

    Kim, Na Eun; Lee, Jae Hyuk; Chung, In Sun; Lee, Jun Yong

    2016-06-01

    Sjogren's syndrome is one of the most common autoimmune disorders and has a female predominance. Maternal circulating autoantibodies such as anti-Ro/SSA and anti-La/SSB antibodies can cause congenital heart block of fetus, and in severe case, emergency pacemaker implantation may be needed for neonate. Therefore, it is very important to understand maternal and fetal condition and pay attention to the status of the neonate during delivery. In this paper, we present a case of patient with Sjogren's syndrome who underwent cesarean section under spinal anesthesia. PMID:27274376

  15. A preliminary study of patients' perceptions on the implementation of the WHO surgical safety checklist in women who had Cesarean sections.

    PubMed

    Kawano, Takashi; Tani, Megumi; Taniwaki, Miki; Ogata, Kimiyo; Yokoyama, Masataka

    2015-06-01

    The surgical safety checklist (SSCL), developed by the World Health Organization, is widely implemented by surgical staff for the improvement of their communication, teamwork, and safety culture in the operating room. However, there is no research available addressing the question of how surgical patients perceive the implementation of the SSCL. In order to address this issue, a questionnaire-based preliminary study was conducted for patients who had undergone elective Cesarean section under awake regional anesthesia. Although most participants had not been informed about the implementation of the SSCL before surgery, all of the patients were aware that the SSCL had been performed in the operating room. Over 80% of patients answered that the implementation of the SSCL could help to reduce their feelings of anxiety, tension, and fear, as well as enhance their feeling of security. Furthermore, most patients answered that they were able to understand the components as well as the purpose of the SSCL, and considered that the SSCL should be implemented. These results suggest that awake patients undergoing Cesarean section perceive the implementation of the SSCL to be a highly positive aspect of their surgical care. PMID:25374137

  16. Nutrition assessment in patients undergoing liver transplant

    PubMed Central

    Bakshi, Neha; Singh, Kalyani

    2014-01-01

    Liver transplantation (LT) is a major surgery performed on patients with end stage liver disease. Nutrition is an integral part of patient care, and protein-energy malnutrition is almost universally present in patients suffering from liver disease undergoing LT. Nutrition assessment of preliver transplant phase helps to make a good nutrition care plan for the patients. Nutrition status has been associated with various factors which are related to the success of liver transplant such as morbidity, mortality, and length of hospital stay. To assess the nutritional status of preliver transplant patients, combinations of nutrition assessment methods should be used like subjective global assessment, Anthropometry mid arm-muscle circumference, Bioelectrical impedance analysis (BIA) and handgrip strength. PMID:25316978

  17. Transfusion Related Acute Lung Injury after Cesarean Section in a Patient with HELLP Syndrome.

    PubMed

    Moon, Kyoung Min; Han, Min Soo; Rim, Ch'ang Bum; Kim, So Ri; Shin, Sang Ho; Kang, Min Seok; Lee, Jun Ho; Kim, Jihye; Kim, Sang Il

    2016-01-01

    Transfusion-related acute lung injury (TRALI) is a serious adverse reaction of transfusion, and presents as hypoxemia and non-cardiogenic pulmonary edema within 6 hours of transfusion. A 14-year-old primigravida woman at 34 weeks of gestation presented with upper abdominal pain without dyspnea. Because she showed the syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelet count), an emergency cesarean section delivery was performed, and blood was transfused. In the case of such patients, clinicians should closely observe the patient's condition at least during the 6 hours while the patient receives blood transfusion, and should suspect TRALI if the patient complains of respiratory symptoms such as dyspnea. Furthermore, echocardiography should be performed to distinguish between the different types of transfusion-related adverse reactions.

  18. Constipation Risk in Patients Undergoing Abdominal Surgery

    PubMed Central

    Celik, Sevim; Atar, Nurdan Yalcin; Ozturk, Nilgun; Mendes, Guler; Kuytak, Figen; Bakar, Esra; Dalgiran, Duygu; Ergin, Sumeyra

    2015-01-01

    Background: Problems regarding bowel elimination are quite common in patients undergoing abdominal surgery. Objectives: To determine constipation risk before the surgery, bowel elimination during postoperative period, and the factors affecting bowel elimination. Patients and Methods: This is a cross-sectional study. It was conducted in a general surgery ward of a university hospital in Zonguldak, Turkey between January 2013 and May 2013. A total of 107 patients were included in the study, who were selected by convenience sampling. Constipation Risk Assessment Scale (CRAS), patient information form, medical and nursing records were used in the study. Results: The mean age of the patients was found to be 55.97 ± 15.74 (year). Most of the patients have undergone colon (37.4%) and stomach surgeries (21.5%). Open surgical intervention (83.2%) was performed on almost all patients (96.3%) under general anesthesia. Patients were at moderate risk for constipation with average scores of 11.71 before the surgery. A total of 77 patients (72%) did not have bowel elimination problem during postoperative period. The type of the surgery (P < 0.05), starting time for oral feeding after the surgery (P < 0.05), and mobilization (P < 0.05) were effective on postoperative bowel elimination. Conclusions: There is a risk for constipation after abdominal surgery. Postoperative practices are effective on the risk of constipation. PMID:26380107

  19. Oral surgery in patients undergoing chemoradiation therapy.

    PubMed

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

    2014-05-01

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

  20. Oral surgery in patients undergoing chemoradiation therapy.

    PubMed

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

    2014-05-01

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

  1. INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY

    PubMed Central

    VIDAL, Eduardo Arevalo; RENDON, Francisco Abarca; ZAMBRANO, Trino Andrade; GARCÍA, Yudoco Andrade; VITERI, Mario Ferrin; CAMPOS, Josemberg Marins; RAMOS, Manoela Galvão; RAMOS, Almino Cardoso

    2016-01-01

    ABSTRACT Background: Intestinal malrotation is a rare congenital anomaly. In adults is very difficult to recognize due to the lack of symptoms. Diagnosis is usually incidental during surgical procedures or at autopsy. Aim: To review the occurrence and recognition of uneventful intestinal malrotation discovered during regular cases of bariatric surgeries. Methods: Were retrospectively reviewed the medical registry of 20,000 cases undergoing bariatric surgery, from January 2002 to January 2016, looking for the occurrence of intestinal malrotation and consequences in the intraoperative technique and immediate evolution of the patients. Results: Five cases (0,025%) of intestinal malrotation were found. All of them were males, aging 45, 49, 37,52 and 39 years; BMI 35, 42, 49, 47 and 52 kg/m2, all of them with a past medical history of morbid obesity. The patient with BMI 35 kg/m2 suffered from type 2 diabetes also. All procedures were completed by laparoscopic approach, with no conversions. In one patient was not possible to move the jejunum to the upper abdomen in order to establish the gastrojejunostomy and a sleeve gastrectomy was performed. In another patient was not possible to fully recognize the anatomy due to bowel adhesions and a single anastomosis gastric bypass was preferred. No leaks or bleeding were identified. There were no perioperative complications. All patients were discharged 72 h after the procedure and no immediate 30-day complications were reported. Conclusion: Patients with malrotation can successfully undergo laparoscopic bariatric surgery. May be necessary changes in the surgical original strategy regarding the malrotation. Surgeons must check full abdominal anatomical condition prior to start the division of the stomach. PMID:27683770

  2. [Emergency cesarean section and craniectomy in a patient with rupture of a cerebral arteriovenous malformation].

    PubMed

    Monsalve-Mejía, G; Palacio, W; Rodríguez, C

    2014-04-01

    The intracerebral hemorrhage in pregnancy is a rare event, but can have catastrophic consequences for both mother and fetus. The management of non-ruptured arteriovenous malformations in pregnancy is not free of controversy in the current literature, as there is the possibility of spontaneous bleeding and becoming a true emergency. We report the case of a pregnant patient of 35 weeks with a diagnosis of a cerebral arteriovenous malformation, who developed a sudden onset of headache, generalized tonic-clonic seizures, loss of consciousness, and hemiparesis with radiological images of an intracranial hematoma with a mass effect, and signs of herniation. The multidisciplinary management is discussed, emphasizing perioperative cesarean approach plus craniotomy and drainage of the hematoma, and subsequent management in intensive care, and definitive management by neuroradiology, with a successful outcome.

  3. [Emergency cesarean section and craniectomy in a patient with rupture of a cerebral arteriovenous malformation].

    PubMed

    Monsalve-Mejía, G; Palacio, W; Rodríguez, C

    2014-04-01

    The intracerebral hemorrhage in pregnancy is a rare event, but can have catastrophic consequences for both mother and fetus. The management of non-ruptured arteriovenous malformations in pregnancy is not free of controversy in the current literature, as there is the possibility of spontaneous bleeding and becoming a true emergency. We report the case of a pregnant patient of 35 weeks with a diagnosis of a cerebral arteriovenous malformation, who developed a sudden onset of headache, generalized tonic-clonic seizures, loss of consciousness, and hemiparesis with radiological images of an intracranial hematoma with a mass effect, and signs of herniation. The multidisciplinary management is discussed, emphasizing perioperative cesarean approach plus craniotomy and drainage of the hematoma, and subsequent management in intensive care, and definitive management by neuroradiology, with a successful outcome. PMID:23664062

  4. Sleep Disorders in ESRD Patients Undergoing Hemodialysis.

    PubMed

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

    2016-03-01

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

  5. Hearing Preservation Among Patients Undergoing Cochlear Implantation

    PubMed Central

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

    2015-01-01

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

  6. Bladder Injury During Cesarean Delivery

    PubMed Central

    Tarney, Christopher M.

    2013-01-01

    Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury. PMID:24876830

  7. Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma?

    PubMed Central

    Kinay, Tugba; Basarir, Zehra O.; Tuncer, Serap F.; Akpinar, Funda; Kayikcioglu, Fulya; Koc, Sevgi; Karakaya, Jale

    2016-01-01

    Objectives: To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. Methods: We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding. Results: In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding. Conclusion: A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors. PMID:27464864

  8. Exchange of intraoperative balloon occlusion of the internal iliac artery for the common iliac artery during cesarean hysterectomy in a patient with placenta percreta

    PubMed Central

    Hishikawa, Kenji; Koshiyama, Masafumi; Ueda, Masashi; Yamaguchi, Ayaka; Ukita, Shingo; Yagi, Haruhiko; Kakui, Kazuyo

    2013-01-01

    Patient: Female, 36 Final Diagnosis: Pregnancy – placenta increta Symptoms: — Medication: — Clinical Procedure: Cesarean hysterectomy Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: The generally accepted treatment for placenta percreta is cesarean hysterectomy without attempts to detach the placenta. Preoperative internal iliac artery balloon occlusion (IIABO) has been widely performed to minimize blood loss during cesarean hysterectomy for an abnormal attachment of the placenta. Our case is the first reported case of common iliac artery balloon occlusion (CIABO) being more effective than IIABO for reducing blood loss during a cesarean hysterectomy in the same patient. Case Report: We performed cesarean hysterectomy with IIABO in a 36-year-old Japanese female who had placenta percreta. However, there was still a large amount of blood loss. We immediately changed the balloon from the internal iliac artery to the common iliac artery, which visibly reduced the amount of blood loss. We finally achieved cesarean hysterectomy. Conclusions: CIABO was found to be more effective than IIABO for reducing blood loss during cesarean hysterectomy. Failure of IIABO can be explained by the presence of extensive anastomoses in the pelvic vasculature. PMID:24147189

  9. Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report.

    PubMed

    Lee, Jae Woo; Song, In Ae; Ryu, Junghee; Park, Hee-Pyoung; Jeon, Young-Tae; Hwang, Jung-Won

    2014-10-01

    Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.

  10. Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report.

    PubMed

    Lee, Jae Woo; Song, In Ae; Ryu, Junghee; Park, Hee-Pyoung; Jeon, Young-Tae; Hwang, Jung-Won

    2014-10-01

    Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach. PMID:25368788

  11. Implementing Family-Centered Cesarean Birth.

    PubMed

    Schorn, Mavis N; Moore, Elizabeth; Spetalnick, Bennett M; Morad, Anna

    2015-01-01

    Cesarean birth is recognized as a physical and psychological stressor for many women. Maternity practices during cesarean birth should meet women's needs, while maintaining safety, to optimize the experience. Family-centered cesarean birth is a package of interventions that encourages a woman to participate in choosing interventions that would be helpful when undergoing a planned or unplanned cesarean birth. Included in family-centered cesarean birth is implementation of skin-to-skin care in the operating room for neonates who appear term and healthy. The process of attempting to implement family-centered cesarean birth at one academic center is presented, including steps for implementation, benefits, challenges, and areas for continued improvement and research. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. PMID:26618328

  12. Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

    PubMed Central

    Hasdemir, Pınar Solmaz; Guvenal, Tevfik; Ozcakir, Hasan Tayfun; Koyuncu, Faik Mumtaz; Dinc Horasan, Gonul; Erkan, Mustafa; Oruc Koltan, Semra

    2015-01-01

    Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure. PMID:26413566

  13. Cesarean Section

    MedlinePlus

    A Cesarean section (C-section) is surgery to deliver a baby. The baby is taken out through the mother's abdomen. In the United ... three women has their babies this way. Some C-sections are planned, but many are done when ...

  14. Patient-Perceived Pressure from Clinicians for Labor Induction and Cesarean Delivery: A Population-Based Survey of U.S. Women

    PubMed Central

    Jou, Judy; Kozhimannil, Katy B; Johnson, Pamela Jo; Sakala, Carol

    2015-01-01

    Objective To determine whether patient-perceived pressure from clinicians for labor induction or cesarean delivery is significantly associated with having these procedures. Data Sources/Study Setting Listening to Mothers III, a nationally representative survey of women 18–45 years who delivered a singleton infant in a U.S. hospital July 2011–June 2012 (N = 2,400). Study Design Multivariate logistic regression analysis of factors associated with perceived pressure and estimation of odds of induction and cesarean given perceived pressure. Principal Findings Overall, 14.8 percent of respondents perceived pressure from a clinician for labor induction and 13.3 percent for cesarean delivery. Women who perceived pressure for labor induction had higher odds of induction overall (adjusted odds ratio [aOR]: 3.51; 95 percent confidence interval [CI]: 2.5–5.0) and without medical reason (aOR: 2.13; 95 percent CI: 1.3–3.4) compared with women who did not perceive pressure. Those perceiving pressure for cesarean delivery had higher odds of cesarean overall (aOR: 5.17; 95 percent CI: 3.2–8.4), without medical reason (aOR: 6.13; 95 percent CI: 3.4–11.1), and unplanned cesarean (aOR: 6.70; 95 percent CI: 4.0–11.3). Conclusions Patient-perceived pressure from clinicians significantly predicts labor induction and cesarean delivery. Efforts to reduce provider–patient miscommunication and minimize potentially unnecessary procedures may be warranted. PMID:25250981

  15. Interdisciplinary modular teaching for patients undergoing progenitor cell transplantation.

    PubMed

    Kemp, Jackie; Dickerson, Jill

    2002-01-01

    Patient-education information provided to patients undergoing progenitor cell transplantation (PCT) is complex. Patients' and caregivers' inability to process this information and apply principles of self-care can result in poor outcomes. An interdisciplinary team developed a three-part modular teaching program and documentation tool to address the complex informational needs of patients undergoing PCT. The modules were designed to reflect information relative to the three phases of PCT: pretransplantation, transplantation, and post-transplantation. The structured content of the documentation tool allows for consistent documentation that systematically reflects the content of the patient-education modules.

  16. Hope language in patients undergoing epilepsy surgery.

    PubMed

    Patton, D J; Busch, R M; Yee, K M; Kubu, C S; Gonzalez-Martinez, J; Ford, P J

    2013-10-01

    Candidates for epilepsy surgery often use the word "hope" to express their attitudes and beliefs about surgery. However, studies suggest that hope has a multiplicity of meanings that are not well understood. The goal of this analysis was to evaluate whether Candidates for epilepsy surgery use hope language to express a traditional, expected optimism during presurgery interviews. We examined patients' uses of the word "hope" and its derivatives (hoping, hopeful, hopefully) through a secondary analysis of 37 interviews of adult patients prior to epilepsy surgery. Approximately 1/3 of all hope statements were coded as expressions of optimism, while 1/3 were not optimistic, and 1/3 had unclear meanings. In addition to traditionally optimistic uses of the term, other themes surrounding use of this word included ideas of dread, worry, uncertainty, and temporizing language. This information may help clinicians communicate more effectively with patients, enhancing the informed consent process for epilepsy surgery.

  17. [Anesthetic management of cesarean section in a patient with pulmonary embolism due to protein S deficiency].

    PubMed

    Etoh, Takashi

    2014-08-01

    A 37-year-old pregnant woman (23 weeks' gestation) was consulted to us because of the left leg pain. On examination, she was diagnosed as deep vein thrombosis (DVT) and pulmonary embolism due to protein S deficiency. She was admitted to our hospital and underwent anticoagulant therapy (heparin 10,000 units per day). At 38 weeks' gestation, she was scheduled for cesarean section. Before operation, she received anticoagulant therapy with continuous infusion of heparin (30,000 units per day) and prophylactic placement of an inferior vena cava (IVC) filter. Heparin was discontinued 6 hours before operation. Spinal anesthesia using hyperbaric bupivacaine 10 mg and fentanyl 25 microg was performed and the operation was completed uneventfully. Preoperative anticoagulant therapy and placement of an IVC filter may be effective in preventing new pulmonary embolism, and regional anesthesia may be safe for cesarean section. PMID:25199326

  18. Clopidogrel Responsiveness in Patients Undergoing Peripheral Angioplasty

    SciTech Connect

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

    2013-12-15

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

  19. Necrotizing fasciitis of anterior abdominal wall following cesarean section in a low-risk patient

    PubMed Central

    Chhetry, Manisha; Banerjee, Basudeb; Subedi, Shanti; Koirala, Ashok

    2016-01-01

    We report a case of a mono-microbial post-cesarean necrotizing fasciitis caused by methicillin resistant Staphylococcus aureus, in a low-risk healthy woman who presented with acute fulminant infection, sepsis and features of multi-organ dysfunction syndrome on sixth post-operative day. Aggressive management with multiple surgical debridement and supportive therapy was the key to favorable outcome in this case. PMID:27402541

  20. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.

    PubMed

    Watters, William; Rethman, Michael P; Hanson, Nicholas Buck; Abt, Elliot; Anderson, Paul A; Carroll, Karen C; Futrell, Harry C; Garvin, Kevin; Glenn, Stephen O; Hellstein, John; Hewlett, Angela; Kolessar, David; Moucha, Calin; O'Donnell, Richard J; O'Toole, John E; Osmon, Douglas R; Evans, Richard Parker; Rinella, Anthony; Steinberg, Mark J; Goldberg, Michael; Ristic, Helen; Boyer, Kevin; Sluka, Patrick; Martin, William Robert; Cummins, Deborah S; Song, Sharon; Woznica, Anne; Gross, Leeaht

    2013-03-01

    The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.

  1. Cesarean delivery: counseling issues and complication management.

    PubMed

    Quinlan, Jeffrey D; Murphy, Neil J

    2015-02-01

    Nearly one-third of all deliveries in the United States are cesarean deliveries. Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased maternal and neonatal morbidity and mortality. Interventions that decrease the chance of a cesarean delivery include avoiding non-medically indicated induction of labor, avoiding amniotomy, and having a doula present. In North America, the most common reasons for cesarean delivery include elective repeat cesarean delivery, dystocia or failure to progress, malpresentation, and fetal heart rate tracings that suggest fetal distress. Post-cesarean delivery complications include pain, endomyometritis, wound separation/infection, urinary tract infection, gastrointestinal problems, deep venous thrombosis, and septic thrombophlebitis. Women with no risk factors for deep venous thrombosis other than the postpartum state and the operative delivery do not require thromboembolism prophylaxis other than early ambulation. A pregnant woman's decision to attempt a trial of labor after cesarean delivery or have a planned repeat cesarean delivery involves a balancing of maternal and neonatal risks, as well as personal preference after counseling by her physician. Approximately 75% of attempted trials of labor after cesarean delivery are successful. Provision of advanced maternity care practices by family physicians, including serving as primary surgeons for cesarean deliveries, is consistent with the goals of the patient-centered medical home. PMID:25822271

  2. A suicidal pregnant patient's request for premature Cesarean section: Clinical and ethical challenges.

    PubMed

    Teng, Jia Ying; Yin Ing Chee, Cornelia; Chong, Yap-Seng; Lee, Le Ye; Yong, Eu Leong; Chi, Claudia; Broekman, Birit

    2016-04-01

    We present the case of a 36-year-old lady with severe borderline personality disorder and depression, who made repeated requests for an immediate Cesarean section at 31 weeks of gestation. Her mood was extremely depressed and she had intense suicidal thoughts. She was worried that she would kill herself and the baby, therefore believing that early delivery would save the baby's life. This was a challenging case that required multidisciplinary collaboration, suicide risk assessment and detailed evaluation of mental capacity. The clinical and ethical dilemmas of this case are discussed by a team of psychiatrists, obstetricians and neonatologists. PMID:26826866

  3. Periodontal Management of a Patient Undergoing Liver Transplantation.

    PubMed

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

    2016-01-01

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

  4. Safety of cesarean delivery through placental incision in patients with anterior placenta previa

    PubMed Central

    Hong, Deok-Ho; Kim, Eugene; Kyeong, Kyu-Sang; Hong, Seung Hwa

    2016-01-01

    Objective To demonstrate the safety of fetal delivery through placental incision in a placenta previa pregnancy. Methods We examined the medical records of 80 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between May 2010 and May 2015 at the Department of Obstetrics and Gynecology, Chungbuk National University Hospital. Among the women with placenta previa, those who did not have the placenta in the uterine incision site gave birth via conventional uterine incision, while those with anterior placenta previa or had placenta attached to the uterine incision site gave birth via uterine incision plus placental incision. We compared the postoperative hemoglobin level and duration of hospital stay for the mother and newborn of the two groups. Results There was no difference between the placental incision group and non-incision group in terms of preoperative and postoperative hemoglobin change, the amount of blood transfusions required by the mother, newborns with 1-min or 5-min Apgar scores below 7 points or showing signs of acidosis on umbilical cord blood gas analysis result of pH below 7.20. Moreover, neonatal hemoglobin levels did not differ between the two groups. Conclusion Fetal delivery through placental incision during cesarean section for placenta previa pregnancy does not negatively influence the prognosis of the mother or the newborn, and therefore, is considered a safe surgical technique. PMID:27004200

  5. Impaired leukocyte phagocytosis in patients undergoing hemihepatectomy for liver metastases.

    PubMed

    Wiezer, M J; Meijer, C; Wallast-Groenewoud, H P; Tool, A T; Prins, H A; Houdijk, A P; Beelen, R H; Meijer, S; Hack, C E; van Leeuwen, P A

    1999-05-01

    Patients undergoing partial hepatectomy have an increased susceptibility to infection. To investigate whether this increased risk is related to impaired leukocyte function, we studied polymorphonuclear leukocyte (PMN) phagocytosis in patients undergoing a hemihepatectomy because of liver metastasis (LM, n = 11) and in patients undergoing major abdominal surgery because of abdominal malignancy (AM, n = 8). Eight healthy volunteers (HVs) served as controls. Leukocyte suspensions were incubated with fluorescein isothiocyanate-labeled Staphylococcus aureus, and phagocytosis was measured by flow cytometry. Preoperative PMN phagocytosis, in the presence of autologous plasma, was significantly less in patients with LM compared with patients with AM or HVs. This impaired phagocytosis was potentially restored in the presence of normal plasma. The decreased phagocytic capacity of PMNs from patients with LM was not related to levels of known plasma opsonins or phenotypic changes of PMNs. Rather, it was related to a deficiency of unidentified plasma factors. After surgery, the phagocytic capacity of PMNs of patients with AM decreased by approximately 30%, which correlated with decreasing levels of immunoglobulin G and C3. In conclusion, patients with LM had a decreased PMN phagocytic capacity before surgery. This impairment in phagocytosis disappeared 1 week after surgery. We propose that the presence of LM leads to a deficiency of factor(s) in the blood that impairs PMN phagocytic capacity.

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

    PubMed Central

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

    2015-01-01

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

  7. [Echocardiographic alterations in patients with chronic kidney failure undergoing hemodialysis].

    PubMed

    Barberato, Silvio Henrique; Pecoits-Filho, Roberto

    2010-01-01

    Changes in cardiac structure and function detected by echocardiography are common in patients with chronic kidney disease undergoing hemodialysis, and have been recognized as key outcome predictors. This review attempts to summarize recent evidence pointing to the usefulness of the method in the detection of clinical and subclinical cardiac dysfunction, stratification of cardiovascular risk and assessment of intervention strategies.

  8. Nutritional status of patients undergoing chemoradiotherapy for lung cancer.

    PubMed

    Shintani, Yasushi; Ikeda, Naoki; Matsumoto, Tomoshige; Kadota, Yoshihisa; Okumura, Meinoshin; Ohno, Yuko; Ohta, Mitsunori

    2012-04-01

    Impaired nutrition is an important predictor of perioperative complications in lung cancer patients, and preoperative chemoradiotherapy increases the risk of such complications. The goal of this study was to assess the effect of an immune-enhancing diet on nutritional status in patients undergoing lung resection after chemoradiotherapy. We compared the preoperative nutritional status in 15 patients with lung cancer undergoing lung resection without chemoradiotherapy and 15 who had chemoradiotherapy. Body mass index and lymphocyte counts were lower in patients who had chemoradiotherapy. Although there was no difference in the rate of postoperative morbidity between groups, the chemoradiotherapy patients were more likely to have severe complications postoperatively. After chemoradiotherapy in 12 patients, 6 received oral Impact for 5 days, and 6 had a conventional diet before surgery. Oral intake of Impact for 5 days before surgery modified the decrease in transferrin and lymphocytes after the operation. Preoperative immunonutrition may improve the perioperative nutritional status after induction chemoradiotherapy in patients undergoing lung cancer surgery, and reduce the severity of postoperative complications. These potential benefits need to be confirmed in a randomized controlled trial.

  9. Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia

    PubMed Central

    Voigt, Matthias; Fröhlich, Christian W.; Hüttel, Christiane; Kranke, Peter; Mennen, Jan; Boessneck, Oliver; Lenz, Christian; Erbes, Thalia; Ernst, Jürgen; Kerger, Heinz

    2013-01-01

    Background This paper describes a randomized prospective study conducted in 308 patients undergoing caesarean section in spinal anaesthesia at a single hospital between 2010 and 2012 to find a suitable anti-emetic strategy for these patients. Material/Methods Spinal anesthesia was performed in left prone position, at L3/L4 with hyperbaric 0.5% Bupivacaine according to a cc/cm body height ratio. There were no opioids given peri-operatively. The patients received either no prophylaxis (Group I) or tropisetron and metoclopramide (Group II) or dimenhydrinate and dexamethasone (Group III), or tropisetron as a single medication (Group IV). The primary outcome was nausea and/or vomiting (NV) in the intraoperative, early (0–2 h) or late (2–24 h) postoperative period. Multivariate statistical analysis was conducted with a regression analysis and a backward elimination of factors without significant correlation. Results All prophylactic agents significantly reduced NV incidence intraoperatively. Relative risk reduction for NV by prophylaxis was most effective (59.5%) in Group II (tropisetron and metoclopramide). In Group III (dimenhydrinate and dexamethasone), NV risk was reduced by 29.9% and by 28.7% in Group IV (tropisetron mono-therapy). The incidence of NV in the early (0–2 h) and the late (2–24 h) postoperative period was low all over (7.8%), but the relative risk reduction of NV in the early postoperative period was 54.1% (Group IV), 45.1% (Group III), and 34.8% (Group II), respectively. In the late postoperative period, there was no significant difference between the 4 groups. Conclusions We recommend a prophylactic medication with tropisetron 2 mg and metoclopramide 20 mg for patients during caesarean section. These agents are safe, reasonably priced, and highly efficient in preventing nausea and vomiting. PMID:24226381

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

    PubMed

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

    2014-03-01

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

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

    PubMed

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

    2016-09-01

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

  12. [Pharmacokinetics of defibrotide in uremic patients undergoing hemodialysis].

    PubMed

    Rossi, R; Farma, A; Maggi, G C; Marelli, A

    1991-12-01

    Defibrotide pharmacokinetics were studied in 6 voluntary healthy subjects and in 10 uremic patients undergoing dialysis during which (instead of heparin) defibrotide was administered to prevent fibrino-formation in the circuit. Blood concentrations of the drug were assessed (expressed with reference to the residual glycidic deoxyribose) during a standard dialysis using defibrotide, 3.5, 15, 30, 45, 60 and 90 minutes after the defibrotide bolus (200 mg) had been injected into the arterial channel. The half-lives of the alpha and beta plasmatic phases were found to be equal at 3.79 and 41.4 min in dialysed subjects and at 1.13 and 16.54 in healthy volunteers. These results indicate that in uremic patients undergoing dialysis at intervals using defibrotide, a longer time is required to eliminate the drug from the circulation. This variation does not however appear to be significant in terms of the therapeutic use of the drug during dialysis.

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

    PubMed

    Mondelli, Mauro; Aretini, Alessandro; Greco, Giuseppe

    2014-01-01

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

  14. 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

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

    PubMed

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

    2016-09-01

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

  16. Cognitive function in patients with Parkinson's disease undergoing stereotaxic thalamotomy.

    PubMed Central

    Lund-Johansen, M; Hugdahl, K; Wester, K

    1996-01-01

    OBJECTIVE--To determine whether thalamotomy leads to cognitive disturbances in patients with Parkinson's disease. METHODS--A total of 53 patients with Parkinson's disease undergoing stereotaxic ventrolateral thalamotomy for tremor and rigidity were tested for cognitive functions before and after surgery. The cognitive functions investigated involved visuospatial perception and memory. verbal memory, attention shift, and executive functions including set maintenance and shift. A neuropsychological test battery was used that contained the Wisconsin card sorting test, Street completion test, Stroop test, a dichotic memory listening test, and a facial recognition test. RESULTS--Clinically, a good or moderately good effect on parkinsonian symptoms was obtained in 50 patients. The neuropsychological investigations showed that the patients were impaired compared with healthy age matched control subjects on most tests, showing slight improvement postoperatively on verbal memory and visuospatial perception. No major differences were found between tests before and after operation, and there were no significant differences between patients undergoing surgery in the right or in the left thalamus. CONCLUSION--The study indicates that ventrolateral thalamotomy does not reduce the cognitive capacity in this group of patients. PMID:8778265

  17. [Has ketamine preemptive analgesic effect in patients undergoing abdominal hysterectomy?].

    PubMed

    Karaman, Semra; Kocabaş, Seden; Zincircioğlu, Ciler; Firat, Vicdan

    2006-07-01

    The aim of this study was to determine if preemptive use of the NMDA receptor antogonist ketamine decreases postoperative pain in patients undergoing abdominal hystrectomy. A total of 60 patients admitted for total abdominal hysterectomy were included in this study after the approval of the ethic committee, and the patients were randomly classified into three groups. After standart general anaesthesia, before or after incision patients received bolus saline or ketamine. Group S received only saline while Group Kpre received ketamine 0.4 mg/kg before incision and saline after incision, and Group Kpost received saline before incision and 0.4 mg/kg ketamine after incision. Postoperatif analgesia was maintained with i.v. PCA morphine. Pain scores were assessed with Vizüal Analog Scale (VAS), Verbal Rating Scale (VRS) at 1., 2, 3., 4., 8., 12. ve 24. hours postoperatively. First analgesic requirement time, morphine consumption and side effects were recorded. There were no significant differences between groups with respect to VAS / VRS scores, the time for first analgesic dose, and morphine consumption ( p>0.05). Patients in Group S had significantly lower sedation scores than either of the ketamine treated groups ( p<0.05). In conclusion, a single dose of ketamin had no preemptive analgesic effect in patients undergoing abdominal hysterectomy, but further investigation is needed for different operation types and dose regimens.

  18. Renal and Gastrointestinal Considerations in Patients Undergoing Elective Orthopaedic Surgery.

    PubMed

    Pyrko, Peter; Parvizi, Javad

    2016-01-01

    To minimize perioperative complications after orthopaedic procedures, patients may undergo medical optimization, which includes an assessment of their renal function and gastrointestinal (GI) system. The GI and renal systems are complex, and their proper optimization in the preoperative period can influence the success of any procedure. Several factors can prevent complications and reduce morbidity, mortality, and the cost of care, including a thorough evaluation and screening, with particular emphasis on anemia and its renal and GI causes; management of medications that are metabolized by the liver and excreted by the kidneys; and careful attention to the patient's nutritional status.

  19. General anesthesia for cesarean section at a tertiary care hospital 1990-1995: indications and implications.

    PubMed

    Tsen, L C; Pitner, R; Camann, W R

    1998-07-01

    Complications of general anesthesia for cesarean section remain the leading cause of anesthesia-related maternal mortality. General anesthesia, however, is becoming less popular for obstetric anesthesia, and thus fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult intubations witnessed and managed by residents decreases. In addition, patients who undergo general anesthesia may have co-morbidities which, while not contraindicating regional anesthesia, may increase the risk of providing anesthesia. We reviewed the medical records of 6 calendar years (1990-1995) at our busy tertiary center, to determine patient demographics, indications for cesarean section, indications for general anesthesia, time of day, and complications related to airway management. From 1990 through 1995, cesarean sections under general anesthesia decreased from 7.2% to 3.6% (P=0.0001), however, they were performed on parturients with more maternal diseases (17.2% to 35.8%; P=0.0034). Although the incidence of difficult intubations in those years ranged from 16.3% to 1.3%, only one failed intubation with resultant maternal mortality occurred. Few residency programs offer instruction on the difficult airway in the parturient population. Organized airway management programs specifically for the obstetric population may assist efforts to decrease the morbidity and mortality associated with the provision of general anesthesia for cesarean section. PMID:15321206

  20. Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery

    PubMed Central

    Pretto, Pericles; Martins, Gerez Fernandes; Biscaro, Andressa; Kruczan, Dany David; Jessen, Barbara

    2015-01-01

    Introduction Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized. Objective To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft. Methods Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used. Results We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases. Conclusion The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death. PMID:25859867

  1. 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

  2. Economic evaluation of end stage renal disease patients undergoing hemodialysis

    PubMed Central

    Suja, A.; Anju, R.; Anju, V.; Neethu, J.; Peeyush, P.; Saraswathy, R.

    2012-01-01

    Background: In India the incidence of end stage renal disease (ESRD) is increasing day by day and the option for the treatment of ESRD is dialysis or transplantation. In the present scenario, due to the cost of treatment normal people can afford only hemodialysis rather than transplantation. Since the cost of hemodialysis differs across the country, research is needed to evaluate its exact cost. Aim: This study is to analyze the healthcare cost of hemodialysis in a private hospital of South India. Materials and Methods: This is a prospective, observational study carried out in a tertiary care hospital. Patients who are undergoing routine hemodialysis in this hospital were selected for the study. Patient data as well as cost details were collected for a period of six months. Thirty patients were selected for the study and a total of 2160 dialysis sessions were studied. Patient perspective was taken for the analysis of cost. Both direct and indirect costs were analyzed. This includes cost of dialysis, investigations, erythropoietin, food, transportation, lost wages etc. Socioeconomic status of the patient was also studied. Result: The total cost per session was found to be around Rs. 4500. Fifty six percent contributes direct medical cost whereas 20% contributes direct non medical cost. Twenty four percent cost was due to indirect costs. Since the patients are paying from their own pocket, only the upper or upper middle class patient can undergo hemodialysis regularly. Conclusion: These findings are important to find out the impact of cost of hemodialysis on patients suffering from ESRD. Further studies related to costs and outcome, otherwise known as pharmacoeconomic studies, are needed to analyze the pros and cons of renal replacement therapy and to improve the quality of life of ESRD patients. Thus pharmacoeconomical studies are needed to realize that government has to take initiative to provide insurance or reimbursement for the common people. PMID:22557920

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  4. Respiratory management of the obese patient undergoing surgery.

    PubMed

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

    2015-05-01

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

  5. Respiratory management of the obese patient undergoing surgery.

    PubMed

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

    2015-05-01

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

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

    PubMed

    Kaido, Toshimi; Tamai, Yumiko; Uemoto, Shinji

    2016-07-01

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

  7. Aspects of personality in patients with anxiety disorders undergoing capsulotomy.

    PubMed

    Mindus, P; Nyman, H; Rosenquist, A; Rydin, E; Meyerson, B A

    1988-01-01

    Capsulotomy is an established psychosurgical intervention for anxiety disorders. While the effectiveness of the intervention in reducing target symptoms is undisputed, the issue of negative personality changes following capsulotomy is of great concern. We studied prospectively personality traits in nine consecutive patients undergoing capsulotomy for anxiety disorder, using the Rorschach test and a personality inventory, the Karolinska Scales of Personality (KSP), administered before and one year after operation. The protocols were evaluated under blind conditions by an independent assessor who had access to no data other than the age and sex of the patients. The Rorschach findings were used in two main comparison procedures: between the patients pre- and postoperative scores, and between that group and three reference groups. The KSP data were compared both with an age-stratified non-patient control group and with data obtained from groups of neurotic patients. In summary, the capsulotomy patients' personalities, as expressed in their Rorschach interpretations, remained intact, and significant reductions were noted in scales reflecting anxiety and hospitality. Statistically significant changes were also noted after operation in 10 of the 17 scales included in the KSP. While pathological scores were observed preoperatively in many scales, all the postoperative scores but one (Socialization) were within the normal range. Scores on the Socialization scale remained low, which is often the case in chronic patients. It is concluded that the patients displayed more normal personality features after operation than before and that adverse personality changes are not likely to occur after capsulotomy. PMID:3223360

  8. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco

    PubMed Central

    Benzouina, Soukayna; Boubkraoui, Mohamed El-mahdi; Mrabet, Mustapha; Chahid, Naima; Kharbach, Aicha; El-hassani, Amine; Barkat, Amina

    2016-01-01

    Introduction Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are

  9. Immediate hemodynamic response to furosemide in patients undergoing chronic hemodialysis.

    PubMed

    Schmieder, R E; Messerli, F H; deCarvalho, J G; Husserl, F E

    1987-01-01

    To evaluate the effect of furosemide on cardiovascular hemodynamics in patients with end-stage renal failure, we studied ten patients undergoing hemodialysis three times a week. Arterial pressure, heart rate, and cardiac output (indocyanine green dye) were measured in triplicate; total peripheral resistance and central blood volume were calculated by standard formulas. Hemodynamics were determined at baseline and 5, 10, 15, and 30 minutes after intravenous (IV) bolus injection of furosemide 60 mg. Furosemide produced a decrease in central blood volume of -13% +/- 2.2% from pretreatment values (P less than .01) that was most pronounced five minutes after injection, together with a fall in cardiac output (from 6.76 +/- 0.59 to 6.17 +/- 0.52 L/min, P less than .10). Stroke volume decreased with a maximum fall occurring after 15 minutes (from 84 +/- 7 to 79 +/- 7 mL/min, P less than .05), and total peripheral resistance increased (from 15.8 +/- 2.1 to 17.8 +/- 2.3 units, P less than .05) after furosemide. Arterial pressure and heart rate did not change. The decrease in central blood volume reflects a shift of the total blood volume from the cardiopulmonary circulation to the periphery, suggesting dilation of the peripheral venous bed. Thus, even in patients undergoing hemodialysis, furosemide acutely decreases left ventricular preload by venous dilation and should therefore prove to be beneficial in acute volume overload.

  10. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    NASA Astrophysics Data System (ADS)

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

    2016-06-01

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

  11. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    PubMed Central

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

    2016-01-01

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

  12. Efficacy of Carperitide in Hemodialysis Patients Undergoing Cardiac Surgery

    PubMed Central

    Osaka, Shunji; Yaoita, Hiroko; Ishii, Yusuke; Arimoto, Munehito; Hata, Hiroaki; Shiono, Motomi

    2016-01-01

    Purpose: Recently, performance of cardiac surgery in hemodialysis patients has increased, but the mortality rate is high. Methods: We retrospectively examined the early and long-term outcomes in 128 dialysis patients who underwent cardiac surgery with or without carperitide infusion and were followed for 2 years. Sixty-three patients received carperitide infusion during surgery and 65 patients did not. Results: The hospital mortality rate was 1.6% in the carperitide group and 12.3% in the non-carperitide group, being significantly lower in the carperitide group. The 2-year actuarial survival rate was 90.5% ± 3.7% in the carperitide group, and 76.9% ± 5.2% in the non-carperitide group, while the major adverse cardiovascular and cerebrovascular events (MACCE)-free rate at 2 years postoperatively was 90.5% ± 3.7% in the carperitide group and 67.7% ± 5.8% in the non-carperitide group. Conclusions: These findings suggest that carperitide improves the early postoperative outcome in dialysis patients undergoing cardiac surgery, as has already been demonstrated in non-dialysis patients. An early postoperative cardioprotective effect of carperitide and improvement of renal function in oliguric patients might have contributed to this outcome. However, this was a retrospective study, so a prospective investigation is required to demonstrate the mechanisms involved. In addition, further evaluation of the long-term results would be desirable. PMID:27025780

  13. Outcomes of cancer patients undergoing percutaneous pericardiocentesis for pericardial effusion

    PubMed Central

    El Haddad, Danielle; Iliescu, Cezar; Yusuf, Syed Wamique; William, William Nassib; Khair, Tarif H.; Song, Juhee; Mouhayar, Elie N.

    2015-01-01

    BACKGROUND Pericardial effusion (PE) is common in cancer patients but the optimal therapeutic approach is not well defined. Percutaneous pericardiocentesis is less invasive than surgery, but its long-term effectiveness and safety are not well documented. OBJECTIVES We evaluated outcomes of cancer patients undergoing percutaneous pericardiocentesis for PE and assessed the procedure’s safety in patients with thrombocytopenia. METHODS Cancer patients who underwent percutaneous pericardiocentesis for PE between November 2009 and October 2014 at MD Anderson Cancer Center were included. Procedure-related complications, effusion recurrence rate, and overall survival were analyzed. RESULTS Of 1,645 cancer patients referred for PE, 212 (13%) underwent percutaneous pericardiocentesis. The procedure was successful in 99% of the cases with no procedure-related deaths. Four patients had major procedure-related bleeding that did not vary by platelet count <50,000/µl or ≥50,000/µl (p = 0.1281). Patients with catheter drainage for 3 to 5 days had the lowest recurrence rate (10%). Median overall survival was 143 days with age >65 years, lung cancer, platelet count <20,000/µl, and malignant pericardial fluid independently associated with poor prognosis. Lung cancer patients with proven malignant effusions had a significantly shorter median 1-year survival compared to those with nonmalignant effusions (16.2% vs. 49.0%, respectively; log-rank test p value = 0.0101). A similar difference in 1-year survival was not observed in breast cancer patients (40.2% vs. 40.0%, respectively; log-rank test p = 0.4170). CONCLUSION Percutaneous pericardiocentesis with extended catheter drainage, as primary treatment for PE in cancer patients, is safe and effective, including in those with thrombocytopenia. Malignant PE significantly shortens the survival outcome of lung, but not breast, cancer patients. PMID:26337990

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

    PubMed Central

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

    2014-01-01

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

  15. Fat tissue and inflammation in patients undergoing peritoneal dialysis

    PubMed Central

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

    2016-01-01

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

  16. Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy

    SciTech Connect

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

    2005-04-15

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

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

    PubMed Central

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

    2011-01-01

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

  18. Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation.

    PubMed

    Wesling, Michele; Brady, Susan; Jensen, Mary; Nickell, Melissa; Statkus, Donna; Escobar, Nelson

    2003-01-01

    The purpose of this retrospective study was to compare functional dysphagia outcomes following inpatient rehabilitation for patients with brain tumors with that of patients following a stroke. Group 1 (n = 24) consisted of consecutive admissions to the brain injury program with the diagnosis of brain tumor and dysphagia. Group 2 (n = 24) consisted of matched, consecutive admissions, with the diagnosis of acute stroke and dysphagia. Group 2 was matched for age, site of lesion, and initial composite cognitive FIM score. The main outcome measures for this study included the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale, length of stay, hospital charges, and medical complications. Results showed that swallowing gains made by both groups as evaluated by the admission and discharge ASHA NOMS levels were considered to be statistically significant. The differences for length of stay, total hospital charges, and speech charges between the two groups were not considered to be statistically significant. Three patients in the brain tumor group (12.5%) demonstrated dysphagia complications of either dehydration or pneumonia during their treatment course as compared to 0% in the stroke group. This study confirms that functional dysphagia gains can be achieved for patients with brain tumors undergoing inpatient rehabilitation and that they should be afforded the same type and intensity of rehabilitation for their swallowing that is provided to patients following a stroke.

  19. Prediction of cardiac risk in patients undergoing vascular surgery

    SciTech Connect

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

    1987-03-01

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

  20. Psychological nursing support for elderly patients undergoing chronic regular haemodialysis.

    PubMed

    Triantaphillopoulou, E; Iphou, A; Arvaniti, P; Michalopoulos, D; Nousis, T; Tserkezis, G; Velissari, E; Iphos, C

    1998-01-01

    The elderly constitute a continuously increasing social group of the Hellenic, but also of the global population. This phenomenon is also evident in the haemodialysis patient population, which grows continually. Faced with this reality, Nursing is obliged to adapt itself and, in this effort that it is putting forward it has achieved many positive steps (geriatric nursing). It is imperative however for nursing that there is a particular way of dealing with the elderly, especially those that undergo chronic periodic haemodialysis, which regards as much the problems stemming from the disease, as it regards their grave psychological condition. The objective of our study was to develop the need for the presence of the Nephrology Nurse in the psychological support of the elderly renal patient and we have been able to define: level of communication, level of dietetic information, psycho-social condition and restrictions imposed by the disease. 30 patients (age 65-80, mean 72.92 years) were included with an observation time of 3 years, less than 60% responded positively to the efforts for psychological support, on the basis of the studied factors. The rest did not show any willingness to answer. We conclude that psychological support is of paramount importance for these patients but also that the Nephrology Nurse has not yet discovered and detected some unknown aspects of the different problems arising due to insufficient knowledge of geriatric caring.

  1. NUTRITIONAL STATUS AND LIFE QUALITY IN PATIENTS UNDERGOING BARIATRIC SURGERY

    PubMed Central

    da SILVA, Paulo Roberto Bezerra; de SOUZA, Marcela Ramos; da SILVA, Evane Moises; da SILVA, Silvia Alves

    2014-01-01

    Background The obesity has achieved an alarming increase in recent years, which led this disease to global epidemic condition. Aim To evaluate the nutritional status as well as the quality of life of obese patients undergoing bariatric surgery. Methods A transversal study was conducted with obese adults of both genders who underwent bariatric surgery by Fobi-Capella technique for at least 30 days. It was evaluated: age, gender, marital status, occupation, weight before surgery, current weight, height, preoperative and current BMI, weight loss and loss of excess weight percentages, presence of clinical manifestations and food intolerances. Results The sample consisted of 70 patients, being 81.4% female, 37.1% aged 30 to 39 years, 58.6% were married, 41.4% have undergone the bariatric surgery in the last 12 months. It was observed a reduction in BMI from 37.2 kg/m2 (one to three months) to 28.9 kg/m2 (>12 months) and consequent increase in weight loss and loss of excess weight percentages. The most frequent clinical manifestation was alopecia (62.9%). The most reported food intolerance was on the red meat (24%). According to the Baros questionnaire, 50% of patients were classified as having good quality of life. Conclusion The operation of Fobi-Capella proved to be effective in promoting gradual and lasting weight loss. Quality of life was considered good in most patients, indicating that the operation had a positive impact on their lives. PMID:25409963

  2. Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia

    PubMed Central

    Chan, Yoke Mun; Zalilah, Mohd Shariff; Hii, Sing Ziunn

    2012-01-01

    Background Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen, leading to undesirable outcomes. This study aimed to examine and identify factors influencing dietary, fluid, medication and dialysis compliance behaviours in patients undergoing hemodialysis. Methods This was a cross-sectional study which employed purposive sampling design. A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008–2011. Self-reported compliance behaviours and biochemical measurements were used as evaluation tools. Results Compliance rates of dietary, fluid, medication and dialysis were 27.7%, 24.5%, 66.5% and 91.0%, respectively. Younger, male, working patients and those with longer duration on hemodialysis were found more likely to be non-compliant. Lacks of adequate knowledge, inadequate self-efficacy skills, forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid, dietary, medication and dialysis, respectively. Conclusions Healthcare professionals should recognise the factors hindering compliance from the patients' perspective while assisting them with appropriate skills in making necessary changes possible. PMID:22870215

  3. Efficacy of lipophilic vs lipophobic opioids in addition to hyperbaric bupivacaine for patients undergoing lower segment caeserean section

    PubMed Central

    Agrawal, Amit; Asthana, Veena; Sharma, J. P.; Gupta, Vineeta

    2016-01-01

    Background: Subarachnoid block is the preferred technique for providing anesthesia for patients undergoing cesarean section. Various pharmacological agents in added to local anesthetics (LA) modify their original effects in terms of block characteristics and quality of analgesia. However, there is ongoing debate about this practice of using adjuncts with LA. We tested whether addition of lipophilic versus lipophobic opioids to LA gives any clinical benefits to maternal and fetal outcome when used in these patients requiring spinal anesthesia. Subjects and Methods: Sixty American Society of Anesthesiologists I and II parturients, undergoing elective cesarean section requiring subarachnoid block, were included in our study. The parturients were allocated randomly to three groups of 20 each to receive bupivacaine 12.5 mg (Group I), bupivacaine 12.5 mg + morphine 0.2 mg (Group II), bupivacaine 12.5 mg + fentanyl 25 μg (Group III), preservative free physiological saline 0.9% was added to all the solutions to achieve a total volume of 4 ml. The parameters studied were the time of onset, sensory level of the block achieved, total duration of analgesia, any need of rescue analgesics, maternal side effects, and fetal outcome. Results: Onset of block was early 4.30 ± 0.12 min in Group III as compared to Group I 4.64 ± 0.28 min and Group II 4.505 ± 0.22 min. Mean duration of analgesia (hours) was higher in Group II 15.91 ± 0.96 h as compared to Group I 1.95 ± 0.55 h and Group III 4.39 ± 0.2 h. Incidence of nausea, vomiting, and shivering was more in the control group as compared to study groups, whereas sedation and pruritus were seen more in the study groups. No adverse effects on fetus were seen with use of opioids and comparable Apgar scores were noted. Conclusion: Addition of intrthecal fentanyl causes rapid onset of block whereas intrathecal morphine provides prolonged analgesia with comparable neonatal wellbeing. PMID:27746526

  4. Fibroblast Growth Factor 23 in Patients Undergoing Peritoneal Dialysis

    PubMed Central

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

    2011-01-01

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

  5. Myoinositol Improves Embryo Development in PCOS Patients Undergoing ICSI

    PubMed Central

    2016-01-01

    The aim of this study was to investigate the activity of myoinositol, in a court of 217 PCOS women undergoing intracytoplasmic sperm injection (ICSI), on pregnancy rate, embryo development, estradiol, and progesterone concentration in blood serum, superoxide dismutase (SOD), and catalase (CAT) in follicular fluid. Concerning the court of patient, 112 (groups I and II) out of 217 were PCOS women, whereas group III consisted of healthy subjects (not PCOS). Group I patients were treated with 400 μg of folic acid per day for 3 months before ICSI, whereas group II patients received 4000 mg of myoinositol and 400 μg of folic acid per day for 3 months before ICSI. Group II revealed a shorter embryo/blastocyst development period between microinjection and 5-cell stage compared to group I. The difference in SOD concentration between groups I and II and between groups II and III was statistically significant. In group II, 34.62% of pregnancies were obtained, whereas in group I this number reached 20% (NS). Myoinositol increased embryo development dynamics and accelerated blastocyst stage reaching time; however, no effect was shown on clinical pregnancy. Furthermore, it restored SOD concentration, lowered in PCOS women, but did not exert any effect on CAT concentration. PMID:27777587

  6. Radiation Dose Estimation for Pediatric Patients Undergoing Cardiac Catheterization

    NASA Astrophysics Data System (ADS)

    Wang, Chu

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

  7. Pheochromocytoma after Cesarean Section

    PubMed Central

    Naghshineh, Elham; Shahraki, Azar Danesh; Sheikhalian, Somaye; Hashemi, Leila

    2016-01-01

    Pheochromocytoma is a catecholamine-producing tumor. There are a very few reported cases of clinical pheochromocytoma. Here, we report a 27-year-old woman para 1 live 1 with chief complaint of headache, confusion, nausea, and vomiting 2 days after cesarean section. She was anxious and had palpitation. On physical examination, fever, tachycardia, tachypnea, high blood pressure, and right thyroid nodule were found. She was managed as pregnancy-induced hypertension at first. In laboratory data, epinephrine, norepinephrine, metanephrine, normetanephrine, and vanillylmandelic acid were increased in 24 h urine collection. An adrenal mass was detected in abdominal computed tomography. Regarding clinical and paraclinical findings, pheochromocytoma was diagnosed. The patient received medical treatment, but it was not effective; hence, she underwent adrenalectomy. PMID:27076898

  8. 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

  9. [Panniculitis in patient undergoing treatment for dermatomyositis with methotrexate].

    PubMed

    Feki, Nabil Bel; Khanfir, Monia Smiti; Ghorbel, Imed Ben; Said, Fatma; Houman, Mohamed Habib

    2016-01-01

    Panniculitis is a rare cutaneous manifestation of dermatomyositis (DM). The appearance of panniculitis during treatment with methotrexate (MTX) is exceptional and has only been described in 3 cases. We report a case of a 50-year-old woman suffering from DM since 1997 who was treated with corticosteroids showing favorable clinical and biological evolution. When a relapse occurred 2 years later, she was treated with higher-dose of corticosteroids in combination with a 7,5 mg weekly dose of methotrexate. The evolution was rapidly favorable. Eighteen months later, the patient had multiple subcutaneous nodules on limbs and buttocks. Anatomopathological examination showed panniculitis. There was no evidence supporting progression in DM. Prednisone dose was increased to 0.5 mg/kg/day, always in combination with MTX, without any clear signs of improvement. MTX treatment was stopped and the cutaneous lesions completely disappeared in 2 months without any relapse. This objective response lasted for 42 months. Our observation is particular given the occurrence of panniculitis in a patient undergoing treatment for dermatomyositis with methotrexate and illustrates the difficulties in the diagnosis. This entity must be known despite its exceptional nature since cutting off MTX treatment generally induces the disappearance of subcutaneous nodules. PMID:27279974

  10. A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery

    PubMed Central

    Tuuli, Methodius G.; Liu, Jingxia; Stout, Molly J.; Martin, Shannon; Cahill, Alison G.; Odibo, Anthony O.; Colditz, Graham A.; Macones, George A.

    2016-01-01

    BACKGROUND Preoperative skin antisepsis has the potential to decrease the risk of surgical-site infection. However, evidence is limited to guide the choice of antiseptic agent at cesarean delivery, which is the most common major surgical procedure among women in the United States. METHODS In this single-center, randomized, controlled trial, we evaluated whether the use of chlorhexidine–alcohol for preoperative skin antisepsis was superior to the use of iodine–alcohol for the prevention of surgical-site infection after cesarean delivery. We randomly assigned patients undergoing cesarean delivery to skin preparation with either chlorhexidine–alcohol or iodine–alcohol. The primary outcome was superficial or deep surgical-site infection within 30 days after cesarean delivery, on the basis of definitions from the Centers for Disease Control and Prevention. RESULTS From September 2011 through June 2015, a total of 1147 patients were enrolled; 572 patients were assigned to chlorhexidine–alcohol and 575 to iodine–alcohol. In an intention-to-treat analysis, surgical-site infection was diagnosed in 23 patients (4.0%) in the chlorhexidine–alcohol group and in 42 (7.3%) in the iodine–alcohol group (relative risk, 0.55; 95% confidence interval, 0.34 to 0.90; P = 0.02). The rate of superficial surgical-site infection was 3.0% in the chlorhexidine–alcohol group and 4.9% in the iodine–alcohol group (P = 0.10); the rate of deep infection was 1.0% and 2.4%, respectively (P = 0.07). The frequency of adverse skin reactions was similar in the two groups. CONCLUSIONS The use of chlorhexidine–alcohol for preoperative skin antisepsis resulted in a significantly lower risk of surgical-site infection after cesarean delivery than did the use of iodine–alcohol. (Funded by the National Institutes of Health and Washington University School of Medicine in St. Louis; ClinicalTrials.gov number, NCT01472549.) PMID:26844840

  11. Continuous Glucose Monitoring in Patients Undergoing Extracorporeal Ventricular Assist Therapy

    PubMed Central

    Leser, Laura; Lanckohr, Christian; Wempe, Carola; Ellger, Björn

    2016-01-01

    Background Dysregulations of blood glucose (BG) are associated with adverse outcome in critical illness; controlling BG to target appears to improve outcome. Since BG-control is challenging in daily intensive care practice BG-control remains poor especially in patients with rapidly fluctuating BG. To improve BG-control and to avoid deleterious hypoglycemia, automated online-measurement tools are advocated. We thus evaluated the point-accuracy of the subcutaneous Sentrino® Continuous Glucose Monitoring System (CGM, Medtronic Diabetes, Northridge, California) in patients undergoing extracorporeal cardiac life support (ECLS) for cardiogenic shock. Methods Management of BG was performed according to institute’s standard aiming at BG-levels between 100–145 mg/dl. CGM-values were recorded without taking measures into therapeutic account. Point-accuracy in comparison to intermittent BG-measurement by the ABL-blood-gas analyzer was determined. Results CGM (n = 25 patients) correlated significantly with ABL-values (r = 0.733, p<0.001). Mean error from standard was 15.0 mg/dl (11.9%). 44.2% of the readings were outside a 15% range around ABL-values. In one of 635 paired data-points, ABL revealed hypoglycemia (BG 32 mg/dl) whereas CGM did not show hypoglycemic values (132mg/dl). Conclusions CGM reveals minimally invasive BG-values in critically ill adults with dynamically impaired tissue perfusion. Because of potential deviations from standard, CGM-readings must be interpreted with caution in specific ICU-populations. PMID:26963806

  12. Complications and outcomes of repeat cesarean section in adolescent women

    PubMed Central

    Kaplanoglu, Mustafa; Karateke, Atilla; Un, Burak; Akgor, Utku; Baloğlu, Ali

    2014-01-01

    Aim: The evaluation of the effect of repeat cesarean sections in adolescent pregnancies on the morbidity, obstetric and perinatal results. Materials and methods: We reviewed the patient file and hospital records of patients who underwent at least one cesarean section among adolescent age group pregnant women who gave birth at our clinic between January 2010 and May 2013. The patients were divided into two groups as the patients who underwent the second cesarean section (116 patients) and those who underwent the third cesarean section (36 patients). The demographic data, maternal data and obstetric and perinatal results of the patients were evaluated. Results: A significant difference was present between the patients in the evaluation of the total number of examinations during pregnancy (P = 0.001), total maternal weight gain during pregnancy (P = 0.006), and the first examination gestational age (P = 0.006) and all values were less favorable in the third cesarean group. The gestational week at birth (P < 0.001), birth weight (P < 0.001), and APGAR score (P < 0.001) in the group with the third cesarean section were statistically significantly lower than the second cesarean section. The third cesarean cesarean was found to cause a significant risk increase for placenta accreta risk in adolescent pregnancies (P = 0.042). Conclusion: The increasing number of cesarean sections in the adolescent group is seen to be a significant risk factor for low gestational week of birth, low birth weight and related morbidities. The most important reason for the increased morbidity with increasing cesarean sections in the adolescent age has been defined as placenta accreta. PMID:25664081

  13. Predictors of stroke in patients undergoing cardiac surgery

    PubMed Central

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

    2014-01-01

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

  14. Enhanced Recovery After Surgery Program in Patients Undergoing Pancreaticoduodenectomy

    PubMed Central

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

    2016-01-01

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

  15. Obese patients undergoing total knee arthroplasty have distinct preoperative characteristics: an institutional study of 4718 patients.

    PubMed

    Vulcano, Ettore; Lee, Yuo-Yu; Yamany, Tarek; Lyman, Stephen; Valle, Alejandro González Della

    2013-08-01

    Obesity affects a disproportionate proportion of total knee arthroplasty (TKA) patients. Our study explores pre-operative characteristics between obese and non-obese patients undergoing TKA surgery. A cohort of 4718 osteoarthritic patients, undergoing primary TKA, was studied. Patients were stratified according to BMI classes. Each class was compared in terms of age, race, gender, level of education, insurance status, pre-operative WOMAC, SF-36, and Elixhauser comorbidities. There was a positive relationship between BMI and female gender, non-white race, Medicaid, private insurance, and self-pay. A negative relationship was observed between BMI and age, Medicare, WOMAC and SF-36. Obese TKA candidates differ from their non-obese counterparts in a number of demographic, socioeconomic, and clinical characteristics. PMID:23523207

  16. The safety of cesarean myomectomy in women with large myomas

    PubMed Central

    Kwon, Dam Hye; Yoon, Kyung Ran; Lee, Keun Young

    2014-01-01

    Objective To evaluate the safety of cesarean myomectomy in large myomas sized >5 cm. Methods One hundred sixty-five pregnant women with myomas who delivered via cesarean section were identified. Ninety-six women had cesarean section without myomectomy, and 65 women underwent cesarean myomectomy. We compared the maternal characteristics, neonatal weight, myoma types, and operative outcomes between two groups. We further analyzed cesarean myomectomy group according to myoma size. The large myoma was defined as myoma >5 cm in size. The maternal characteristics, neonatal weight, and myoma types were compared between two groups. We also compared the operative outcomes such as preoperative and postoperative hemoglobin, operative time, and hospitalized days between two groups. Results There were no significant differences in the maternal characteristics, myoma types, neonatal weight and operative outcomes between cesarean section without myomectomy and cesarean myomectomy. The subgroup analysis according to myoma size (>5 cm or not) in cesarean myomectomy group revealed that there were no significant differences in the mean hemoglobin change (1.2 vs. 1.3 mg/dL, P=0.6), operative time (90.5 vs. 93.1 minutes, P=0.46), and the length of hospital stay (4.7 vs. 5.2 days, P=0.15) between two groups. The comparison of maternal characteristics, neonatal weight, and myoma types between two groups also showed no statistical significance. Conclusion Cesarean myomectomy in patients with large myomas is a safe and effective procedure. PMID:25264526

  17. Educational Needs of Patients Undergoing Total Joint Arthroplasty

    PubMed Central

    MacKay, Crystal; Saryeddine, Tina; Davis, Aileen M.; Flannery, John F.; Jaglal, Susan B.; Levy, Charissa; Mahomed, Nizar

    2010-01-01

    ABSTRACT Purpose: To identify the educational needs of adults who undergo total hip and total knee replacement surgery. Methods: A qualitative research design using a semi-standardized interviewing method was employed. A purposive sampling technique was used to recruit participants, who were eligible if they were scheduled to undergo total hip or total knee replacement or had undergone total hip or total knee replacement in the previous 3 to 6 months. A comparative contrast method of analysis was used. Results: Of 22 potential participants who were approached, 15 participated. Five were booked for upcoming total hip or total knee replacement and 10 had undergone at least one total hip or total knee replacement in the previous 3 to 6 months. Several themes related to specific educational needs and factors affecting educational needs, including access, preoperative phase, surgery and medical recovery, rehabilitation process and functional recovery, fears, and expectations counterbalanced with responsibility, emerged from the interviews. Conclusions: Educational needs of adults who undergo total hip and knee replacement surgery encompass a broad range of topics, confirming the importance of offering an all-inclusive information package regarding total hip and total knee replacement. PMID:21629598

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

    PubMed Central

    Dixon, Sandra

    2015-01-01

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

  19. Patient variables and referral paradigms associated with osteoporosis screening and treatment in neurosurgical patients undergoing kyphoplasty.

    PubMed

    Morr, Simon; Shakir, Hakeem J; Lipinski, Lindsay J; Dimopoulos, Vassilios G; Leonardo, Jody; Pollina, John

    2015-12-01

    OBJECT Vertebral fractures are the most common osteoporotic fracture. Bone density testing and medical treatment with bisphosphonates or parathormone are recommended for all patients with an osteoporotic fracture diagnosis. Inadequate testing and treatment of patients presenting with low-impact fractures have been reported in various specialties. Similar data are not available from academic neurosurgery groups. The authors assessed compliance with treatment and testing of osteoporosis in patients with vertebral compression fractures evaluated by the authors' academic neurosurgery service, and patient variable and health-systems factors associated with improved compliance. METHODS Data for patients who underwent percutaneous kyphoplasty for compression fractures was retrospectively collected. Diagnostic and medical interventions were tabulated. Pre-, intra-, and posthospital factors that had been theorized to affect the compliance of patients with osteoporosis-related therapies were tabulated and statistically analyzed. RESULTS Less than 50% of patients with kyphoplasty received such therapies. Age was not found to correlate with other variables. Referral from a specialist rather than a primary care physician was associated with a higher rate of bone density screening, as well as vitamin D and calcium therapy, but not bisphosphonate/parathormone therapy. Patients who underwent preoperative evaluation by their primary care physician were significantly more likely to receive bisphosphonates compared with those only evaluated by a hospitalist. Patients with unprovoked fractures were more likely to undergo multiple surgeries compared with those with minor trauma. CONCLUSIONS These results suggest poor compliance with current standard of care for medical therapies in patients with osteoporotic compression fractures undergoing kyphoplasty under the care of an academic neurosurgery service.

  20. Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer?

    PubMed Central

    Choi, Young Yeon; Park, Jun Seok; Park, Soo Yeun; Kim, Hye Jin; Yeo, Jinseok; Kim, Jong-Chan; Park, Sungsik

    2015-01-01

    Purpose Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach. Methods Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured. Results Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03). Conclusion Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer. PMID:25692119

  1. Continuous Ilioinguinal-iliohypogastric Nerve Block for Groin Pain in a Breast-feeding Patient after Cesarean Delivery.

    PubMed

    Kim, Eun Soo; Kim, Hae Kyu; Baik, Ji Seok; Ji, Young Tae

    2016-07-01

    Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants.

  2. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery.

    PubMed

    Tita, Alan T N; Szychowski, Jeff M; Boggess, Kim; Saade, George; Longo, Sherri; Clark, Erin; Esplin, Sean; Cleary, Kirsten; Wapner, Ron; Letson, Kellett; Owens, Michelle; Abramovici, Adi; Ambalavanan, Namasivayam; Cutter, Gary; Andrews, William

    2016-09-29

    Background The addition of azithromycin to standard regimens for antibiotic prophylaxis before cesarean delivery may further reduce the rate of postoperative infection. We evaluated the benefits and safety of azithromycin-based extended-spectrum prophylaxis in women undergoing nonelective cesarean section. Methods In this trial conducted at 14 centers in the United States, we studied 2013 women who had a singleton pregnancy with a gestation of 24 weeks or more and who were undergoing cesarean delivery during labor or after membrane rupture. We randomly assigned 1019 to receive 500 mg of intravenous azithromycin and 994 to receive placebo. All the women were also scheduled to receive standard antibiotic prophylaxis. The primary outcome was a composite of endometritis, wound infection, or other infection occurring within 6 weeks. Results The primary outcome occurred in 62 women (6.1%) who received azithromycin and in 119 (12.0%) who received placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; P<0.001). There were significant differences between the azithromycin group and the placebo group in rates of endometritis (3.8% vs. 6.1%, P=0.02), wound infection (2.4% vs. 6.6%, P<0.001), and serious maternal adverse events (1.5% vs. 2.9%, P=0.03). There was no significant between-group difference in a secondary neonatal composite outcome that included neonatal death and serious neonatal complications (14.3% vs. 13.6%, P=0.63). Conclusions Among women undergoing nonelective cesarean delivery who were all receiving standard antibiotic prophylaxis, extended-spectrum prophylaxis with adjunctive azithromycin was more effective than placebo in reducing the risk of postoperative infection. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; C/SOAP ClinicalTrials.gov number, NCT01235546 .). PMID:27682034

  3. Patients undergoing reconstructive surgery versus unburned children as "controls" in studies of pediatric patients with burns.

    PubMed

    Neely, A N; Rieman, M T; Warden, G D

    1995-01-01

    A valid control group is an essential part of any patient study. We asked whether burned children returning for reconstructive surgery could be used as "controls" in a study of seven proteolytic elements in the circulation. Functional levels of elastase, plasminogen, prekallikrein, antithrombin, alpha 2-antiplasmin, alpha 2-macroglobulin, and total proteolytic activity in 30 healthy unburned children were compared with levels in 29 patients admitted for reconstructive surgery an average of 7.9 years after burn. The two groups were not statistically different in distributions of sex and race but differed in mean age. Levels of six of the seven parameters were equal in the two groups. However, even when correction for the age difference was done between the groups, alpha 2-macroglobulin in the patients undergoing reconstructive surgery still was significantly less (p < 0.021) than in the unburned group. Therefore caution may be needed when readily available patients undergoing reconstructive surgery are used as "controls" in studies of patients with acute burns.

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

    PubMed

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

    1996-07-01

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

  5. Efficacy of desmopressin in preventing hemorrhagic complications in a patient with Marfan syndrome undergoing cardiac surgery.

    PubMed

    Franchini, Massimo; Lippi, Giuseppe; Veneri, Dino

    2006-06-01

    In this case report, we describe the successful use of desmopressin as prophylaxis against hemorrhage in a patient with a bleeding tendency associated with Marfan syndrome and a platelet function defect undergoing cardiovascular surgery.

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

    PubMed Central

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

    2013-01-01

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

  7. Painless neutropenic enterocolitis in a patient undergoing chemotherapy

    PubMed Central

    Chow, E.J.; Bishop, K.D.

    2016-01-01

    Case Description A 60-year-old man developed painless neutropenic enterocolitis after induction chemotherapy for newly diagnosed acute myelogenous leukemia. The patient had recurrent fever while neutropenic, without experiencing abdominal pain or tenderness on physical examination. His diagnosis was delayed by the fact that he had no localizing symptoms. Discussion Neutropenic enterocolitis is a common complication, generally occurring in patients who are severely neutropenic; the condition presents with fever and abdominal pain. No cases of painless neutropenic enterocolitis have yet been reported. Review of the literature shows that patients can develop this condition in the absence of fever and, sometimes, neutropenia. Furthermore, few comprehensive studies or reviews have investigated the utility of computed tomography imaging in identifying a source for abdominal pain in neutropenic patients with fever. Summary Many potential causes of febrile neutropenia should be considered in chemotherapy patients. PMID:27803612

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

    PubMed

    Bobbio, Marco

    2015-03-01

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

  9. Bacteria on Catheters in Patients Undergoing Peritoneal Dialysis

    PubMed Central

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

    2013-01-01

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

  10. The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery.

    PubMed

    Khanbhai, M; Dubb, S; Patel, K; Ahmed, A; Richards, T

    2015-01-01

    As bariatric surgery rates continue to climb, anaemia will become an increasing concern. We assessed the prevalence of anaemia and length of hospital stay in patients undergoing bariatric surgery. Prospective data (anaemia [haemoglobin <12 g/dL], haematinics and length of hospital stay) was analysed on 400 hundred patients undergoing elective laparoscopic bariatric surgery. Results from a prospective database of 1530 patients undergoing elective general surgery were used as a baseline. Fifty-seven patients (14%) were anaemic pre-operatively, of which 98% were females. Median MCV (fL) and overall median ferritin (μg/L) was lower in anaemic patients (83 vs. 86, p=0.001) and (28 vs. 61, p<0.0001) respectively. In the elective general surgery patients, prevalence of anaemia was similar (14% vs. 16%) but absolute iron deficiency was more common in those undergoing bariatric surgery; microcytosis p<0.0001, ferritin <30 p<0.0001. Mean length of stay (days) was increased in the anaemic compared to in the non-anaemic group (2.7 vs. 1.9) and patients who were anaemic immediately post-operatively, also had an increased length of stay (2.7 vs. 1.9), p<0.05. Absolute iron deficiency was more common in patients undergoing bariatric surgery. In bariatric patients with anaemia there was an overall increased length of hospital stay.

  11. Expectations and quality of life of cancer patients undergoing radiotherapy.

    PubMed Central

    Koller, M; Lorenz, W; Wagner, K; Keil, A; Trott, D; Engenhart-Cabillic, R; Nies, C

    2000-01-01

    Expectations, real or false, affect the way patients respond to their illnesses. We assessed therapy-related expectations in relation to global quality of life in 55 cancer patients before and after radiotherapy. Factor analysis indicated that therapy-related expectations come into three broad categories--pain/emotional control, healing and tumour/symptom control. 35 patients expected 'healing' even though curative treatment was intended in only 19 and all patients had been fully informed. The expectation of healing was associated with high quality of life, and the same was true of perception of healing after radiotherapy. In the group as a whole, quality of life was little altered by radiotherapy, but it became substantially worse in those patients who had expected healing but perceived that this had failed, even though physician-assessed Karnofsky status did not change. These findings indicate that the expectation of healing, in cancer patients, is a component of a good global quality of life, whereas more limited expectations (pain control, tumour control) relate to lower quality of life. Patients' expectations deserve further study as a novel approach to improving care. PMID:11193059

  12. Use of herbal remedies among patients undergoing hemodialysis.

    PubMed

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

    2013-11-01

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

  13. Factors determining discharge destination for patients undergoing total joint arthroplasty.

    PubMed

    Sharareh, Behnam; Le, Natasha B; Hoang, Melinda T; Schwarzkopf, Ran

    2014-07-01

    Discharge destination to skilled nursing facilities (SNF) following total joint arthroplasty (TJA) plays an important role in healthcare costs. The pre-operative, intra-operative, and post-operative factors of 50 consecutive patients discharged to an SNF following TJA were compared to that of 50 consecutive patients discharged to home. Patients discharged to SNFs had slower pre-operative Get Up and Go scores (TGUG), lower pre-operative EQ-5D scores, higher ASA scores, increased hospital length of stay, increased self-reported post-operative pain, and decreased physical therapy achievements. We believe that the results of this study indicate that patients who get discharged to SNFs fit a certain criteria and this may be used to guide post-operative discharge destination during pre-operative planning, which can help lower costs while helping decrease the length of inpatient stay.

  14. Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Ullery, Brant W; Lee, Jason T

    2014-09-01

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

  16. Emergence in Elderly Patient Undergoing General Anesthesia with Xenon

    PubMed Central

    Wefki Abdelgawwad Shousha, Ahmed Abdelgawwad; Paparazzo, Antonella

    2013-01-01

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

  17. Evaluation of the analgesic effect of subcutaneous methadone after cesarean section

    PubMed Central

    Jabalameli, Mitra; Kalantari, Forough

    2014-01-01

    Background: Inadequate pain control has a significant role in maternal and neonatal health in early post-partum period which interferes with breastfeeding and has a negative influence on child normal growth. The aim of this study is evaluation of subcutaneous methadone effectiveness on post-operative pain control. Materials and Methods: Double blind randomized prospective clinical trial involving 60 term pregnancy patients through 2008 to 2009 Undergo cesarean. Inclusion criteria: Prime gravid candidate of elective cesarean and spinal anesthesia class 1 or 2. Known case of drug allergy and methadone interaction, addiction, uncontrolled medical disease excluded. Case group injected 10 mg of subcutaneous methadone in the site of incision before final suture. Morphine was a pain reliever in follow up examination. Data include mean of pain, nausea and vomiting, MAP, etc., collected and analyzed by independent-T test and Man Whitney test. Results: Although mean usage of morphine between groups was not significant statistically but the mean pain severity (P value < 0.05) and mean satisfactory (P value = 0.02) was statistically significant between groups. Other parameters were not statistically significant. Conclusion: We suggest subcutaneous methadone as a safe pain reliever in post cesarean section patients. PMID:25337527

  18. [Cesarean section through history].

    PubMed

    Rabinerson, David; Ashwal, Eran; Gabbay-Benziv, Rinat

    2014-11-01

    According to historic documents, delivery by abdominal and uterine incision was already known to mankind at the beginning of the second millennium BC. This delivery method was eventually referred to as "Cesarean Section" because it was wrongfully attributed to the way by which Julius Caesar was born. The indications for cesarean sections performed in ancient cultures and to the end of the medieval period were mainly kings law, that mandated burial of the fetus separately from his mother, legal rights regarding inheritance of the father or religious motives mandating baptism of the newborn in order to ensure him eternal life in heaven. As from the second half of the 19th century AD, and with improvement in surgical techniques, as well as in the perioperative environment (asepsis, antibiotics, anaesthesia, blood transfusion, etc.), the obstetric outcome of cesarean sections was dramaticay improved, both in terms of maternal, as well as fetal, outcome. Hence, it became very prevalent throughout the world. The emergence of medico-legal medicine and medical ethics issues, have further contributed to the use of cesarean sections as the ultimate solution of every unusual delivery. PMID:25563029

  19. Antimicrobial prophylaxis in patients with colorectal lesions undergoing endoscopic resection

    PubMed Central

    Zhang, Qi-Sheng; Han, Bing; Xu, Jian-Hua; Gao, Peng; Shen, Yu-Cui

    2015-01-01

    AIM: To investigate the effect of prophylaxis with antibiotics on clinical adverse events in patients who underwent endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) for colorectal lesions. METHODS: From June 2011 to December 2013, a total of 428 patients were enrolled into the study, of which 214 patients admitted to hospital underwent EMR or ESD procedures. These patients were randomized to an antibiotic group, in which patients were given cefuroxime 1.5 g iv half an hour before and 6 h after surgery respectively, and a control group, in which patients were not given any antibiotic. A further 214 outpatients with small polyps treated by polypectomy were compared with controls that were matched by age and gender, and operations were performed as outpatient surgery. Recorded patient parameters were demographics, characteristics of lesions and treatment modality, and the size of the wound area. The primary outcome measures were clinical adverse events, including abdominal pain, diarrhea, hemotachezia, and fever. Secondary outcome measures were white blood cell count, C-reactive protein and blood culture. Additionlly, the relationship between the size of the wound area and clinical adverse events was analyzed. RESULTS: A total of 409 patients were enrolled in this study, with 107 patients in the control group, 107 patients in the antibiotic group, and another 195 cases in the follow-up outpatient group. The patients’ demographic characteristics, including age, gender, characteristics of lesions, treatment modality, and the size of the wound area were similar between the 2 groups. The rates of adverse events in the antibiotic group were significantly lower than in the control group: abdominal pain (2.8% vs 14.9%, P < 0.01), diarrhea (2.0% vs 9.3%, P < 0.05), and fever (0.9% vs 8.4%, P < 0.05) respectively. The levels of inflammatory markers also decreased significantly in the antibiotic group compared with the control group: leukocytosis

  20. The case against cesarean delivery on maternal request in labor.

    PubMed

    Burcher, Paul; Gabriel, Jazmine L; Campo-Engelstein, Lisa; Kiley, Kevin C

    2013-09-01

    The ethical obligations of an obstetrician to a patient who requests a cesarean delivery without maternal or fetal indication differ depending on whether the request is made before or during labor. Informed consent is an essential dimension of respecting patient autonomy, and the process of informed consent should be extensive for a cesarean delivery in the absence of maternal or fetal indications during active labor. For this reason, physicians should rarely grant a request for cesarean delivery made during active labor. Although physicians may think that declining a request for cesarean delivery is a violation of patient autonomy, they should also be concerned about the violation of patient autonomy that results if they are unable to adequately complete the process of informed consent during labor.

  1. Trough Concentrations of Vancomycin in Patients Undergoing Extracorporeal Membrane Oxygenation.

    PubMed

    Park, So Jin; Yang, Jeong Hoon; Park, Hyo Jung; In, Yong Won; Lee, Young Mi; Cho, Yang Hyun; Chung, Chi Ryang; Park, Chi-Min; Jeon, Kyeongman; Suh, Gee Young

    2015-01-01

    To investigate the appropriateness of the current vancomycin dosing strategy in adult patients with extracorporeal membrane oxygenation (ECMO), between March 2013 and November 2013, patients who were treated with vancomycin while on ECMO were enrolled. Control group consisted of 60 patients on vancomycin without ECMO, stayed in medical intensive care unit during the same study period and with the same exclusion criteria. Early trough levels were obtained within the fourth dosing, and maintenance levels were measured at steady state. A total of 20 patients were included in the analysis in ECMO group. Sixteen patients received an initial intravenous dose of 1.0 g vancomycin followed by 1.0 g every 12 hours. The non-steady state trough level of vancomycin after starting administration was subtherapeutic in 19 patients (95.00%) in ECMO group as compared with 40 patients (66.67%) in the control group (p = 0.013). Vancomycin clearance was 1.27±0.51 mL/min/kg, vancomycin clearance/creatinine clearance ratio was 0.90 ± 0.37, and elimination rate constant was 0.12 ± 0.04 h-1. Vancomycin dosingfrequency and total daily dose were significantly increased after clinical pharmacokinetic services of the pharmacist based on calculated pharmacokinetic parameters (from 2.10 ± 0.72 to 2.90 ± 0.97 times/day, p = 0.002 and from 32.54 ± 8.43 to 42.24 ± 14.62mg/kg, p = 0.014) in ECMO group in contrast with those (from 2.11 ± 0.69 to 2.37 ± 0.86 times/day, p = 0.071 and from 33.91 ± 11.85 to 31.61 ± 17.50 mg/kg, p = 0.350) in the control group.Although the elimination rate for vancomycin was similar with population parameter of non ECMO patients, the current dosing strategy of our institution for vancomycinin our ICU was not sufficient to achieve the target trough in the initial period in most patients receiving ECMO.

  2. [Prevention and Information for Patients Undergoing Periodontal Treatment: Potentials for Improvement from the Patients' Perspective].

    PubMed

    Klingenberg, A; Walther, W; Dörfer, C E; Szecsenyi, J

    2016-05-01

    2 334 patients from 29 dental practices took part in a written survey on their experiences with dental treatment in general as well as treatment of periodontal disease (response rate 80.8%). 72.6% of all participating patients fully agreed that they could recommend their dentist to their friends. 63.6% of patients undergoing treatment of periodontitis (N=328) rated this treatment as "excellent". However, for important aspects (prevention, patient information, treatment) potentials for improvement became obvious. 43.7% of patients treated for periodontitis were not completely satisfied with information on how this disease develops; 40.7% saw potentials for better information on preventive care (dental-hygiene, nutrition). An even higher percentage of patients actually not treated for periodontitis was interested in more information on prevention (51.4%). The results of the survey show that dentists should offer information and exercise on how to prevent periodontal desease more actively. There is a lack of research on the present state of affairs and potentials for improvement concerning treatment and prevention of periodontitis including the patients' perspective. PMID:26086539

  3. Exploring expectations and needs of patients undergoing angioplasty.

    PubMed

    Aazami, Sanaz; Jaafarpour, Molouk; Mozafari, Mosayeb

    2016-09-01

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

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

    PubMed

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

    1990-06-01

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

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

    PubMed

    Basora Macaya, M

    2015-06-01

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

  6. Rights of chronic renal failure patients undergoing chronic dialysis therapy.

    PubMed

    Andreucci, Vittorio E; Kerr, David N S; Kopple, Joel D

    2004-01-01

    The Patient Advocacy Committee of the International Federation of Kidney Foundations (IFKF) has developed a document proposing a set of rights for individuals with end stage renal failure (ESRF). These rights have been approved by the Board of Directors of the IFKF. Twenty rights have been developed and are organized into the following categories: (i) need of treatment and choice of patients; (ii) treatment of ESRF by haemodialysis; (iii) treatment of ESRF by peritoneal dialysis; and (iv) renal transplantation. It is the hope of this Committee and the IFKF that this document will provide a stimulus to more scientific inquiry and discussion as to what rights do patients possess with regard to treatment of chronic kidney disease, regardless of where they live or what may be their economic, social, ethnic or political status.

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

    SciTech Connect

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

    1990-06-01

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

  8. Bispectral Index Monitoring in Patients Undergoing Open Heart Surgery

    PubMed Central

    Kabukcu, Hanife Karakaya; Sahin, Nursel; Ozkaloglu, Kezban; Golbasi, Ilhan; Titiz, Tulin Aydogdu

    2016-01-01

    Introduction To obtain the optimal anesthesia depth is not easy in cardiovascular surgery patients where the haemodynamic reserve is limited, due to reasons such as not being able to give the desired dose of anesthetic agent, or the change in the pharmacokinetics of the agent in the heart-lung machine. This study was planned to assess the contribution of bispectral index (BIS) monitoring in the depth of anesthesia. Methods The patients were divided into 2 groups, and BIS monitoring was used for each patient. Group 1 (G1 n=35): keeping the BIS monitor screen open, the anesthesia need was set. Group 2 (G2 n=35): BIS monitor was tied to the patient and the monitor screen was closed in such a way that the anaesthesist couldn't see the BIS value. When the recording time came, the data on the monitor was recorded. The need for the anesthetic agent was set according to the parameters such as haemodynamics or follow up of pupils, instead of BIS value, by titrating the anesthetic infusion doses. Results BIS values were similar in both groups before the induction, BIS values in both groups showed a decrease, showing no significant statistical difference (P>0.05). One patient in each group said that he dreamt, and one patient in G2 said that he had heard a noise and felt that he was taken from one place to another. Conclusion The management should be done with clinical evaluation, haemodynamics and other monitorization methods and BIS monitoring findings together. PMID:27556320

  9. Surgical Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery: A Randomized Controlled Trial

    PubMed Central

    Figueroa, Dana; Jauk, Victoria Chapman; Szychowski, Jeff M.; Garner, Rachel; Biggio, Joseph R.; Andrews, William W.; Hauth, John; Tita, Alan T. N.

    2013-01-01

    Objective To compare the risk of cesarean wound disruption or infection after closure with surgical staples compared with subcuticular suture. Methods Women with viable pregnancies at 24 weeks of gestation or greater undergoing scheduled or unscheduled cesarean delivery were randomized to wound closure with surgical staples or absorbable suture. Staples were removed at postoperative days 3-4 for low transverse incisions and days 7-10 for vertical incisions. Standardized wound evaluations were performed at discharge (days 3-4) and 4-6 weeks post-operatively. The primary outcome was a composite of wound disruption or infection within 4-6 weeks. Secondary outcomes included operative time, highest pain score on analog scale, cosmesis score and patient scar satisfaction score. Analyses were by intent-to-treat. Results Of 398 patients, 198 were randomized to staples and 200 to suture (but four received staples). Baseline characteristics including body mass index, prior cesarean, labor, and type of skin incision were similar by group. The primary outcome incidence at hospital discharge was 7.1% for staples and 0.5% for suture; P <0.001 (RR 14.1; 95% CI 1.9-106). Of 350 (87.9%) with follow up at 4-6 weeks, the cumulative risk of the primary outcome at 4-6 weeks was 14.5% for staples and 5.9% for suture; P=0.008 (RR 2.5; 95% CI 1.2-5.0). Operative time, pain scores at 72-96 hours and at 6 weeks, cosmesis score, and patient satisfaction score did not differ by group. Conclusion Staples closure compared with suture is associated with significantly increased composite wound morbidity after cesarean delivery. PMID:23262925

  10. Nutritional implications for the patient undergoing extracorporeal membrane oxygenation.

    PubMed

    Farías, María Magdalena; Olivos, Cristina; Díaz, Rodrigo

    2015-06-01

    Extracorporeal membrane oxygenation (ECMO) for cardiovascular collapse or catastrophic respiratory failure in the critically ill patient imposes a multidisciplinary approach. Nutritional support is one of the issues that must be faced, as this population presents a state of increased metabolic activity, elevated catabolism of protein and rapid accumulating energy deficiency. Provision of adequate nutritional therapy is hard to achieve due to different factors. This article provides a brief overview of the current literature regarding nutritional support during ECMO in adult patients, as no current guidelines address this issue.

  11. Continuous Ilioinguinal-iliohypogastric Nerve Block for Groin Pain in a Breast-feeding Patient after Cesarean Delivery

    PubMed Central

    Kim, Eun Soo; Baik, Ji Seok; Ji, Young Tae

    2016-01-01

    Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants. PMID:27413486

  12. Anti-ENA antibody profile in hepatitis C patients undergoing hemodialysis.

    PubMed

    Batchoun, Raymond G; Al-Najdawi, Malek A; Al-Taamary, Sameh

    2011-07-01

    Infection with hepatitis C virus (HCV) is increasing all over the world, especially among hemodialysis patients. HCV is one of the major autoantibody inducing viruses, where anti-nuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA), anti-liver kidney microsome antibodies (LKM-1), and rheumatoid factor (RF) have been related to HCV. Few studies have investigated the presence of anti-extractable nuclear antigens (ENA) antibodies in chronic liver diseases, especially in chronic hepatitis C cases, but none investigated its immunostimulation role in hemodialysis units. The aim of the study was to assess the prevalence of HCV among chronic kidney disease- Stage 5 (CKD5) patients undergoing hemodialysis and the prevalence of ENA antibodies among them. Sera of 134 patients with chronic kidney disease undergoing hemodialysis, were screened for HCV antibodies and ENA antibodies profile, using ELISA and Immunoblot technique. 41 HCV-positive blood bank donors were used as controls. Sixty-four (47.7%) of 134 patients undergoing hemodialysis were infected with HCV. Thirty-three (51.6%) of 64 patients with HCV infection undergoing hemodialysis had anti-ENA antibodies: 9 (27.3%) showed anti-SSA antibodies and 22 (66.7%) had anti-SSB antibodies. The prevalence of anti-ENA antibodies was significantly higher in the patients with HCV infection, undergoing hemodialysis, compared with both control groups (hepatitis C-positive blood bank donors and hepatitis C-negative patients undergoing hemodialysis). Seventeen of 33 HCV antibodies-positive males undergoing hemodialysis had anti-ENA antibodies, compared with 16 of 31 females, indicating no sex related difference. This study emphasizes the high prevalence of HCV infection in our hemodialysis patients, comparable to that of other Middle Eastern countries, but higher than Western ones. A strong association was observed between anti-HCV positivity and hemodialysis duration, as well as anti-ENA antibody profile. However, these

  13. Perioperative cardiovascular care for patients undergoing noncardiac surgical intervention.

    PubMed

    Eagle, Kim A; Vaishnava, Prashant; Froehlich, James B

    2015-05-01

    The field of perioperative medicine has garnered legitimacy during the past 3 decades. Adverse cardiovascular events in the perioperative period account for significant morbidity and mortality. Although testing patients preoperatively to detect ischemia and identify those who may benefit from modifications in care is a tempting strategy, risk assessment should account for posterior probability. Validated risk stratification tools, such as the Revised Cardiac Risk Index or the National Surgical Quality Improvement Program risk calculator, can assist in the identification of patients for whom preoperative noninvasive testing is justified and may change the plan of care. Furthermore, current guidelines emphasize that prophylactic coronary revascularization should not be performed exclusively for the purposes of reducing the risk of perioperative events. There has been enthusiasm for medical therapies that may reduce the risk of adverse cardiovascular events in the perioperative period. Current guidelines encourage the perioperative use of β-blockade in patients already receiving such therapy and caution against initiating such therapy on the day of the surgical procedure. Reduction of morbidity and mortality in the perioperative period relies on an understanding of the myriad physiological perturbations in this period and thoughtful selection of patients for further testing and treatment.

  14. ET-1 levels in cardioischemic patients undergoing atrial pacing.

    PubMed

    Parlapiano, C; Borgia, M C; Tonnarini, G; Alessandri, N; Campana, E; Quaglione, R; Ciccaglioni, A; Giancaspro, G; Pantone, P; Giovanniello, T; Califano, F

    2001-01-01

    Atrial pacing (AP) procedure was carried out in 11 cardioischemic patients to reproduce tachycardia-induced myocardial ischemia. Six control subjects underwent the same procedure until the maximum pacing rate was reached. During the procedure, endothelin-1 (ET-1) and plasma lactate levels were measured in the coronary sinus and in the aortic root. In all the patients, atrial pacing provoked electrocardiographic signs and metabolic evidence of myocardial ischemia and a significant decrease (p<0.001) in left ventricular ejection fraction. At AP-induced ischemia, coronary sinus (17.31 +/- 4.20 pg/mL) and arterial (9.60 +/- 3.31 pg/mL) ET-1 plasma levels were significantly different (p<0.001) in the patients. On the contrary, at maximum pacing rate, no significant difference (p=0.186) emerged between coronary sinus (9.72 +/- 1.09 pg/mL) and arterial (8.95 +/- 0.75 pg/mL) plasma ET-1 levels in the control group. These results suggest that, in cardioischemic patients, tachycardia can induce the coronary endothelium to release significant amounts of ET-1. PMID:11563817

  15. Sarcopenia and Sarcopenic Obesity in Patients Undergoing Orthopedic Surgery

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    Mameli, Antonella; Marongiu, Francesco

    2014-01-01

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

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

    PubMed Central

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

    2010-01-01

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

  18. Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

    PubMed Central

    Ooka, Kohtaro; Lim, Joseph K.

    2016-01-01

    Abstract With 185 million people chronically infected globally, hepatitis C is a leading bloodborne infection. All-oral regimens of direct acting agents have superior efficacy compared to the historical interferon-based regimens and are significantly more tolerable. However, trials of both types of regimens have often excluded patients on immunosuppressive medications for reasons other than organ transplantation. Yet, these patients—most often suffering from malignancy or autoimmune diseases—could stand to benefit from these treatments. In this study, we systematically review the literature on the treatment of hepatitis C in these neglected populations. Research on patients with organ transplants is more robust and this literature is reviewed here non-systematically. Our systematic review produced 2273 unique works, of which 56 met our inclusion criteria and were used in our review. The quality of data was low; only 3 of the 56 studies were randomized controlled trials. Sustained virologic response was reported sporadically. Interferon-containing regimens achieved this end-point at rates comparable to that in immunocompetent individuals. Severe adverse effects and death were rare. Data on all-oral regimens were sparse, but in the most robust study, rates of sustained virologic response were again comparable to immunocompetent individuals (40/41). Efficacy and safety of interferon-containing regimens and all-oral regimens were similar to rates in immunocompetent individuals; however, there were few interventional trials. The large number of case reports and case series makes conclusions vulnerable to publication bias. While firm conclusions are challenging, given the dearth of high-quality studies, our results demonstrate that antiviral therapy can be safe and effective. The advent of all-oral regimens offers patients and clinicians greatly increased chances of cure and fewer side effects. Preliminary data reveal that these regimens may confer such benefits in

  19. Femoral nerve block for patient undergoing total knee arthroplasty

    PubMed Central

    Heo, Bong Ha; Lee, Hyeon Jung; Lee, Hyung Gon; Kim, Man Young; Park, Keun Suk; Choi, Jeong Il; Yoon, Myung Ha; Kim, Woong Mo

    2016-01-01

    Abstract Background: The existence of peripheral opioid receptors and its effectiveness in peripheral nerve block remain controversial. The aim of this prospective, randomized, double-blinded study was to examine the analgesic effects of adding fentanyl to ropivacaine for continuous femoral nerve block (CFNB) using patient-controlled analgesia after total knee arthroplasty (TKA). Methods: The patients were divided into 2 groups, each with n = 40 in ropivacaine (R) group and n = 42 in R with fentanyl (R + F) group. After operation, the patients in each group received R + F and R alone via a femoral nerve catheter, respectively. We assessed the visual analog scale (VAS) pain immediately before administration (baseline) and at 15, 30, and 60 minutes on postanesthesia care unit (PACU), and resting and ambulatory VAS score up to 24 hours. Results: Overall, the average VAS scores in the R + F group were slightly lower than those of the R group. However, the VAS score differences between groups were not statistically significant, except for 30 minutes (P = 0.009) in PACU. R group showed higher supplemental analgesics consumption in average compared with R + F group, but not significant. Conclusion: Additional fentanyl did not show prominent enhancement of analgesic effect in the field of CFNB after TKA. PMID:27603376

  20. GASTRIC AND JEJUNAL HISTOPATHOLOGICAL CHANGES IN PATIENTS UNDERGOING BARIATRIC SURGERY

    PubMed Central

    RODRIGUES, Rosemary Simões Nomelini; ALMEIDA, Élia Cláudia de Souza; CAMILO, Silvia Maria Perrone; TERRA-JÚNIOR, Júverson Alves; GUIMARÃES, Lucinda Calheiros; DUQUE, Ana Cristina da Rocha; ETCHEBEHERE, Renata Margarida

    2016-01-01

    ABSTRACT Background: Morbid obesity is a multifactorial disease that increasingly is being treated by surgery. Aim: To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. Methods: This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. Results: In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in H. pylori infection (p=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. Conclusion: There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients. PMID:27683773

  1. Role of frailty assessment in patients undergoing cardiac interventions

    PubMed Central

    Rowe, Rebecca; Iqbal, Javaid; Murali-krishnan, Rachel; Sultan, Ayyaz; Orme, Rachel; Briffa, Norman; Denvir, Martin; Gunn, Julian

    2014-01-01

    Average life expectancy is increasing in the western world resulting in a growing number of frail individuals with coronary heart disease, often associated with comorbidities. Decisions to proceed to invasive interventions in elderly frail patients is challenging because they may gain benefit, but are also at risk of procedure-related complications. Current risk scores designed to predict mortality in cardiac procedures are mainly based on clinical and angiographic factors, with limitations in the elderly because they are mainly derived from a middle-aged population, do not account for frailty and do not predict the impact of the procedure on quality of life which often matters more to elderly patients than mortality. Frailty assessment has emerged as a measure of biological age that correlates well with quality of life, hospital admissions and mortality. Potentially, the incorporation of frailty into current risk assessment models will cause a shift towards more appropriate care. The need for a more accurate method of risk stratification incorporating frailty, particularly for elderly patients is pressing. This article reviews the association between frailty and cardiovascular disease, the impact of frailty on outcomes of cardiac interventions and suggests ways in which frailty assessment could be incorporated into cardiology clinical practice. PMID:25332792

  2. Contemporary anticoagulation therapy in patients undergoing percutaneous intervention.

    PubMed

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

    2014-04-01

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

  3. Contemporary anticoagulation therapy in patients undergoing percutaneous intervention.

    PubMed

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

    2014-04-01

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

  4. Bowel Prep Quality in Patients of Low Socioeconomic Status Undergoing Screening Colonoscopy With Patient Navigation.

    PubMed

    Miller, Sarah Johanna; Itzkowitz, Steven H; Shah, Brijen; Jandorf, Lina

    2016-10-01

    The effectiveness of colonoscopy is directly affected by the quality of the patient's bowel preparation. Patients with lower socioeconomic status (SES) are at increased risk of having suboptimal bowel prep quality. Patient navigators can play a key role in clarifying bowel prep instructions. The aim of the present study was to examine the quality of bowel prep and its predictors among individuals of low SES undergoing screening colonoscopy with patient navigation. Participants (N = 607) were individuals of low SES who completed a screening colonoscopy with patient navigation. Demographic information was collected after the participants received a primary care referral for a screening colonoscopy. After the colonoscopy was completed, medical charts were reviewed to document the colonoscopists' bowel prep quality ratings. A total of 6.8% (41/607) of the sample had poor bowel prep, which significantly correlated with having a colonoscopy that did not reach the cecum. If fair preps were included, approximately 19.3% (117/607) of our cohort would be considered to have suboptimal bowel prep. Our suboptimal bowel prep rates were better than those reported from other low SES samples.

  5. Efficacy of crushed lanthanum carbonate for hyperphosphatemia in hemodialysis patients undergoing tube feeding.

    PubMed

    Kitajima, Yukie; Takahashi, Taeko; Sato, Yuzuru; Nakaya, Yutaka

    2011-08-01

    Lanthanum carbonate (LaC) is a non-calcium-based phosphate binder used to treat hyperphosphatemia in patients with chronic kidney disease. Oral administration of LaC is difficult in patients undergoing tube feeding or those who are of advanced age because it is essential to chew the LaC tablet sufficiently before swallowing it. We report two cases in whom crushed LaC was used in hemodialysis patients undergoing tube feeding. In both cases, previously crushed LaC was mixed into enteral nutrients. We found that LaC administered this way was effective for decreasing serum phosphorus levels.

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

    PubMed Central

    2014-01-01

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

  7. Risk factors for cardiovascular disease in patients undergoing peritoneal dialysis.

    PubMed

    García-López, Elvia; Carrero, Juan J; Suliman, Mohamed E; Lindholm, Bengt; Stenvinkel, Peter

    2007-06-01

    Patients on peritoneal dialysis (PD) are at high cardiovascular risk. Although some risk factors are unmodifiable (for example, age, sex, genetics), others are exacerbated in the unfriendly uremic milieu (inflammation, oxidative stress, mineral disturbances) or contribute per se to kidney disease and cardiovascular progression (diabetes mellitus, hypertension). Moreover, several factors associated with PD therapy may both increase (by altered lipid profile, hyperinsulinemia, and formation of advanced glycation end-products) and decrease (by better blood pressure control and anemia management) cardiovascular risk. The present review discusses recent findings and therapy trends in cardiovascular research on the PD population, with emphasis on the roles of inflammation, insulin resistance, homocysteinemia, dyslipidemia, vascular calcification, and genetics/epigenetics.

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

    PubMed Central

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

    1992-01-01

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

  9. Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy

    PubMed Central

    2014-01-01

    Background Uterine artery pseudoaneurysms are dangerous and can lead to severe hemorrhage. We report an uncommon cause of a giant pseudoaneurysm in a missed miscarriage in a woman with a cesarean scar pregnancy. Case presentation The patient was a 25-year-old Chinese woman with a missed miscarriage in a cesarean scar pregnancy. Curettage was performed under ultrasound monitoring. A uterine artery pseudoaneurysm measuring 71 × 44 × 39 mm was detected the next day by Doppler ultrasonography. While waiting for admittance to an advanced institution to undergo embolization treatment, the pseudoaneurysm ruptured spontaneously. The subsequent severe hemorrhage necessitated hysterectomy. Conclusion A delay in diagnosis of uterine artery pseudoaneurysms may result from a long period between the curettage and follow-up examination. Ultrasound and Doppler ultrasonography should be performed repeatedly at short intervals to rule out them, especially in cesarean scar pregnancies. For a giant uterine artery pseudoaneurysm, interventional embolization might be the first treatment choice. If time allows, intra-operative ligation of the feeding vessels should be attempted before any decision to perform a hysterectomy is made. However, hysterectomy remains a possibility when severe bleeding occurs. PMID:25070087

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

    PubMed

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

    2016-06-01

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

  11. Incidence of clinically significant venous thromboembolic events in Asian patients undergoing total knee arthroplasty without anticoagulation.

    PubMed

    Bin Abd Razak, Hamid Rahmatullah; Soon, Ang Teng; Dhanaraj, Ian Dominic; Tan, Andrew Hwee Chye

    2012-06-01

    This study aimed to evaluate the incidence of clinically significant venous thromboembolic events (VTE) in Asian patients undergoing total knee arthroplasty (TKA) without anticoagulation. All patients who underwent TKA by a single surgeon from 2006 to 2010 in Singapore General Hospital were reviewed. Only symptomatic patients were referred for ultrasonography. Of the 531 patients reviewed, 3 patients developed symptoms of deep vein thrombosis with subsequent ultrasonographic confirmation, whereas 1 patient developed fatal pulmonary embolism without any clinical or radiologic evidence of deep vein thrombosis. Hence, the incidence of clinically significant VTE was 0.75%. Given the low incidence of clinically significant VTE, there is a need to review the current practice of routine chemoprophylaxis in Asian patients undergoing TKA.

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

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

    1980-05-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  16. The use of midwives as first assistants in cesarean section.

    PubMed

    Marks; Thacher; Camargo

    1998-07-01

    Introduction: In 1997, medical insurance gives limited financial reimbursement to physicians who first assist cesarean sections. Therefore, a formal program was developed at our community teaching hospital using midwives in place of physicians as first assistant in cesarean section. Midwives on the midwifery service were taught the principles and procedures of obstetrical anesthesia, anatomy, and physiology of the gravid abdomen.A team approach using obstetrician/gynecologist, anesthesiologist, midwives, and operating nurses performed the tracking in a 1-day course. A 28-minute video was developed to depict the role of the midwife as first assistant. Additionally, the principles of operation room set-up and instrumentation were taught.Result: All 24 midwives on the midwifery service were involved in the teaching of first assisting an attending obstetrician. After taking the course, nurse-midwives received formal certification from the department of obstetrics and gynecology and were approved by risk management. They also received clinical privileges outlining these guidelines. Their malpractice rates have not increased. The time to complete a cesarean section has not increased for the physician, and an emergency cesarean section is no longer delayed by waiting for an assistant to arrive. Patient satisfaction has increased because of decreased waiting time for a cesarean section and increased familiarity with the entire operating team.Discussion: Midwives can be trained to first assist the obstetrician/gynecologist in a cesarean section. Since the duration of a cesarean section is not prolonged, the patient will not experience increased blood loss or infection secondary to a prolonged procedure. The patient is more relaxed since they know that their provider during labor is also one of their surgeons for the cesarean section. PMID:10838393

  17. Influence of Continuous Nursing on the Psychological State and Coping Style of Patients Undergoing Pacemaker Implantation

    PubMed Central

    LIU, Xin; HE, Xu; LI, Ling; HUANG, Lili; LIU, Zhaojun

    2015-01-01

    Background: Patients undergoing pacemaker implantation often experience anxiety and fear. As such, studies have focused on the mechanisms that relieve the negative emotions caused by the intervention. Continuous nursing is a safe and effective nursing mode. In this study, continuous nursing intervention was provided for elderly patients undergoing pacemaker implantation and an empirical investigation was performed to determine the effects of their negative emotion and disease-coping ability. Methods: Overall, 114 (68 males and 46 females) elderly patients who were undergoing pacemaker implantation from Harbin City (China), were enrolled in the study. The patients were divided into two groups, namely, the control group and the intervention group, based on different nursing methods. Routine nursing was applied to the control group; continuous nursing support was provided for the intervention group from January 2014 to January 2015. The nursing results of the two groups were compared. These results were also evaluated using self-rating depression scale, self-rating anxiety scale, and trait coping style questionnaire. Result: The effects of depression and anxiety intervention were significant in the intervention group (P<0.05). Compared with the control group, the intervention group did not significantly differ. The coping style of the intervention group elicited significant effects. Compared with the control group, the intervention group was significantly different (P < 0.05). Conclusion: Continuous nursing can relieve the negative emotion and improve the negative coping style of patients undergoing pacemaker implantation. PMID:26576373

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    2014-01-01

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

  20. The effect of royal jelly on oral mucositis in patients undergoing radiotherapy and chemotherapy.

    PubMed

    Erdem, Ozden; Güngörmüş, Zeynep

    2014-01-01

    This study was conducted to evaluate the effect of royal jelly on oral mucositis in patients undergoing radiotherapy and chemotherapy. The study population consisted of 103 patients undergoing radiotherapy and chemotherapy. Oral mucositis was graded according to the World Health Organization criteria, and patients were divided into 2 groups. All patients received mouthwash therapy with benzydamine hydrochloride and nystatin rinses. In addition, patients in the experimental group received royal jelly. The mean resolution time of oral mucositis in the royal jelly group was significantly shorter than that of the control group. As a result, the study results demonstrate that royal jelly administrated by a certain procedure improved the signs and symptoms of oral mucositis and markedly shortened its healing time.

  1. Intravenous patient-controlled analgesia to manage the postoperative pain in patients undergoing craniotomy

    PubMed Central

    Na, Hyo-Seok; An, Sang-Bum; Park, Hee-Pyoung; Lim, Young-Jin; Hwang, Jung-Won; Jeon, Young-Tae

    2011-01-01

    Background This randomized controlled study evaluated the efficacy of intravenous patient-controlled analgesia (IV-PCA) with fentanyl and ketorolac for neurosurgical patients, and compared the effectiveness of IV-PCA with intermittent analgesics injection. Methods The patients undergoing craniotomy were randomly assigned to two groups. Patients of group P (n = 53) received fentanyl (0.2 µg/kg/hr) and ketorolac (0.3 mg/kg/hr) via IV-PCA, and those of group N (n = 53) received intermittent fentanyl or ketorolac injection as needed. Pain was evaluated using a 0-10 visual analogue scale (VAS) at postoperative 1, 4, and 24 hr. The amount of infused analgesic drugs, Glasgow Coma Scale (GCS) score, systolic arterial pressure, heart rate, respiratory rate, and the incidence of nausea and miosis were measured at the same time points. Results Although VAS of pain (VASp) was comparable at postoperative 1 hr (P = 0.168) between the two groups, the group P had significantly lower VASp at postoperative 4 hr (P = 0.007) and 24 hr (P = 0.017). In group P, less analgesic drugs were administered at postoperative 1 hr, and more analgesic drugs were administered at postoperative 24 hr. There were no differences between two groups with respect to nausea, GCS, systolic arterial pressure, and heart rate. IV-PCA did not further incur respiratory depression or miosis. Conclusions IV-PCA with fentanyl and ketorolac after craniotomy is more effective analgesic technique, without adverse events, than the intermittent administration of analgesics. PMID:21359078

  2. Toward an Ethically Responsible Approach to Vaginal Birth After Cesarean

    PubMed Central

    Lyerly, Anne Drapkin; Little, Margaret Olivia

    2010-01-01

    Determining approach to delivery after prior cesarean is among the most contentious areas of obstetrics. This paper presents a framework for ethically responsible guidelines and practice around VBAC. We describe ethical complexities of three key issues that mark the debate: the cesarean delivery rate, safety, and patient autonomy. We then describe a taxonomy of considerations that should inform a responsible framework for guideline development, and highlight critical distinctions between types of guidelines which have been blurred in the past. We then forward two central claims. First, in otherwise uncomplicated birth after a single prior cesarean, both VBAC and repeat cesarean should be regarded as reasonable options; women, rather than policymakers, providers, insurance carriers, or hospitals, should determine delivery approach. Second, in complicated cases, providers and policymakers should carefully calibrate the strength of evidence to ensure differential risk and cost are adequate to justify directive guidelines given important variations in values women bring to childbirth. PMID:20869550

  3. Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy

    PubMed Central

    2016-01-01

    Introduction. Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs. Case. A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation. Conclusion. Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality. PMID:27375911

  4. Placenta Increta Complicating Persistent Cesarean Scar Ectopic Pregnancy following Failed Excision with Subsequent Preterm Cesarean Hysterectomy.

    PubMed

    Malik, M F; Hoyos, L R; Rodriguez-Kovacs, J; Gillum, J; Johnson, S C

    2016-01-01

    Introduction. Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs. Case. A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation. Conclusion. Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality. PMID:27375911

  5. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia

    PubMed Central

    Senturk, Mehmet Baki; Cakmak, Yusuf; Atac, Halit; Budak, Mehmet Sukru

    2015-01-01

    Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P<0.01), but these were minor. The rate of blood transfusion and prevalence of changes in hemoglobin level were similar in both groups (P>0.05). In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients’ requests influenced outcome. Trial of labor should take into consideration the patient’s preference, together with the proper setting. PMID:26203286

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

    PubMed Central

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

    2014-01-01

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

  7. Outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer

    PubMed Central

    Kimura, Kosei; Tanaka, Satoru; Iwamoto, Mitsuhiko; Fujioka, Hiroya; Sato, Nayuko; Terasawa, Risa; Kawaguchi, Kanako; Matsuda, Junna; Umezaki, Nodoka; Uchiyama, Kazuhisa

    2016-01-01

    The purpose of this study was to retrospectively analyze the feasibility of outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer. A total of 131 consecutive patients with breast cancer treated with adjuvant or neoadjuvant chemotherapy from 2011 to 2013 at Osaka Medical College Hospital (Osaka, Japan) were retrospectively reviewed. In the case of developing a fever (body temperature, ≥38°C), the outpatients had been instructed to take previously prescribed oral antibiotics for 3 days without any initial assessment, and if no improvement had occurred by then, they were required to visit the hospital for examination and to undergo treatment based on the results of a risk assessment for complications. The primary aim of the present study was to assess the outcome of febrile episodes, while the secondary aim was to assess the incidence of febrile episodes, hospitalizations, and the type of chemotherapy. The 131 patients received 840 chemotherapy administrations. Fifty-five patients (42.0%) had a total of 75 febrile episodes after 840 chemotherapy administrations (8.9%). Treatment failure occurred in 12 of the 75 episodes (16.0%) in 11 of the 55 patients (20.0%). Only four episodes required hospitalization. Treatment success was achieved in 63 episodes (84.0%). In conclusion, the feasibility of outpatient management without initial assessment was evaluated in the present study for febrile patients undergoing adjuvant chemotherapy for breast cancer, and the outpatient strategy regimen may be safe and convenient for these patients. PMID:27699031

  8. Metabolic syndrome in patients with prostate cancer undergoing intermittent androgen-deprivation therapy

    PubMed Central

    Rezaei, Mohammadali Mohammadzadeh; Rezaei, Mohammadhadi Mohammadzadeh; Ghoreifi, Alireza; Kerigh, Behzad Feyzzadeh

    2016-01-01

    Introduction: The presence of metabolic syndrome in men with prostate cancer (PCa) undergoing androgen-deprivation therapy (ADT), especially intermittent type, has not been completely evaluated. The aim of this study is to evaluate metabolic syndrome in men with PCa undergoing intermittent ADT. Methods: In this longitudinal study, we studied the prevalence of metabolic syndrome and its components in 190 patients who were undergoing intermittent ADT. The metabolic syndrome was defined according to the Adult Treatment Panel III criteria. All metabolic parameters, including lipid profile, blood glucose, blood pressures, and waist circumferences of the patients were measured six and 12 months after treatment. Results: Mean age of the patients was 67.5 ± 6.74 years. The incidence of metabolic syndrome after six and 12 months was 6.8% and 14.7%, respectively. Analysis of various components of the metabolic syndrome revealed that patients had significantly higher overall prevalence of hyperglycemia, abdominal obesity, and hypertriglyceridemia in their six- and 12-month followups, but blood pressure has not been changed in the same period except for diastolic blood pressure after six months. Conclusions: Although there was an increased risk of metabolic syndrome in patients receiving intermittent ADT, it was lower than other studies that treated the same patients with continuous ADT. Also it seems that intermittent ADT has less metabolic complications than continuous ADT and could be used as a safe alternative in patients with advanced and metastatic PCa.

  9. Outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer

    PubMed Central

    Kimura, Kosei; Tanaka, Satoru; Iwamoto, Mitsuhiko; Fujioka, Hiroya; Sato, Nayuko; Terasawa, Risa; Kawaguchi, Kanako; Matsuda, Junna; Umezaki, Nodoka; Uchiyama, Kazuhisa

    2016-01-01

    The purpose of this study was to retrospectively analyze the feasibility of outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer. A total of 131 consecutive patients with breast cancer treated with adjuvant or neoadjuvant chemotherapy from 2011 to 2013 at Osaka Medical College Hospital (Osaka, Japan) were retrospectively reviewed. In the case of developing a fever (body temperature, ≥38°C), the outpatients had been instructed to take previously prescribed oral antibiotics for 3 days without any initial assessment, and if no improvement had occurred by then, they were required to visit the hospital for examination and to undergo treatment based on the results of a risk assessment for complications. The primary aim of the present study was to assess the outcome of febrile episodes, while the secondary aim was to assess the incidence of febrile episodes, hospitalizations, and the type of chemotherapy. The 131 patients received 840 chemotherapy administrations. Fifty-five patients (42.0%) had a total of 75 febrile episodes after 840 chemotherapy administrations (8.9%). Treatment failure occurred in 12 of the 75 episodes (16.0%) in 11 of the 55 patients (20.0%). Only four episodes required hospitalization. Treatment success was achieved in 63 episodes (84.0%). In conclusion, the feasibility of outpatient management without initial assessment was evaluated in the present study for febrile patients undergoing adjuvant chemotherapy for breast cancer, and the outpatient strategy regimen may be safe and convenient for these patients.

  10. Metabolic syndrome in patients with prostate cancer undergoing intermittent androgen-deprivation therapy

    PubMed Central

    Rezaei, Mohammadali Mohammadzadeh; Rezaei, Mohammadhadi Mohammadzadeh; Ghoreifi, Alireza; Kerigh, Behzad Feyzzadeh

    2016-01-01

    Introduction: The presence of metabolic syndrome in men with prostate cancer (PCa) undergoing androgen-deprivation therapy (ADT), especially intermittent type, has not been completely evaluated. The aim of this study is to evaluate metabolic syndrome in men with PCa undergoing intermittent ADT. Methods: In this longitudinal study, we studied the prevalence of metabolic syndrome and its components in 190 patients who were undergoing intermittent ADT. The metabolic syndrome was defined according to the Adult Treatment Panel III criteria. All metabolic parameters, including lipid profile, blood glucose, blood pressures, and waist circumferences of the patients were measured six and 12 months after treatment. Results: Mean age of the patients was 67.5 ± 6.74 years. The incidence of metabolic syndrome after six and 12 months was 6.8% and 14.7%, respectively. Analysis of various components of the metabolic syndrome revealed that patients had significantly higher overall prevalence of hyperglycemia, abdominal obesity, and hypertriglyceridemia in their six- and 12-month followups, but blood pressure has not been changed in the same period except for diastolic blood pressure after six months. Conclusions: Although there was an increased risk of metabolic syndrome in patients receiving intermittent ADT, it was lower than other studies that treated the same patients with continuous ADT. Also it seems that intermittent ADT has less metabolic complications than continuous ADT and could be used as a safe alternative in patients with advanced and metastatic PCa. PMID:27695584

  11. Current Practice and Recommendation for Presurgical Cardiac Evaluation in Patients Undergoing Noncardiac Surgeries

    PubMed Central

    Padma, Subramanyam; Sundaram, P. Shanmuga

    2014-01-01

    The increasing number of patients with coronary artery disease (CAD) undergoing major noncardiac surgery justifies guidelines concerning preoperative cardiac evaluation. This is compounded by increasing chances for a volatile perioperative period if the underlying cardiac problems are left uncorrected prior to major noncardiac surgeries. Preoperative cardiac evaluation requires the clinician to assess the patient's probability to have CAD, severity and stability of CAD, placing these in perspective regarding the likelihood of a perioperative cardiac complication based on the planned surgical procedure. Coronary events like new onset ischemia, infarction, or revascularization, induce a high-risk period of 6 weeks, and an intermediate-risk period of 3 months before performing noncardiac surgery. This delay is unwarranted in cases where surgery is the mainstay of treatment. The objective of this review is to offer a comprehensive algorithm in the preoperative assessment of patients undergoing noncardiac surgery and highlight the importance of myocardial perfusion imaging in risk stratifying these patients. PMID:25191106

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

    PubMed

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

    2015-09-01

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

  13. Cytogenic effects of diatrizoate and ioxaglate on patients undergoing excretory urography

    SciTech Connect

    Nunez, M.E.; Sinues, B. )

    1990-06-01

    Possible cytogenic alterations due to radiologic contrast medium in patients undergoing a common radiologic examination is studied. Two groups of 20 patients each were used. Group I consisted of patients undergoing excretory urography, using sodium and meglumine diatrizoate as contrast. A different agent, sodium and meglumine ioxaglate, was used with group II. Three blood samples were taken from each patient before urography, immediately after urography, and 1 week later. The frequency of sister chromatid exchanges (SCE) and chromosomal aberrations (CA) were found to increase significantly in the B samples from both groups, that of group I being higher (P less than .01 compared with P less than .05). Furthermore, these alterations were found to persist in the C samples from group I. No modification of the Proliferating Rate Index (PRI) was found. The osmolarity or other components of the contrast media studied could be involved in the process. The results indicate that ioxaglate produces less cytogenic damage than diatrizoate.

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

    PubMed Central

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

    2015-01-01

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

  15. Optimizing perioperative outcomes for older patients with rheumatoid arthritis undergoing arthroplasty: emphasis on medication management.

    PubMed

    Goodman, Susan M

    2015-05-01

    Patients with rheumatoid arthritis continue to undergo arthroplasty despite widespread use of potent disease-modifying drugs (DMARDs), including the biologic tumor necrosis-α inhibitors. In fact, over 80 % of RA patients are taking DMARDs or biologics at the time of arthroplasty. While many RA-specific factors including disease activity and disability may contribute to the increase in infection in RA patients undergoing arthroplasty, immunosuppressant medications may also play a role. As the age of patients with RA undergoing arthroplasty is rising, and the incidence of arthroplasty among the older population is increasing, optimal perioperative management of DMARDs and biologics in older patients with RA is an increasing challenge. Although evidence is sparse, most evidence supports withholding tumor necrosis-α inhibitors and other biologics prior to surgery based on the dosing interval, and continuing methotrexate and hydroxychloroquine through the perioperative period. There is no consensus regarding leflunomide, and rituximab risk does not appear related to the interval between infusion and surgery. This paper reviews arthroplasty outcomes including complications in patients with RA, and discusses the rationale for strategies for the optimal medication management of DMARDs and biologics in the perioperative period to minimize complications and improve outcomes.

  16. Association between ambient carbon monoxide and secondary hyperparathyroidism in nondiabetic patients undergoing peritoneal dialysis

    PubMed Central

    Weng, Cheng-Hao; Hu, Ching-Chih; Yen, Tzung-Hai; Huang, Wen-Hung

    2015-01-01

    Background Secondary hyperparathyroidism (SHPT) is a major disorder in patients with chronic renal disease with or without dialysis. Air pollution has been confirmed as being associated with increased incidence of human morbidity and mortality. To our knowledge, investigating air pollution as a dialysis-unrelated factor for SHPT in patients undergoing dialysis is limited. We developed this study to assess the effect of air pollution and other important risk factors on SHPT in patients undergoing peritoneal dialysis (PD). Materials and methods We recruited a total of 141 patients who did not have diabetes mellitus, were nonsmokers, and were undergoing PD in this cross-sectional study. We analyzed the difference in air quality based on the patients’ living areas. We estimated demographic, hematological, nutritional, inflammatory, biochemical, air pollutant, and dialysis-related data based on this cross-sectional study. Subgroup analysis of the relationship between air pollutants and the clinical variables and having or not having hyperparathyroidism (HPT) (intact parathyroid hormone level ≥180 pg/dL) was also performed. Results A total of 141 patients undergoing PD (30 men and 111 women) were enrolled in the study. Sixty-eight patients had SHPT. In a binary logistic regression, high environmental CO exposure (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.42–7.28; P=0.005), serum phosphate levels (OR 1.66, 95% CI 1.17–2.37; P=0.005), hypoalbuminemia (OR 3.76, 95% CI 1.29–10.94; P=0.015), and use of calcitriol (OR 8.25, 95% CI 3.43–19.85; P<0.001) were positively associated with SHPT. Conclusion The findings of this cross-sectional study indicated the presence of an association between environmental CO exposure and SHPT in patients undergoing PD who did not have diabetes mellitus. Therefore, poor environmental air quality may be a risk factor for deterioration of SHPT in patients undergoing PD. PMID:26396525

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

    SciTech Connect

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

    1987-04-24

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  20. Cesarean section in sub-Saharan Africa.

    PubMed

    Harrison, Margo S; Goldenberg, Robert L

    2016-01-01

    Cesarean section is an essential maternal healthcare service. Its role in labor and delivery care in low- and middle-income countries is complex; in many low-resource settings it is underutilized in the most needy of populations and overused by the less needy, without clear methods to ensure that universal access is available. Additionally, even if universal access were available, it is not evident that these countries would have the capacity or the finances to appropriate meet demand for the procedure, or that patients would want to utilize the care. This review summarizes the literature and illustrates the complicated relationship that cesarean section, which is rapidly on the rise around the world, has with individuals, communities, and nations in sub-Saharan Africa. PMID:27398224

  1. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

    PubMed Central

    Cordeiro, André Luiz Lisboa; de Melo, Thiago Araújo; Neves, Daniela; Luna, Julianne; Esquivel, Mateus Souza; Guimarães, André Raimundo França; Borges, Daniel Lago; Petto, Jefferson

    2016-01-01

    Introduction Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). Conclusion We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery. PMID:27556313

  2. Initial experience with ketamine-based analgesia in patients undergoing robotic radical cystectomy and diversion

    PubMed Central

    Jacobsohn, Kenneth; Davis, Tanya D.; El-Arabi, Ahmad M.; Tlachac, Jonathan; Langenstroer, Peter; O’Connor, R. Corey; Guralnick, Michael L.; See, William A.; Schlosser, Robert

    2015-01-01

    Introduction: We instituted a ketamine-predominant analgesic regimen in the peri- and postoperative periods to limit the effects of narcotic analgesia on bowel function in patients undergoing radical cystectomy. The primary end points of interest were time to return of bowel function, time to discharge, and efficacy of the analgesic regimen. Methods: We performed a retrospective chart review of patients undergoing robotic-assisted laparoscopic cystectomy (RARC) with urinary diversion by a single surgeon at our institution from January 1, 2011 to June 30, 2012. Patients receiving the opioid-minimizing ketamine protocol were compared to a cohort of patients undergoing RARC with an opioid-predominant analgesic regimen. Results: In total, 15 patients (Group A) were included in the ketamine-predominant regimen and 25 patients (Group B) in the opioid-predominant control group. Three patients (19%) in Group A discontinued the protocol due to ketamine side effects. The mean time to bowel movement and length of stay in Group A versus Group B was 3 versus 6 days (p < 0.001), and 4 versus 8 days, respectively (p < 0.001). Group A patients received an average of 13.0 mg of morphine versus 97.5 mg in Group B (p < 0.001). Conclusions: Patients who received our ketamine pain control regimen had a shorter time to return of bowel function and length of hospitalization after RARC. Our study has its limitations as a retrospective, single surgeon, single institution study and the non-randomization of patients. Notwithstanding these limitations, this study was not designed to show inferiority of one approach, but instead to show that our protocol is safe and efficacious, warranting further study in a prospective fashion. PMID:26225179

  3. Nonclinical factors affecting women's access to trial of labor after cesarean delivery.

    PubMed

    Korst, Lisa M; Gregory, Kimberly D; Fridman, Moshe; Phelan, Jeffrey P

    2011-06-01

    The use of trial of labor after cesarean (TOLAC) has declined in the last decade, and the clinical risks of TOLAC remain low. Nonclinical factors continue to affect women's access to TOLAC. This article considers 5 categories of factors that seem to be influencing rates of TOLAC and vaginal birth after cesarean: opinion leaders and professional guidelines, hospital facilities and cesarean availability, reimbursement for providing TOLAC, medical liability, and patient-level factors. An evidence base and strategies to provide guidance to create a safe environment for vaginal birth after cesarean are needed. Obstetric information systems are critical to this effort.

  4. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis.

    PubMed

    Kadry, Bassam; Press, Christopher D; Alosh, Hassan; Opper, Isaac M; Orsini, Joe; Popov, Igor A; Brodsky, Jay B; Macario, Alex

    2014-01-01

    Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI) in patients undergoing total hip arthroplasty (THA) with different components of operating room (OR) time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE) was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P < 0.001) for morbidly obese patients. At a BMI > 35 kg/m(2) each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.

  5. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis

    PubMed Central

    Kadry, Bassam; Press, Christopher D.; Alosh, Hassan; Opper, Isaac M.; Orsini, Joe; Popov, Igor A.; Macario, Alex

    2014-01-01

    Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI) in patients undergoing total hip arthroplasty (THA) with different components of operating room (OR) time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE) was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P < 0.001) for morbidly obese patients. At a BMI > 35 kg/m2 each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization. PMID:25210656

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

    SciTech Connect

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

    1991-08-01

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

  7. Defining the Relationship between Patient Decisions to Undergo Breast Reconstruction and Contralateral Prophylactic Mastectomy

    PubMed Central

    Agarwal, Shailesh; Kidwell, Kelley M.; Kraft, Casey T.; Kozlow, Jeffrey H.; Sabel, Michael S.; Chung, Kevin C.; Momoh, Adeyiza O.

    2016-01-01

    BACKGROUND Recent studies suggest that the decision to undergo breast reconstruction and contralateral prophylactic mastectomy (CPM) are closely related. Here we describe the relationship between method of reconstruction and decision to undergo CPM. We also evaluate recent trends in CPM use in the context of literature questioning its oncologic benefit. STUDY DESIGN Female patients with unilateral breast cancer were identified and data extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 through 2010. Logistic regression analyses were performed to study the relationship between having CPM and key demographic, oncologic and reconstructive factors among women with unilateral breast cancer. RESULTS A total of 157,042 patients with unilateral breast cancer were included. CPM rate increased from 7.7% to 28.3% during the study period, and the proportion of reconstructed patients who underwent CPM increased from 19% to 46%. Reconstruction was associated with higher odds of CPM (odds ratio (OR) 2.79, 95% CI 2.70-2.88, p<0.0001) after controlling for oncologic and demographic factors. Among women who had reconstruction, implant-based reconstruction was associated with significantly higher odds of CPM than autologous tissue reconstruction (OR 1.38, p<0.0001). Over the study period Implant reconstruction rates increased from 28.2% to 43.5% while autologous reconstruction rates decreased from 32.2% to 27.3% in CPM patients. CONCLUSIONS The frequency of CPM continues to increase in spite of literature questioning its oncologic benefit. Our study confirms that reconstruction and the decision to undergo CPM are closely related, with implant reconstruction dominating in patients who undergo CPM. Given the relationship between reconstruction and the choice for CPM, plastic surgeons should play an active role in educating patients to avoid decisions made based on inaccurate information. PMID:25719688

  8. The management of common bile duct stones in patients undergoing laparoscopic cholecystectomy.

    PubMed

    Franceschi, D; Brandt, C; Margolin, D; Szopa, B; Ponsky, J; Priebe, P; Stellato, T; Eckhauser, M L

    1993-08-01

    The management of suspected and/or unsuspected common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC) is controversial. Decisions on whether to perform an open CBD exploration versus employing therapeutic options such as preoperative/post-operative endoscopic retrograde cholangiography (ERCP) or endoscopic duct exploration are polemic. To determine indications, timing, benefits, and potential morbidity of these approaches, we gathered data on 401 patients undergoing LC within the last 18 months. Indications for preoperative ERCP included jaundice (40%), dilated ducts (28%), elevated amylase (19%) or alkaline phosphatase (21%), suspicion of CBD stones by ultrasound (17%) and "other" (17%). Indications for postoperative ERCP were retained stones (33%) and CBD evaluation (67%). Indications for CBD exploration included abnormal cholangiogram (64%), palpable stones (18%), and other (18%). A significant correlation was observed between suspected stones by ultrasound and stones found by ERCP (P < 0.01). For patients in the "other" category, preoperative ERCP was universally negative (P = 0.04). Overall ERCP morbidity was 4/59 (6.8%), and the overall failure rate for clearing CBD stones was 2/28 (7.1%). The timing of the ERCP did not affect morbidity/mortality. Multivariate analysis revealed that age (P < 0.001), the presence of pre-existing medical risk factors (P < 0.001), and duration of LC (P = 0.0034), but not ERCP (P = 0.08), were the important factors determining LC morbidity. In summary, common bile duct stones can be successfully cleared endoscopically in the majority of patients undergoing LC. Patients with suspected CBD stones should undergo pre-operative ERCP, and strict criteria should be applied in the selection of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Cephalometric comparison of cesarean and normal births

    PubMed Central

    Goymen, Merve; Topcuoglu, Tolga; Aktan, Ali Murat; Isman, Ozlem

    2016-01-01

    Objective: The aim of this study was to compare cephalometric variables of subjects with normal and cesarean births. Materials and Methods: Ninety age- and gender-matched patients, who were treated in Gaziantep University, Faculty of Dentistry Orthodontics Department were equally divided into normal and cesarean groups according to the birth methods reported by their mothers. To eliminate the negative effects of being different in terms of age and gender among parameters, control, and patient groups were matched in the present study. Pretreatment cephalometrics radiographs were used. Six measurements representing sagittal and vertical relationships were evaluated from pretreatment cephalograms using Dolphin Imaging Orthodontics Software was used in this issue by an orthodontist. Kolmogorov–Smirnov test, Student's t-test, and Mann–Whitney U-test were used for statistical comparisons. Results: A point-nasion-B point angle (ANB) and Wits values were higher in the normal group, while sella-nasion-A point angle, sella-nasion-B point angle, Frankfort horizontal-mandibular plane angle, and gonion-gnathion-SN plane angle values were higher in the cesarean group. However, the groups showed no significant differences (P > 0.05). ANB angle and Wits values showed high correlation. Conclusions: Within the study limitations, the results suggest that the birth method may not have a considerable effect on the development of the craniofacial skeletal system. PMID:27095896

  10. Influence of dexmedetomidine on incidence of adverse reactions introduced by hemabate in postpartum hemorrhage during cesarean section

    PubMed Central

    Liu, Yang; Chen, Hong-Xia; Kang, Dao-Lin; Kuang, Xiao-Hua; Liu, Wen-Xing; Ni, Jin

    2015-01-01

    Objective: The purpose of our study was to observe the influence of dexmedetomidine on complications caused by hemabate in patients undergoing caesarean section. Methods: A total of 120 females (age range, 20-40 years) at 35-40 weeks gestation who delivered by cesarean between September, 2014 and December, 2014 were enrolled in our study. Patients were randomly allocated into three groups that received intravenously physiological saline 20 mL (placebo group), lower dose (0.5 μg kg-1) of dexmedetomidine (low-dex gruop) and higher dose (1 μg kg-1) of dexmedetomidine (high-dex group) during cesarean section, following the delivery of the infant and intramuscular hemabate injection. Results: Nausea, vomiting, chest congestion and elevated blood pressure were the most common adverse events of placebo group. Compared with placebo group, the above mentioned adverse reactions decreased significantly in both low-dex group and high-dex group (P<0.05), whereas there were no significant difference between low-dex group and high-dex group (P>0.05). As to patient satisfaction score, low-dex group and high-dex group were all higher than placebo group (P<0.05). Furthermore, there were more patients satisfied with high-dex group than low-dex group (P<0.05). Conclusion: Dexmedetomidine (0.5 μg kg-1 and 1 μg kg-1) were all effective in preventing adverse reactions introduced by hemabate and improve parturients’ satisfaction in patients undergoing cesarean delivery. And higher dose (1 μg kg-1) of dexmedetomidine is superior to lower dose (0.5 μg kg-1) in patient satisfaction. PMID:26550325

  11. Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery.

    PubMed

    Rejeh, Nahid; Heravi-Karimooi, Majideh; Vaismoradi, Mojtaba; Jasper, Melanie

    2013-10-01

    Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control.

  12. Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy.

    PubMed

    Jung, Su-Young; Kim, Hyunwook; Park, Seohyun; Jhee, Jong Hyun; Yun, Hae-Ryong; Kim, Hyoungnae; Kee, Youn Kyung; Yoon, Chang-Yun; Oh, Hyung Jung; Chang, Tae Ik; Park, Jung Tak; Yoo, Tae-Hyun; Kang, Shin-Wook; Lee, Hajeong; Kim, Dong Ki; Han, Seung Hyeok

    2016-09-01

    Electrolyte and mineral disturbances remain a major concern in patients undergoing continuous renal replacement therapy (CRRT); however, it is not clear whether those imbalances are associated with adverse outcomes in patients with septic acute kidney injury (AKI) undergoing CRRT. We conducted a post-hoc analysis of data from a prospective randomized controlled trial. A total of 210 patients with a mean age of 62.2 years (136 [64.8%] males) in 2 hospitals were enrolled. Levels of sodium, potassium, calcium, and phosphate measured before (0 hour) and 24 hours after CRRT initiation. Before starting CRRT, at least 1 deficiency and excess in electrolytes or minerals were observed in 126 (60.0%) and 188 (67.6%) patients, respectively. The excess in these parameters was greatly improved, whereas hypokalemia and hypophosphatemia became more prevalent at 24 hours after CRRT. However, 1 and 2 or more deficiencies in those parameters at the 2 time points were not associated with mortality. However, during 28 days, 89 (71.2%) deaths occurred in patients with phosphate levels at 0 hour of ≥4.5 mg/dL as compared with 49 (57.6%) in patients with phosphate levels <4.5 mg/dL. The 90-day mortality was also significantly higher in patients with hyperphosphatemia. Similarly, in 184 patients who survived at 24 hours after CRRT, hyperphosphatemia conferred a 2.2-fold and 2.6-fold increased risk of 28- and 90-day mortality, respectively. The results remained unaltered when the serum phosphate level was analyzed as a continuous variable. Electrolyte and mineral disturbances are common, and hyperphosphatemia may predict poor prognosis in septic AKI patients undergoing CRRT. PMID:27603344

  13. Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy

    PubMed Central

    Jung, Su-Young; Kim, Hyunwook; Park, Seohyun; Jhee, Jong Hyun; Yun, Hae-Ryong; Kim, Hyoungnae; Kee, Youn Kyung; Yoon, Chang-Yun; Oh, Hyung Jung; Chang, Tae Ik; Park, Jung Tak; Yoo, Tae-Hyun; Kang, Shin-Wook; Lee, Hajeong; Kim, Dong Ki; Han, Seung Hyeok

    2016-01-01

    Abstract Electrolyte and mineral disturbances remain a major concern in patients undergoing continuous renal replacement therapy (CRRT); however, it is not clear whether those imbalances are associated with adverse outcomes in patients with septic acute kidney injury (AKI) undergoing CRRT. We conducted a post-hoc analysis of data from a prospective randomized controlled trial. A total of 210 patients with a mean age of 62.2 years (136 [64.8%] males) in 2 hospitals were enrolled. Levels of sodium, potassium, calcium, and phosphate measured before (0 hour) and 24 hours after CRRT initiation. Before starting CRRT, at least 1 deficiency and excess in electrolytes or minerals were observed in 126 (60.0%) and 188 (67.6%) patients, respectively. The excess in these parameters was greatly improved, whereas hypokalemia and hypophosphatemia became more prevalent at 24 hours after CRRT. However, 1 and 2 or more deficiencies in those parameters at the 2 time points were not associated with mortality. However, during 28 days, 89 (71.2%) deaths occurred in patients with phosphate levels at 0 hour of ≥4.5 mg/dL as compared with 49 (57.6%) in patients with phosphate levels <4.5 mg/dL. The 90-day mortality was also significantly higher in patients with hyperphosphatemia. Similarly, in 184 patients who survived at 24 hours after CRRT, hyperphosphatemia conferred a 2.2-fold and 2.6-fold increased risk of 28- and 90-day mortality, respectively. The results remained unaltered when the serum phosphate level was analyzed as a continuous variable. Electrolyte and mineral disturbances are common, and hyperphosphatemia may predict poor prognosis in septic AKI patients undergoing CRRT. PMID:27603344

  14. Outcomes of Male Patients with Alport Syndrome Undergoing Renal Replacement Therapy

    PubMed Central

    Temme, Johanna; Kramer, Anneke; Jager, Kitty J.; Lange, Katharina; Peters, Frederick; Müller, Gerhard-Anton; Kramar, Reinhard; Heaf, James G.; Finne, Patrik; Palsson, Runolfur; Reisæter, Anna V.; Hoitsma, Andries J.; Metcalfe, Wendy; Postorino, Maurizio; Zurriaga, Oscar; Santos, Julio P.; Ravani, Pietro; Jarraya, Faical; Verrina, Enrico; Dekker, Friedo W.

    2012-01-01

    Summary Background and objectives Patients with the hereditary disease Alport syndrome commonly require renal replacement therapy (RRT) in the second or third decade of life. This study compared age at onset of RRT, renal allograft, and patient survival in men with Alport syndrome receiving various forms of RRT (peritoneal dialysis, hemodialysis, or transplantation) with those of men with other renal diseases. Design, setting, participants, & measurements Patients with Alport syndrome receiving RRT identified from 14 registries in Europe were matched to patients with other renal diseases. A linear spline model was used to detect changes in the age at start of RRT over time. Kaplan-Meier method and Cox regression analysis were used to examine patient and graft survival. Results Age at start of RRT among patients with Alport syndrome remained stable during the 1990s but increased by 6 years between 2000–2004 and 2005–2009. Survival of patients with Alport syndrome requiring dialysis or transplantation did not change between 1990 and 2009. However, patients with Alport syndrome had better renal graft and patient survival than matched controls. Numbers of living-donor transplantations were lower in patients with Alport syndrome than in matched controls. Conclusions These data suggest that kidney failure in patients with Alport syndrome is now being delayed compared with previous decades. These patients appear to have superior patient survival while undergoing dialysis and superior patient and graft survival after deceased-donor kidney transplantation compared with patients receiving RRT because of other causes of kidney failure. PMID:22997344

  15. [Anxiety in patients undergoing fast-track knee arthroplasty in the light of recent literature].

    PubMed

    Ziętek, Paweł; Ziętek, Joanna; Szczypiór, Karina

    2014-01-01

    The rapid progress in knee implants technology and operational techniques go together with more and more modem medical programs, designed to optimize the patients' care and shorten their stay in hospital. However, this does not guarantee any elimination ofperioperative stress in patients. Anxiety is a negative emotional state arising from stressful circumstances accompanied by activation of the autonomous nervous system. Anxiety causes negative physiological changes, including wound healing, resistance to anesthetic induction, it is associated with an increased perioperative pain and prolong recovery period. The purpose of this work is to present the current state of knowledge on the preoperative anxiety and discuss its impact on pain and other parameters in patients undergoing fast-track arthroplasty of big joints. The work also shows selected issues of anxiety pathomechanism, and actual methods reducing preoperative anxiety in hospitalized patients. The common prevalence of anxiety in patients undergoing surgery induces the attempt to routinely identify patients with higher anxiety, which may be a predictive factor of worse results after TKA. Undertaking widely understood psychological support in these patients before and after the operation could be a favorable element, which would influence thefinal result of the treatment of patients after big joints arthroplasties. PMID:25639020

  16. The Effect of Live Classical Piano Music on the Vital Signs of Patients Undergoing Ophthalmic Surgery

    PubMed Central

    Camara, Jorge G.; Ruszkowski, Joseph M.; Worak, Sandra R.

    2008-01-01

    Context Music and surgery. Objective To determine the effect of live classical piano music on vital signs of patients undergoing ophthalmic surgery. Design Retrospective case series. Setting and Patients 203 patients who underwent various ophthalmologic procedures in a period during which a piano was present in the operating room of St. Francis Medical Center. [Note: St. Francis Medical Center has recently been renamed Hawaii Medical Center East.] Intervention Demographic data, surgical procedures, and the vital signs of 203 patients who underwent ophthalmic procedures were obtained from patient records. Blood pressure, heart rate, and respiratory rate measured in the preoperative holding area were compared with the same parameters taken in the operating room, with and without exposure to live piano music. A paired t-test was used for statistical analysis. Main outcome measure Mean arterial pressure, heart rate, and respiratory rate. Results 115 patients who were exposed to live piano music showed a statistically significant decrease in mean arterial blood pressure, heart rate, and respiratory rate in the operating room compared with their vital signs measured in the preoperative holding area (P < .0001). The control group of 88 patients not exposed to live piano music showed a statistically significant increase in mean arterial blood pressure (P < .0002) and heart rate and respiratory rate (P < .0001). Conclusion Live classical piano music lowered the blood pressure, heart rate, and respiratory rate in patients undergoing ophthalmic surgery. PMID:18679538

  17. Smoking behaviour and attitudes in patients undergoing cardiac surgery. The Radboud experience.

    PubMed

    Saksens, Nicole T M; Noyez, Luc

    2010-02-01

    Changes in smoking behaviour and attitudes of 2642 patients, undergoing cardiac surgery, between January 2000 and July 2008 were studied. All patients completed a preoperative questionnaire concerning smoking behaviour and attitude. Study endpoints are behaviour and attitude in relation to tobacco use in hospitals, cessation smoking before and after the operation. Over the years there have been no notable differences in smoking behaviour, however, significantly less patients accept smoking in the hospital (0.9% vs. 5.3%). Significantly more patients stopped within the two weeks before surgery (9.4% vs. 5.3%). The percentage of patients who did not have the intention to stop smoking after the operation did not decrease significantly. Significantly less older patients smoke (1.6% vs. 13.4%) and are less tolerant towards smoking in the hospital (1.8% vs. 4.1%). A significant higher percentage of older patients have stopped smoking over five years before the operation. Concerning the intention to stop smoking after the operation, there is no significant difference. These results show that over the years, patients undergoing cardiac surgery seem to be more aware about the relation between health and smoking. This is not related to the type of operation, however, apparently with age.

  18. [DIAGNOSTIC AND THERAPEUTIC BRONCHOSCOPY IN PATIENTS UNDERGOING CARDIAC SURGERY IN INTRA- AND POSTOPERATIVE PERIODS].

    PubMed

    Titova, I V; Khrustaleva, M V; Pshenichnyy, T A; Aksel'rod, B A; Eremenko, A A; Bogomolova, N S; Kuznetsova, S M

    2016-01-01

    The article presents research conducted to evaluate the use of diagnostic and therapeutic fiberoptic bronchoscopy in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis in patients in cardiac ICU. The paper presents the results of the study and comparison of invasive techniques for sampling from the respiratory tract for bacteriological analysis. We studied the bacterial profile of ICU, original content of the respiratory tract of cardiac patients in the intraoperative period and possible ways for prevention of VAP and tracheobronchitis in the postoperative period using bronchoscopy. In addition data on the effect of bronchoscopy on the respiratory and cardiovascular systems in cardiac surgical patients undergoing mechanical ventilation presented. PMID:27468503

  19. [Perioperative ocular surface evaluation and management in meibomian gland dysfunction patients undergoing cataract surgery].

    PubMed

    Liang, Qingfeng; Dong, Zhe; Wang, Ningli

    2014-04-01

    Meibomian gland dysfunction (MGD) is one of the most common conditions in the elderly. Most of MGD patients undergoing cataract surgery were found to have significant dry eye symptoms and ocular surface disease. The severe cases with ocular surface disease are also at higher risk of postoperative complications, namely infections and corneal ulcers. To improve the operation effect and achieve the best visual outcome and life quality in cataract patients, it is important to evaluate the ocular surface and meibomian glands in MGD patients preoperatively, pay attention to the intraoperative care and detect the postoperative complications carefully and use medicine properly.

  20. Nursing care of patients undergoing isolated limb procedures for recurrent melanoma of the extremity.

    PubMed

    Ashton, Kathleen S

    2012-04-01

    Isolated limb perfusion and isolated limb infusion are surgical interventions that provide high-dose regional chemotherapy to patients experiencing a recurrence of melanoma in an extremity. Nurses may be unfamiliar with these treatment options, as they are not available in all hospitals; however, the number of people diagnosed with melanoma is increasing. It is important for nurses to understand these surgical procedures to provide safe high-quality care before and after the surgery. Currently, there are several gaps in our knowledge about patients' experiences or nurse-sensitive outcomes. There are abundant opportunities for nurses to improve the care of patients who undergo surgical interventions to manage melanoma in the extremity.

  1. [Perioperative ocular surface evaluation and management in meibomian gland dysfunction patients undergoing cataract surgery].

    PubMed

    Liang, Qingfeng; Dong, Zhe; Wang, Ningli

    2014-04-01

    Meibomian gland dysfunction (MGD) is one of the most common conditions in the elderly. Most of MGD patients undergoing cataract surgery were found to have significant dry eye symptoms and ocular surface disease. The severe cases with ocular surface disease are also at higher risk of postoperative complications, namely infections and corneal ulcers. To improve the operation effect and achieve the best visual outcome and life quality in cataract patients, it is important to evaluate the ocular surface and meibomian glands in MGD patients preoperatively, pay attention to the intraoperative care and detect the postoperative complications carefully and use medicine properly. PMID:24931148

  2. The chronic disease self-management program--A pilot study in patients undergoing hemodialysis.

    PubMed

    Slesnick, Nate; Pienkos, Shawn; Sun, Sumi; Doss-McQuitty, Sheila; Schiller, Brigitte

    2015-04-01

    A strong emphasis on self-management for health maintenance in a variety of chronic diseases has been shown to benefit patients' outcomes and quality of life. However, little has been published on such programs in patients with chronic kidney disease. We studied the feasibility and effectiveness of the Chronic Disease Self-Management Program (CDSMP) in 14 patients with ESRD undergoing conventional hemodialysis. This program is designed to enhance skills in the areas of medical, emotional, and role management. Outcome measures in health status, self-management behaviors, self-efficacy, and health care utilization were evaluated through use of questionnaires at baseline and after six months. PMID:26263750

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  5. Effectively Screening for Coronary Artery Disease in Patients Undergoing Orthotopic Liver Transplant Evaluation.

    PubMed

    Lee, Bryan C; Li, Feng; Hanje, Adam J; Mumtaz, Khalid; Boudoulas, Konstantinos D; Lilly, Scott M

    2016-01-01

    Coronary artery disease (CAD) is prevalent in patients with end-stage liver disease and associated with poor outcomes when undergoing orthotopic liver transplantation (OLT); however, noninvasive screening for CAD in this population is less sensitive. In an attempt to identify redundancy, we reviewed our experience among patients undergoing CAD screening as part of their OLT evaluation between May 2009 and February 2014. Demographic, clinical, and procedural characteristics were analyzed. Of the total number of screened patients (n = 132), initial screening was more common via stress testing (n = 100; 75.8%) than coronary angiography (n = 32; 24.2%). Most with initial stress testing underwent angiography (n = 52; 39.4%). Among those undergoing angiography, CAD was common (n = 31; 23.5%). Across the entire cohort the number of traditional risk factors was linearly associated with CAD, and those with two or more risk factors were found to have CAD by angiography 50% of the time (OR 1.92; CI 1.07-3.44, p = 0.026). Our data supports that CAD is prevalent among pre-OLT patients, especially among those with 2 or more risk factors. Moreover, we identified a lack of uniformity in practice and the need for evidence-based and standardized screening protocols. PMID:27418975

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

    PubMed

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

    2016-07-01

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

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

    PubMed

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

    2016-07-01

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

  8. Functional evolution of critically ill patients undergoing an early rehabilitation protocol

    PubMed Central

    Murakami, Fernanda Murata; Yamaguti, Wellington Pereira; Onoue, Mirian Akemi; Mendes, Juliana Mesti; Pedrosa, Renata Santos; Maida, Ana Lígia Vasconcellos; Kondo, Cláudia Seiko; de Salles, Isabel Chateaubriand Diniz; de Brito, Christina May Moran; Rodrigues, Miguel Koite

    2015-01-01

    Objective Evaluation of the functional outcomes of patients undergoing an early rehabilitation protocol for critically ill patients from admission to discharge from the intensive care unit. Methods A retrospective cross-sectional study was conducted that included 463 adult patients with clinical and/or surgical diagnosis undergoing an early rehabilitation protocol. The overall muscle strength was evaluated at admission to the intensive care unit using the Medical Research Council scale. Patients were allocated to one of four intervention plans according to the Medical Research Council score, the suitability of the plan’s parameters, and the increasing scale of the plan expressing improved functional status. Uncooperative patients were allocated to intervention plans based on their functional status. The overall muscle strength and/or functional status were reevaluated upon discharge from the intensive care unit by comparison between the Intervention Plans upon admission (Planinitial) and discharge (Planfinal). Patients were classified into three groups according to the improvement of their functional status or not: responsive 1 (Planfinal > Planinitial), responsive 2 (Planfinal = Planinitial) and unresponsive (Planfinal < Planinitial). Results In total, 432 (93.3%) of 463 patients undergoing the protocol responded positively to the intervention strategy, showing maintenance and/or improvement of the initial functional status. Clinical patients classified as unresponsive were older (74.3 ± 15.1 years of age; p = 0.03) and had longer lengths of intensive care unit (11.6 ± 14.2 days; p = 0.047) and hospital (34.5 ± 34.1 days; p = 0.002) stays. Conclusion The maintenance and/or improvement of the admission functional status were associated with shorter lengths of intensive care unit and hospital stays. The results suggest that the type of diagnosis, clinical or surgical, fails to define the positive response to an early rehabilitation protocol. PMID:26340157

  9. CLARIFYING THE EXPECTATIONS OF PATIENTS UNDERGOING IMPLANT BREAST RECONSTRUCTION: A QUALITATIVE STUDY

    PubMed Central

    Snell, L; McCarthy, C.; Klassen, A.; Cano, S.; Rubin, Lisa; Hurley, K.; Montgomery, G.H.; Cordeiro, P.G.; Pusic, A.

    2015-01-01

    Background Unfulfilled expectations can lead to patient dissatisfaction with surgical outcomes. Understanding expectations allows surgeons to identify those patients who hold inaccurate expectations preoperatively, and to reset those expectations through focused pre-operative education. The purpose of this study is to investigate preoperative expectations of women undergoing implant breast reconstruction. Identifying inaccurate or unfulfilled expectations is a critical step towards the advancement of preoperative education and subsequently improving patient satisfaction with surgical outcomes. Methods In-depth, open-ended interviews were conducted with 28 women undergoing implant breast reconstruction. The interviews were recorded, transcribed, and data were coded using standard qualitative techniques. Results Interviews ascertained that implant-based breast reconstruction patients may have inaccurate expectations regarding the results of their surgery despite having received standard preoperative teaching. Specifically, patients often had unclear expectations regarding the appearance and physical outcome of the reconstructed breast(s). Some patients were surprised by the “flatness” of the tissue expander immediately following its insertion. Most patients felt unprepared for the “unnatural” final appearance of the breast(s). Furthermore, they did not expect many of the physical outcomes, including loss of sensation, firmness of the reconstructed breast(s), and lack of movement of the reconstructed breast(s). Inaccurate expectations corresponded to areas of dissatisfaction highlighted by the patients in postoperative interviews. Conclusion This study has important implications for preoperative education of women undergoing implant breast reconstruction. Physicians and nurses involved in the preoperative preparation process should take care to explore patients’ expectations regarding the look, feel, sensation, and movement of reconstructed breasts to

  10. Systematic review of peri-operative nutritional support for patients undergoing hepatobiliary surgery

    PubMed Central

    Liu, Yin

    2015-01-01

    Background Malnutrition is prevalent among peri-operative patients undergoing hepatobiliary surgery and is an important prognostic factor. Both hepatobiliary disease and surgical trauma significantly affects body’s metabolism and environment. Therefore, it is very important for patients with liver diseases undergoing hepatobiliary surgery to receive essential nutritional support during peri-operative period. Methods We summarized our clinical experience and reviewed of related literature to find the way for implementing the appropriate nutritional strategy. Results We found after comprehensively evaluating nutrition status, function of liver and gastrointestinal tract, nutritional strategy would be selected correctly. In severe malnutrition, initiation of enteral nutrition (EN) and/or parenteral nutrition (PN) with essential or special formulae is often recommended. Especially nasojejunal feeding is indicated that early application can improve nutritional status and liver function, reduce complications and prolong survival. Conclusions The reasonable peri-operative nutritional support therapy can improve the effect of surgical treatment and promote the patients’ recovery. PMID:26605277

  11. Diagnosis by ultrasound of severe carotid artery disease in patients undergoing cardiopulmonary bypass operations.

    PubMed Central

    Lewis, R R; Beasley, M G; Ayoub, A; Deverall, P B; Yates, A K; Gosling, R G

    1980-01-01

    A non-invasive method using continuous wave Doppler shift ultrasound and spectral analysis was used as a screening test for severe carotid artery disease in patients undergoing cardiopulmonary bypass operations. One hundred and eighty-eight patients were examined before cardiac surgery (91 for ischaemic heart disease, 17 for ischaemic heart disease and valve replacement, 66 for valve replacement alone, and 14 for congenital abnormalities). The mean age of the 108 patients suffering from ischaemic heart disease was 54 years (+/- 8) and that of the 80 patients admitted either for valve replacement alone or for congenital abnormalities was 52 years (+/- 12). Five of the 108 patients suffering from ischaemic heart disease were found to have severe occlusive disease of the internal carotid artery by the ultrasound test, while the test was normal in the other two groups. Patients with severe carotid artery disease proceeded to carotid arteriography and endarterectomy before the planned heart operation. Images PMID:7397042

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

    PubMed Central

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

    2016-01-01

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

  13. 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

  14. Body mass index, conversion rate and complications among patients undergoing robotic surgery for endometrial carcinoma.

    PubMed

    Cunningham, Mary J; Dorzin, Esther; Nguyen, Loan; Anderson, Elizabeth; Bunn, W Douglas

    2015-12-01

    A retrospective cohort study was performed to evaluate the relationship of BMI to conversion rate in patients undergoing robotic surgery for endometrial cancer. Secondary outcomes were operative times, number of lymph nodes retrieved, and complications. Women with endometrial cancer scheduled for robotic surgery from September 2008 to September 2012 were included. Women were divided into three groups based on BMI, and conversion rates to laparotomy were compared. Descriptive and comparative analyses were performed among non-obese, obese, and morbidly obese women who completed robotic surgery. 298 women were scheduled for robotic surgery for endometrial carcinoma: 87 non-obese (BMI 19-29, μ 25.23), 110 obese (BMI 30-39, μ 34.21), and 101 morbidly obese (BMI 40-71, μ 47.38). Conversion to laparotomy occurred in 18 patients (6%), with no difference in conversion rate between BMI categories. Direct comparison between converted and completed robotic patients showed no significant differences in preoperative characteristics, except that patients who required conversion had a higher number of previous abdominal surgeries. Patients completing robotic surgery underwent node dissections at similar rates in all three BMI categories. Operating room time, but not surgical time, was increased in morbidly obese patients. There were no significant differences in complications, performance of lymphadenectomy, or lymph node yields between BMI categories. Increase in BMI was not associated with an increase in rate of conversion to laparotomy or complication rate in patients undergoing robotic surgery for endometrial carcinoma. Node dissections were pathologically equivalent between BMI categories.

  15. Patients' reasons for electing to undergo total knee arthroplasty impact post-operative pain severity and range of motion.

    PubMed

    Cremeans-Smith, Julie K; Boarts, Jessica M; Greene, Kenneth; Delahanty, Douglas L

    2009-06-01

    The present study examines the reasons cited by 103 patients for their electing to undergo total knee arthroplastic surgery and the relationship between these reasons and their post-operative pain and range of motion. Results suggest that individuals who describe different reasons for undergoing surgery vary in their post-operative recovery. Specifically, patients who cite pain as the reason they are undergoing surgery report greater levels of pain during the early post-operative period. In contrast, patients who describe goals of regaining mobility or a specific activity as their reason for undergoing surgery achieve a greater range of motion during early post-operative physical therapy. Individuals who express avoidance goals for undergoing total knee arthroplasty report more severe post-operative pain at 1 and 3 months following surgery compared to patients who express approach goals. Interventions targeted towards patients reporting pre-operative pain or avoidance goals may decrease subsequent post-operative pain and increase mobility.

  16. The laboratory of clinical virology in monitoring patients undergoing monoclonal antibody therapy.

    PubMed

    Cavallo, R

    2011-12-01

    The relevant efficacy of monoclonal antibodies (mAbs) has resulted in the successful treatment of several diseases, although susceptibility to infections remains a major problem. This review summarizes aspects of the literature regarding viral infections and mAbs, specifically addressing the risk of infection/reactivation, the measures that can reduce this risk, and the role played by the laboratory of clinical virology in monitoring patients undergoing mAb therapy.

  17. [Determinants of vascular wall stiffness in patients with chronic renal disease undergoing hemodialysis].

    PubMed

    Kharlamova, U V; Il'icheva, O E

    2012-01-01

    Examination of 109 patients with chronic renal disease undergoing hemodialysis revealed significant impairment of arterial wall distensibility (accordingly, decreased Peterson's and Young's elastic moduli, distensibility coefficient). The relative thickness of the common carotid artery and pulse wave velocity were significantly greater than in practically healthy subjects. Independent factors influencing arterial wall rigidity included age, arterial pressure, total cholesterol and homocystein, stable metabolites of nitric oxide, creatinine, calcium, phosphorus levels, calcium x phosphorus product, duration of hemodialysis, interdialytic weight gain. PMID:23516853

  18. The myocardial protective effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery

    PubMed Central

    Soliman, Rabie; Zohry, Gomaa

    2016-01-01

    Objective: The aim of the study was to assess the effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. Design: A randomized prospective study. Setting: Cairo University, Egypt. Materials and Methods: The study included 150 patients undergoing aortic vascular surgery. Intervention: The patients were classified into two groups (n = 75). Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/h to the end of the procedure. Group C: The patients received an equal volume of normal saline. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included the heart rate, mean arterial blood pressure, central venous pressure, electrocardiogram (ECG), serum troponin I level, end-tidal sevoflurane, and total dose of morphine in addition transthoracic echocardiography to the postoperative in cases with elevated serum troponin I level. Main Results: The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (P < 0.05). Furthermore, it decreased the incidence of myocardial ischemia reflected by troponin I level, ECG changes, and the development of new regional wall motion abnormalities (P < 0.05). Dexmedetomidine decreased the requirement for nitroglycerin and norepinephrine compared to control group (P < 0.05). The incidence of hypotension and bradycardia was significantly higher with dexmedetomidine (P < 0.05). Conclusion: The dexmedetomidine is safe and effective in patients undergoing aortic vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provides cardiac protection in high-risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia. PMID:27716690

  19. Cardiothoracic ratio within the “normal” range independently predicts mortality in patients undergoing coronary angiography

    PubMed Central

    Zaman, M Justin S; Sanders, Julie; Crook, Angela M; Feder, Gene; Shipley, Martin; Timmis, Adam; Hemingway, Harry

    2007-01-01

    Objective To determine whether cardiothoracic ratio (CTR), within the range conventionally considered normal, predicted prognosis in patients undergoing coronary angiography. Design Cohort study with a median of 7‐years follow‐up. Setting Consecutive patients undergoing coronary angiography at Barts and The London National Health Service (NHS) Trust. Subjects 1005 patients with CTRs measured by chest radiography, and who subsequently underwent coronary angiography. Of these patients, 7.3% had a CTR ⩾0.5 and were excluded from the analyses. Outcomes All‐cause mortality and coronary event (non‐fatal myocardial infarction or coronary death). Adjustments were made for age, left ventricular dysfunction, ACE inhibitor treatment, body mass index, number of diseased coronary vessels and past coronary artery bypass graft. Results The risk of death was increased among patients with a CTR in the upper part of the normal range. In total, 94 (18.9%) of those with a CTR below the median of 0.42 died compared with 120 (27.8%) of those with a CTR between 0.42 and 0.49 (log rank test p<0.001). After adjusting for potential confounders, this increased risk remained (adjusted HR 1.45, 95% CI 1.03 to 2.05). CTR, at values below 0.5, was linearly related to the risk of coronary event (test for trend p = 0.024). Conclusion : In patients undergoing coronary angiography, CTR between 0.42 and 0.49 was associated with higher mortality than in patients with smaller hearts. There was evidence of a continuous increase in risk with higher CTR. These findings, along with those in healthy populations, question the conventional textbook cut‐off point of ⩾0.5 being an abnormal CTR. PMID:17164481

  20. The management of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation: in-hospital-data from the Atrial Fibrillation undergoing Coronary Artery Stenting study.

    PubMed

    Schlitt, Axel; Rubboli, Andrea; Lip, Gregory Y H; Lahtela, Heli; Valencia, Josè; Karjalainen, Pasi P; Weber, Michael; Laine, Mika; Kirchhof, Paulus; Niemelä, Matti; Vikman, Saila; Buerke, Michael; Airaksinen, K E Juhani

    2013-12-01

    Current recommendations on the management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI-S) essentially derive from small, single-center, retrospective datasets. To obtain larger and better quality data, we carried out the prospective, multicenter Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) study. Therefore, consecutive patients with history of or ongoing AF undergoing PCI-S were enrolled, and occurrence of adverse ischemic and bleeding events recorded during 12 months follow-up. In this article, we report the in-hospital observations. Out of the 963 patients, in the majority of cases (49.1%) AF was permanent. The associated risk of stroke, as defined by a CHADS2 -score ≥2, was in 70% of patients moderate to high. Upon enrollment in the registry, 69.3% of patients were on VKA therapy. Overall occurrence of in-hospital major adverse cardiac events was 4.5% (cardiovascular death 1.9%, urgent revascularization in 1.5%, and stroke/arterial thromboembolism in 0.6%). Bleeding complications occurred in 7.1% of patients, being severe in 2.5%. In a logistic regression analysis, no risk factor was independently associated with bleeding events, whereas Clopidogrel treatment decreased and female gender/treatment with gpIIb/IIIa-antagonists, respectively increased the risk for the combined ischemic endpoint. The majority of AF patients undergoing PCI-S are at high stroke risk, and therefore VKA treatment should not be withdrawn and combined anticoagulant and antiplatelet treatment is warranted. Current management appears largely in accordance with current recommendations, whereby accounting for the limited occurrence of in-hospital adverse ischemic and bleeding events.

  1. Impact of Triple Therapy in Elderly Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

    PubMed Central

    Sambola, Antonia; Mutuberría, Maria; García del Blanco, Bruno; Alonso, Albert; Barrabés, José A.; Bueno, Héctor; Alfonso, Fernando; Cequier, Angel; Zueco, Javier; Rodríguez-Leor, Oriol; Tornos, Pilar; García-Dorado, David

    2016-01-01

    Background and Purpose Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplatelet therapy: aspirin plus clopidogrel) in patients ≥75 years of age with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). Methods A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT) was analyzed. All outcomes were evaluated at 1-year of follow-up. Results Five hundred and eighty-five patients, 289 (49%) of whom were ≥75 years of age (79.6±3.4 years; 33% women) were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA2DS2VASc score: 4.23±1.51 vs 3.76±1.40, p = 0.007 and a higher bleeding risk (HAS-BLED ≥3: 88.6% vs 79.2%, p = 0.02) than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01–0.70, p = 0.004). Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53–17.57, p = 0.008). The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38); however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12–0.86, p = 0.02). Conclusions In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding. PMID:26808678

  2. The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion

    PubMed Central

    Golan, Shani; Rabina, Gilad; Kurtz, Shimon; Leibovitch, Igal

    2016-01-01

    Purpose and design The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed. Participants All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial. Methods The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period. Main outcome measure In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure. Results A total of 227 patients (57% men, mean age: 79.2 years) who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01), 30 of the study patients (13.2%) had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications. Conclusion An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in elderly patients. PMID:27785003

  3. Vaginal birth after cesarean delivery.

    PubMed

    Martins, M E

    1996-03-01

    The rate of vaginal birth after a previous cesarean delivery continues to rise due to both national organization recommendations and trials spanning 10 years of experience demonstrating its effectiveness and general safety. Broadening eligibility criteria and investigation of the clinical and nonclinical factors influencing this rate should place us on the glide path to reduction of the overall cesarean rate by the year 2000. Remaining controversies and management strategy will be discussed.

  4. Cytogenetic damage in lymphocytes of patients undergoing therapy for small cell lung cancer and ovarian carcinoma

    SciTech Connect

    Padjas, Anna; Lesisz, Dominika; Lankoff, Anna; Banasik, Anna; Lisowska, Halina; Bakalarz, Robert; Gozdz, Stanislaw; Wojcik, Andrzej . E-mail: awojcik@pu.kielce.pl

    2005-12-01

    The level of cytogenetic damage in peripheral blood lymphocytes of patients undergoing chemotherapy has been analyzed incisively 20 years ago. The results showed that the highest level of cytogenetic damage was observed at the end of therapy. In recent years, the doses of anticancer drugs were intensified thanks to the discovery of colony stimulating factors. Therefore, it was interesting to analyze the kinetics of micronuclei formation in lymphocytes of patients undergoing modern chemotherapy. The frequencies of micronuclei were measured in lymphocytes of 6 patients with small cell lung cancer treated with a combination of cisplatin and etoposide and 7 patients with ovarian carcinoma treated with a combination of taxol and cisplatin. 3 patients with lung cancer received radiotherapy in addition to chemotherapy. Micronuclei were analyzed in lymphocytes collected before the start of therapy and 1 day before each following cycle of chemotherapy. The micronucleus frequencies were compared with the kinetics of leukocyte counts. The micronucleus frequencies showed an interindividual variability. On average, the frequencies of micronuclei increased during the first half of therapy and declined thereafter, reaching, in some patients with ovarian carcinoma, values below the pre-treatment level. Leukocyte counts decreased strongly at the beginning of therapy with an upward trend at the end. We suggest that the decline of micronuclei was due to repopulation of lymphocytes and acquired drug resistance.

  5. Prevalence of hepatitis C virus infection among patients undergoing haemodialysis in Latin America.

    PubMed

    Gómez-Gutiérrez, Cristina; Chávez-Tapia, Norberto C; Ponciano-Rodríguez, Guadalupe; Uribe, Misael; Méndez-Sánchez, Nahum

    2015-01-01

    Hepatitis C infection is a worldwide problem. The global prevalence of the hepatitis C virus (HCV) averages 3%. Moreover, its prevalence among patients undergoing haemodialysis (HD) varies worldwide, ranging from as low as 1% to up to 70%. There are few data on its prevalence in developing countries, and even less information is available on HD patients. A literature review revealed that the prevalence of HCV infection among patients undergoing HD in Latin America ranges from 4.2 to 83.9%, with most data stemming from Argentina, Brazil, Mexico, Peru, Chile, Venezuela and Cuba. The most common genotype was genotype 1, and subtype 1b was the most frequent. The risk factors associated with this condition were the duration of the HD treatment and blood transfusion before hepatitis C screening. In addition, HCV RNA detection by polymerase chain reaction is crucial for the diagnosis of HCV infection in HD patients. Trials using combinations of new oral antiviral drugs, such as sofosbuvir and combo (ombitasvir, paritaprevir, ritonavir and dasabuvir), should be the next step in the improvement of care among HD patients with HCV, because these therapeutic agents apparently do not require dose adjustment according to renal function. Finally, information on this subgroup of patients remains unavailable in some countries; therefore, additional studies are needed to determine the prevalence trend of HCV infection in these populations.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-12-01

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

  8. Procedural Predictors of Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

    SciTech Connect

    Rai, Ansaar T. Jhadhav, Yahodeep; Domico, Jennifer; Hobbs, Gerald R.

    2012-12-15

    Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help

  9. Outcomes and Complications of Diabetes Mellitus on Patients Undergoing Degenerative Lumbar Spine Surgery

    PubMed Central

    Guzman, Javier Z.; Iatridis, James C.; Skovrlj, Branko; Cutler, Holt; Hecht, Andrew C.; Qureshi, Sheeraz A.; Cho, Samuel K.

    2014-01-01

    Study Design Retrospective database analysis. Objective To assess the effect glycemic control has on perioperative morbidity and mortality in patients undergoing elective degenerative lumbar spine surgery. Summary of background data Diabetes Mellitus (DM) is a prevalent disease of glucose dysregulation that has been demonstrated to increase morbidity and mortality following spine surgery. However, there is limited understanding of whether glycemic control influences surgical outcomes in DM patients undergoing lumbar spine procedures for degenerative conditions. Methods The Nationwide Inpatient Sample was analyzed from 2002 to 2011. Hospitalizations were isolated based on International Classification of Diseases Ninth Revision, Clinical Modification procedural codes for lumbar spine surgery and diagnoses codes for degenerative conditions of the lumbar spine. Patients were then classified into three cohorts: controlled diabetics, uncontrolled diabetics and non-diabetics. Patient demographic data, acute complications and hospitalization outcomes were determined for each cohort. Results A total of 403,629 (15.7%) controlled diabetics and 19,421(0.75%) uncontrolled diabetics underwent degenerative lumbar spine surgery from 2002-2011. Relative to non-diabetics, uncontrolled diabetics had significantly increased odds of cardiac complications, deep venous thrombosis and post-operative shock; additionally, uncontrolled diabetics also had an increased mean length of stay (approximately 2.5 days), greater costs (1.3-fold) and a greater risk of inpatient mortality (odds ratio=2.6, 95% confidence interval=1.5-4.8, p < .0009). Controlled diabetics also had increased risk of acute complications and inpatient mortality when compared to non-diabetics, but not nearly to the same magnitude as uncontrolled diabetics. Conclusion Suboptimal glycemic control in diabetic patients undergoing degenerative lumbar spine surgery leads to increased risk of acute complications and poor outcomes

  10. Perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery

    PubMed Central

    Degnan, Meredith; Brodt, Jessica; Rodriguez-Blanco, Yiliam

    2016-01-01

    Aim: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. Materials and Methods: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality. Statistical Analysis: Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable. Results: During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiac anesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure. Conclusion: At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under

  11. Clinical problems in patient with Ehlers-Danlos syndrome and Multiple Chemical Sensitivity undergoing total thyroidectomy.

    PubMed

    Pasta, V; D'Orazi, V; Ruggeri, L; Toni, M F; Urciuoli, P; Tellan, G

    2015-01-01

    Clinical practice sometimes brings to face with situations quite peculiar, potentially dangerous for the patient's life. In the great majority of cases, pathologies associated with each other (cardiovascular, respiratory, neurological), while in other cases we can treat rare diseases or syndromes. It's considered exceptional the simultaneous presence of "rare" pathologies in a single patient. This exceptionality has been a push to treat a patient as a "unique" asking for help to deeper studies of pharmacogenetics. Our case reports the management of a patient with Ehlers-Danlos syndrome (EDS) and Multiple Chemical Sensitivity (MCS), undergoing a total thyroidectomy. We found several problems, and we tried to find effective solutions for the management of the patient during the whole peri-operative process, from a clinical, pharmacological and also from a surgical point of view. PMID:26712072

  12. Case Report of a Patient Undergoing Peritoneal Dialysis with Encapsulating Peritoneal Sclerosis Superimposed With Calciphylaxis

    PubMed Central

    Li Tsai, Jun; Ju Wu, Ming; Hsu Chen, Cheng; Feng Tsai, Shang

    2016-01-01

    Introduction Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis (PD). Tamoxifen has been generally well-tolerated, even without randomized controlled trials. Case Presentation Herein, we report a case of a patient undergoing 12 years of PD who developed EPS and calciphylaxis simultaneously. We also provide a comprehensive discussion about the association between EPS and calciphylaxis. Moreover, although tamoxifen is used in EPS due to its inhibition of fibroblast-transforming growth factor beta (TGFβ) production, it may worsen the calciphylaxis due to a hypercoagulable state. Conclusions We suggest avoiding the use of tamoxifen for EPS in patients with superimposed calciphylaxis.

  13. Coronary sinus plasma beta endorphin levels in cardioischemic patients undergoing PTCA.

    PubMed

    Parlapiano, C; Negri, M; Tonnarini, G; Borgia, M C; Martuscelli, E; Nigri, A; Campana, E; Giovanniello, T; Pantone, P

    1998-01-01

    Plasma beta-endorphin levels were studied in the coronary sinus of 8 patients undergoing percutaneous transluminal coronary angioplasty (PTCA). All the patients had ECG ischemic signs and pain during the inflation of the balloon. No significant changes in plasma beta-endorphin levels were observed during PTCA-induced ischemia. Baseline coronary sinus plasma beta-endorphin levels were found to be elevated when compared with peripheral ones which would suggest an accumulation of beta-endorphin in the ischemic heart. PMID:10503168

  14. [Current Status of Perioperative Rehabilitation in Patients who Undergo Esophagectomy for Cancer].

    PubMed

    Oikawa, Masato; Hanada, Masatoshi; Hidaka, Shigekazu; Nagayasu, Takeshi; Kozu, Ryo

    2016-01-01

    The esophagectomy for esophageal cancer is major surgery and has the highest rate of postoperative pulmonary complications. Respiratory physiotherapy in patients undergoing esophagectomy has been applied to improve oxygenation and airway secretion clearance. Recently, the utility and effectiveness of enhanced recovery after surgery for gastroenterological surgery have been reported in Japan, and patients should be encouraged to participate in early mobilization. Perioperative rehabilitation which includes early mobilization reduces postoperative complications and improves fast-track recovery after esophagectomy. These interventions play important role in postoperative care. PMID:26975645

  15. The role of intraoperative transesophageal echocardiographic monitoring in a patient with hypertrophic cardiomyopathy undergoing laparoscopic surgery.

    PubMed

    Gregory, Stephen H; Fierro, Michael A

    2016-11-01

    Hypertrophic cardiomyopathy (HCM) presents a significant perioperative challenge. Anesthetic drugs, patient positioning, and surgical technique can provoke worsening left ventricular outflow tract obstruction and hemodynamic deterioration. In this case report, we present the perioperative management of a 70-year-old male with a history of HCM who underwent a robotic laparoscopic prostatectomy. Discussion focuses on the utilization of echocardiographic guidance in the care of patients with HCM undergoing noncardiac surgery, as well as the pathophysiology of laparoscopic insufflation and its effects on left ventricular outflow tract obstruction in HCM. PMID:27687358

  16. Intra-operative haemodynamic volatility in a patient undergoing retroperitoneal cyst excision.

    PubMed

    Tantry, Thrivikrama Padur; Shenoy, Sunil P; Shetty, Pramal; Adappa, Karunakara K

    2012-03-01

    Excision of a suspected retroperitoneal, duodenal duplication cyst was performed in a pre-operatively normotensive patient under combined epidural and general anaesthesia. Intraoperatively, the cystic tumour was discovered to be a retroperitoneal mass, free from duodenal or adrenal origin. Development of severe arrhythmias, ST segment changes and hypertensive spikes during cyst handling and dissection suggested the possibility of a catecholamine-secreting tumour. These were managed effectively with pharmacological agents. Subsequently, histopathology of the specimen revealed a paraganglioma. Vasoactive tumour has to be suspected in every patient undergoing anaesthesia for retroperitoneal cystic lesion.

  17. Intra-operative haemodynamic volatility in a patient undergoing retroperitoneal cyst excision

    PubMed Central

    Tantry, Thrivikrama Padur; Shenoy, Sunil P; Shetty, Pramal; Adappa, Karunakara K

    2012-01-01

    Excision of a suspected retroperitoneal, duodenal duplication cyst was performed in a pre-operatively normotensive patient under combined epidural and general anaesthesia. Intraoperatively, the cystic tumour was discovered to be a retroperitoneal mass, free from duodenal or adrenal origin. Development of severe arrhythmias, ST segment changes and hypertensive spikes during cyst handling and dissection suggested the possibility of a catecholamine-secreting tumour. These were managed effectively with pharmacological agents. Subsequently, histopathology of the specimen revealed a paraganglioma. Vasoactive tumour has to be suspected in every patient undergoing anaesthesia for retroperitoneal cystic lesion. PMID:22701212

  18. Management of Cesarean Deliveries and Cesarean Scars With Osteopathic Manipulative Treatment: A Brief Report.

    PubMed

    Martingano, Daniel

    2016-07-01

    Cesarean scars pose a unique set of risks for women who have had previous cesarean deliveries. Between 1996 and 2007, the rate of trial of labor after previous cesarean delivery increased, along with reported rates of uterine rupture and other complications. Consequently, trial of labor after previous cesarean delivery and resultant vaginal birth after cesarean delivery have decreased and cesarean delivery has increased. With nearly one-third of women having cesarean delivery, the rate of rare complications such as cesarean scar ectopic pregnancy has also increased. An integration of osteopathic manipulative treatment techniques into the management of cesarean deliveries and cesarean scars has yet to be defined. The author presents 4 cases of cesarean delivery in which osteopathic manipulative treatment was integrated with successful outcomes. PMID:27367961

  19. Management of Cesarean Deliveries and Cesarean Scars With Osteopathic Manipulative Treatment: A Brief Report.

    PubMed

    Martingano, Daniel

    2016-07-01

    Cesarean scars pose a unique set of risks for women who have had previous cesarean deliveries. Between 1996 and 2007, the rate of trial of labor after previous cesarean delivery increased, along with reported rates of uterine rupture and other complications. Consequently, trial of labor after previous cesarean delivery and resultant vaginal birth after cesarean delivery have decreased and cesarean delivery has increased. With nearly one-third of women having cesarean delivery, the rate of rare complications such as cesarean scar ectopic pregnancy has also increased. An integration of osteopathic manipulative treatment techniques into the management of cesarean deliveries and cesarean scars has yet to be defined. The author presents 4 cases of cesarean delivery in which osteopathic manipulative treatment was integrated with successful outcomes.

  20. Anticoagulant and antiplatelet therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention.

    PubMed

    Goto, Koji; Nakai, Kentaro; Shizuta, Satoshi; Morimoto, Takeshi; Shiomi, Hiroki; Natsuaki, Masahiro; Yahata, Mitsuhiko; Ota, Chihiro; Ono, Koh; Makiyama, Takeru; Nakagawa, Yoshihisa; Furukawa, Yutaka; Kadota, Kazushige; Takatsu, Yoshiki; Tamura, Takashi; Takizawa, Akinori; Inada, Tsukasa; Doi, Osamu; Nohara, Ryuji; Matsuda, Mitsuo; Takeda, Teruki; Kato, Masayuki; Shirotani, Manabu; Eizawa, Hiroshi; Ishii, Katsuhisa; Lee, Jong-Dae; Takahashi, Masaaki; Horie, Minoru; Takahashi, Mamoru; Miki, Shinji; Aoyama, Takeshi; Suwa, Satoru; Hamasaki, Shuichi; Ogawa, Hisao; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Kita, Toru; Kimura, Takeshi

    2014-07-01

    The prevalence, intensity, safety, and efficacy of oral anticoagulation (OAC) in addition to dual antiplatelet therapy (DAPT) in "real-world" patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) have not yet been fully evaluated. In the Coronary REvascularization Demonstrating Outcome Study in Kyoto registry cohort-2, a total of 1,057 patients with AF (8.3%) were identified among 12,716 patients undergoing first PCI. Cumulative 5-year incidence of stroke was higher in patients with AF than in no-AF patients (12.8% vs 5.8%, p <0.0001). Although most patients with AF had CHADS2 score ≥2 (75.2%), only 506 patients (47.9%) received OAC with warfarin at hospital discharge. Cumulative 5-year incidence of stroke in the OAC group was not different from that in the no-OAC group (13.8% vs 11.8%, p = 0.49). Time in therapeutic range (TTR) was only 52.6% with an international normalized ratio of 1.6 to 2.6, and only 154 of 409 patients (37.7%) with international normalized ratio data had TTR ≥65%. Cumulative 5-year incidence of stroke in patients with TTR ≥65% was markedly lower than that in patients with TTR <65% (6.9% vs 15.1%, p = 0.01). In a 4-month landmark analysis in the OAC group, there was a trend for higher cumulative incidences of stroke and major bleeding in the on-DAPT (n = 286) than in the off-DAPT (n = 173) groups (15.1% vs 6.7%, p = 0.052 and 14.7% vs 8.7%, p = 0.10, respectively). In conclusion, OAC was underused and its intensity was mostly suboptimal in real-world patients with AF undergoing PCI, which lead to inadequate stroke prevention. Long-term DAPT in patients receiving OAC did not reduce stroke incidence.

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  3. Pharmacokinetics of imipenem-cilastatin in patients with renal insufficiency undergoing continuous ambulatory peritoneal dialysis.

    PubMed Central

    Somani, P; Freimer, E H; Gross, M L; Higgins, J T

    1988-01-01

    In six patients with end-stage renal disease, a single bolus of imipenem-cilastatin (500 mg each) was given either intravenously or intraperitoneally in a randomized crossover protocol such that each patient received the drug by both routes at a 2- to 3-week interval. Drug levels in plasma and the peritoneal dialysis fluid were analyzed at frequent intervals, and various pharmacokinetic variables were calculated for a one-compartment open model. Data obtained in the present study suggest that while no significant difference in peak plasma levels or volume of distribution were noted, the following variables were significantly different for imipenem as compared with cilastatin: elimination half-life, total plasma clearance, area under the concentration-time curve, and percent drug excretion in the peritoneal dialysis fluid. The elimination half-life of imipenem (3.28 h) or cilastatin (8.84 h) in our patients was in the same range as observed in patients with minimal renal function undergoing hemodialysis. The dose of imipenem-cilastatin should be reduced appropriately in patients with end-stage renal disease undergoing peritoneal dialysis. PMID:3377464

  4. Red blood cell distribution width and 3-year outcome in patients undergoing cardiac catheterization.

    PubMed

    Arbel, Yaron; Birati, Edo Y; Finkelstein, Ariel; Halkin, Amir; Berliner, Shlomo; Katz, Ben-Zion; Revivo, Miri; Saranga, Hila; Herz, Itzhak; Keren, Gad; Banai, Shmuel

    2014-05-01

    Red blood cell distribution width (RDW), which is routinely reported in complete blood counts, is a measure of the variability in size of circulating erythrocytes. RDW is a novel, independent predictor of prognosis in patients with cardiovascular diseases. The aim of the present study was to evaluate the significance of this biomarker in a relatively large cohort of patients, and to assess its association with a more severe underlying cardiovascular disease. A cohort of 3,222 consecutive patients undergoing coronary angiography was divided according RDW median. The association between RDW and 3-year outcome in the context of other predictors was assessed using Cox's proportional hazards analysis. Patients with elevated RDWs were older, had higher body mass indices, and had more cardiovascular risk factors and more cardiovascular diseases. The total rate of mortality, MI and stroke (MACE) was 7.7% (120 events) in the lower RDW group, and 18.2% (303 events) in the higher RDW group, p < 0.001. Following adjustment for multiple background risk factors, medications, and laboratory results, the RDW value was independently associated with worse outcome (HR = 1.12, 95% CI 1.07-1.18, p < 0.001, for each 1% increase in RDW). Elevated RDW values are independently associated with adverse 3-year outcome in patients undergoing coronary angiography. PMID:23836454

  5. Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section

    PubMed Central

    Nikooseresht, Mahshid; Seif Rabiei, Mohamad Ali; Hajian, Pooran; Dastaran, Razieh; Alipour, Nasim

    2016-01-01

    Background Despite controversies about the safest anesthetic technique for cesarean delivery in severely preeclamptic women, there is evidence that supports the use of spinal anesthesia in this group of patients. Objectives This prospective randomized clinical trial was designed to determine the hemodynamic effects of low-dose spinal bupivacaine and the incidence of spinal anesthesia-associated hypotension in severely preeclamptic and healthy parturients undergoing cesarean sections. Patients and Methods Spinal anesthesia was performed with 10 mg (= 2 mL) hyperbaric 0.5% bupivacaine plus 2.5 µg sufentanil in two groups of patients after they received 500 mL of IV lactated Ringer’s solution. Heart rate and blood pressure were recorded before spinal anesthesia and at two minutes intervals for 15 minutes after the block, and then every five minutes until the end of the surgery. Hypotension was defined as more than 25% of decline in the mean arterial blood pressure compared to the baseline in both groups (or systolic blood pressure < 100 mmHg in healthy parturients) and was treated with 5 mg IV ephedrine. The total amounts of intravenous administered fluid and the total doses of ephedrine were recorded for each patient as well. Results The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients, despite the former group receiving smaller volumes of intravenous fluids (P < 0.05). The total doses of IV ephedrine for treating hypotension were significantly lower among the preeclamptic patients (3.2 mg in preeclamptic patients versus 7.6 mg in normotensive patients) (P = 0.02). The one-minute Apgar score was significantly lower for the preeclamptic parturients (8.4 ± 0.7 versus 7.2 ± 1.5) (P = 0.001), but there was no significant difference in the five-minute Apgar scores between the two groups. Conclusions Our results confirm that low-dose bupivacaine spinal anesthesia is associated with a lower risk of hypotension

  6. Blood Pressure and Heart Rate Alterations through Music in Patients Undergoing Cataract Surgery in Greece

    PubMed Central

    Merakou, Kyriakoula; Varouxi, Georgia; Barbouni, Anastasia; Antoniadou, Eleni; Karageorgos, Georgios; Theodoridis, Dimitrios; Koutsouri, Aristea; Kourea-Kremastinou, Jenny

    2015-01-01

    INTRODUCTION Music has been proposed as a safe, inexpensive, nonpharmacological antistress intervention. The purpose of this study was to determine whether patients undergoing cataract surgery while listening to meditation music experience lower levels of blood pressure and heart rate. METHODS Two hundred individuals undergoing cataract surgery participated in the study. Hundred individuals listened to meditation music, through headphones, before and during the operation (intervention group) and 100 individuals received standard care (control group). Patients stress coping skills were measured by the Sense of Coherence Scale (SOC Scale). Systolic and diastolic blood pressure and heart rate were defined as outcome measures. RESULTS According to the SOC Scale, both groups had similar stress coping skills (mean score: 127.6 for the intervention group and 127.3 for the control group). Before entering the operating room (OR) as well as during surgery the rise in systolic and diastolic pressures was significantly lower in the intervention group (P < 0.001). Among patients receiving antihypertensive therapy, those in the intervention group presented a lower increase only in systolic pressure (P < 0.001) at both time recordings. For those patients in the intervention group who did not receive antihypertensive treatment, lower systolic blood pressure at both time recordings was recorded (P < 0.001) while lower diastolic pressure was observed only during entry to the OR (P = 0.021). Heart rate was not altered between the two groups in any of the recordings. CONCLUSIONS Meditation music influenced patients’ preoperative stress with regard to systolic blood pressure. This kind of music can be used as an alternative or complementary method for blood pressure stabilizing in patients undergoing cataract surgery. PMID:26106264

  7. Benefits of Intraaortic Balloon Support for Myocardial Infarction Patients in Severe Cardiogenic Shock Undergoing Coronary Revascularization

    PubMed Central

    Chen, Dong-Yi; Tsai, Ming-Lung; Lin, Yu-Sheng; Cherng, Wen-Jin; Wang, Chao-Hung; Wen, Ming-Shien; Hsieh, I-Chang; Hung, Ming-Jui; Chen, Chun-Chi; Chen, Tien-Hsing

    2016-01-01

    Background Prior studies have suggested intraaortic balloon pump (IABP) have a neutral effect on acute myocardial infarction (AMI) patients with cardiogenic shock (CS). However, the effects of IABP on patients with severe CS remain unclear. We therefore investigated the benefits of IABP in AMI patients with severe CS undergoing coronary revascularization. Methods and Results This study identified 14,088 adult patients with AMI and severe CS undergoing coronary revascularization from Taiwan’s National Health Insurance Research Database between January 1, 1997 and December 31, 2011, dividing them into the IABP group (n = 7044) and the Nonusers group (n = 7044) after propensity score matching to equalize confounding variables. The primary outcomes included myocardial infarction(MI), cerebrovascular accidents or cardiovascular death. In-hospital events including dialysis, stroke, pneumonia and sepsis were secondary outcomes. Primary outcomes were worse in the IABP group than in the Nonusers group in 1 month (Hazard ratio (HR) = 1.97, 95% confidence interval (CI) = 1.84–2.12). The MI rate was higher in the IABP group (HR = 1.44, 95% CI = 1.16–1.79), and the cardiovascular death was much higher in the IABP group (HR = 2.07, 95% CI = 1.92–2.23). The IABP users had lower incidence of dialysis (8.5% and 9.5%, P = 0.04), stroke (2.6% and 3.8%, P<0.001), pneumonia (13.9% and 16.5%, P<0.001) and sepsis (13.2% and 16%, P<0.001) during hospitalization than Nonusers. Conclusion The use of IABP in patients with myocardial infarction and severe cardiogenic shock undergoing coronary revascularization did not improve the outcomes of recurrent myocardial infarction and cardiovascular death. However, it did reduce the incidence of dialysis, stroke, pneumonia and sepsis during hospitalization. PMID:27483439

  8. Hearing outcomes following primary malleostapedial rotation ossiculoplasty in patients undergoing modified radical mastoidectomy

    PubMed Central

    Kanegaonkar, RG; Najuko-Mafemera, A

    2014-01-01

    Introduction Treatment of cholesteatoma consists of either excision or exteriorisation of disease. Approaches have traditionally included a radical or modified radical mastoidectomy and combined approach tympanoplasty. Hearing thresholds following a modified radical mastoidectomy alone have been reported as poor. We assessed hearing outcomes in patients undergoing a primary malleostapedial reconstruction combined with their open cavity surgery. Methods All patients undergoing open cavity mastoidectomy with primary malleostapedial rotation ossiculoplasty between 2009 and 2013 were identified. Case notes were reviewed, and demographic data, recurrence rate and audiometry were recorded. Results Twenty-one patients were identified. The age range was 10–65 years. There was no evidence of recurrence of cholesteatoma. The mean postoperative air-bone gap was 20dBHL, 23dBHL, 10dBHL and 27dBHL at 0.5kHz, 1kHz, 2kHz and 4kHz respectively. Excluding cases consistent with a postoperative ossicular discontinuity (n=3), the mean postoperative air-bone gap was 15dBHL, 19dBHL, 8dBHL and 26dBHL at 0.5kHz, 1kHz, 2kHz and 4kHz respectively. Conclusions The improvement in hearing thresholds demonstrated in this cohort of patients supports the use of this form of ossiculoplasty in those undergoing open cavity procedures. This would also suggest that the subsequent use of hearing aids in these patients would require less amplification and therefore provide superior hearing outcomes. As hearing loss remains a significant concern following modified radical mastoidectomy, we suggest an open cavity with primary malleostapedial rotation ossiculoplasty as a viable alternative to modified radical mastoidectomy alone, in selected cases. PMID:25198979

  9. Desflurane reinforces the efficacy of propofol target-controlled infusion in patients undergoing laparoscopic cholecystectomy.

    PubMed

    Chen, Po-Nien; Lu, I-Cheng; Chen, Hui-Ming; Cheng, Kuang-I; Tseng, Kuang-Yi; Lee, King-Teh

    2016-01-01

    Whether low-concentration desflurane reinforces propofol-based intravenous anesthesia on maintenance of anesthesia for patients undergoing laparoscopic cholecystectomy is to be determined. The aim of this study was to investigate whether propofol-based anesthesia adding low-concentration desflurane is feasible for laparoscopic cholecystectomy. Fifty-two patients undergoing laparoscopic cholecystectomy were enrolled in the prospective, randomized, clinical trial. Induction of anesthesia was achieved in all patients with fentanyl 2 μg/kg, lidocaine 1 mg/kg, propofol 2 mg/kg, and rocuronium 0.8 mg/kg to facilitate tracheal intubation and to initiate propofol target-controlled infusion (TCI) to effect site concentration (Ce: 4 μg/mL with infusion rate 400 mL/h). The patients were then allocated into either propofol TCI based (group P) or propofol TCI adding low-concentration desflurane (group PD) for maintenance of anesthesia. The peri-anesthesia hemodynamic responses to stimuli were measured. The perioperative psychomotor test included p-deletion test, minus calculation, orientation, and alert/sedation scales. Group PD showed stable hemodynamic responses at CO2 inflation, initial 15 minutes of operation, and recovery from general anesthesia as compared with group P. There is no significant difference between the groups in operation time and anesthesia time, perioperative psychomotor functional tests, postoperative vomiting, and pain score. Based on our findings, the anesthetic technique combination propofol and desflurane for the maintenance of general anesthesia for laparoscopic cholecystectomy provided more stable hemodynamic responses than propofol alone. The combined regimen is recommended for patients undergoing laparoscopic cholecystectomy.

  10. Gender differences in health-related quality of life in patients undergoing coronary angiography

    PubMed Central

    Gijsberts, Crystel M; Agostoni, Pierfrancesco; Hoefer, Imo E; Asselbergs, Folkert W; Pasterkamp, Gerard; Nathoe, Hendrik; Appelman, Yolande E; de Kleijn, Dominique P V; den Ruijter, Hester M

    2015-01-01

    Background Health-related quality of life (HRQOL) reflects the general well-being of individuals. In patients with coronary artery disease (CAD), HRQOL is compromised. Female patients with CAD have been reported to have lower HRQOL. In this study, we investigate gender differences in HRQOL and in associations of patient characteristics with HRQOL in patients with coronary angiography (CAG). Methods We cross-sectionally analysed patients from the Utrecht Coronary Biobank undergoing CAG. All patients filled in an HRQOL questionnaire (RAND-36 and EuroQoL) on inclusion. RAND-36 and EuroQoL HRQOL measures were compared between the genders across indications for CAG, CAD severity and treatment of CAD. RAND-36 HRQOL measures were compared with the general Dutch population. Additionally, we assessed interactions of gender with patient characteristics in their association with HRQOL (EuroQoL). Results We included 1421 patients (1020 men and 401 women) with a mean age of 65 in our analysis. Women reported lower HRQOL measures than men (mean EuroQoL self-rated health grade 6.84±1.49 in men, 6.46±1.40 in women, p<0.001). The reduction in RAND-36 HRQOL as compared with the general Dutch population was larger in women than in men. From regression analysis, we found that diabetes, a history of cardiovascular disease and symptoms of shortness of breath determined HRQOL (EuroQoL) more strongly in men than in women. Conclusions Women reported lower HRQOL than men throughout all indications for CAG and regardless of CAD severity or treatment. As compared with the general population, the reduction in HRQOL was more extreme in women than in men. Evident gender differences were found in determinants of HRQOL in patients undergoing CAG, which deserve attention in future research. Trial registration NCT02304744 (clinicaltrials.gov). PMID:26339493

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  12. Myoclonus-like involuntary movements following cesarean delivery epidural anesthesia.

    PubMed

    Kang, Hee Yong; Lee, Sang Wook; Hong, Eun Pyo; Sim, Yeo Hae; Lee, Su-Mi; Park, Sung Wook; Kang, Jong-Man

    2016-11-01

    Spinal myoclonus following neuraxial anesthesia is rare. This report describes a case of myoclonus-like involuntary movement that occurred during the recovery from epidural anesthesia for a cesarean delivery. The patient's symptom improved with the administration of benzodiazepine, and the patient recovered with no neurological sequelae. In conclusion, epidural anesthesia can cause spinal myoclonus, which can be treated with a benzodiazepine. PMID:27687419

  13. Classifying Cytogenetics in Patients with AML in Complete Remission Undergoing Allogeneic Transplantation: A CIBMTR Study

    PubMed Central

    Armand, Philippe; Kim, Haesook T.; Zhang, Mei-Jie; Perez, Waleska S.; Dal Cin, Paola S.; Klumpp, Thomas R.; Waller, Edmund K.; Litzow, Mark R.; Liesveld, Jane L.; Lazarus, Hillard M.; Artz, Andrew S.; Gupta, Vikas; Savani, Bipin N.; McCarthy, Philip L.; Cahn, Jean-Yves; Schouten, Harry C.; Finke, Jürgen; Ball, Edward D.; Aljurf, Mahmoud D.; Cutler, Corey S.; Rowe, Jacob M.; Antin, Joseph H.; Isola, Luis M.; Di Bartolomeo, Paolo; Camitta, Bruce M.; Miller, Alan M.; Cairo, Mitchell S.; Stockerl-Goldstein, Keith; Sierra, Jorge; Savoie, M. Lynn; Halter, Joerg; Stiff, Patrick J.; Nabhan, Chadi; Jakubowski, Ann A.; Bunjes, Donald W.; Petersdorf, Effie W.; Devine, Steven M.; Maziarz, Richard T.; Bornhauser, Martin; Lewis, Victor A.; Marks, David I.; Bredeson, Christopher N.; Soiffer, Robert J.; Weisdorf, Daniel J.

    2011-01-01

    Cytogenetics play a major role in determining the prognosis of patients with AML. However, the existing cytogenetics classifications were developed on chemotherapy-treated patients and may not be optimal for patients undergoing allogeneic hematopoietic cell transplantation (HCT). We studied 821 adult patients reported to the CIBMTR who underwent HCT for AML in first or second CR between 1999 and 2004. We compared the ability of the 6 existing classifications to stratify patients by overall survival (OS). We then defined a new schema specifically applicable to HCT patients using this patient cohort. Under this CIBMTR schema, inv(16) is favorable, complex karyotype (4+ abnormalities) is adverse, and all other classified abnormalities are intermediate in predicting survival after HCT (5y OS 64%, 18%, and 50%, respectively, p=0.0001). This schema stratified patients into 3 groups with similar non-relapse mortality, but significantly different incidences of relapse, overall and leukemia-free survival. It applied to patients regardless of their disease status (CR1 or CR2), donor type (MRD or URD), or conditioning intensity (myeloablative or reduced intensity). This transplantation-specific classification could be adopted for prognostication purposes and to stratify patients with AML and karyotypic abnormalities entering HCT clinical trials. PMID:21810400

  14. Reduced-intensity conditioning using fludarabine, melphalan and thiotepa for adult patients undergoing haploidentical SCT

    PubMed Central

    Ciurea, SO; Saliba, R; Rondon, G; Pesoa, S; Cano, P; Fernandez-Vina, M; Qureshi, S; Worth, LL; McMannis, J; Kebriaei, P; Jones, RB; Korbling, M; Qazilbash, M; Shpall, EJ; Giralt, S; de Lima, M; Champlin, RE; Gajewski, J

    2014-01-01

    Haploidentical SCT (HaploSCT) has been most commonly performed using a myeloablative, TBI-based preparative regimen; however, the toxicity with this approach remains very high. We studied the feasibility of a reduced-intensity conditioning regimen in a phase II clinical trial using fludarabine, melphalan and thiotepa and antithymocyte globulin (ATG) for patients with advanced hematological malignancies undergoing T-cell depleted HaploSCT. Twenty-eight patients were entered in the study. Engraftment with donor-derived hematopoiesis was achieved in 78% of patients after a median of 13 days. Six patients experienced primary graft failure, three out of four tested patients had donor-specific anti-HLA antibodies (DSA) (P = 0.001). Toxicity included mostly infections. A total of 21 out of 22 patients with AML/myelodysplastic syndrome (MDS) achieved remission after transplant (16 with relapsed/refractory AML). Five out of the 12 patients (42%) with AML/MDS with <15% BM blasts survived long term as compared with none with more advanced disease (P = 0.03). HaploSCT with this fludarabine, melphalan and thiotepa and ATG RIC is an effective, well-tolerated conditioning regimen for patients with AML/MDS with low disease burden at the time of transplant and allowed a high rate of engraftment in patients without DSA. Patients with overt relapse fared poorly and require novel treatment strategies. PMID:19668237

  15. [Control of weight gain between dialyses in patients undergoing periodic hemodialysis. Psychological aspects].

    PubMed

    Persichetti, S; Sagliaschi, G; Clemenzia, G; Bolletta, A

    1991-09-01

    Some patients undergoing periodic hemodialysis have complained that between one treatment session and the next they suffer form thirst and have serious problems in maintaining their interdialytic weight gain within the limits indicated by the medical team. Weight gain may usually be explained by psychological factors: they may be more or less acute depending on the situation in which the patient finds himself. On the basis of the present study, the Authors affirm that the lack of interdialytic weight control may be easily improved by providing the patient with psychological support capable of optimising his general level of adaptation, and that this can lead to excellent results with regard to specific problems which otherwise detract from the wellbeing of the patient and hamper the work of the medical team.

  16. Clinical problems in patient with Ehlers-Danlos syndrome and Multiple Chemical Sensitivity undergoing total thyroidectomy

    PubMed Central

    PASTA, V.; D’ORAZI, V.; RUGGERI, L.; TONI, M.F.; URCIUOLI, P.; TELLAN, G.

    2015-01-01

    Clinical practice sometimes brings to face with situations quite peculiar, potentially dangerous for the patient’s life. In the great majority of cases, pathologies associated with each other (cardiovascular, respiratory, neurological), while in other cases we can treat rare diseases or syndromes. It’s considered exceptional the simultaneous presence of “rare” pathologies in a single patient. This exceptionality has been a push to treat a patient as a “unique” asking for help to deeper studies of pharmacogenetics. Our case reports the management of a patient with Ehlers-Danlos syndrome (EDS) and Multiple Chemical Sensitivity (MCS), undergoing a total thyroidectomy. We found several problems, and we tried to find effective solutions for the management of the patient during the whole peri-operative process, from a clinical, pharmacological and also from a surgical point of view. PMID:26712072

  17. Quality of Life and Symptom Experience of Breast Cancer Patients Undergoing Chemotherapy.

    PubMed

    Şahin, Zümrüt Akgün; Tan, Mehtap

    2016-01-01

    The purpose of this study was to examine the effect of educational interventions on breast cancer patients during chemotherapy, with a secondary aim of focusing on describing symptoms in patients during chemotherapy and their effects on the quality of life of patients with breast cancer undergoing chemotherapy. The study was quasi-experimental. A sample of 120 patients participated, of which 60 were in the experimental group and 60 were in the control group. Pre/posttest quality-of-life subgroups were compared in terms of their mean scores. In the posttest in the experimental group, mean scores of the Family subscale, Health and Functioning subscale, Psychological/Spiritual subscale, and Social and Economic subscale correlated negatively and the difference was statistically significant (P < .05). PMID:27309408

  18. Respiratory muscle dysfunction: a multicausal entity in the critically ill patient undergoing mechanical ventilation.

    PubMed

    Díaz, Magda C; Ospina-Tascón, Gustavo A; Salazar C, Blanca C

    2014-02-01

    Respiratory muscle dysfunction, particularly of the diaphragm, may play a key role in the pathophysiological mechanisms that lead to difficulty in weaning patients from mechanical ventilation. The limited mobility of critically ill patients, and of the diaphragm in particular when prolonged mechanical ventilation support is required, promotes the early onset of respiratory muscle dysfunction, but this can also be caused or exacerbated by other factors that are common in these patients, such as sepsis, malnutrition, advanced age, duration and type of ventilation, and use of certain medications, such as steroids and neuromuscular blocking agents. In this review we will study in depth this multicausal origin, in which a common mechanism is altered protein metabolism, according to the findings reported in various models. The understanding of this multicausality produced by the same pathophysiological mechanism could facilitate the management and monitoring of patients undergoing mechanical ventilation.

  19. Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis.

    PubMed

    Sabanis, Nikos; Paschou, Eleni; Gavriilaki, Eleni; Mourounoglou, Maria; Vasileiou, Sotirios

    2015-01-01

    Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location. PMID:26301109

  20. Respiratory muscle dysfunction: a multicausal entity in the critically ill patient undergoing mechanical ventilation.

    PubMed

    Díaz, Magda C; Ospina-Tascón, Gustavo A; Salazar C, Blanca C

    2014-02-01

    Respiratory muscle dysfunction, particularly of the diaphragm, may play a key role in the pathophysiological mechanisms that lead to difficulty in weaning patients from mechanical ventilation. The limited mobility of critically ill patients, and of the diaphragm in particular when prolonged mechanical ventilation support is required, promotes the early onset of respiratory muscle dysfunction, but this can also be caused or exacerbated by other factors that are common in these patients, such as sepsis, malnutrition, advanced age, duration and type of ventilation, and use of certain medications, such as steroids and neuromuscular blocking agents. In this review we will study in depth this multicausal origin, in which a common mechanism is altered protein metabolism, according to the findings reported in various models. The understanding of this multicausality produced by the same pathophysiological mechanism could facilitate the management and monitoring of patients undergoing mechanical ventilation. PMID:23669061

  1. [Non-indicated cesarean section--does the "Golem" counteract?].

    PubMed

    Herman, Arie

    2011-11-01

    Cesarean section rate is steadily increasing and in Israel it has risen to 20%. MultipLe and different reasons have led to this phenomenon, among them are non-indicated cesarean sections. Although health care providers disagree whether this development is medically, ethically and publically justified, national associations allow it, while respecting those obstetricians who decline to do so. In Israel there are some hospitals which allow non-indicated cesarean sections, whereas others reject them. When discussing this issue with the patients, documentation is advised concerning the reasons for approval or rejection of the patients' request in order to avoid future complaints in the case of adverse outcome. Low risk vaginal delivery should be regarded as a natural process and not as a medical treatment and keeping balanced and reasonable decisions may help to contain the phenomenon and avoid a situation in which the "Golem" created by the medical system, counteracts.

  2. Patients With Small Left Ventricular Size Undergoing Balloon Aortic Valvuloplasty Have Worse Intraprocedural Outcomes

    PubMed Central

    Don, Creighton; Gupta, Pritha P.; Witzke, Christian; Kesarwani, Manoj; Cubeddu, Roberto J.; Inglessis, Ignacio; Palacios, Igor F.

    2014-01-01

    Objectives To evaluate the impact of left ventricular (LV) chamber size on procedural and hospital outcomes of patients undergoing aortic valvuloplasty. Background Balloon aortic valvuloplasty (BAV) is used as an integral step during transcatheter aortic valve implantation. Patients with small, thickened ventricles are thought to have more complications during and following BAV. Methods Retrospective study of consecutive patients with severe, symptomatic calcific aortic stenosis who underwent retrograde BAV at Massachusetts General Hospital. We compared patients with left ventricular end-diastolic diameters (LVEDD) <4.0 cm (n = 31) to those with LVEDD ≥4.0 cm (n = 78). Baseline and procedural characteristics as well as clinical outcomes were compared. Multivariate logistic regression was used for the adjusted analysis. Results Patients with smaller LV chamber size were mostly women (80.7% vs. 19.4%, P < 0.01) and had a smaller body surface area (BSA), (1.61 ± 0.20 m2 vs. 1.79 ± 0.25 m2, P < 0.01). Patients with smaller LV chamber size had higher ejection fractions and thicker ventricles. Otherwise, baseline characteristics were similar. The intraprocedural composite of death, cardiopulmonary arrest, intubation, hemodynamic collapse, and tamponade was higher for patients with LVEDD < 4.0 cm (32.3% v. 11.5%, P = 0.01). Adjusting for age, gender, BSA, LV pressure, and New York Heart Association class, LVEDD < 4.0 cm remained an independent predictor of procedural (OR 5.1, 95% CI 1.4– 18.2) and in-hospital complications (OR 3.8, 95% CI 1.2–11.6). Conclusions Compared to patients undergoing BAV with LVEDD ≥4.0 cm, those with smaller LV chambers had worse procedural and in-hospital outcomes. PMID:22926957

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

    PubMed Central

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

    2016-01-01

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

  4. Prospective Study of Psychosocial Distress Among Patients Undergoing Radiotherapy for Head and Neck Cancer

    SciTech Connect

    Chen, Allen M. Jennelle, Richard; Grady, Victoria; Tovar, Adrienne; Bowen, Kris; Simonin, Patty; Tracy, Janice; McCrudden, Dale; Stella, Jonathan R.; Vijayakumar, Srinivasan

    2009-01-01

    Purpose: To determine the prevalence of psychosocial distress among patients undergoing radiotherapy (RT) for head and neck cancer and to examine the association between depression and anxiety and demographic and medical variables. Methods and Materials: A total of 40 patients (25 men and 15 women) with nonmetastatic head and neck cancer were enrolled in this prospective study and underwent RT administered with definitive (24 patients) or postoperative (16 patients) intent. Twenty patients (50%) received concurrent chemotherapy. All patients completed the Hospital Anxiety and Depression Scale and Beck Depression Inventory-II instrument before RT, on the last day of RT, and at the first follow-up visit. The effect of patient-, tumor-, and treatment-related factors on psychosocial distress was analyzed. Results: The prevalence of mild to severe pre-RT depression was 58% and 45% using the Hospital Anxiety and Depression Scale-D and Beck Depression Inventory-II scale, respectively. The prevalence of severe pre-RT anxiety was 7%. The depression levels, as determined by the Hospital Anxiety and Depression Scale and Beck Depression Inventory-II instrument increased significantly during RT and remained elevated at the first follow-up visit (p < 0.001 for both). The variables that were significantly associated with post-RT depression included a greater pre-RT depression level, employment status (working at enrollment), younger age (<55 years), single marital status, and living alone (p < 0.05, for all). Conclusion: The results of our study have shown that an alarming number of patients undergoing RT for head and neck cancer have symptoms suggestive of psychosocial distress even before beginning treatment. This proportion increases significantly during RT. Studies investigating the role of antidepressants and/or psychiatric counseling might be warranted in the future.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  8. Comparison of Perioperative Ranibizumab Injections for Diabetic Macular Edema in Patients Undergoing Cataract Surgery

    PubMed Central

    2016-01-01

    Purpose. To compare the efficacy of perioperative ranibizumab injections on diabetic macular edema (DME) in patients undergoing cataract surgery. Methods. This study included 59 eyes of 59 patients. All patients had advanced cataract with DME and underwent an uneventful phacoemulsification surgery. There were 3 subgroups. The first group received intravitreal ranibizumab injection 2 weeks preoperatively, the second group received intraoperatively, and the third group received 2 weeks postoperatively. Follow-up examinations were performed at 1 week as well as at 1 and 3 months. Results. Baseline visual acuity showed a significant increase in all groups at 1 month. In group 1, compared to baseline value, foveal thickness (FT) increased significantly at 1 month and showed a significant decrease up to month 3. In group 2, FT increased at month 1 and this continued up to month 3. In group 3, FT increased at month 1 and was almost stable up to month 3. There were not any significant differences for visual acuity and FT between the groups. Conclusions. Although intrapostoperative ranibizumab injection for DME seems to be more effective than preoperative injections in patients undergoing cataract surgery, the treatment still needs to be continued following surgery. PMID:27493795

  9. Ratio of C-Reactive Protein to Albumin Predicts Muscle Mass in Adult Patients Undergoing Hemodialysis

    PubMed Central

    Chen, Yu-Tong; Wu, Pei-Yu; Chen, Hsi-Hsien; Chen, Tso-Hsiao; Hsu, Yung-Ho

    2016-01-01

    Recent studies have indicated that the ratio of C-reactive protein to albumin (CRP–Alb ratio) is associated with clinical outcomes in patients with disease. We examined the predictive value of this ratio in patients undergoing hemodialysis (HD). In this cross-sectional study, 91 eligible adult HD patients were analyzed, and the correlation between the CRP–Alb ratio and skeletal muscle mass normalized for body weight (SMM/wt; estimated using a bioelectrical impedance analyzer) was investigated. The mean age of the study participants was 54.9 ± 6.6 years (ranging from 27 to 64 years); 43 (47.2%) were men. The mean values for the SMM/wt were 39.1% ± 5.4%. The CRP–Alb ratio was found to be negatively correlated with SMM/wt (r = −0.33, P = 0.002) and creatinine (r = −0.20, P = 0.056). All the univariate significant and nonsignificant relevant covariates were selected for multivariable stepwise regression analysis. We determined that the homeostasis model assessment-estimated insulin resistance and CRP–Alb ratio were independent risk determinants for SMM/wt (βHOMA-IR = −0.18 and βCRP–Alb ratio = −3.84, adjusted R2 = 0.32). This study indicated that the CRP–Alb ratio may help clinicians in predicting muscle mass in adult patients undergoing HD. PMID:27768746

  10. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement

    PubMed Central

    Schuetz, Philipp; Huber, Andreas; Müller, Beat; Maisano, Francesco; Taramasso, Maurizio; Moarof, Igal; Obeid, Slayman; Stähli, Barbara E.; Cahenzly, Martin; Binder, Ronald K.; Liebetrau, Christoph; Möllmann, Helge; Kim, Won-Keun; Hamm, Christian; Lüscher, Thomas F.

    2015-01-01

    Background Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR). Elevated levels of midregional proadrenomedullin (MR-proADM) levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population. Objectives We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population. Methods We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality. Results During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%). Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l) had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0–26.0, P < 0.01), whereas patients with EuroSCORE II scores above the 75th percentile (> 6.8) only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8–5.6, P = 0.13). The Harrell’s C-statistic was 0.58 (95% CI 0.45–0.82) for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71–0.92, P = 0.01). In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1–31.3), P <0.01) and improved the model’s net reclassification index (0.89, 95% CI (0.28–1.59). These results were confirmed in the independent validation cohort. Conclusions Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis. PMID

  11. Risk factors for obstetric morbidity in patients with uterine atony undergoing Caesarean delivery†

    PubMed Central

    Butwick, A. J.; Carvalho, B.; El-Sayed, Y. Y.

    2014-01-01

    Background Uterine atony (UA) is recognized as a leading cause of postpartum haemorrhage. However, knowledge of risk factors of haemorrhage-related morbidity among patients diagnosed with UA is uncertain. We investigated risk factors for haemorrhage-related morbidity among patients undergoing Caesarean delivery with UA. Methods We conducted a secondary analysis of data sourced from a 4-yr observational study at 19 US academic centres. Patients with UA were identified based on receiving methylergonovine or carboprost. Our primary outcome (haemorrhage-related morbidity) included a composite of intra- or postpartum transfusion; Caesarean hysterectomy; uterine or hypogastric artery ligation; intensive care admission for: pulmonary oedema, coagulopathy, adult respiratory distress syndrome, postoperative ventilation, or invasive line monitoring. Results Among 57 182 patients who underwent Caesarean delivery, 2294 (4%) patients developed UA. Haemorrhage-related morbidity occurred in 450 (19.6%) patients with UA. The risk of haemorrhage-related morbidity was increased among African-Americans [adjusted odds ratio (aOR)=2.36; 95% confidence interval (CI)=1.73–3.23], Hispanics (aOR=1.4; 95% CI=1.04–1.9), women with multiple gestations (aOR=1.59; 95% CI=1.06–2.38), placenta praevia (aOR=4.89; 95% CI=3.04–7.87), patients with ASA class III (aOR=1.4; 95 CI=1.03–1.9), or ASA class IV (aOR=5.88; 95% CI=2.48–13.9), exposure to general anaesthesia (GA) (aOR=2.4; 95% CI=1.59–3.62) and combined general and regional anaesthesia (aOR=4.0; 95% CI=2.62–6.09), and ≥2 prior Caesarean deliveries (aOR=1.62; 95% CI=1.1–2.39). Conclusions Among patients with UA undergoing Caesarean delivery, the risk of haemorrhage-related morbidity is increased in African-Americans, Hispanics, patients with multiple gestations, placenta praevia, ASA class III or IV, ≥2 prior Caesarean deliveries and those undergoing GA. PMID:24907281

  12. A cohort and database study of airway management in patients undergoing thyroidectomy for retrosternal goitre.

    PubMed

    Gilfillan, N; Ball, C M; Myles, P S; Serpell, J; Johnson, W R; Paul, E

    2014-11-01

    Patients undergoing thyroid surgery with retrosternal goitre may raise concerns for the anaesthetist, especially airway management. We reviewed a multicentre prospective thyroid surgery database and extracted data for those patients with retrosternal goitre. Additionally, we reviewed the anaesthetic charts of patients with retrosternal goitre at our institution to identify the anaesthetic induction technique and airway management. Of 4572 patients in the database, 919 (20%) had a retrosternal goitre. Two cases of early postoperative tracheomalacia were reported, one in the retrosternal group. Despite some very large goitres, no patient required tracheostomy or cardiopulmonary bypass and there were no perioperative deaths. In the subset of 133 patients managed at our institution over six years, there were no major adverse anaesthetic outcomes and no patient had a failed airway or tracheomalacia. In the latter cohort, of 32 (24%) patients identified as having a potentially difficult airway, 17 underwent awake fibreoptic tracheal intubation, but two of these were abandoned and converted to intravenous induction and general anaesthesia. Eleven had inhalational induction; two of these were also abandoned and converted to intravenous induction and general anaesthesia. Of those suspected as having a difficult airway, 28 (87.5%) subsequently had direct laryngoscopy where the laryngeal inlet was clearly visible. We found no good evidence that thyroid surgery patients with retrosternal goitre, with or without symptoms and signs of tracheal compression, present the experienced anaesthetist with an airway that cannot be managed using conventional techniques. This does not preclude the need for multidisciplinary discussion and planning. PMID:25342401

  13. Helicobacter pylori status among patients undergoing gastroscopy in rural northern Alberta

    PubMed Central

    Colmers-Gray, Isabelle N.; Vandermeer, Ben; Greidanus, Robert I.; Kolber, Michael R.

    2016-01-01

    Abstract Objective To determine the Helicobacter pylori status of patients who underwent gastroscopy. Design Retrospective chart review. Setting Peace River Community Health Centre in rural northwestern Alberta. Participants Data were collected from patients who had a gastroscopy performed by either of 2 family physicians between January 1, 2011, and December 31, 2012. Main outcome measures The proportion of patients who had positive test results for H pylori overall and among first-time gastroscopy patients. For first-time gastroscopy patients, the associations between H pylori infection and patient age, sex, residence, and procedural indications and findings were explored. Results A total of 251 gastroscopies were conducted in 229 unique patients during the study period. Overall, 12.4% (95% CI 8.3% to 16.4%) of patients had positive results for H pylori and among the 159 first-time gastroscopy patients, 17.6% (95% CI 11.7% to 23.5%) had positive test results for H pylori. Helicobacter pylori status did not differ significantly by geography, sex, or age. The prevalence of H pylori was higher among patients with H pylori–related indications for gastroscopy (such as dyspepsia and upper gastrointestinal tract bleeding) than among patients with other indications; however, H pylori infection was not statistically significantly greater in patients diagnosed with peptic ulcer disease. Conclusion The prevalence of H pylori infection among patients undergoing gastroscopy in rural northern Alberta appears lower than other Canadian estimates. In regions with low H pylori rates, patients with dyspepsia might be better served by acid suppression and nonsteroidal anti-inflammatory drug cessation before investigating for H pylori infection. Population-based research is required to further describe regional differences in H pylori rates. PMID:27629690

  14. Lung protective ventilation in patients undergoing major surgery: a systematic review incorporating a Bayesian approach

    PubMed Central

    Zhang, Zhongheng; Hu, Xiaoyun; Zhang, Xia; Zhu, Xiuqi; Chen, Liqian; Zhu, Li; Hu, Caibao; Du, Bin

    2015-01-01

    Objective Protective ventilation (PV) has been validated in patients with acute respiratory distress syndrome. However, the effect of PV in patients undergoing major surgery is controversial. The study aimed to explore the beneficial effect of PV on patients undergoing a major operation by systematic review and meta-analysis. Setting Various levels of medical centres. Participants Patients undergoing general anaesthesia. Interventions PV with low tidal volume. Primary and secondary outcome measures Study end points included acute lung injury (ALI), pneumonia, atelectasis, mortality, length of stay (LOS) in intensive care unit (ICU) and hospital. Methods Databases including PubMed, Scopus, EBSCO and EMBASE were searched from inception to May 2015. Search strategies consisted of terms related to PV and anaesthesia. We reported OR for binary outcomes including ALI, mortality, pneumonia, atelectasis and other adverse outcomes. Weighted mean difference was reported for continuous outcomes such as LOS in the ICU and hospital, pH value, partial pressure of carbon dioxide, oxygenation and duration of mechanical ventilation (MV). Main results A total of 22 citations were included in the systematic review and meta-analysis. PV had protective effect against the development of ALI as compared with the control group, with an OR of 0.41 (95% CI 0.19 to 0.87). PV tended to be beneficial with regard to the development of pneumonia (OR 0.46, 95% CI 0.16 to 1.28) and atelectasis (OR 0.68, 95% CI 0.46 to 1.01), but statistical significance was not reached. Other adverse outcomes such as new onset arrhythmia were significantly reduced with the use of PV (OR 0.47, 95% CI 0.48 to 0.93). Conclusions The study demonstrates that PV can reduce the risk of ALI in patients undergoing major surgery. However, there is insufficient evidence that such a beneficial effect can be translated to more clinically relevant outcomes such as mortality or duration of MV. Trial registration number The study

  15. Functional improvement in patients with idiopathic pulmonary fibrosis undergoing single lung transplantation *

    PubMed Central

    Rubin, Adalberto Sperb; Nascimento, Douglas Zaione; Sanchez, Letícia; Watte, Guilherme; Holand, Arthur Rodrigo Ronconi; Fassbind, Derrick Alexandre; Camargo, José Jesus

    2015-01-01

    Abstract Objective: To evaluate the changes in lung function in the first year after single lung transplantation in patients with idiopathic pulmonary fibrosis (IPF). Methods: We retrospectively evaluated patients with IPF who underwent single lung transplantation between January of 2006 and December of 2012, reviewing the changes in the lung function occurring during the first year after the procedure. Results: Of the 218 patients undergoing lung transplantation during the study period, 79 (36.2%) had IPF. Of those 79 patients, 24 (30%) died, and 11 (14%) did not undergo spirometry at the end of the first year. Of the 44 patients included in the study, 29 (66%) were men. The mean age of the patients was 57 years. Before transplantation, mean FVC, FEV1, and FEV1/FVC ratio were 1.78 L (50% of predicted), 1.48 L (52% of predicted), and 83%, respectively. In the first month after transplantation, there was a mean increase of 12% in FVC (400 mL) and FEV1 (350 mL). In the third month after transplantation, there were additional increases, of 5% (170 mL) in FVC and 1% (50 mL) in FEV1. At the end of the first year, the functional improvement persisted, with a mean gain of 19% (620 mL) in FVC and 16% (430 mL) in FEV1. Conclusions: Single lung transplantation in IPF patients who survive for at least one year provides significant and progressive benefits in lung function during the first year. This procedure is an important therapeutic alternative in the management of IPF. PMID:26398749

  16. Incidence and risk factors for infection in oral cancer patients undergoing different treatments protocols

    PubMed Central

    2012-01-01

    Background Over the past decade, advances in cancer treatments have been counterbalanced by a rising number of immunosuppressed patients with a multitude of new risk factors for infection. Hence, the aim of this study was to determine risk factors, infectious pathogens in blood and oral cavity of oral cancer patients undergoing different treatment procedures. Methods The present prospective cohort analysis was conducted on the patients undergoing treatment in the radiotherapy unit of Regional Cancer Institute, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, during the period of January 2007 to October 2009. Total 186 patients with squamous cell carcinoma of oral cavity were analyzed in the study. Based on treatment procedures patients were divided into three groups, group I were under radiotherapy, group II under chemotherapy and group III were of radio chemotherapy together. Clinical isolates from blood and oral cavity were identified by following general microbiological, staining and biochemical methods. The absolute neutrophile counts were done by following the standard methods. Results Prevalent bacterial pathogens isolated were Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, Proteus vulgaris and the fungal pathogens were Candida albicans, Aspergillus fumigatus. The predominant gram negative bacteria, Pseudomonas aeruginosa and Klebsiella pneumonia were isolated from blood of radiotherapy and oral cavity of chemotherapy treated cases respectively. The predominance of gram positive bacteria (Staphylococcus aureus and Staphylococcus epidermidis) were observed in blood of chemotherapy, radio chemotherapy cases and oral cavity of radiotherapy, radio chemotherapy treated cases. Our study also revealed the presence of C. albicans fungi as most significant oral cavity pathogens in radiotherapy and radio chemotherapy cases. Conclusion Gram positive bacteria and Gram

  17. Incidence and severity of atherosclerotic cardiovascular artery disease in patients undergoing TAVI.

    PubMed

    Fusini, Laura; Mirea, Oana; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Cefalù, Claudia; Ghulam Ali, Sarah; Maffessanti, Francesco; Andreini, Daniele; Pontone, Gianluca; Bartorelli, Antonio L; Alamanni, Francesco; Agrifoglio, Marco; Pepi, Mauro

    2015-06-01

    Transcatheter aortic valve implantation (TAVI) has extended the treatment options for severe, symptomatic aortic valve stenosis (AS). Risk factors for AS have been shown to be similar to atherosclerosis. Consequently, coronary artery disease (CAD), peripheral vascular and carotid artery diseases are often found concurrently with diagnostic, procedural and prognostic implications. This study sought to describe comprehensive vascular assessment in terms of prevalence, severity and correlations in TAVI candidates. A total of 323 patients (81 ± 6 years) undergoing TAVI were enrolled. Vascular pathologies were evaluated by invasive coronary angiography, computer-tomography (abdominal aorta, renal, iliac and femoral arteries), echo-color Doppler ultrasound (carotid artery), and transoesophageal echocardiography (thoracic aorta). CAD was found in 173 (54%) patients, of which 65 (38%) had 1-vessel, 45 (26%) 2-vessel and 59 (34%) 3-vessel disease. Carotid artery disease was present in 33.6% patients, of which 23.6% unilateral and 10.0% bilateral. Iliac, femoral and renal stenosis were found in 29.2%, 22.0%, and 4.7%, respectively. Cardiovascular risk factor and gender correlated with CAD. CAD patients presented more frequently with significant stenosis (luminal narrowing ≥ 50%) of at least one other district. Multi-districts significant stenosis stratified patients on long-term survival and the coexistence of 3-districts involvement with CAD negatively impacts on mortality. Multimodality imaging assessment shows that coronary, carotid, and peripheral artery disease are often found concurrently in patients undergoing TAVI. Several risk factors and gender correlate with the presence and severity of CAD and peripheral pathologies. Long-term mortality is increased in patients with a more compromised vascular situation. PMID:25805046

  18. Antithrombotic or Anti-Platelet Agents in Patients Undergoing Permanent Pacemaker Implantation

    PubMed Central

    Lee, Chang Kun; Yoo, Sang Yong; Hong, Man Yong

    2012-01-01

    Background and Objectives The growing implantations of electrophysiological devices in the context of increasing rates of chronic antithrombotic therapy in cardiovascular disease patients underscore the importance of an effective periprocedural prophylactic strategy for prevention of bleeding complications. We assessed the risk of significant bleeding complications in patients receiving anti-platelet agents or anticoagulants at the time of permanent pacemaker (PPM) implantation. Subjects and Methods We reviewed bleeding complications in patients undergoing PPM implantation. The use of aspirin or clopidogrel was defined as having taking drugs within 5 days of the procedure and warfarin was changed to heparin before the procedure. A significant bleeding complication was defined as a bleeding incident requiring pocket exploration or blood transfusion. Results Permanent pacemaker implantations were performed in 164 men and 96 women. The mean patient age was 73±11 years old. Among the 260 patients, 14 patients took warfarin (in all of them, warfarin was changed to heparin at least 3 days before procedure), 54 patients took aspirin, 4 patients took clopidogrel, and 25 patients took both. Significant bleeding complications occurred in 8 patients (3.1%), all of them were patients with heparin bridging (p<0.0001). Heparin bridging markedly increased the length of required hospital stay when compare with other groups and the 4 patients (1.5%) that underwent the pocket revision for treatment of hematoma. Conclusion This study suggests that hematoma formation after PPM implantation was rare, even among those who had taken the anti-platelet agents. The significant bleeding complications frequently occurred in patients with heparin bridging therapy. Therefore, heparin bridging therapy was deemed as high risk for significant bleeding complication in PPM implantation. PMID:22977449

  19. Usefulness of chewing gum for recovering intestinal function after cesarean delivery: A systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Huang, Hua-Ping; He, Mei

    2015-04-01

    Chewing gum has been reported to enhance bowel function. However, the efficacy remains unclear for women undergoing cesarean delivery. The aim of this meta-analysis is to evaluate the efficacy of chewing gum for recovering intestinal function following cesarean delivery in the early postoperative period. Electronic databases including MEDLINE, EMBASE, Cochrane Library were searched to identify English language randomized controlled trials comparing chewing gum with other procedures for promoting the recovery of intestinal function after cesarean delivery. Two of the authors independently extracted data from the eligibility studies, and Review Manager Version 5.2 was used to pool the data. Finally, five randomized controlled trials involving 882 patients were included and all the trials were considered as at high risk of bias. The pooled findings showed that chewing gum after cesarean delivery can significantly shorten the time to first flatus [standardized mean difference (SMD) = -0.73; 95% confidence interval (CI) = -1.01 to -0.14; p < 0.001]; time to first hearing of normal intestinal sounds (SMD = -0.69; 95% CI = -1.20 to -0.17; p = 0.009; I² = 92%). Time to the first defecation (SMD = -0.53; 95% CI = -1.61 to -0.07; p = 0.07; I² = 92%) and length of hospital stay (SMD = -0.59; 95% CI = -1.18 to 0.00; p = 0.05; I² = 93%) were also reduced in the chewing gum group; however, these results were not statistically significant. The current evidence suggests that chewing gum has a positive effect on intestinal function recovery following cesarean delivery in the early postoperative period. However, more large-scale and high-quality randomized controlled trials are needed to confirm these results. PMID:25951713

  20. [Clinical evaluation of hydrocolloidal dressing in 147 patients undergoing cardiovascular surgery].

    PubMed

    Ogawa, Mitsugu; Tsukui, H; Ishii, H; Yokoyama, S; Koh, E

    2005-07-01

    Recent evidence has suggested that a moist environment plays an important role in wound healing. Karayahesive, one type of hydrocolloidal dressing, contains natural karaya gum as a hydrophilic gel. We applied hydrocolloidal dressing to operative wounds in 147 patients who underwent cardiovascular surgery from April 2001 through August 2002 to evaluate its clinical usefulness. The dressing was kept on the wounds for 7 days after operation, but was immediately switched to conventional dressing with gauze if there was any problem. A total of 144 patients (98%) had no wound chest infections. Good wound healing was obtained with only 1 dressing, removed 7 days after operation, in 128 patients (87%). In 19 patients (13%), the hydrocolloidal dressing was switched to conventional dressing. In 13 of these patients the hydrocolloidal dressing dissolved naturally or exudation occurred; clinically, there were no local problems; however, 3 patients had infection, 2 had fat necrosis, and 1 had burn injury caused by electrocautery. No patients had skin problems caused by this dressing. We conclude that hydrocolloidal dressing can be used safely and effectively in patients undergoing cardiovascular surgery and reduce the workload of healthcare workers.

  1. [Conventional surgery versus endovascular surgery in a patient who undergoes an abdominal aorta aneurism. Nursing treatment].

    PubMed

    Espelosín Azpilicueta, M Dolores; Odériz Baquedano, M Arántzazu

    2006-06-01

    Patients diagnosed with an Abdominal Aorta Aneurism who undergo an operation using either conventional surgery or endovascular surgery require a series of different nursing treatment. The authors comparatively analyze nursing treatment applied to patients who have undergone an abdominal aorta aneurism according to the technique used; their study is retrospective, observational and comparative for all 61 patients who underwent an abdominal aorta aneurism in the Navarre Hospital in 2004. The authors describe both techniques, their advantages and inconveniences, and in a well-developed comparative manner, point out the differences in nursing treatment during post-operative care. Part of this study was presented in a poster format at the XVII National Congress on Vascular Nursing. PMID:16875361

  2. Group JK corynebacterium peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis.

    PubMed Central

    Pierard, D; Lauwers, S; Mouton, M C; Sennesael, J; Verbeelen, D

    1983-01-01

    We describe a case of peritonitis with isolation of a group JK corynebacterium from the peritoneal effluent in a patient undergoing continuous ambulatory peritoneal dialysis and treated with corticosteroids. Therapy with intraperitoneal vancomycin resulted in a rapid eradication of the organism. However, only 1 month after discontinuation of the 26-day therapy, a second episode of peritonitis with JK corynebacterium occurred. After vancomycin was restarted, the organism disappeared again from the peritoneal fluid, but the patient died a few days later from heart failure apparently unrelated to the infection. Some authors have mentioned the isolation of diphtheroids (without further identification) from peritoneal effluent of continuous ambulatory peritoneal dialysis patients, but to our knowledge, this is the first report of peritonitis associated with JK corynebacterium, an opportunistic organism that must be differentiated from other corynebacteria. PMID:6630457

  3. Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

    PubMed Central

    Jannati, Yadollah; Bagheri-Nesami, Masoumeh; Sohrabi, Maryam; Yazdani-Cherati, Jamshid; Mazdarani, Shahrzad

    2014-01-01

    Objective The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Method This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression) on SPSS software version 15. Results We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium. PMID:25337310

  4. The effects of cryoanalgesia combined with thoracic epidural analgesia in patients undergoing thoracotomy.

    PubMed

    Yang, M K; Cho, C H; Kim, Y C

    2004-11-01

    This study was performed to evaluate the effects of cryoanalgesia combined with thoracic epidural analgesia on pain and respiratory complications in patients undergoing thoracotomy. Ninety patients were prospectively randomised to epidural analgesia alone (n = 45) or epidural analgesia and cryoanalgesia combined (n = 45). We monitored the use of rescue pain medication and changes in forced vital capacity and forced expired volume in 1 s, and recorded pain and opioid-related side-effects during the immediate postoperative period. The incidence of post-thoracotomy pain and numbness were also assessed up to the sixth month after surgery. Cryoanalgesia combined with thoracic epidural analgesia was associated with earlier recovery in pulmonary function, less pain during movement and a lower daily requirement for rescue analgesia one week after surgery. However, the combination of cryoanalgesia and epidural analgesia failed to decrease the incidence of long-term pain and numbness. In view of its associated long-term morbidity, cryoanalgesia combined with thoracic epidural analgesia is not recommended for patients undergoing thoracotomy. PMID:15479314

  5. Value-based Clinical Quality Improvement (CQI) for Patients Undergoing Abdominal Wall Reconstruction.

    PubMed

    Stephan, Bradley; Ramshaw, Bruce; Forman, Brandie

    2015-05-01

    Patients with complex ventral/incisional hernias often undergo an abdominal wall reconstruction (AWR). These operations have a high cost of care and often result in a long hospital stay and high complication rates. Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a 3-year period. For consecutive cases of patients undergoing abdominal wall reconstruction, process improvement attempts included the use of a long-term resorbable synthetic mesh (TIGR® Resorbable Matrix, Novus Scientific, Uppsala, Sweden) in place of a biologic mesh, the use of the transversus abdominis release approach in place of an open or endoscopic component separation (external oblique release) technique, and the use of a preoperative transversus abdominis plane (TAP) block using a long-acting local anesthetic (Exparel®, Pacira Pharmaceutical, Parsippany, NJ) as a part of perioperative multi-modal pain management and an enhanced recovery program. After over 60 cases, improvement in materials costs and postoperative outcomes were documented. No mesh-related complications occurred and no mesh removal was required. In this real-world, value-based application of CQI, several attempts at process improvement led to decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral/incisional hernias. Value-based CQI could be a tool for improved health care value globally.

  6. Visual Performance in Patients with Neovascular Age-Related Macular Degeneration Undergoing Treatment with Intravitreal Ranibizumab

    PubMed Central

    Loughman, James; Nolan, John M.; Stack, Jim; Pesudovs, Konrad; Meagher, Katherine A.; Beatty, Stephen

    2013-01-01

    Purpose. To assess visual function and its response to serial intravitreal ranibizumab (Lucentis, Genentech) in patients with neovascular age-related macular degeneration (nv-AMD). Methods. Forty-seven eyes of 47 patients with nv-AMD, and corrected distance visual acuity (CDVA) logMAR 0.7 or better, undergoing intravitreal injections of ranibizumab, were enrolled into this prospective study. Visual function was assessed using a range of psychophysical tests, while mean foveal thickness (MFT) was determined by optical coherence tomography (OCT). Results. Group mean (±sd) MFT reduced significantly from baseline (233 (±59)) to exit (205 (±40)) (P = 0.001). CDVA exhibited no change between baseline and exit visits (P = 0.48 and P = 0.31, resp.). Measures of visual function that did exhibit statistically significant improvements (P < 0.05 for all) included reading acuity, reading speed, mesopic and photopic contrast sensitivity (CS), mesopic and photopic glare disability (GD), and retinotopic ocular sensitivity (ROS) at all eccentricities. Conclusion. Eyes with nv-AMD undergoing intravitreal ranibizumab injections exhibit improvements in many parameters of visual function. Outcome measures other than CDVA, such as CS, GD, and ROS, should not only be considered in the design of studies investigating nv-AMD, but also in treatment and retreatment strategies for patients with the condition. PMID:23533703

  7. Predictive and Prognostic Significance of Glutathione Levels and DNA Damage in Cervix Cancer Patients Undergoing Radiotherapy

    SciTech Connect

    Vidyasagar, Mamidipudi Srinivasa; Kodali, Maheedhar; Prakash Saxena, Pu

    2010-10-01

    Purpose: To assess the predictive significance of serum glutathione (GSH) and tumor tissue DNA damage in the treatment of cervical cancer patients undergoing chemoradiotherapy. Methods and Materials: This study included subjects undergoing hysterectomy (for normal cervix tissue) and cervical cancer patients who underwent conventional concurrent chemoradiotherapy (cisplatin once per week for 5 weeks with concurrent external radiotherapy of 2 Gy per fraction for 5 weeks, followed by two applications of intracavitary brachytherapy once per week after 2 weeks' rest). Blood was collected after two fractions, whereas both blood and tissues were collected after five fractions of radiotherapy in separate groups of subjects. Serum for total GSH content and tissues were processed for single-cell gel electrophoresis (SCGE) assay for DNA damage analysis. Clinical tumor radioresponse was assessed 2 months after the completion of treatment as complete responders (CR) (100% shrinkage), partial responders (PR) (>50%), and nonresponders (NR) (<50%). Results: Serum GSH content depleted significantly after a total dose of 4 Gy and 10 Gy of radiotherapy with a single dose of cisplatin, which was significantly lesser in NR than of CR patients. Similarly, Olive Tail Moment, the index of DNA damage, indicated significantly higher values in the fifth fraction of radiotherapy (5-RT) than in pretreatment. The DNA damage after 5-RT in the NR subgroup was significantly lower than that of CR. Conclusions: Serum GSH analysis and tumor tissue SCGE assay found to be useful parameters for predicting chemoradioresponse prior to and also at an early stage of treatment of cervical cancers.

  8. Cesarean section by maternal request.

    PubMed

    Câmara, Raphael; Burlá, Marcelo; Ferrari, José; Lima, Lana; Amim, Joffre; Braga, Antonio; Rezende, Jorge

    2016-01-01

    Cesarean section by maternal request is the one performed on a pregnant woman without medical indication and without contraindication to vaginal delivery. There is great controversy over requested cesarean section. Potential risks include complications in subsequent pregnancies, such as uterine rupture, placenta previa and accreta. Potential benefits of requested cesareans include a lower risk of postpartum hemorrhage in the first cesarean and fewer surgical complications compared with vaginal delivery. Cesarean section by request should never be performed before 39 weeks. RESUMO A cesariana a pedido materno é aquela realizada em uma gestante sem indicações médicas e sem contraindicação para tentativa do parto vaginal. Existe grande controvérsia sobre a realização da cesariana a pedido. Riscos potenciais da cesariana a pedido incluem complicações em gravidezes subsequentes, tais como: rotura uterina, placenta prévia e acretismo. Potenciais benefícios da cesariana a pedido englobam um menor risco de hemorragia pós-parto na primeira cesariana e menos complicações cirúrgicas quando comparada ao parto vaginal. A cesariana a pedido jamais deve ser realizada antes de 39 semanas.

  9. Cesarean section by maternal request.

    PubMed

    Câmara, Raphael; Burlá, Marcelo; Ferrari, José; Lima, Lana; Amim, Joffre; Braga, Antonio; Rezende, Jorge

    2016-01-01

    Cesarean section by maternal request is the one performed on a pregnant woman without medical indication and without contraindication to vaginal delivery. There is great controversy over requested cesarean section. Potential risks include complications in subsequent pregnancies, such as uterine rupture, placenta previa and accreta. Potential benefits of requested cesareans include a lower risk of postpartum hemorrhage in the first cesarean and fewer surgical complications compared with vaginal delivery. Cesarean section by request should never be performed before 39 weeks. RESUMO A cesariana a pedido materno é aquela realizada em uma gestante sem indicações médicas e sem contraindicação para tentativa do parto vaginal. Existe grande controvérsia sobre a realização da cesariana a pedido. Riscos potenciais da cesariana a pedido incluem complicações em gravidezes subsequentes, tais como: rotura uterina, placenta prévia e acretismo. Potenciais benefícios da cesariana a pedido englobam um menor risco de hemorragia pós-parto na primeira cesariana e menos complicações cirúrgicas quando comparada ao parto vaginal. A cesariana a pedido jamais deve ser realizada antes de 39 semanas. PMID:27679953

  10. Use of Dabigatran for Peri-Procedural Anticoagulation in Patients Undergoing Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Bassiouny, Mohamed; Saliba, Walid; Rickard, John; Shao, Mingyuan; Sey, Albert; Diab, Mariam; Martin, David O.; Hussein, Ayman; Khoury, Maurice; Abi-Saleh, Bernard; Alam, Samir; Sengupta, Jay; Borek, P. Peter; Baranowski, Bryan; Niebauer, Mark; Callahan, Thomas; Varma, Niraj; Chung, Mina; Tchou, Patrick J.; Kanj, Mohamed; Dresing, Thomas; Lindsay, Bruce D.; Wazni, Oussama

    2013-01-01

    Background Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is associated with a transient increased risk of thromboembolic and hemorrhagic events. We hypothesized that dabigatran can be safely used as an alternative to continuous warfarin for the peri-procedural anticoagulation in PVI. Methods and Results 999 consecutive patients undergoing PVI were included; 376 patients were on dabigatran (150 mg) and 623 were on warfarin with therapeutic INR. Dabigatran was held 1 to 2 doses prior to PVI and restarted at the conclusion of the procedure or as soon as patients were transferred to the nursing floor. Propensity score matching was applied to generate a cohort of 344 patients in each group with balanced baseline data. Total hemorrhagic and thromboembolic complications were similar in both groups, before (3.2% vs 3.9%; p = 0.59), and after (3.2% vs 4.1%; p = 0.53) matching. Major hemorrhage occurred in 1.1% vs 1.6% (p = 0.48) before, and 1.2% vs 1.5% (p = 0.74) after matching in the dabigatran vs warfarin group respectively. A single thromboembolic event occurred in each of the dabigatran and warfarin groups. Despite higher doses of intra-procedural heparin, the mean ACT was significantly lower in patients who held dabigatran for 1 or 2 doses than those on warfarin. Conclusions Our study found no evidence to suggest a higher risk of thromboembolic or hemorrhagic complications with use of dabigatran for peri-procedural anticoagulation in patients undergoing PVI compared to uninterrupted warfarin therapy. PMID:23553523

  11. Detailed Transthoracic and Transesophageal Echocardiographic Analysis of Mitral Leaflets in Patients Undergoing Mitral Valve Repair.

    PubMed

    Ghulam Ali, Sarah; Fusini, Laura; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Mapelli, Massimo; Zanobini, Marco; Alamanni, Francesco; Pepi, Mauro

    2016-07-01

    A recent histological study of resected scallop-P2 in mitral valve (MV) prolapse, showed that chordae tendinae may be missing or hidden in superimposed fibrous tissue of the leaflets, contributing to their thickening. This may have relevant clinical implication because detailed analysis of MV leaflets has a central role in the evaluation of patients undergoing repair. The aim of this study was to analyze MV leaflets focusing on thickness of prolapsing segments and the presence of chordal rupture (CR). We enrolled 246 patients (age 63 ± 13 years, 72 men) with isolated P2 prolapse and also 50 age-matched patients with normal MV anatomy as control group. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were retrospectively analyzed to quantify the length and the proximal and distal thickness of both anterior (A2) and posterior (P2) MV scallops. Measurements were performed at end diastole in the standard TTE and TEE views. TTE and TEE measurements were feasible in all cases. Echocardiographically 176 patients had CR (group A), 45 had no rupture (group B), and 25 had an uncertain diagnosis (group C). All pathological groups showed thickening and elongation of involved leaflets versus normal, whereas no differences in leaflets characteristics were found among MV groups. Most patients undergoing MV repair had CR with thickening of the prolapsed segment. These findings are in agreement with recent histological studies showing superimposed fibrous tissue on MV leaflets partially including ruptured chordae. This may also explain that in cases without ruptured chordae, thickness of the leaflets is markedly increased (hidden chordae?). In conclusion, detailed analysis of MV apparatus may further improve knowledge of these patients and may influence surgical timing. PMID:27184171

  12. Hypovitaminosis D in Patients Undergoing Shoulder Arthroplasty: A Single-Center Analysis.

    PubMed

    Inkrott, Bradley P; Koberling, Jessica L; Noel, Curtis R

    2016-07-01

    Vitamin D is recognized as an essential component in bone health, muscle function, and immune system regulation. This study sought to characterize the prevalence of hypovitaminosis D in patients undergoing total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), and shoulder hemiarthroplasty (HA). Between September 2013 and December 2014, a total of 218 patients undergoing TSA, RSA, and HA by a single surgeon were screened for hypovitaminosis D and retrospectively reviewed. Demographic variables and risk factors were recorded. Overall, 93 shoulder arthroplasty patients (43%) were vitamin D insufficient (<30 ng/mL) and 24 patients (11%) were vitamin D deficient (<20 ng/mL). Body mass index (BMI) had a significant effect on vitamin D levels; BMI of 30 kg/m(2) or greater was associated with lower vitamin D levels (31.5±12.1 ng/mL) compared with patients with a BMI of less than 30 kg/m(2) (36.2±15.7 ng/mL, P ≤.01). The absence of supplementation with vitamin D and calcium prior to serum testing was the most significant risk factor for hypovitaminosis D (odds ratio [OR], 8.234, P<.001). Age, gender, race, smoking status, American Society of Anesthesiologists (ASA) score, procedure, and surgical indication were not significant. This is the largest cohort of shoulder arthroplasty patients screened for hypovitaminosis D. Almost half (43%) of the study population was insufficient, and both the absence of supplementation prior to serum testing and BMI of 30 kg/m(2) or greater were found to be predictive of lower serum 25-hydroxyvitamin D levels. Given the extent of vitamin D involvement in normal musculoskeletal physiology, routine preoperative evaluation is merited. [Orthopedics. 2016; 39(4):e651-e656.]. PMID:27286046

  13. Documentation of various approaches and outcomes in patients on warfarin undergoing dental procedures: a review article

    PubMed Central

    Shaer, Fayez El; Raslan, Ismael; Osaimi, Nora Al; Bawazeer, Ghada; Alayobi, Fhakr; Alhogbani, Tarek; Kharabsheh, Suliman; Habeeb, Walid Al

    2016-01-01

    Appropriate management of patients with mechanical prosthetic valves on warfarin during dental procedures is crucial. If the patients continue warfarin, they might develop bleeding, while interruption of therapy can cause thromboembolic events. Bridging therapy (mostly heparin) is used in some patients, while others stop medications. There is no unifying protocol. Information on management of patients on warfarin undergoing dental procedures in Saudi Arabia is lacking. Therefore, the current study aimed to provide more insight into various approaches utilized by clinicians to deal with such patients at a large teaching hospital in Riyadh, and to evaluate the frequency and severity of bleeding and thromboembolic complications during different types of dental procedures in this population. This was a cohort study. Patient records were used to collect data on peri-procedural management of patients on warfarin, continuation or interruption of warfarin therapy, as well as bleeding and thromboembolic complications. Fifty medical records were reviewed from March to October 2012. Regarding management, 10% had no proper documentation, 74% underwent bridging therapy, 12% discontinued warfarin therapy, and 4% continued warfarin. Of the patients, 31% had minor bleeding (15% in patients on bridging therapy and 16% in patients continuing warfarin). Thromboembolic complications were documented in 4%, (2% in those on bridging therapy and 2% in those discontinuing warfarin). Patients on bridging therapy (heparin) were admitted to the hospital for a mean of five days, and none of the other patients were admitted. Adopting the protocol to continue warfarin caused bleeding tendency that was controlled with the usual measures, with more cost effectiveness, and no thromboembolic risks. PMID:27679745

  14. Documentation of various approaches and outcomes in patients on warfarin undergoing dental procedures: a review article

    PubMed Central

    Shaer, Fayez El; Raslan, Ismael; Osaimi, Nora Al; Bawazeer, Ghada; Alayobi, Fhakr; Alhogbani, Tarek; Kharabsheh, Suliman; Habeeb, Walid Al

    2016-01-01

    Appropriate management of patients with mechanical prosthetic valves on warfarin during dental procedures is crucial. If the patients continue warfarin, they might develop bleeding, while interruption of therapy can cause thromboembolic events. Bridging therapy (mostly heparin) is used in some patients, while others stop medications. There is no unifying protocol. Information on management of patients on warfarin undergoing dental procedures in Saudi Arabia is lacking. Therefore, the current study aimed to provide more insight into various approaches utilized by clinicians to deal with such patients at a large teaching hospital in Riyadh, and to evaluate the frequency and severity of bleeding and thromboembolic complications during different types of dental procedures in this population. This was a cohort study. Patient records were used to collect data on peri-procedural management of patients on warfarin, continuation or interruption of warfarin therapy, as well as bleeding and thromboembolic complications. Fifty medical records were reviewed from March to October 2012. Regarding management, 10% had no proper documentation, 74% underwent bridging therapy, 12% discontinued warfarin therapy, and 4% continued warfarin. Of the patients, 31% had minor bleeding (15% in patients on bridging therapy and 16% in patients continuing warfarin). Thromboembolic complications were documented in 4%, (2% in those on bridging therapy and 2% in those discontinuing warfarin). Patients on bridging therapy (heparin) were admitted to the hospital for a mean of five days, and none of the other patients were admitted. Adopting the protocol to continue warfarin caused bleeding tendency that was controlled with the usual measures, with more cost effectiveness, and no thromboembolic risks.

  15. Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section

    PubMed Central

    Cohen, Shaul; Chhokra, Renu; Stein, Mark H; Denny, John T; Shah, Shruti; Mohiuddin, Adil; Naftalovich, Rotem; Zhao, Rong; Pashkova, Anna; Rolleri, Noah; Patel, Arpan G; Hunter-Fratzola, Christine W

    2015-01-01

    Background and Aims: We aimed to determine the ropivacaine concentration that provided adequate analgesia with early ambulation and minimal urinary retention or other side-effects when used with fentanyl and epinephrine for patient-controlled epidural analgesia (PCEA) after elective cesarean section. Material and Methods: Forty-eight patients were randomized to four groups in a double-blinded fashion. All groups received an initial 10 ml/h of epidural study solution for 24 h. The solution contained: 0.2, 0.1, 0.05, or 0.025% ropivacaine for Groups I-IV, respectively, with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml. Patients could administer additional PCEA doses of 4 ml of their study solution with a lock-out time of 10 min. Overall satisfaction, side-effects, motor block, neurologic function, and pain using Visual Analog Scale were assessed. Results: Patients in all groups showed no difference in sedation, pruritus, nausea, vomiting, and uterine cramps. Pain scores at rest were lower for Group IV than Groups I-III (P < 0.001). Twelve, five, one, and zero patients could not ambulate in Groups I-IV, respectively. Nine, nine, two, and zero (III patients reported urinary retention in Groups I-IV, respectively. Overall satisfaction scores were high for all groups. Neonatal behavior score was similar and high in all groups. Conclusion: 0.025% ropivacaine PCEA combined with fentanyl and epinephrine provided effective pain relief after cesarean section with early ambulation and without sensory loss, urinary retention, or increase of side-effects. PMID:26702203

  16. Incidence of urinary tract infection in patients without bacteriuria undergoing SWL: comparison of stone types.

    PubMed

    Dinçel, C; Ozdiler, E; Ozenci, H; Tazici, N; Koşar, A

    1998-02-01

    Extracorporeal shockwave lithotripsy (SWL) currently is accepted as the preferred treatment for most renal and upper ureteral calculi. However, little is known about the infection risks of SWL. In this study, the incidence and severity of urinary tract infection in 117 patients with renal calculi undergoing SWL were evaluated and the stone characteristics of those with and without infection were compared. The patients were followed clinically and bacteriologically 1 and 14 days after the procedure. Bacteriuria was noted in six patients within 24 hours after SWL. No bacteriuria was noted 2 weeks later. Of these patients, three were symptomatic (including dysuria, burning, and fever >38 degrees C). No patient was hospitalized. We found no significant correlation between the occurrence of bacteriuria and the number or size of the stones (P > 0.05), nor was there any correlation between bacteriuria and the stone-free rate or the location of the calculi (P > 0.05). However, there was a significantly higher risk of urinary tract infection in patients with struvite stones than in those with other types of stones (17.3% v 2.1%). In patients with infection stones, prophylactic antimicrobial chemotherapy is necessary even if bacteriuria is not present before SWL.

  17. 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

  18. Serum N-Glycan Profiling Predicts Prognosis in Patients Undergoing Hemodialysis

    PubMed Central

    Amano, Maho; Tobisawa, Yuki; Yoneyama, Tohru; Tsushima, Megumi; Hirose, Kazuko; Yoneyama, Takahiro; Hashimoto, Yasuhiro; Koie, Takuya; Saitoh, Hisao; Yamaya, Kanemitsu; Funyu, Tomihisa; Nishimura, Shin-Ichiro; Ohyama, Chikara

    2013-01-01

    Background. The aim of this study is to evaluate the usefulness of serum N-glycan profiling for prognosis in hemodialysis patients. Methods. Serum N-glycan analysis was performed in 100 hemodialysis patients in June 2008 using the glycoblotting method, which allows high-throughput, comprehensive, and quantitative N-glycan analysis. All patients were longitudinally followed up for 5 years. To evaluate the independent predictors for prognosis, patients' background, blood biochemistry, and N-glycans intensity were analyzed using Cox regression multivariate analysis. Selected N-glycans and independent factors were evaluated using the log-rank test with the Kaplan-Meier method to identify the predictive indicators for prognosis. Each patient was categorized according to the number of risk factors to evaluate the predictive potential of the risk criteria for prognosis. Results. In total, 56 N-glycan types were identified in the hemodialysis patients. Cox regression multivariate analysis showed cardiovascular events, body mass index, maximum intima media thickness, and the serum N-glycan intensity of peak number 49 were predictive indicators for overall survival. Risk classification according to the number of independent risk factors revealed significantly poor survival by increasing the number of risk factors. Conclusions. Serum N-glycan profiling may have a potential to predict prognosis in patients undergoing hemodialysis. PMID:24453820

  19. The Effects of Diabetes Mellitus in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

    PubMed Central

    Han, Jinsong; Liu, Tao; Yang, Zhonglu; Jiang, Hui

    2016-01-01

    Objective. To investigate the effects of diabetes mellitus (DM) in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Method. A total of 728 patients with DM and 1380 patients without DM who underwent OPCAB treatment from March 2012 to April 2015 were reviewed. The effects of DM on intraoperative variables and postoperative complications were determined using propensity score analysis. Results. Two well-matched subgroups were selected using propensity score analysis (DM = 728, no-DM = 728) to compare the perioperative outcome. The duration of the ICU stay, in hours (55.2 ± 53.0 versus 49.29 ± 51.30, P < 0.05), postoperative new-onset atrial fibrillation (20.9% versus 14.97%, P < 0.05), and postoperative infection (9.2% versus 4.67%, P < 0.05) were greater in DM patients, as indicated by univariate analysis. Conclusion. OPCAB was found to be effective in DM patients, but postoperative infection and postoperative new-onset atrial fibrillation were found to be more likely to occur in DM patients than in other patients. DM was found to be a powerful risk factor for postoperative infection and postoperative new-onset atrial fibrillation. PMID:27777946

  20. Preprocedural Coagulation Studies in Pediatric Patients Undergoing Percutaneous Intervention for Appendiceal Abscesses.

    PubMed

    Farach, Sandra M; Danielson, Paul D; Chandler, Nicole M

    2015-09-01

    The literature reports poor correlation between coagulation screening and prediction of bleeding risk in children. Our aim is to determine whether there is a role for coagulation studies in children undergoing percutaneous intervention for appendiceal abscesses. A retrospective review of 1805 patients presenting with a diagnosis of appendicitis from September 2008 to September 2013 was performed. Patients presenting with appendiceal abscess who underwent percutaneous intervention were selected for further review (n = 131). A total of 76 patients (58%) had normal coagulation studies, whereas 55 (42%) had elevated values. An international normalized ratio ≥ 1.3 was found in 26 patients. Patients with normal coagulation values had an incidence of bleeding of 1.3 per cent. In the abnormal coagulation group, 8 patients received fresh frozen plasma before intervention, whereas 47 did not. There was one hematoma noted in each group with an incidence of bleeding of 3.6 per cent. The overall incidence of hematoma was 2.3 per cent with no significant difference in bleeding risk between the normal and abnormal coagulation groups. In conclusion, although many patients are found to have elevated coagulation studies, most do not have bleeding complications after intervention. There is poor correlation between coagulation screening and postprocedural outcomes evidenced by the low risk of bleeding.

  1. Animal-Assisted Therapy for Patients Undergoing Treatment at NIH Clinical Center | NIH MedlinePlus the Magazine

    MedlinePlus

    ... page please turn JavaScript on. Feature: Therapy Dogs Animal-Assisted Therapy for Patients Undergoing Treatment at NIH ... is unlike any other." A self-described "huge animal lover," she coordinates 14 teams of trained and ...

  2. Perioperative Management of Patients on Clopidogrel (Plavix) Undergoing Major Lung Resection

    PubMed Central

    Ceppa, DuyKhanh P.; Welsby, Ian J.; Wang, Tracy Y.; Onaitis, Mark W.; Tong, Betty C.; Harpole, David H.; D’Amico, Thomas A.; Berry, Mark F.

    2014-01-01

    BACKGROUND Management of patients requiring antiplatelet therapy with clopidogrel (Plavix) and major lung resection must balance the risks of bleeding and cardiovascular events. We reviewed our experience with patients treated with clopidogrel perioperatively to examine outcomes, including results of a new strategy for high-risk patients. METHODS Patients who underwent major lung resection and received perioperative clopidogrel between January 2005 and September 2010 were reviewed. Initially, clopidogrel management consisted of discontinuation approximately 5 days before surgery and resumption immediately after surgery. Following July 2010, high-risk patients (drug-eluting coronary stent placement within prior year or previous coronary event after clopidogrel discontinuation) were admitted 2–3 days preoperatively and bridged with the intravenous GP IIb/IIIa receptor inhibitor eptifibatide (Integrilin) according to a multidisciplinary cardiology/anesthesiology/thoracic surgery protocol. Outcomes were compared to control patients (matched for preoperative risk factors and extent of pulmonary resection) who did not receive perioperative clopidogrel. RESULTS Fifty-four patients who had major lung resection between January 2005 and September 2010 and received clopidogrel perioperatively were matched with 108 controls. Both groups had similar mortality, postoperative length of stay, and no differences in the rates of perioperative transfusions, reoperations for bleeding, myocardial infarctions, and strokes. Seven of the 54 clopidogrel patients were admitted preoperatively for an eptifibatide bridge. Two of these patients received perioperative transfusions, but there were no mortalities, reoperations, myocardial infarctions, or stroke. CONCLUSIONS Patients taking clopidogrel can safely undergo major lung resection. Treatment with an eptifibatide bridge may minimize the risk of cardiovascular events in higher risk patients. PMID:21978871

  3. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery?

    PubMed Central

    Ogutu, Peter; Werner, Raphael; Oertel, Frank; Beyer, Michael

    2014-01-01

    A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether patients with severe asymptomatic carotid and coronary artery diseases should undergo simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). A total of 624 papers were found using the reported search, of which 20 represent the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study results of these papers are tabulated. Previous cohort studies showed mixed results, while advocating for the necessity of a randomized controlled trial (RCT). A recent RCT showed that patients undergoing prophylactic or simultaneous CEA + CABG had lower rates of stroke (0%) compared with delayed CEA 1–3 months after CABG (7.7%), without significant perioperative mortality difference. This study included patients with unilateral severe (>70%) asymptomatic carotid stenosis requiring CABG. An earlier partly randomized trial also showed better outcomes for patients undergoing simultaneous procedures (P = 0.045). Interestingly, systematic reviews previously failed to show compelling evidence supporting prophylactic CEA. This could be partly due to the fact that these reviews collectively analyse different cohort qualities. Neurological studies have, however, shown reduced cognitive and phonetic quality and function in patients with unilateral and bilateral asymptomatic carotid artery stenosis. Twenty-one RCTs comparing lone carotid artery stenting (CAS) and CEA informed the American Heart Association guidelines, which declared CAS comparable with CEA for symptomatic and asymptomatic carotid stenosis (CS). However, the risk of death/stroke for CAS alone is double that for CEA alone in the acute phase following onset of symptoms, while CEA alone is associated with a doubled risk of myocardial infarction. There is

  4. Knowledge of blood loss at delivery among postpartum patients

    PubMed Central

    Miller, Claire M.; Ramachandran, Bharathi; Hegde, Priya; Akbar, Kulsum; Goodnough, Lawrence Tim; Butwick, Alexander J.

    2016-01-01

    Background Postpartum hemorrhage (PPH) is a leading cause of obstetric morbidity. There is limited understanding of patients’ knowledge about blood loss at delivery, PPH, and PPH-related morbidities, including transfusion and anemia. Methods We surveyed 100 healthy postpartum patients who underwent vaginal or cesarean delivery about blood loss, and whether they received information about transfusion and peripartum hemoglobin (Hb) testing. Responses were compared between women undergoing vaginal delivery vs. cesarean delivery; P < 0.05 considered as statistically significant. Results In our cohort, 49 women underwent vaginal delivery and 51 women underwent cesarean delivery. Only 29 (29%) of women provided blood loss estimates for their delivery. Women who underwent cesarean delivery were more likely to receive clear information about transfusion therapy than those undergoing vaginal delivery (43.1% vs. 20.4% respectively; P = 0.04). Women who underwent vaginal delivery were more likely to receive results of postpartum Hb tests compared to those undergoing cesarean delivery (49% vs. 29.4%; P = 0.02). Conclusion Our findings suggest that women are poorly informed about the magnitude of blood loss at delivery. Hematologic information given to patients varies according to mode of delivery. Further research is needed to better understand the clinical implications of patients’ knowledge gaps about PPH, transfusion and postpartum anemia.

  5. Knowledge of blood loss at delivery among postpartum patients

    PubMed Central

    Miller, Claire M.; Ramachandran, Bharathi; Hegde, Priya; Akbar, Kulsum; Goodnough, Lawrence Tim; Butwick, Alexander J.

    2016-01-01

    Background Postpartum hemorrhage (PPH) is a leading cause of obstetric morbidity. There is limited understanding of patients’ knowledge about blood loss at delivery, PPH, and PPH-related morbidities, including transfusion and anemia. Methods We surveyed 100 healthy postpartum patients who underwent vaginal or cesarean delivery about blood loss, and whether they received information about transfusion and peripartum hemoglobin (Hb) testing. Responses were compared between women undergoing vaginal delivery vs. cesarean delivery; P < 0.05 considered as statistically significant. Results In our cohort, 49 women underwent vaginal delivery and 51 women underwent cesarean delivery. Only 29 (29%) of women provided blood loss estimates for their delivery. Women who underwent cesarean delivery were more likely to receive clear information about transfusion therapy than those undergoing vaginal delivery (43.1% vs. 20.4% respectively; P = 0.04). Women who underwent vaginal delivery were more likely to receive results of postpartum Hb tests compared to those undergoing cesarean delivery (49% vs. 29.4%; P = 0.02). Conclusion Our findings suggest that women are poorly informed about the magnitude of blood loss at delivery. Hematologic information given to patients varies according to mode of delivery. Further research is needed to better understand the clinical implications of patients’ knowledge gaps about PPH, transfusion and postpartum anemia. PMID:27635332

  6. Low-dose adjunctive cilostazol in patients with complex lesions undergoing percutaneous coronary intervention.

    PubMed

    Zheng, Xin-Tian; Chen, Kang-Yin; Liu, Tong; Xu, Ling-Xia; Che, Jing-Jin; Rha, Seung-Woon; Li, Guang-Ping

    2016-01-01

    Patients with complex coronary lesions undergoing percutaneous coronary intervention (PCI) have more major adverse cardiac events (MACE) than do those with simpler cases. Therefore, intensive antiplatelet therapy might be needed in these patients. A total of 127 patients with complex lesions undergoing PCI in the Second Hospital of Tianjin Medical University from October 2012 to April 2014 were randomized to receive either dual (aspirin plus clopidogrel, DAPT, n = 66), or triple antiplatelet therapy (aspirin plus clopidogrel plus cilostazol; TAPT, n = 61). Patients in the TAPT group received low-dose cilostazol (100 mg loading, followed with 50 mg twice per day) for 3-6 months. The primary endpoint was composite MACE. The complex coronary target lesions were defined as at least one of the following: left main disease; severe 3-vessel disease; chronic total occlusion lesions; true bifurcation lesion; ostial lesions; severe calcified lesions; and highly thrombotic lesions. The two groups had similar baseline clinical and angiographic characteristics. One-year clinical outcomes showed that the TAPT group had significantly lower incidences of myocardial infarction (1.6% vs 13.6%, P = 0.018) and MACE (1.6% vs 16.7%, P = 0.004) than DAPT group. The DAPT group had two cases of stent thrombosis, while the TAPT group did not. Furthermore, adjunctive low-dose cilostazol didn't significantly increase the incidence of bleeding events (26.2% vs 19.7%, P = 0.381) regardless of major (4.9% vs 4.5%, P = 0.921) or minor (21.3% vs 15.2%, P = 0.368) bleeding events. In conclusion, low-dose adjunctive cilostazol seems superior to dual antiplatelet therapy in reducing recurrent ischemic events in patients with complex coronary lesions and the two test groups have a similar incidence of bleeding events.

  7. The Influence of Perioperative Dexmedetomidine on Patients Undergoing Cardiac Surgery: A Meta-Analysis

    PubMed Central

    Geng, Jun; Qian, Ju; Cheng, Hao; Ji, Fuhai; Liu, Hong

    2016-01-01

    Background The use of dexmedetomidine may have benefits on the clinical outcomes of cardiac surgery. We conducted a meta-analysis comparing the postoperative complications in patients undergoing cardiac surgery with dexmedetomidine versus other perioperative medications to determine the influence of perioperative dexmedetomidine on cardiac surgery patients. Methods Randomized or quasi-randomized controlled trials comparing outcomes in patients who underwent cardiac surgery with dexmedetomidine, another medication, or a placebo were retrieved from EMBASE, PubMed, the Cochrane Library, and Science Citation Index. Results A total of 1702 patients in 14 studies met the selection criteria among 1,535 studies that fit the research strategy. Compared to other medications, dexmedetomidine has combined risk ratios of 0.28 (95% confidence interval [CI] 0.15, 0.55, P = 0.0002) for ventricular tachycardia, 0.35 (95% CI 0.20, 0.62, P = 0.0004) for postoperative delirium, 0.76 (95% CI 0.55, 1.06, P = 0.11) for atrial fibrillation, 1.08 (95% CI 0.74, 1.57, P = 0.69) for hypotension, and 2.23 (95% CI 1.36, 3.67, P = 0.001) for bradycardia. In addition, dexmedetomidine may reduce the length of intensive care unit (ICU) and hospital stay. Conclusions This meta-analysis revealed that the perioperative use of dexmedetomidine in patients undergoing cardiac surgery can reduce the risk of postoperative ventricular tachycardia and delirium, but may increase the risk of bradycardia. The estimates showed a decreased risk of atrial fibrillation, shorter length of ICU stay and hospitalization, and increased risk of hypotension with dexmedetomidine. PMID:27049318

  8. Electrical Impedance Tomography-guided PEEP Titration in Patients Undergoing Laparoscopic Abdominal Surgery

    PubMed Central

    He, Xingying; Jiang, Jingjing; Liu, Yuli; Xu, Haitao; Zhou, Shuangqiong; Yang, Shibo; Shi, Xueyin; Yuan, Hongbin

    2016-01-01

    Abstract The aim of the study is to utilize electrical impedance tomography (EIT) to guide positive end-expiratory pressure (PEEP) and to optimize oxygenation in patients undergoing laparoscopic abdominal surgery. Fifty patients were randomly assigned to the control (C) group and the EIT (E) group (n = 25 each). We set the fraction of inspired oxygen (FiO2) at 0.30. The PEEP was titrated and increased in a 2-cm H2O stepwise manner, from 6 to 14 cm H2O. Hemodynamic variables, respiratory mechanics, EIT images, analysis of blood gas, and regional cerebral oxygen saturation were recorded. The postoperative pulmonary complications within the first 5 days were also observed. We chose 10 cm H2O and 8 cm H2O as the “ideal” PEEP for the C and the E groups, respectively. EIT-guided PEEP titration led to a more dorsal shift of ventilation. The PaO2/FiO2 ratio in the E group was superior to that in the C group in the pneumoperitoneum period, though the difference was not significant (330 ± 10 vs 305.56 ± 4 mm Hg; P = 0.09). The C group patients experienced 8.7% postoperative pulmonary complications versus 5.3% among the E group patients (relative risk 1.27, 95% confidence interval 0.31–5.3, P = 0.75). Electrical impedance tomography represents a new promising technique that could enable anesthesiologists to assess regional ventilation of the lungs and optimize global oxygenation for patients undergoing laparoscopic abdominal surgery. PMID:27057904

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

    PubMed Central

    Rahimipour, Meisam; Shahgholian, Nahid; Yazdani, Mohsen

    2015-01-01

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

  10. Serotonergic antidepressants and increased bleeding risk in patients undergoing breast biopsy

    PubMed Central

    Mahdanian, Artin A.; Looper, Karl J.; Bacon, Simon L.; Mesurolle, Benoit; Meterissian, Sarkis H.; Rej, Soham

    2015-01-01

    Objectives: Recent investigations have shown that serotonergic antidepressant (SAd) use may increase the risk of peri-operative bleeding events. Our objective was to evaluate the possibility of a similar association in patients undergoing radiologic breast biopsies. Methods: We used data from 3890 patients undergoing 6300 biopsy procedures between January 2011 and October 2014 in the Breast Clinic of McGill University Health Centre, Montreal, Canada. In this case-control study, cases were patients reported to have abnormal bleeding during their biopsy by board-certified radiologists. A control group of nonbleeders was selected using matching according to age and type of biopsy. The correlation between abnormal bleeding and SAd use was assessed using bivariate and multivariate statistical analyses. Results: There were 97 patients with abnormal bleeding and 137 matched controls; 10 bleeders (cases) were on SAds (7 citalopram, 3 paroxetine) while only 1 nonbleeder (control group) was on a SAd (low-dose sertraline, 25 mg/day). SAds were significantly associated with increased bleeding risk (10.3% versus 0.7%, Fisher’s Exact p = 0.001). Moreover, after adjusting for confounding factors (age, type of biopsy, size of biopsy, needle caliber, pathology result and nonsteroidal anti-inflammatory drug use, multivariate logistic regression confirmed that SAds were associated with elevated bleeding risk (16.2, 95% confidence interval 1.87–140.1, p = 0.01). Conclusions: This is the first study demonstrating increased bleeding events in breast biopsy patients using SAds. Clinicians should be aware that SAds may be associated with peri-operative bleeding risk, even in relatively minor procedures such as breast biopsies. PMID:26834966

  11. Youssef's Syndrome following Cesarean Section

    PubMed Central

    Birge, Ozer; Ozbey, Ertugrul Gazi; Erkan, Mustafa Melih; Arslan, Deniz; Kayar, Ilkan

    2015-01-01

    Youssef's syndrome is characterized by cyclic hematuria (menouria), absence of vaginal bleeding (amenorrhea), and urinary incontinence due to vesicouterine fistula (VUF), the least common of the urogynecological fistulas. Youssef's syndrome has a variable clinical presentation. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be appropriate in some cases, but surgery is the definitive treatment. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section. Diagnostic tests as well as necessary appropriate surgery should be performed on cases with suspected vesicouterine fistula. We present a 40-year-old multiparous woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence, hematuria, and amenorrhea 1 year after the birth. Here, we discuss our case with the help of previously published studies found in the literature. PMID:26457214

  12. Outcomes of gynecologic oncology patients undergoing robotic-assisted laparoscopic procedures in a university setting.

    PubMed

    Walters Haygood, Christen L; Fauci, Janelle M; Huddleston-Colburn, Mary Katherine; Huh, Warner K; Straughn, J Michael

    2014-09-01

    This study evaluated intraoperative complications and postoperative outcomes of gynecologic oncology patients undergoing robotic-assisted (RA) laparoscopic procedures in a university setting. A retrospective chart review evaluated all gynecologic oncology patients at the University of Alabama at Birmingham who underwent attempted RA procedures between August 2006 and October 2011. Patient demographics, medical/surgical history, intraoperative complications, postoperative outcomes, conversion rates, readmission rates, and length of stay were examined. Total complication rates were assessed over time for each surgeon. 681 patients underwent planned RA procedures by seven gynecologic oncologists. The mean body mass index was 33.5 kg/m(2) (range 16.6-71.0 kg/m(2)). 61.4 % were diagnosed with malignancy. The most common procedure was RA hysterectomy with unilateral/bilateral salpingo-oophorectomy (37.2 %). Robotic staging was performed in 291 patients (45.1 %). Mean estimated blood loss was 75 ml (range 5-700 ml). 36 patients (5.3 %) were converted to laparotomy. The most common reason for conversion was adhesions (30.1 %), followed by uterine size (22.2 %). In 107 cases, a surgical modification was required for specimen removal including mini-laparotomy (24), extension of accessory port (36), morcellation (9), and difficult vaginal delivery (38). 3.7 % had intraoperative complications; 6 patients had a cystotomy and 5 had a vascular injury. Postoperatively, 20 patients had a febrile episode, 9 had wound complications, and 3 had a vaginal cuff dehiscence. 27 (4.2 %) patients were readmitted within 30 days. Complication rates and conversion rates were similar per surgeon. Total complication rates for evaluable surgeons were similar between the first 10 cases and subsequent 50 cases. Although patients undergoing RA procedures in a university setting are high risk, the conversion rate to laparotomy is low and intraoperative and postoperative complications are

  13. Thyroid Function, Prevalent Coronary Heart Disease, and Severity of Coronary Atherosclerosis in Patients Undergoing Coronary Angiography

    PubMed Central

    Ling, Yan; Jiang, Jingjing; Gui, Minghui; Liu, Lin; Aleteng, Qiqige; Wu, Bingjie; Wang, Shanshan; Liu, Xiaojing; Gao, Xin

    2015-01-01

    This study investigated if free T4 and TSH concentrations or thyroid function categories were associated with prevalent CHD and the severity of coronary atherosclerosis in a population undergoing coronary angiography. This was a cross-sectional study including 1799 patients who were consecutively admitted and underwent coronary angiography. We evaluated the severity of coronary atherosclerosis using Gensini score. In the entire study population, free T4 level was inversely associated with prevalent CHD (OR = 0.95, 95% CI 0.91–0.99, P = 0.01) and the natural log-transformed Gensini score (ln(Gensini score)) (β = −0.03, 95% CI −0.05–−0.01, P = 0.005). The odds of CHD increased gradually across hyperthyroidism, subclinical hypothyroidism, and overt hypothyroidism groups using the euthyroid group as the reference, and the trend is borderline significant (P for trend = 0.051). When comparing to the euthyroid group, ln(Gensini score) of the overt hypothyroidism group was significantly higher (P = 0.009), but the trend was not significant (P for trend = 0.08). A significant association of thyroid function with CHD or ln(Gensini score) in euthyroid patients was not observed. The present study demonstrated an association of thyroid function with prevalent CHD and the severity of coronary atherosclerosis in a population undergoing coronary angiography. However, this association was not observed in euthyroid individuals. PMID:26770196

  14. Liver Manipulation Causes Hepatocyte Injury and Precedes Systemic Inflammation in Patients Undergoing Liver Resection

    PubMed Central

    Derikx, Joep P. M.; Buurman, Wim A.; Peters, Wilbert H. M.; Roelofs, Hennie M. J.; Wigmore, Stephen J.; Dejong, Cornelis HC

    2007-01-01

    Background Liver failure following liver surgery is caused by an insufficient functioning remnant cell mass. This can be due to insufficient liver volume and can be aggravated by additional cell death during or after surgery. The aim of this study was to elucidate the causes of hepatocellular injury in patients undergoing liver resection. Methods Markers of hepatocyte injury (AST, GSTα, and L-FABP) and inflammation (IL-6) were measured in plasma of patients undergoing liver resection with and without intermittent inflow occlusion. To study the separate involvement of the intestines and the liver in systemic L-FABP release, arteriovenous concentration differences for L-FABP were measured. Results During liver manipulation, liver injury markers increased significantly. Arterial plasma levels and transhepatic and transintestinal concentration gradients of L-FABP indicated that this increase was exclusively due to hepatic and not due to intestinal release. Intermittent hepatic inflow occlusion, anesthesia, and liver transection did not further enhance arterial L-FABP and GSTα levels. Hepatocyte injury was followed by an inflammatory response. Conclusions This study shows that liver manipulation is a leading cause of hepatocyte injury during liver surgery. A potential causal relation between liver manipulation and systemic inflammation remains to be established; but since the inflammatory response is apparently initiated early during major abdominal surgery, interventions aimed at reducing postoperative inflammation and related complications should be started early during surgery or beforehand. PMID:17668263

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

    PubMed Central

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

    2012-01-01

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

  16. Complications associated with single-dose, perioperative mitomycin-C for patients undergoing bladder tumor resection

    PubMed Central

    Filson, Christopher P.; Montgomery, Jeffrey S.; Dailey, Stephen M.; Crossley, Heather S.; Lentz, Heidi; Tallman, Christopher T.; He, Chang; Weizer, Alon Z.

    2014-01-01

    OBJECTIVES To better understand the risk of short-term complications associated with perioperative intravesical mitomycin-C (MMC) therapy for patients undergoing endoscopic management of non-muscle invasive bladder cancer (NMIBC). METHODS AND MATERIALS Using an institutional database of patients with bladder cancer, we performed a retrospective case-control study of patients receiving perioperative MMC after tumor resection (2008–2012). MMC cases were matched by clinical stage to controls receiving endoscopic resection alone. Demographic information, clinicopathologic details and outcomes were compared between groups. Outcomes of interest included overall, genitourinary (GU) and major complications. Chi-square tests and multivariable logistic regression were used to evaluate associations between patient characteristics, clinical factors, exposure to MMC and outcomes of interest. RESULTS One-hundred sixteen patients treated with MMC were matched to 116 controls. Patients receiving MMC were younger (p=0.04) and more likely to have invasive disease (i.e., T1 or greater) (23% vs. 15%, p=0.02). Complications were more frequent among patients who were treated with MMC (34.5% vs. 19.8%, OR 2.89, 95% CI 1.43–5.81). The most common complication among MMC patients that required medical management was dysuria (17%). Major complications were more common among MMC patients (5.2% vs. 0.9%), but this difference did not reach statistical significance (p=0.11). CONCLUSIONS Use of MMC is associated with a greater odds of complications compared to controls. Patients should be counseled regarding both the benefits and potential risks of perioperative intravesical MMC. Continued research is required to understand the safety implications associated with the use of perioperative, intravesical MMC. PMID:23787296

  17. Bowel Prep Quality in Patients of Low Socioeconomic Status Undergoing Screening Colonoscopy with Patient Navigation

    ERIC Educational Resources Information Center

    Miller, Sarah Johanna; Itzkowitz, Steven H.; Shah, Brijen; Jandorf, Lina

    2016-01-01

    The effectiveness of colonoscopy is directly affected by the quality of the patient's bowel preparation. Patients with lower socioeconomic status (SES) are at increased risk of having suboptimal bowel prep quality. Patient navigators can play a key role in clarifying bowel prep instructions. The aim of the present study was to examine the quality…

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

    PubMed

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

    2016-08-01

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

  19. Importance of colonoscopy in patients undergoing endoscopic resection for superficial esophageal squamous cell carcinoma

    PubMed Central

    Tominaga, Kei; Doyama, Hisashi; Nakanishi, Hiroyoshi; Yoshida, Naohiro; Takeda, Yasuhito; Ota, Ryosuke; Tsuji, Kunihiro; Matsunaga, Kazuhiro; Tsuji, Shigetsugu; Takemura, Kenichi; Yamada, Shinya; Katayanagi, Kazuyoshi; Kurumaya, Hiroshi

    2016-01-01

    Background The aim of the study was to clarify the frequency of colorectal neoplasm (CRN) complicating superficial esophageal squamous cell carcinoma (ESCC) and the need for colonoscopy. Methods We retrospectively reviewed 101 patients who had undergone initial endoscopic resection (ER) for superficial ESCC. Control group participants were age- and sex-matched asymptomatic subjects screened at our hospital over the same period of time. Advanced adenoma was defined as an adenoma ≥10 mm, with villous features, or high-grade dysplasia. Advanced CRN referred to advanced adenoma or cancer. We measured the incidence of advanced CRN in superficial ESCC and controls, and we compared the characteristics of superficial ESCC patients with and without advanced CRN. Results In the superficial ESCC group, advanced CRNs were found in 17 patients (16.8%). A history of smoking alone was found to be a significant risk factor of advanced CRN [odds ratio 6.02 (95% CI 1.30-27.8), P=0.005]. Conclusion The frequency of synchronous advanced CRN is high in superficial ESCC patients subjected to ER. Colonoscopy should be highly considered for most patients who undergo ER for superficial ESCC with a history of smoking, and is recommended even in superficial ESCC patients. PMID:27366032

  20. Best practices in the management of newly diagnosed multiple myeloma patients who will not undergo transplant.

    PubMed

    Niesvizky, Ruben; Coleman, Morton; Mark, Tomer

    2010-03-01

    No survival advantage of autologous stem cell transplantation (ASCT) has been documented for patients older than 65 years, and in the era of thalidomide (Thalomid), bortezomib (Velcade), and lenalidomide (Revlimid), ASCT has a diminished role in the front-line treatment of older patients with myeloma. For these individuals and for those who cannot or choose not to undergo ASCT, the initial treatment regimens now recommended by both the National Comprehensive Cancer Network and the International Myeloma Working Group are melphalan (Alkeran)/prednisone/thalidomide (MPT), bortezomib/melphalan/prednisone (VMP), and lenalidomide/low-dose dexamethasone. Melphalan/prednisone should no longer be considered the reference treatment, although it may be appropriate for a small number of patients with serious comorbidity and/or poor performance status. Advantages of VMP over MPT include rapid response, high rates of complete response, patient compliance, and more extensive evidence of efficacy in patients with certain cytogenetic abnormalities. Lenalidomide/low-dose dexamethasone is particularly appropriate for patients with preexisting neurotoxicity and those who wish to postpone ASCT. Toxicity profiles differ among the newly established and emerging regimens, and oncology teams must take care to apply the appropriate risk management measures, including dose reduction where necessary.

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

    PubMed

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

    2016-03-01

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

  2. Prognostic Value of the Modified Glasgow Prognostic Score in Patients Undergoing Radical Surgery for Hepatocellular Carcinoma.

    PubMed

    Ni, Xiao-Chun; Yi, Yong; Fu, Yi-Peng; He, Hong-Wei; Cai, Xiao-Yan; Wang, Jia-Xing; Zhou, Jian; Cheng, Yun-Feng; Jin, Jian-Jun; Fan, Jia; Qiu, Shuang-Jian

    2015-09-01

    There is increasing and consistent evidence concerning the association of systemic inflammation and poor outcome in patients with hepatocellular carcinoma (HCC). The aim of this study was to identify a superior inflammation-based prognostic scoring system for patients with HCC undergoing hepatectomy.We analyzed two independent cohorts of a total of 723 patients with HCC who underwent radical surgery between 2010 and 2012. The prognostic value of the inflammation scores, including the Glasgow Prognostic Score (GPS), modified GPS (mGPS), neutrophil-to-lymphocyte ratio, platelet lymphocyte ratio, prognostic index, and prognostic nutritional index, as well as the Barcelona Clinic Liver Cancer and Cancer of the Liver Italian Program staging systems was analyzed in a test cohort of 367 patients and validated in a validation cohort of 356 patients.A high score with the mGPS was associated with large tumor size, vascular invasion, and advanced clinical stage. Multivariate analysis showed that the mGPS was independently associated with overall survival and disease-free survival, and had a higher area under the curve value in comparison with other inflammation-based scores.The results of this study demonstrated that the mGPS is an independent marker of poor prognosis in patients with resectable HCC and is superior to other inflammation-based scores. PMID:26356714

  3. Acute secondary effects in the esophagus in patients undergoing radiotherapy for carcinoma of the lung

    SciTech Connect

    Mascarenhas, F.; Silvestre, M.E.; Sa da Costa, M.; Grima, N.; Campos, C.; Chaves, P.

    1989-02-01

    The incidence and nature of acute secondary irradiation esophagitis was studied in a series of 38 patients undergoing 60Co teletherapy for carcinoma of the lung. Thirty-four patients were male and four female, with ages ranging from 38 to 78 years. The mediastinum being irradiated in the process, all the patients underwent endoscopy for signs of esophagitis and/or gastritis after a dose of 30-40 Gy was delivered to the esophagus. Eighteen patients complained of dysphagia, but only in 12 of them did endoscopy show esophagitis. Of the remaining patients without complaints five had endoscopic signs of esophagitis. Gastritis was found in 18 cases and confirmed histologically in 14. In 17 cases, esophagitis and/or gastritis were confirmed histologically. It is believed that there is a fairly close correlation among clinical, endoscopic, and histological findings to support the claim that esophagitis in these patients is radiation induced. However, the cause of gastritis is not well understood. Data in the literature suggest that nonsteroid anti-inflammatory agents can act as prophylactic means of preventing radiation esophagitis.

  4. [Case of lymphangioleiomyomatosis (LAM) discovered during cesarean section under spinal anesthesia].

    PubMed

    Nakanishi, Mika; Okura, Nahomi; Kashii, Tomoko; Matsushita, Mitsuji; Mori, Masanobu; Yoshida, Masayo; Tsujimura, Shigehisa

    2014-02-01

    We experienced a case of scheduled cesarean section under spinal anesthesia in a patient with LAM which had been missed in spite of preoperative medical examination and consultation with specialists but discovered because of perioperative hypoxia A 35-year-old woman, Gravida 1 Para 0, with breech presentation was scheduled to undergo cesarean section under spinal anesthesia at 38 weeks of gestation. She had no history of asthma or abnormal findings at annual medical examination. She had suffered from dry cough and nocturnal dyspnea for 7 weeks and an inhaled bronchodilator was administered with diagnosis of inflammatory airway disease by her respiratory physicians. Spinal anesthesia was performed with bupivacaine 12.5 mg. At the beginning of anesthesia SPO2 was 97% in supine position, but it rapidly decreased to less than 90% and 3 l x min(-1) oxygen was supplied with a facial mask. The anesthetic level was thoracal 4 bilaterally and her breathing was stable. The circulatory state, Apgar score and other vital signs were within normal ranges. Postoperative chest X-ray showed bilateral numerous grained spots and computed tomography scans showed multiple thin-walled cysts. The characteristic history and the fluoroscopic data gave her clinical diagnosis of LAM. PMID:24601117

  5. Study of incidence of lymphedema in Indian patients undergoing axillary dissection for breast cancer.

    PubMed

    Pillai, Pramod R; Sharma, Shekhar; Ahmed, Sheikh Zahoor; Vijaykumar, D K

    2010-09-01

    Lymphedema of the upper extremity, in addition to being unsightly, can be painful, can limit the arm movements, increases the risk of infection and is psychologically distressing, serving as a constant reminder of cancer. 1. To ascertain the incidence of lymphedema in a hospital based population (in patients undergoing axillary dissection for breast cancer. 2. To determine the clinico-epidemilogical factors associated with the occurrence of lymphedema in these patients. For all patients undergoing axillary dissection, arm measurements were taken in the pre-& post-operative period from at least 3 sites; one in the arm, forearm and wrist (points fixed in reference to fixed bony landmarks). Patients included in this study were followed up for at least 12 months. Circumference difference of more than 5% was taken as mild lymphedema; more than 10% as moderate lymphedema and more than 15% as severe lymphedema. Data was analyzed using SPSS 11.0 statistical software. Of the 231 patients in this study mean age was 51.2 years, majority were housewives (71.9%) and postmenopausal (58.5%). Modified radical mastectomy (MRM), was performed on 203 (87.9%) patients. 57.2% patients had positive lymph nodes. The mean number of positive nodes was 6.52. Majority of the patients received chemo and radio therapy. Overall incidence of lymphedema was 41.1%. The definition of 5-10% increase as mild lymphedema may be a bit severe as in most patients with this increase, lymphedema is not clinically apparent. The incidence of moderate and severe lymphedema in our series is only 7.4%. The incidence of clinically significant lymphedema (moderate to severe lymphedema & symptomatic mild lymphedema) was 16.8%. Only axillary irradiation and pathological nodal status (pN3) emerged as significant risk factors for lymphedema development on multivariate analysis. Lymphedema once established is difficult to treat. Combination of axillary dissection with radiation and more nodal positivity seems to

  6. Prognosis and Complications of Diabetic Patients Undergoing Isolated Coronary Artery Bypass Surgery

    PubMed Central

    Santos, Karen Alcantara Queiroz; Berto, Bharbara; Sousa, Alexandre Gonçalves; da Costa, Fernando Augusto Alves

    2016-01-01

    Objective: Compare the prognosis and complications of diabetic and non-diabetic patients undergoing isolated coronary artery bypass surgery at a hospital with a high surgical volume. Methods: Data of patients who underwent coronary artery bypass surgery from June 2009 to July 2010 were analyzed. We selected diabetic and non-diabetic patients and evaluated their postoperative and long-term prognosis based on clinical complications. To reduce the disparity within the sample, statistical analyses were performed using propensity scores. Results: We included 2,688 patients who underwent coronary artery bypass surgery; 36% of them had diabetes, their mean age was 62.1±9.49 years and 70% (1,884) of them were men. Patients with diabetes were older (63±9 years vs. 61±10 years; P<0.001), more often obese (BMI>25 kg/m2: 70.7% vs. 64.5%; P<0.001), dyslipidemic (50.4% vs. 41.1%; P<0.001), hypertensive (89.2% vs. 78.7%; P<0.001), and presented chronic renal failure (8.3% vs. 3.8%; P<0.001). They also presented higher rates of acute renal failure (5.6% vs. 2.7%, P<0.001), infection (11.4% vs. 7.2%, P<0.001) and mortality after one year (9.1% vs. 5.6%, P<0.001). Pneumonia was more common among patients with diabetes (7.7% vs. 4.0%, P<0.001). According to propensity scoring, 430 patients (215 diabetics and 215 non-diabetics) had a mean age of 61.3±8.97 years, and 21.2% (91 of 430) were women. However, diabetes was not an independent factor for poor prognosis. Conclusion: Patients with diabetes were at higher risk for postoperative complications and mortality after undergoing coronary artery bypass surgery. However, diabetes did not explain the poor prognosis of these patients after pairing this factor with the propensity score. PMID:27074269

  7. Comparative study of continuous lateral osteotomy and microperforating osteotomy in patients undergoing primary rhinoplasty

    PubMed Central

    Pizzamiglio, Diego Sherlon; Berger, Cezar Augusto Sarraf

    2012-01-01

    Summary Introduction: Lateral osteotomies play an important role in rhinoplasty and can be performed with different techniques. Objective: To compare the results of narrowing of the nasal dorsum and base through 2 types of lateral osteotomy: continuous and microperforating. Method: We selected 74 patients undergoing rhinoplasty: 37 patients underwent lateral continuous osteotomy and the other 37 underwent microperforating osteotomy, all performed by the same surgeon. We analyzed frontal photography from the pre- and post-operative (6 months) periods, evaluating the width of the nasal dorsum and base. This was a retrospective study. Results and Conclusion: Using Student's t-test, statistical analysis concluded that there was a statistically significant difference in the post-operative narrowing of the nasal dorsum and base following both osteotomy techniques, and there was no statistically significant difference between the 2 techniques. PMID:25991961

  8. Acute esophageal necrosis occurring in a patient undergoing percutaneous coronary intervention.

    PubMed

    Kwon, Hyung-Jin; Park, Sang-Ho; Ahn, Ji-Hoon; Lee, Tae-Hoon; Lee, Chang-Kyun

    2014-05-01

    Acute esophageal necrosis is uncommon in the literature. Its etiology is unknown, although cardiovascular disease, hemodynamic compromise, gastric outlet obstruction, alcohol ingestion, hypoxemia, hypercoagulable state, infection, and trauma have all been suggested as possible causes. A 67-year-old female underwent a coronary angiography (CAG) for evaluation of chest pain. CAG findings showed coronary three-vessel disease. We planned percutaneous coronary intervention (PCI). Coronary arterial dissection during the PCI led to sudden hypotension. Six hours after the index procedure, the patient experienced a large amount of hematemesis. Emergency gastrofibroscopy was performed and showed mucosal necrosis with a huge adherent blood clot in the esophagus. After conservative treatment for 3 months, the esophageal lesion was completely improved. She was diagnosed with acute esophageal necrosis. We report herein a case of acute esophageal necrosis occurring in a patient undergoing percutaneous coronary intervention. PMID:24851074

  9. Reducing length of stay in patients undergoing open heart surgery: the University of Pittsburgh experience.

    PubMed

    George, E L; Large, A A

    1995-08-01

    The clinical pathway, one component of the case management model, was implemented at one university medical center in the coronary artery bypass surgical group. In this article, the authors describe the development, use, and evaluation of the clinical pathway. The role of the advanced nurse practitioner as the case manager is discussed. The initial data base created by the case manager includes patient demographics, daily progress, length of stay, charges, discharge disposition, and readmissions within 15 days. Data collected on all patients undergoing coronary artery bypass graft surgery from July 94 to October 94 are reported and compared with the benchmark set with the development of the clinical pathway. Strategies developed for future improvement in the clinical pathway process and data management are identified.

  10. Proposed computerized protocol for epidemiological study of patients undergoing microsurgery of the larynx

    PubMed Central

    Catani, Guilherme Simas do Amaral; Carvalho, Bettina; Filho, Jorge Massaaki Ido; Filho, Evaldo Dacheux de Macedo; Pinto, José Simão de Paula; Malafaia, Osvaldo; Stahlke, Henrique Jorge

    2012-01-01

    Summary Introduction: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. Objective: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. Method: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. Results: We evaluated 245 patients aged 9–79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. Conclusions: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts. PMID:25991956

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  13. Patterns and Timing of Initial Relapse in Patients Subsequently Undergoing Transplantation for Hodgkin's Lymphoma

    SciTech Connect

    Dhakal, Sughosh; Biswas, Tithi; Liesveld, Jane L.; Friedberg, Jonathan W.; Phillips, Gordon L.; Constine, Louis S.

    2009-09-01

    Purpose: To evaluate the patterns and timing of initial recurrence in patients with Hodgkin's lymphoma (HL) who subsequently underwent high-dose chemotherapy with autologous stem cell transplantation to enhance our understanding of the natural history of this disease and its modern treatment strategies and to direct approaches to disease surveillance. Methods and Materials: The records of 69 patients with HL who had undergone high-dose chemotherapy with autologous stem cell transplantation in our center between May 1992 and June 2006 were analyzed. The initial diagnosis had been made between April 1982 and January 2005 at a median patient age of 33 years (range, 19-65). The patients were segregated according to the initial stage (Stage I-II vs. III-IV). Results: Early-stage HL patients developed a relapse at a median of 2.1 years (range, 0.5-10.3), with 91% of relapses at the initial disease site, 71% of which (65% overall) were only in previously involved sites. Advanced-stage HL patients developed a relapse at a median of 1.5 years (range, 0.6-10.5), with 97% at the initial site, 71% of which (69% overall) were only in previously involved sites. Single-site relapses occurred in 47% of early- vs. 26% of advanced-stage patients, and extranodal relapses occurred in 12% of early- vs. 31% of advanced-stage patients. Conclusions: Almost all patients with HL who develop relapse and subsequently undergo high-dose chemotherapy with autologous stem cell transplantation initially developed recurrence in previously involved disease sites. Early-stage HL relapses often occurred in single sites, and advanced-stage disease relapses were more likely in multiple and extranodal sites. The interval to recurrence was brief, suggesting that the frequency of screening should be the greatest in the early post-therapy years.

  14. Analysis of Factors Contributing to the Low Survival of Cervical Cancer Patients Undergoing Radiotherapy in Kenya

    PubMed Central

    Maranga, Innocent O.; Hampson, Lynne; Oliver, Anthony W.; Gamal, Anas; Gichangi, Peter; Opiyo, Anselmy; Holland, Catharine M.; Hampson, Ian N.

    2013-01-01

    Background In contrast to the developed nations, invasive cervical cancer (ICC) is the most common womens malignancy in Kenya and many other locations in sub-Saharan Africa. However, studies on survival from this disease in this area of the world are severely restricted by lack of patient follow-up. We now report a prospective cohort study of ICC in Kenyan women analysing factors affecting tumour response and overall survival in patients undergoing radiotherapy. Methods and Findings Between 2008 and 2010, 355 patients with histologically confirmed ICC were recruited at the Departments of Gynaecology and Radiotherapy at Kenyatta National Hospital (KNH). Structured questionnaires were completed recording socio-demographics, tumour response and overall survival following treatment with combinations of external beam radiation (EBRT), brachytherapy and adjuvant chemotherapy. Of the 355 patients, 42% (146) were lost to follow-up while 18% (64) died during the two year period. 80.5% of patients presented with advanced stage IIB disease or above, with only 6.7% of patients receiving optimal combined EBRT, brachytherapy and adjuvant chemotherapy. Kaplan Meier survival curves projected two year survival at <20%. Conclusion Cervical cancer is preventable yet poverty, poor education, lack of cancer awareness coupled with an absence of regular screening programs, late patient presentation, sub-optimal diagnosis and treatments are major factors contributing to the alarmingly low survival rate of cervical cancer patients in Kenya. It is concluded that simple cost-effective changes in clinical practice could be introduced which would have a marked impact on patient survival in this setting. PMID:24205226

  15. A prospective analysis of factors that influence weight loss in patients undergoing radiotherapy.

    PubMed

    Cacicedo, Jon; Casquero, Francisco; Martinez-Indart, Lorea; del Hoyo, Olga; Gomez de Iturriaga, Alfonso; Navarro, Arturo; Bilbao, Pedro

    2014-04-01

    Malnutrition occurs frequently in patients with cancer. Indeed, a variety of nutritional and tumor-related factors must be taken into account in these patients. Recognizing this relationship, we aimed to prospectively evaluate the risk factors that influence weight loss in patients undergoing radiotherapy with oral nutritional supplementation and dietetic counseling. Weight loss of 74 patients during radiotherapy and 1 month after treatment was analyzed. Parameters such as age, gender, tumor location, tumor stage, Eastern Cooperative Oncology Group performance status (ECOG PS) score, and the use of chemotherapy were analyzed to evaluate their influence on weight loss. All patients underwent oral nutritional supplementation and dietetic counseling. Forty-six (65.7%) patients lost weight, with a mean weight loss of (4.73 ± 3.91) kg, during radiotherapy. At 1 month after treatment, 45 (66.2%) patients lost weight, presenting a mean weight loss of (4.96 ± 4.04) kg, corresponding to a (6.84 ± 5.24)% net reduction from their baseline weight. Head and neck cancer patients had a mean weight loss of (3.25 ± 5.30) kg, whereas the remaining patients had a mean weight loss of (0.64 ± 2.39) kg (P = 0.028) during radiotherapy. In the multivariate analysis, the head and neck tumor location (P = 0.005), use of chemotherapy (P = 0.011), and ECOG PS score of 2-3 (P = 0.026) were considered independent risk factors. Nutritional status and parameters, such as tumor location (especially the head and neck), the use of chemotherapy, and the ECOG PS score, should be evaluated before radiotherapy because these factors can influence weight loss during radiotherapy and 1 month after treatment.

  16. Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia.

    PubMed

    Carmignani, Luca; Bozzini, Giorgio; Macchi, Alberto; Maruccia, Serena; Picozzi, Stefano; Casellato, Stefano

    2015-01-01

    Treatment of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate (ThuLEP) on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life (QoL), five validated questionnaires were used: the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System (IPSS) questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients' mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH (e.g. transurethral resection of the prostate) causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.

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

    PubMed

    2016-06-10

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

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

    PubMed

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

    2014-01-01

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

  19. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis.

    PubMed

    Huang, Wen-Hung; Lin, Jui-Hsiang; Weng, Cheng-Hao; Hsu, Ching-Wei; Yen, Tzung-Hai

    2016-01-01

    Uremic pruritus (UP), also known as chronic kidney disease-associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution-induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of <2.5 μm (PM2.5). In a multivariate logistic regression, hemodialysis duration, serum ferritin levels, low-density lipoprotein levels, and environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD. PMID:27507591

  20. [Perioperative management of an obese patient complicated with sleep apnea syndrome (SAS) undergoing awake craniotomy].

    PubMed

    Komayama, Noriaki; Kamata, Kotoe; Maruyama, Takashi; Nitta, Masayuki; Muragaki, Yoshihiro; Ozaki, Makoto

    2014-10-01

    Both obesity (BMI over 30) and SAS are risks for Supper airway maintenance. We report an obese patient (BMI 33.5) with SAS who underwent awake craniotomy. Weight reduction was instructed 1 month before the operation, and the patient lost enough weight to use intraoperative MRI. Under general anesthesia, surgical pads containing 2% lidocaine with adrenaline were inserted into the nasal cavities. The patient's airway S was secured by i-gel® until dura was opened. A nasal airway was then inserted to confirm the upper airway patency and anesthetics were terminated The patient regained consciousness and started respiration. The i-gel® was removed. The nasal airway was changed to an RAE tracheal tube ; the tube was fixed above the vocal cords under bronchofiberscopic observation. Continuous positive airway pressure (CPAP) via RAE tube was started. Neither coughing nor epistaxis was observed.The RAE tube prevented glossoptosis and did not disturb speech mapping. Emergent endotracheal intubation was easily managed because the tube was close to the glottis. The RAE tube was removed and nasal CP AP was applied overnight Carefully prepared CP AP support via nasal RAE tube was practical in keeping upper airway patency for an obese patient complicated with SAS undergoing awake craniotomy.

  1. Risk of Bleeding in End-Stage Liver Disease Patients Undergoing Cardiac Catheterization.

    PubMed

    Mahmoud, Ahmed M; Elgendy, Islam Y; Choi, Calvin Y; Bavry, Anthony A

    2015-10-01

    Patients with end-stage liver disease frequently have baseline coagulopathies. The international normalized ratio is in common use for the estimation of bleeding tendency in such patients, especially those undergoing an invasive procedure like cardiac catheterization. The practice of international normalized ratio measurement-followed by pharmacologic (for example, vitamin K or fresh frozen plasma) or nonpharmacologic intervention-is still debatable. The results of multiple randomized trials have shown the superiority of the radial approach over femoral access in reducing catheterization bleeding. This reduction in bleeding in turn decreases the risk and cost of blood-product transfusion. However, there is little evidence regarding the use of the radial approach in the end-stage liver disease patient population specifically. In this review, we summarize the studies that have dealt with cardiac catheterization in patients who have end-stage liver disease. We also discuss the role of the current measurements that are used to reduce the risk of bleeding in these same patients.

  2. Perioperative Management of Patients with Diabetes and Hyperglycemia Undergoing Elective Surgery.

    PubMed

    Thompson, Bithika M; Stearns, Joshua D; Apsey, Heidi A; Schlinkert, Richard T; Cook, Curtiss B

    2016-01-01

    Diabetes mellitus (DM) and hyperglycemia are associated with increased surgical morbidity and mortality. Hyperglycemia is a determinant of risk of surgical complications and should be addressed across the continuum of surgical care. While data support the need to address hyperglycemia in patients with DM in the ambulatory setting prior to surgery and in the inpatient setting, data are less certain about hyperglycemia occurring during the perioperative period-that part of the process occurring on the day of surgery itself. The definition of "perioperative" varies in the literature. This paper proposes a standardized definition for the perioperative period as spanning the time of patient admission to the preoperative area through discharge from the recovery area. Available information about the impact of perioperative hyperglycemia on surgical outcomes within the framework of that definition is summarized, and the authors' approach to standardizing perioperative care for patients with DM is outlined, including the special case of patients receiving insulin pump therapy. The discussion is limited to adult ambulatory non-obstetric patients undergoing elective surgical procedures under general anesthesia.

  3. Relationship between plasma level of vitamin D and post operative atrial fibrillation in patients undergoing CABG

    PubMed Central

    Shadvar, Kamran; Ramezani, Fariba; Sanaie, Sarvin; Maleki, Taher Entezari; Arbat, Babak Kazemi; Nagipour, Bahman

    2016-01-01

    Objective: Atrial fibrillation is the most common arrhythmia after cardiac surgery. Several studies have shown the impact of vitamin D on heart disease; however, there have been few studies for the incidence of AF and its relationship with vitamin D levels. According to the different results of these studies, we decided to evaluate the relation of plasma levels of vitamin D and postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery (CABG). Methods: This cross-sectional study was performed on 50 patients after CABG surgery. Simple random sampling was done. Twenty five patients who developed AF within 48 hours after CABG with Cardiopulmonary bypass (CPB) were enrolled in the case group and 25 patients who did not develop AF within 48 hours after CABG with CPB were enrolled in the control group. Plasma levels of vitamin D in both groups of patients were recorded. Collected data were analyzed by the SPSS software version 17. Results: There was no significant difference in terms of demographic characteristics, comorbidities, lipid profile and kidney function between two groups. The mean plasma level of vitamin D was 27.4 ± 2.22 ng/ml in the case group and was 28.2 ± 1.18 ng/ml in the control group it (p= 0.803). Conclusions: Plasma levels of vitamin D were almost the same in both groups and there was no statistically significant difference between the groups with and without atrial fibrillation following CABG.

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

    PubMed

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

    2016-09-01

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

  5. Determinants of Mortality in Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

    PubMed Central

    Papachristidis, Alexandros; Lim, Wei Yao; Voukalis, Christos; Ayis, Salma; Laing, Christopher; Rakhit, Roby D.

    2016-01-01

    Background Renal impairment is a known predictor of mortality in both the general population and in patients with cardiac disease. The aim of this study was to evaluate factors that determine mortality in patients with chronic kidney disease (CKD) who have undergone percutaneous coronary intervention (PCI). Methods In this study we included 293 consecutive patients with CKD who underwent PCI between 1st January 2007 and 30th September 2012. The primary outcome that we studied was all-cause mortality in a follow-up period of 12-69 months (mean 38.8 ± 21.7). Results Age (p < 0.001), PCI indication (p = 0.035), CKD stage (p < 0.001) and left ventricular ejection fraction (p < 0.001) were significantly related to mortality. CKD stage 5 [hazard ratio (HR) = 6.39, 95% CI: 1.51-27.12) and severely impaired left ventricular function (HR = 4.04, 95% CI: 2.15-7.59) were the strongest predictors of mortality. Other factors tested (gender, hypertension, diabetes, hyperlipidaemia, established peripheral vascular disease/stroke, coronary arteries intervened, number of vessels treated, number of stents implanted and length of lesion treated) did not show any correlation with mortality. Conclusions The mortality of patients with CKD undergoing PCI increases with age, worsening CKD stage and deteriorating left ventricular systolic function, and it is also higher in patients with acute coronary syndromes compared to those with stable coronary artery disease. PMID:27275153

  6. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis

    PubMed Central

    Huang, Wen-Hung; Lin, Jui-Hsiang; Weng, Cheng-Hao; Hsu, Ching-Wei; Yen, Tzung-Hai

    2016-01-01

    Uremic pruritus (UP), also known as chronic kidney disease–associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution–induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of <2.5 μm (PM2.5). In a multivariate logistic regression, hemodialysis duration, serum ferritin levels, low-density lipoprotein levels, and environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD. PMID:27507591

  7. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis

    NASA Astrophysics Data System (ADS)

    Huang, Wen-Hung; Lin, Jui-Hsiang; Weng, Cheng-Hao; Hsu, Ching-Wei; Yen, Tzung-Hai

    2016-08-01

    Uremic pruritus (UP), also known as chronic kidney disease–associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution–induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of <2.5 μm (PM2.5). In a multivariate logistic regression, hemodialysis duration, serum ferritin levels, low-density lipoprotein levels, and environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD.

  8. [Anesthetic Management with Dexmedetomidine in Patients with Serious Mental and Physical Disabilities Undergoing Dental Treatment].

    PubMed

    Shimotori, Hisashi; Kawano, Mari

    2016-04-01

    Midazolam and propofol are widely used for the sedation of patients with serious mental and physical disabilities. However, we often experience difficulty in the management of airway and respiratory depression when using these sedatives. Dexmedetomidine (DEX) is being increasingly used as a sedative because of the lack of associated respiratory depression. Here we report anesthetic management with DEX in two patients with disability undergoing dental treatment To avoid movement during treatment, DEX was infused at the rate recommended in the package insert, with an initial administration at 6 μg x kg(-1) x hr(-1) for 10 min followed by maintenance infusion at 0.7 μg x kg(-1) x hr(-1). Although the infusion rate seemed to be sufficient for the patients, DEX was not effective and administration of additional sedatives was required. Further, respiratory depression, such as airway obstruction and increase in the concentration of end-tidal carbon dioxide, was observed even when DEX was used as the sole agent for inducing sedation. No remarkable change in hemodynamics was observed. Therefore, it is difficult to maintain the sedative state using DEX alone in patients with serious mental and physical disabilities in comparison with patients with no disability. PMID:27188121

  9. [Perioperative management in patients with liver cirrhosis undergoing open heart surgery].

    PubMed

    Ota, T; Okumura, S

    1996-10-01

    Perioperative management of patients with liver cirrhosis undergoing open heart surgery (3 males and 1 female, mean age 57.3 years) was evaluated. All 4 patients had NYHA class III acquired valvular heart disease accompanied by severe tricuspid regurgitation, and the operation was a redo operation in 3 of them. Preoperatively, the total serum bilirubin was 1.7 mg/dl, ICGR15 24.3 +/- 1.7%, and blood platelet count was 83,000 +/- 19,000/m3. The postoperative course was uneventful in 2 patients who maintained good cardiac function and did not require homologous blood transfusion. The other two patients who underwent a re-redo operation, sustained a large volume of hemorrhage, and required massive transfusion showed severe postoperative complications (respiratory failure in 1, multiple organ failure in 1). The stage of the disease improved to NYHA class I in all 3 patients who survived the operation. Comprehensive measures including avoidance of massive hemorrhage, preservation of the hepatic blood flow, resolution of hepatic congestion, and prevention of complications such as digestive tract bleeding, infections, and renal failure are considered to be needed for prevention of postoperative liver failure. Especially, sufficient surgical hemostasis and autologous platelet rich plasma were useful for prevention of massive hemorrhage.

  10. Premalignant and malignant lesions in endometrial polyps in patients undergoing hysteroscopic polypectomy

    PubMed Central

    Lenci, Marco Antonio; do Nascimento, Vanessa Alessandra Lui; Grandini, Ana Beatriz; Fahmy, Walid Makin; Depes, Daniella de Batista; Baracat, Fausto Farah; Lopes, Reginaldo Guedes Coelho

    2014-01-01

    ABSTRACT Objective: To evaluate the incidence of premalignant lesions and cancer in endometrial polyps, in patients undergoing hysteroscopic polypectomy. Methods: The results of 1,020 pathological examinations of patients submitted to hysteroscopic polypectomy were analyzed, as well as their diagnostic and surgical hysteroscopy findings. As to their menstrual status, 295 (28.9%) patients were in menacme. Of the total, 193 (65.4%) presented abnormal uterine bleeding, and 102 (34.6%) were asymptomatic with altered endometrial echo on transvaginal ultrasound. Out of 725 (71.1%) postmenopausal patients, 171 (23.6%) were symptomatic (abnormal uterine bleeding), and 554 (76.4%) were asymptomatic with endometrial echo >5.0mm. Results: Twenty-one (2.0%) patients presented premalignant lesions in the polyps, 13 had simple glandular hyperplasia, of which 5 had no atypia, and eight presented atypia. Eight polyps presented focal area of complex hyperplasia: 4 with atypia and 4 without lesions. Cancer was diagnosed in 5 (0.5%) polyps. Of the 21 polyps that harbored premalignant lesions, 12 were interpreted as benign in diagnostic and surgical hysteroscopy. Of the polyps with cancer, 4 were also histeroscopically interpreted as normal. Conclusion: Symptomatic polyps in menacme and in all postmenopausal women should be resected and submitted to histopathological examination, since they may have a benign aspect, even when harboring areas of cellular atypia or cancer. PMID:24728240

  11. Impact of respiratory therapy in vital capacity and functionality of patients undergoing abdominal surgery

    PubMed Central

    Fernandes, Shanlley Cristina da Silva; dos Santos, Rafaella Souza; Giovanetti, Erica Albanez; Taniguchi, Corinne; Silva, Cilene Saghabi de Medeiros; Eid, Raquel Afonso Caserta; Timenetsky, Karina Tavares; Carnieli-Cazati, Denise

    2016-01-01

    ABSTRACT Objective To evaluate the vital capacity after two chest therapy techniques in patients undergoing abdominal surgical. Methods A prospective randomized study carried out with patients admitted to the Intensive Care Unit after abdominal surgery. We checked vital capacity, muscular strength using the Medical Research Council scale, and functionality with the Functional Independence Measure the first time the patient was breathing spontaneously (D1), and also upon discharge from the Intensive Care Unit (Ddis). Between D1 and Ddis, respiratory therapy was carried out according to the randomized group. Results We included 38 patients, 20 randomized to Positive Intermittent Pressure Group and 18 to Volumetric Incentive Spirometer Group. There was no significant gain related to vital capacity of D1 and Ddis of Positive Intermittent Pressure Group (mean 1,410mL±547.2 versus 1,809mL±692.3; p=0.979), as in the Volumetric Incentive Spirometer Group (1,408.3mL±419.1 versus 1,838.8mL±621.3; p=0.889). We observed a significant improvement in vital capacity in D1 (p<0.001) and Ddis (p<0.001) and in the Functional Independence Measure (p<0.001) after respiratory therapy. The vital capacity improvement was not associated with gain of muscle strength. Conclusion Chest therapy, with positive pressure and volumetric incentive spirometer, was effective in improving vital capacity of patients submitted to abdominal surgery. PMID:27462894

  12. Relationship between plasma level of vitamin D and post operative atrial fibrillation in patients undergoing CABG

    PubMed Central

    Shadvar, Kamran; Ramezani, Fariba; Sanaie, Sarvin; Maleki, Taher Entezari; Arbat, Babak Kazemi; Nagipour, Bahman

    2016-01-01

    Objective: Atrial fibrillation is the most common arrhythmia after cardiac surgery. Several studies have shown the impact of vitamin D on heart disease; however, there have been few studies for the incidence of AF and its relationship with vitamin D levels. According to the different results of these studies, we decided to evaluate the relation of plasma levels of vitamin D and postoperative atrial fibrillation in patients undergoing coronary artery bypass surgery (CABG). Methods: This cross-sectional study was performed on 50 patients after CABG surgery. Simple random sampling was done. Twenty five patients who developed AF within 48 hours after CABG with Cardiopulmonary bypass (CPB) were enrolled in the case group and 25 patients who did not develop AF within 48 hours after CABG with CPB were enrolled in the control group. Plasma levels of vitamin D in both groups of patients were recorded. Collected data were analyzed by the SPSS software version 17. Results: There was no significant difference in terms of demographic characteristics, comorbidities, lipid profile and kidney function between two groups. The mean plasma level of vitamin D was 27.4 ± 2.22 ng/ml in the case group and was 28.2 ± 1.18 ng/ml in the control group it (p= 0.803). Conclusions: Plasma levels of vitamin D were almost the same in both groups and there was no statistically significant difference between the groups with and without atrial fibrillation following CABG. PMID:27648036

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

    SciTech Connect

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

    1988-08-01

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

  14. Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia

    PubMed Central

    Carmignani, Luca; Bozzini, Giorgio; Macchi, Alberto; Maruccia, Serena; Picozzi, Stefano; Casellato, Stefano

    2015-01-01

    Treatment of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate (ThuLEP) on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life (QoL), five validated questionnaires were used: the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System (IPSS) questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3–6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients’ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH (e.g. transurethral resection of the prostate) causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function. PMID:25652616

  15. I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study

    PubMed Central

    2012-01-01

    Background Total knee arthroplasty (TKA) is often associated with a severe local inflammatory reaction which, unless controlled, leads to persistent pain up to one year after surgery. Standard and accelerated rehabilitation protocols are currently being implemented after TKA, but no consensus exists regarding the long-term effects. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has been demonstrated to exert an anti-inflammatory effect, to promote early functional recovery and to maintain a positive long-term effect in patients undergoing joint arthroscopy. The aim of this study was to evaluate whether PEMFs can be used to limit the pain and enhance patient recovery after TKA. Methods A prospective, randomized, controlled study in 30 patients undergoing TKA was conducted. Patients were randomized into experimental PEMFs or a control group. Patients in the experimental group were instructed to use I-ONE stimulator 4hours/day for 60days. Postoperatively, all patients received the same rehabilitation program. Treatment outcome was assessed using the Knee Society Score, SF-36 Health-Survey and VAS. Patients were evaluated pre-operatively and one, two, six and 12 months after TKA. Joint swelling and Non Steroidal Anti Inflammatory Drug (NSAID) consumption were recorded. Comparisons between the two groups were carried out using a two-tail heteroschedastic Student’s t-test. Analysis of variance for each individual subject during the study was performed using ANOVA for multiple comparisons, applied on each group, and a Dunnet post hoc test. A p value < 0.05 was considered statistically significant. Results Pre-operatively, no differences were observed between groups in terms of age, sex, weight, height, Knee-Score, VAS, SF-36 and joint swelling, with the exception of the Functional Score. The Knee-Score, SF-36 and VAS demonstrated significantly positive outcomes in the I-ONE stimulated group compared with the controls at follow-ups. In the I

  16. Clinical experience with a novel endotoxin adsorbtion device in patients undergoing cardiac surgery.

    PubMed

    Blomquist, S; Gustafsson, V; Manolopoulos, T; Pierre, L

    2009-01-01

    Endotoxaemia is thought to occur in cardiac surgery using extracorporeal circulation (ECC) and a positive correlation has been proposed between the magnitude of endotoxaemia and risk for postoperative complications. We studied the effects of a new endotoxin adsorber device (Alteco LPS adsorber) in patients undergoing cardiac surgery with ECC, with special reference to safety and ease of use. Fifteen patients undergoing coronary artery bypass and/or valvular surgery were studied. In 9 patients, the LPS Adsorber was included in the bypass circuit between the arterial filter and the venous reservoir. Flow through the adsorber was started when the aorta was clamped and stopped at the end of perfusion. Flow rate was kept at 150 ml/min. Six patients served as controls with no adsorber in the circuit. Samples were taken for analysis of endotoxin, TNFalpha, IL-1beta and IL-6 as well as complement factors C3, C4 and C1q. Whole blood coagulation status was evaluated using thromboelastograpy (TEG) and platelet count. No adverse events were encountered when the adsorber was used in the circuit. Blood flow through the device was easily monitored and kept at the desired level. Platelet count decreased in both groups during surgery. TEG data revealed a decrease in whole blood clot strength in the control group while it was preserved in the adsorber group. Endotoxin was detected in only 2 patients and IL-1beta in 4 patients. IL-6 decreased in both groups whereas no change in TNF concentrations was found. C3 fell in both groups, but no changes wer found in C4 and C1q. The Alteco LPS adsorber can be used safely and is easy to handle in the bypass circuit. No complications related to the use of the adsorber were noted. The intended effects of the adsorber, i.e. removal of endotoxin from the blood stream could not be evaluated in this study, presumably due to the small number of patients and the relatively short perfusion times.

  17. The effect of electroacupuncture on postoperative immunoinflammatory response in patients undergoing supratentorial craniotomy.

    PubMed

    Li, Guoyan; Li, Shuqin; Wang, Baoguo; An, Lixin

    2013-09-01

    The aim of this study was to explore the effect of electroacupuncture (EA) on immune function in patients undergoing supratentorial craniotomy. We also examined whether point specificity in EA was present. The study involved 29 patients undergoing craniotomy. The patients were divided into three groups: a control (C, n=10), an EA (A, n=9) and a sham acupoints group (S, n=10). Blood samples were collected at the following time points: before anesthesia (T0), 4 h after the induction of anesthesia (T1), 1 day post-surgery (T2) and 2 days post-surgery (T3) to determine the levels of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-10 (IL-10), immunoglobulin M (IgM), IgA and IgG. Data were analyzed using SPSS 13.0 software. When comparing the levels of cytokines following surgery, we observed that the peripheral blood IL-8 levels in groups A and S were increased significantly compared with those of group C at 1 and 2 days after surgery. When comparing immunoglobulin levels after surgery, we established that the peripheral blood IgA levels in group C had decreased significantly compared to those of group A and group S 4 h after induction of anesthesia and 1 day after surgery. However, there was no significant difference between group A and group S. Compared with simple general anesthesia, acupuncture combined with anesthesia partially reduces immune suppression in the perioperative periods under the same conditions as the simple general anesthesia. Point specificity in EA was not present. PMID:24137250

  18. The effect of electroacupuncture on postoperative immunoinflammatory response in patients undergoing supratentorial craniotomy

    PubMed Central

    LI, GUOYAN; LI, SHUQIN; WANG, BAOGUO; AN, LIXIN

    2013-01-01

    The aim of this study was to explore the effect of electroacupuncture (EA) on immune function in patients undergoing supratentorial craniotomy. We also examined whether point specificity in EA was present. The study involved 29 patients undergoing craniotomy. The patients were divided into three groups: a control (C, n=10), an EA (A, n=9) and a sham acupoints group (S, n=10). Blood samples were collected at the following time points: before anesthesia (T0), 4 h after the induction of anesthesia (T1), 1 day post-surgery (T2) and 2 days post-surgery (T3) to determine the levels of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-10 (IL-10), immunoglobulin M (IgM), IgA and IgG. Data were analyzed using SPSS 13.0 software. When comparing the levels of cytokines following surgery, we observed that the peripheral blood IL-8 levels in groups A and S were increased significantly compared with those of group C at 1 and 2 days after surgery. When comparing immunoglobulin levels after surgery, we established that the peripheral blood IgA levels in group C had decreased significantly compared to those of group A and group S 4 h after induction of anesthesia and 1 day after surgery. However, there was no significant difference between group A and group S. Compared with simple general anesthesia, acupuncture combined with anesthesia partially reduces immune suppression in the perioperative periods under the same conditions as the simple general anesthesia. Point specificity in EA was not present. PMID:24137250

  19. Dementia in patients undergoing long-term dialysis: aetiology, differential diagnoses, epidemiology and management.

    PubMed

    Rob, P M; Niederstadt, C; Reusche, E

    2001-01-01

    Dementia in patients undergoing long-term dialysis has not been clearly defined; however, four different entities have been described. Uraemic encephalopathy is a complication of uraemia and responds well to dialysis. Dialysis encephalopathy syndrome, the result of acute intoxication of aluminium caused by the use of an aluminium-containing dialysate, was a common occurrence prior to 1980. However, using modern techniques of water purification, such acute intoxication can now be avoided. Dialysis-associated encephalopathy/dementia (DAE) is always associated with elevated serum aluminium levels. Pathognomonic morphological changes in the brain have been described, but the mechanism for the entry of aluminium into the CNS is incompletely understood. The mechanisms involved in the pathogenesis of the neurotoxicity associated with aluminium are numerous. Although only a very small fraction of ingested aluminium is absorbed, the continuous oral aluminium intake from aluminium-based phosphate binders, and also of dietary or environmental origin, is responsible for aluminium overload in dialysis patients. Age-related dementia, especially vascular dementia, occurs in patients undergoing long-term dialysis as frequently as it does in the general population. The differential diagnoses of dialysis-associated dementias should include investigation for metabolic encephalopathies, heavy metal or trace element intoxications, and distinct structural neurological lesions such as subdural haematoma, normal pressure hydrocephalus, stroke and, particularly, hypertensive encephalopathy and multi-infarct dementia. To prevent DAE, dietary training programmes should aim to achieve the lowest phosphate intake and pharmacological tools should be used to keep serum phosphate levels below 2 mmol/L. To prevent vascular dementia, lifestyle modification should be undertaken, including optimal physical activity and fat intake, nicotine abstinence, and targeting optimal blood glucose, cholesterol

  20. Hematological Changes in Patients Undergoing Coronary Artery Bypass Surgery: a Prospective Study

    PubMed Central

    Lako, Sotir; Dedej, Teuta; Nurka, Tatjana; Ostreni, Vera; Demiraj, Aurel; Xhaxho, Roland; Prifti, Edvin

    2015-01-01

    Objectives: Removal of pro inflammatory stimuli after CABG, wound closure and the regenerative ability of the bone marrow will ensure a gradual recovery of hematological parameters. The aim of this study was to assess the hematological changes after CABG. Materials and Methods: A prospective cohort study included 164 consecutive patients undergoing on pump CABG surgery between January 2012 and January 2013. Patients with primary hematologic disease, emergent or urgent CABG and off-pump CABG were not included. A time line protocol was employed. Results: All patients survived surgery. Average values of erythrocytes, hemoglobin and hematocrit declined, to reach lower values on day 3 after surgery (-33.6 %, -33.1 %, -32.6 % versus preoperative value, p<0.001) and then gradually increased to reach normal values after one month and the preoperative values after three months. The average values of leukocytes and neutrophils increased rapidly to achieve the highest value on day 2, while the average value of lymphocytes decreased quickly to achieve lower value on day 1 after surgery (+74.7 %, +127.1 %, -52.4 % respectively from the preoperative value, p<0.001). The average platelet count decreased to the lowest value on day 2 after surgery (-26.4 % from the preoperative value, p<0.001), after which gradually increased up to +100.8 % of preoperative value on day 14 (p<0.001) and then gradually decreased to reach normal values on day 21 and preoperative values after three months. Conclusions: Average values of the three peripheral blood cells parameters undergo important changes after CABG, but not life threatening, and regain normal and preoperative values after 1-3 months after surgery. PMID:26261388

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

    PubMed Central

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

    2016-01-01

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

  2. Long-term outcomes of patients undergoing war-related amputations of the foot and ankle.

    PubMed

    Ebrahimzadeh, Mohammad H; Rajabi, Mohammad T

    2007-01-01

    Long-term clinical and functional outcomes for patients undergoing foot and ankle amputations are not well documented. We attempted to document long-term outcomes for patients who required lower extremity amputations as a result of wounds suffered during wartime. For this study, 27 Iranian soldiers who had wounds requiring amputation of the foot and ankle were selected for follow-up. The participants' wartime medical records were reviewed, a clinical examination was performed, and each participant completed a questionnaire. Postamputation follow-up averaged 17.5 years. The most prevalent (66.6%) cause of injury was a land mine. The prevalences of different clinical symptoms reported by the amputees at the time of the last follow-up were as follows: 11 (40.7%) with phantom sensation, 6 (22.2%) with phantom pain, 12 (44.4%) with stump pain, 12 (44.4%) with back pain, 9 (33.3%) with contralateral knee pain, and 4 (14.8%) with ipsilateral knee pain; 20 (74%) reported treatment for psychological conditions. In regard to social conditions, 13 (48.1) were currently employed, or had been employed, for a number of years after the amputation; 26 (96%) had children, and all of the patients were married. The results of this observational study indicate that individuals have significant long-term pain and discomfort after war-related lower extremity amputation. Although all 27 (100%) of the amputees were able to maintain satisfactory family functioning, only 13 (48.1%) of the study participants were able to remain productively employed after undergoing amputation, and 20 (74%) reported long-term psychological problems in addition to their physical pain.

  3. Estimating Radiation Dose Metrics for Patients Undergoing Tube Current Modulation CT Scans

    NASA Astrophysics Data System (ADS)

    McMillan, Kyle Lorin

    Computed tomography (CT) has long been a powerful tool in the diagnosis of disease, identification of tumors and guidance of interventional procedures. With CT examinations comes the concern of radiation exposure and the associated risks. In order to properly understand those risks on a patient-specific level, organ dose must be quantified for each CT scan. Some of the most widely used organ dose estimates are derived from fixed tube current (FTC) scans of a standard sized idealized patient model. However, in current clinical practice, patient size varies from neonates weighing just a few kg to morbidly obese patients weighing over 200 kg, and nearly all CT exams are performed with tube current modulation (TCM), a scanning technique that adjusts scanner output according to changes in patient attenuation. Methods to account for TCM in CT organ dose estimates have been previously demonstrated, but these methods are limited in scope and/or restricted to idealized TCM profiles that are not based on physical observations and not scanner specific (e.g. don't account for tube limits, scanner-specific effects, etc.). The goal of this work was to develop methods to estimate organ doses to patients undergoing CT scans that take into account both the patient size as well as the effects of TCM. This work started with the development and validation of methods to estimate scanner-specific TCM schemes for any voxelized patient model. An approach was developed to generate estimated TCM schemes that match actual TCM schemes that would have been acquired on the scanner for any patient model. Using this approach, TCM schemes were then generated for a variety of body CT protocols for a set of reference voxelized phantoms for which TCM information does not currently exist. These are whole body patient models representing a variety of sizes, ages and genders that have all radiosensitive organs identified. TCM schemes for these models facilitated Monte Carlo-based estimates of fully

  4. The adaptation problems of patients undergoing hemodialysis: socio-economic and clinical aspects1

    PubMed Central

    Frazão, Cecília Maria Farias de Queiroz; de Sá, Jéssica Dantas; Medeiros, Ana Beatriz de Almeida; Fernandes, Maria Isabel da Conceição Dias; Lira, Ana Luisa Brandão de Carvalho; Lopes, Marcos Venícios de Oliveira

    2014-01-01

    OBJECTIVES: to identify adaptation problems under Roy's Model in patients undergoing hemodialysis and to correlate them with the socioeconomic and clinical aspects. METHOD: a transversal study, undertaken using a questionnaire. The sample was made up of 178 individuals. The Chi-squared and Mann-Whitney U tests were undertaken. RESULTS: the adaptation problems and the socioeconomic and clinical aspects which presented statistical associations were: Hyperkalemia and age; Edema and income; Impairment of a primary sense: touch and income; Role failure and age; Sexual dysfunction and marital status and sex; Impairment of a primary sense: vision and years of education; Intolerance to activity and years of education; Chronic pain and sex and years of education; Impaired skin integrity and age: Hypocalcemia and access; Potential for injury and age and years of education; Nutrition below the organism's requirements and age; Impairment of a primary sense: hearing and sex and kinetic evaluation of urea; Mobility in gait and/or coordination restricted, and months of hemodialysis; and, Loss of ability for self-care, and months of hemodialysis and months of illness. CONCLUSION: adaptation problems in the clientele undergoing hemodialysis can be influenced by socioeconomic/clinical data. These findings contribute to the development of the profession, fostering the nurse's reflection regarding the care. PMID:25591091

  5. Evolution & the Cesarean Section Rate

    ERIC Educational Resources Information Center

    Walsh, Joseph A.

    2008-01-01

    "Nothing in biology makes sense except in the light of evolution." This was the title of an essay by geneticist Theodosius Dobzhansky writing in 1973. Many causes have been given for the increased Cesarean section rate in developed countries, but biologic evolution has not been one of them. The C-section rate will continue to rise, because the…

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  8. Radiation dose measurement and risk estimation for paediatric patients undergoing micturating cystourethrography.

    PubMed

    Sulieman, A; Theodorou, K; Vlychou, M; Topaltzikis, T; Kanavou, D; Fezoulidis, I; Kappas, C

    2007-09-01

    Micturating cystourethrography (MCU) is considered to be the gold-standard method used to detect and grade vesicoureteric reflux (VUR) and show urethral and bladder abnormalities. It accounts for 30-50% of all fluoroscopic examinations in children. Therefore, it is crucial to define and optimize the radiation dose received by a child during MCU examination, taking into account that children have a higher risk of developing radiation-induced cancer than adults. This study aims to quantify and evaluate, by means of thermoluminescence dosimetry (TLD), the radiation dose to the newborn and paediatric populations undergoing MCU using fluoroscopic imaging. Evaluation of entrance surface dose (ESD), organ and surface dose to specific radiosensitive organs was carried out. Furthermore, the surface dose to the co-patient, i.e. individuals helping in the support, care and comfort of the children during the examination, was evaluated in order to estimate the level of risk. 52 patients with mean age of 0.36 years who had undergone MCU using digital fluoroscopy were studied. ESD, surface doses to thyroid, testes/ovaries and co-patients were measured with TLDs. MCU with digital equipment and fluoroscopy-captured image technique can reduce the radiation dose by approximately 50% while still obtaining the necessary diagnostic information. Radiographic exposures were made in cases of the presence of reflux or of the difficulty in evaluating a finding. The radiation surface doses to the thyroid and testes are relatively low, whereas the radiation dose to the co-patient is negligible. The risks associated with MCU for patients and co-patients are negligible. The results of this study provide baseline data to establish reference dose levels for MCU examination in very young patients.

  9. Extramedullary Relapse Following Total Marrow and Lymphoid Irradiation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

    SciTech Connect

    Kim, Ji Hyun; Stein, Anthony; Schultheiss, Timothy E.; Palmer, Joycelynne; Liu, An; Rosenthal, Joseph; Forman, Stephen J.

    2014-05-01

    Purpose: Approximately 5% to 20% of patients who undergo total body irradiation (TBI) in preparation for hematopoietic cell transplantation (HCT) can develop extramedullary (EM) relapse. Whereas total marrow and lymphoid irradiation (TMLI) provides a more conformally targeted radiation therapy for patients, organ sparing has the potential to place the patient at a higher risk for EM relapse than TBI. This study evaluated EM relapse in patients treated with TMLI at our institution. Methods and Materials: Patients eligible for analysis had been enrolled in 1 of 3 prospective TMLI trials between 2006 and 2012. The TMLI targeted bones, major lymph node chains, liver, spleen, testes, and brain, using image-guided tomotherapy with total dose ranging from 12 to 15 Gy. Results: A total of 101 patients with a median age of 47 years were studied. The median follow-up was 12.8 months. Incidence of EM relapse and bone marrow (BM) relapse were 12.9% and 25.7%, respectively. Of the 13 patients who had EM relapse, 4 also had BM relapse, and 7 had EM disease prior to HCT. There were a total of 19 EM relapse sites as the site of initial recurrence: 11 soft tissue, 6 lymph node, 2 skin. Nine of these sites were within the target region and received ≥12 Gy. Ten initial EM relapse sites were outside of the target region: 5 sites received 10.1 to 11.4 Gy while 5 sites received <10 Gy. Pretransplantation EM was the only significant predictor of subsequent EM relapse. The cumulative incidence of EM relapse was 4% at 1 year and 11.4% at 2 years. Conclusions: EM relapse incidence was as frequent in regions receiving ≥10 Gy as those receiving <10 Gy. EM relapse rates following TMLI that included HCT regimens were comparable to published results with regimens including TBI and suggest that TMLI is not associated with an increased EM relapse risk.

  10. Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study1

    PubMed Central

    Ottaviani, Ana Carolina; Souza, Érica Nestor; Drago, Natália de Camargo; de Mendiondo, Marisa Silvana Zazzetta; Pavarini, Sofia Cristina Iost; Orlandi, Fabiana de Souza

    2014-01-01

    Objective to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis. Method this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through individual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS). Results the average HHI score was 38.06 (±4.32) while the average PP-RSS score was 3.67 (±0.62) for "beliefs" and 3.21 (±0.53) for "hope/optimism". Spearman's coefficient indicated there was a moderate positive correlation between the HHI and PP-RSS dimensions of "beliefs" (r=0.430; p<0.001) and "hope/optimism" (r=0.376; p<0.001). Conclusion Since a relationship between the sense of hope and spirituality of patients with chronic kidney disease was found, these constructs should be taken into account at the time health professionals deliver care to help patients coping with the disease and treatment. PMID:26107832

  11. Gelastic seizures: incidence, clinical and EEG features in adult patients undergoing video-EEG telemetry.

    PubMed

    Kovac, Stjepana; Diehl, Beate; Wehner, Tim; Fois, Chiara; Toms, Nathan; Walker, Matthew C; Duncan, John S

    2015-01-01

    This study aimed to determine clinical features of adult patients with gelastic seizures recorded on video -electroencephalography (EEG) over a 5-year period. We screened video-EEG telemetry reports for the occurrence of the term "gelastic" seizures, and assessed the semiology, EEG features, and duration of those seizures. Gelastic seizures were identified in 19 (0.8%) of 2,446 admissions. The presumed epileptogenic zone was in the hypothalamus in one third of the cases, temporal lobe epilepsy was diagnosed in another third, and the remainder of the cases presenting with gelastic seizures were classified as frontal, parietal lobe epilepsy or remained undetermined or were multifocal. Gelastic seizures were embedded in a semiology, with part of the seizure showing features of automotor seizures. A small proportion of patients underwent epilepsy surgery. Outcome of epilepsy surgery was related to the underlying pathology; two patients with hippocampal sclerosis had good outcomes following temporal lobe resection and one of four patients with hypothalamic hamartomas undergoing gamma knife surgery had a good outcome.

  12. Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review.

    PubMed

    Granchi, D; Cenni, E; Giunti, A; Baldini, N

    2012-08-01

    We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement (TJR). Our purpose was to assess the risk of developing metal hypersensitivity post-operatively and its relationship with outcome and to investigate the advantages of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in PubMed and EMBASE: 22 articles (comprising 3634 patients) met the inclusion criteria. The frequency of positive tests increased after TJR, especially in patients with implant failure or a metal-on-metal coupling. The probability of developing a metal allergy was higher post-operatively (odds ratio (OR) 1.52 (95% confidence interval (CI) 1.06 to 2.31)), and the risk was further increased when failed implants were compared with stable TJRs (OR 2.76 (95% CI 1.14 to 6.70)). Hypersensitivity testing was not able to discriminate between stable and failed TJRs, as its predictive value was not statistically proven. However, it is generally thought that hypersensitivity testing should be performed in patients with a history of metal allergy and in failed TJRs, especially with metal-on-metal implants and when the cause of the loosening is doubtful.

  13. FOOD INTOLERANCES AND ASSOCIATED SYMPTOMS IN PATIENTS UNDERGOING FOBI-CAPELLA TECHNIQUE WITHOUT GASTRIC RING

    PubMed Central

    MOREIRA, Marcella de Arruda; ESPÍNOLA, Patrícia Ramos Maciel; de AZEVEDO, Camila Wanderley

    2015-01-01

    Background Bariatric surgery is considered the only effective method to treat refractory obesity, and especially for those in which clinical treatment was not successful. However, the appearance of food intolerances and clinical manifestations are quite common. Aim To identify food intolerances and associated them to symptoms in patients undergoing Fobi-Capella technique without gastric ring. Methods This was a cross-sectional study of adult patients who had more than one year after surgery. Demographic, anthropometric, weight and preoperative height data were investigated. Nutritional status was classified according to the criteria established by the World Health Organization. It was considered food intolerance the presence of nausea, vomiting, diarrhea or bloating after eating a particular food. Results The sample consisted of 61 patients who attended the nutritional consultation of which 26 (42.6%) had food intolerance, mostly related to red meat (n=12; 34.3%) during the first six months of operation; there was a significant difference between the periods between 0 and 6 months, and 7 to 12 (p=0.02). Among the symptoms reported by patients, nausea was the most recurrent until the 6th month, but without significant differences between the two periods (p=0.06). Conclusions The Fobi-Capella procedure without gastric ring promoted high frequency of intolerance to meat in general, especially for the red, chicken and fish, on this sequence; nausea was the most frequent symptom. These data suggest the need for adequate nutritional monitoring throughout the postoperative period. PMID:25861067

  14. Effectiveness of stress management in patients undergoing transrectal ultrasound-guided biopsy of the prostate

    PubMed Central

    Chiu, Li-Pin; Tung, Heng-Hsin; Lin, Kuan-Chia; Lai, Yu-Wei; Chiu, Yi-Chun; Chen, Saint Shiou-Sheng; Chiu, Allen W

    2016-01-01

    Background To assess the utilization of stress management in relieving anxiety and pain among patients who undergo transrectal ultrasound (TRUS)-guided biopsy of the prostate. Methods Eighty-two patients admitted to a community hospital for a TRUS biopsy of the prostate participated in this case-controlled study. They were divided into an experimental group that was provided with stress management and a control group that received only routine nursing care. Stress management included music therapy and one-on-one simulation education. Before and after the TRUS biopsy, the patients’ state-anxiety inventory score, pain visual analogue scale (VAS), respiratory rate, heart rate, and blood pressure were obtained. Results There were no differences in baseline and disease characteristics between the two groups. The VAS in both groups increased after the TRUS biopsy, but the difference in pre- and postbiopsy VAS scores was significantly lower in the experimental group (P=0.03). Patients in both groups experienced mild anxiety before and after the biopsy, but those in the experimental group displayed a significantly greater decrease in postbiopsy state-anxiety inventory score compared to the control group (P=0.02). Conclusion Stress management can alleviate anxiety and pain in patients who received a TRUS biopsy of the prostate under local anesthesia. PMID:26929606

  15. Mitral valve repair for ischemic moderate mitral regurgitation in patients undergoing coronary artery bypass grafting

    PubMed Central

    Toktas, Faruk; Yavuz, Senol; Ozsin, Kadir K.; Sanri, Umut S.

    2016-01-01

    Objectives: To investigate whether mitral valve repair (MVR) at the time of coronary artery bypass grafting (CABG) in patients with ischemic moderate mitral regurgitation (MR) and coronary artery disease could improve short- and mid-term postoperative outcomes. Methods: Between March 2013 and December 2015, 90 patients with moderate ischemic MR underwent first-time CABG in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey. Out of 90 patients, 44 (48.9%) underwent combined CABG+MVR. The remaining 46 (51.1%) underwent CABG alone. Ventricular functions and effort capacities of patients in both groups were evaluated echocardiographically and clinically in the preoperative period, and in the first postoperative year. Results: Postoperative regurgitant volume changes according to preoperative values were -24.76±19 ml/beat in the combined CABG+MVR group, and -8.70±7.2 ml/beat in the CABG alone group (p=0.001). The change of vena contracta width was -3.40±0.2 mm in the combined CABG+MVR group whereas in the CABG alone -1.45±0.7 mm (p=0.019). The changes of left ventricular end-systolic volume index were -30.77±25.9 ml/m2 in the combined CABG+MVR group and -15.6±9.4 ml/m2 in the CABG alone group (p=0.096). Ejection fraction changes in the combined CABG+MVR group was +1.51±5.3% and in the CABG alone group was +1.15±4.3%. No statistically significant difference was found between both groups (p=0.604). Preoperative New York Heart Association class values in the combined CABG+MVR group was 2.18±0.45, and in the CABG alone group was 2.13±0.54. Conclusions: Moderate MR in patients undergoing CABG affects the outcome adversely and it does not reliably improve after CABG alone. Therefore, patients with ischemic moderate MR should undergo simultaneous MVR at the time of CABG. PMID:27464861

  16. Influence of z overscanning on normalized effective doses calculated for pediatric patients undergoing multidetector CT examinations

    SciTech Connect

    Tzedakis, Antonis; Damilakis, John; Perisinakis, Kostas; Karantanas, Apostolos; Karabekios, Spiros; Gourtsoyiannis, Nicholas

    2007-04-15

    The purpose of this study was to evaluate the effect of z overscanning on normalized effective dose for pediatric patients undergoing multidetector-computed tomography (CT) examinations. Five commercially available mathematical anthropomorphic phantoms representing newborn, 1-, 5-, 10-, and 15-year-old patients and the Monte Carlo N-Particle (MCNP, version 4C2) radiation transport code were employed in the current study to simulate pediatric CT exposures. For all phantoms, axial and helical examinations at 120 kV tube voltage were simulated. Scans performed at 80 kV were also simulated. Sex-specific normalized effective doses were estimated for four standard CT examinations i.e., head-neck, chest, abdomen-pelvis, and trunk, for all pediatric phantoms. Data for both axial and helical mode acquisition were obtained. In the helical mode, z overscanning was taken into account. The validity of the Monte Carlo results was verified by comparison with dose data obtained using thermoluminescence dosimetry and a physical pediatric anthropomorphic phantom simulating a 10-year-old child. In all cases normalized effective dose values were found to increase with increasing z overscanning. The percentage differences in normalized data between axial and helical scans may reach 43%, 70%, 36%, and 26% for head-neck, chest, abdomen-pelvis, and trunk studies, respectively. Normalized data for female pediatric patients was in general higher compared to male patients for all ages, examined regions, and z overscanning values. For both male and female children, the normalized effective dose values were reduced as the age was increased. For the same typical exposure conditions, dose values decreased when lower tube voltage was used; for a 1-year-old child, for example, the effective dose was 3.8 times lower when 80 kV instead of 120 kV was used. Normalized data for the estimation of effective dose to pediatric patients undergoing standard axial and helical CT examinations on an

  17. Right heart function deteriorates in breast cancer patients undergoing anthracycline-based chemotherapy

    PubMed Central

    Boczar, Kevin Emery; Aseyev, Olexiy; Sulpher, Jeffrey; Johnson, Christopher; Burwash, Ian G; Turek, Michele; Dent, Susan

    2016-01-01

    Background Cardiotoxicity from anthracycline-based chemotherapy is an important cause of early and late morbidity and mortality in breast cancer patients. Left ventricular (LV) function is assessed for patients receiving anthracycline-based chemotherapy to identify cardiotoxicity. However, animal studies suggest that right ventricular (RV) function may be a more sensitive measure to detect LV dysfunction. The purpose of this pilot study was to determine if breast cancer patients undergoing anthracycline-based chemotherapy experience RV dysfunction. Methods Forty-nine breast cancer patients undergoing anthracycline-based chemotherapy at the Ottawa Hospital between November 2007 and March 2013 and who had 2 echocardiograms performed at least 3months apart were retrospectively identified. Right atrial area (RAA), right ventricular fractional area change (RV FAC) and RV longitudinal strain of the free wall (RV LSFW) were evaluated according to the American Society of Echocardiography guidelines. Results The majority (48/49) of patients were females with an average age of 53.4 (95% CI: 50.1–56.7years). From baseline to follow-up study, average LV ejection fraction (LVEF) decreased from 62.22 (95% CI: 59.1–65.4) to 57.4% (95% CI: 54.0–60.9) (P=0.04). During the same time period, the mean RAA increased from 12.1cm2 (95% CI: 11.1–13.0cm2) to 13.8cm2 (95% CI: 12.7–14.9cm2) (P=0.02), mean RV FAC decreased (P=0.01) from 48.3% (95% CI: 44.8–51.74) to 42.1% (95% CI: 38.5–45.6%), and mean RV LSFW worsened from −16.2% (95% CI: −18.1 to −14.4%) to −13.81% (95% CI: −15.1 to −12.5%) (P=0.04). Conclusion This study demonstrates that breast cancer patients receiving anthracycline-based chemotherapy experience adverse effects on both right atrial size and RV function. Further studies are required to determine the impact of these adverse effects on right heart function and whether this represents an earlier marker of cardiotoxicity. PMID:27457966

  18. Current readings: long-term management of patients undergoing successful pediatric cardiac surgery.

    PubMed

    DiBardino, Daniel J; Jacobs, Jeffrey P

    2014-01-01

    As of 2000, more adults than children are alive with congenital heart disease. Each year, more of these adults with congenital heart disease undergo surgery. Adults with congenital heart disease require lifelong surveillance, follow-up imaging, and clinical decision making by appropriately trained and familiar physicians and extenders. Three common challenges facing adults with congenital heart disease are the neglected patient, weak programmatic infrastructure, and the planning and management of pregnancy in the adult with congenital heart disease. Many challenges must be overcome in order to establish and maintain a comprehensive medical and surgical program for adults with congenital heart disease. Three common and challenging groups of adults with congenital heart disease who may require surgery are adults requiring tricuspid valve surgery for Ebstein's malformation, those requiring reoperation for failing Fontan circulation, and those requiring pulmonary valve replacement (PVR). Surgery for Ebstein's anomaly is now offered to older patients at low risk and with good late outcome. The operation includes tricuspid valve repair or replacement and frequent concomitant procedures such as atrial septal defect closure, arrhythmia surgery (the Maze procedure), and coronary artery bypass grafting. Patients undergoing previous iterations of the Fontan operation are especially prone to arrhythmia and failing circulation. Fontan conversion with arrhythmia surgery and pacemaker therapy was developed by Constantine Mavroudis, Barbara Deal, and Carl Backer to treat these challenging patients, with the first such operation performed in 1994. Fontan conversion involves: (1) conversion of the previously created atriopulmonary connection to a total cavopulmonary connection (TCPC), extracardiac Fontan; (2) arrhythmia surgery, typically with a modified biatrial Maze procedure along with placement of an antitachycardia, dual-chamber pacemaker with steroid-eluting epicardial leads

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

    PubMed Central

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

    2014-01-01

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

  20. Pharmacokinetics and pharmacodynamics of propofol in cancer patients undergoing major lung surgery.

    PubMed

    Przybyłowski, Krzysztof; Tyczka, Joanna; Szczesny, Damian; Bienert, Agnieszka; Wiczling, Paweł; Kut, Katarzyna; Plenzler, Emilia; Kaliszan, Roman; Grześkowiak, Edmund

    2015-04-01

    Despite the growing number of cancer cases and cancer surgeries around the world, the pharmacokinetics (PK) and pharmacodynamics (PD) of anesthetics used in this population are poorly understood. Patients operated due to cancer are usually in severe state and often require chemotherapy. It might affect the PK/PD of drugs used in this population. Therefore, in this study we explored the PK/PD of propofol in cancer patients having a major lung surgery. 23 patients that underwent a propofol-fentanyl total intravenous anesthesia were included in the analysis. A large set of demographic, biochemical and hemodynamic parameters was collected for the purpose of covariate analysis. Nonlinear mixed effect modeling in NONMEM was used to analyze the collected data. A three-compartment model was sufficient to describe PK of propofol. The anesthetic effect (AAI index) was linked to the propofol effect site concentrations through a sigmoidal E max model. A slightly higher value of clearance, a lower value of distribution clearance, and a decreased volume of peripheral compartment were observed in our patients, as compared with the literature values reported for healthy volunteers by Schnider et al. and by Eleveld et al. Despite these differences, both models led to a clinically insignificant bias of -8 and -1 % in concentration predictions, as reflected by the median performance error. The C e50 and propofol biophase concentration at the time of postoperative orientation were low and equaled 1.40 and 1.13 mg/L. The population PK/PD model was proposed for cancer patients undergoing a major lung surgery. The large body of studied covariates did not affect PK/PD of propofol significantly. The modification of propofol dosage in the group of patients under study is not necessary when TCI-guided administration of propofol by means of the Schnider model is used.

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

    PubMed Central

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

    2012-01-01

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

  2. Deficient Neutrophil Extracellular Trap Formation in Patients Undergoing Bone Marrow Transplantation

    PubMed Central

    Glenn, Jared W.; Cody, Mark J.; McManus, Meghann P.; Pulsipher, Michael A.; Schiffman, Joshua D.; Yost, Christian Con

    2016-01-01

    Overwhelming infection causes significant morbidity and mortality among patients treated with bone marrow transplantation (BMT) for primary immune deficiencies, syndromes of bone marrow failure, or cancer. The polymorphonuclear leukocyte (PMN; neutrophil) is the first responder to microbial invasion and acts within the innate immune system to contain and clear infections. PMNs contain, and possibly clear, infections in part by forming neutrophil extracellular traps (NETs). NETs are extensive lattices of extracellular DNA and decondensed chromatin decorated with antimicrobial proteins and degradative enzymes, such as histones, myeloperoxidase, and neutrophil elastase. They trap and contain microbes, including bacteria and fungi, and may directly affect extracellular microbial killing. Whether or not deficient NET formation contributes to the increased risk for overwhelming infection in patients undergoing BMT remains incompletely characterized, especially in the pediatric population. We examined NET formation in vitro in PMNs isolated from 24 patients who had undergone BMT for 13 different clinical indications. For these 24 study participants, the median age was 7 years. For 6 of the 24 patients, we examined NET formation by PMNs isolated from serial, peripheral blood samples drawn at three different clinical time points: pre-BMT, pre-engraftment, and post-engraftment. We found decreased NET formation by PMNs isolated from patients prior to BMT and during the pre-engraftment and post-engraftment phases, with decreased NET formation compared with healthy control PMNs detected even out to 199 days after their BMT. This decrease in NET formation after BMT did not result from neutrophil developmental immaturity as we demonstrated that >80% of the PMNs tested using flow cytometry expressed both CD10 and CD16 as markers of terminal differentiation along the neutrophilic lineage. These pilot study results mandate further exploration regarding the mechanisms or factors

  3. Deficient Neutrophil Extracellular Trap Formation in Patients Undergoing Bone Marrow Transplantation.

    PubMed

    Glenn, Jared W; Cody, Mark J; McManus, Meghann P; Pulsipher, Michael A; Schiffman, Joshua D; Yost, Christian Con

    2016-01-01

    Overwhelming infection causes significant morbidity and mortality among patients treated with bone marrow transplantation (BMT) for primary immune deficiencies, syndromes of bone marrow failure, or cancer. The polymorphonuclear leukocyte (PMN; neutrophil) is the first responder to microbial invasion and acts within the innate immune system to contain and clear infections. PMNs contain, and possibly clear, infections in part by forming neutrophil extracellular traps (NETs). NETs are extensive lattices of extracellular DNA and decondensed chromatin decorated with antimicrobial proteins and degradative enzymes, such as histones, myeloperoxidase, and neutrophil elastase. They trap and contain microbes, including bacteria and fungi, and may directly affect extracellular microbial killing. Whether or not deficient NET formation contributes to the increased risk for overwhelming infection in patients undergoing BMT remains incompletely characterized, especially in the pediatric population. We examined NET formation in vitro in PMNs isolated from 24 patients who had undergone BMT for 13 different clinical indications. For these 24 study participants, the median age was 7 years. For 6 of the 24 patients, we examined NET formation by PMNs isolated from serial, peripheral blood samples drawn at three different clinical time points: pre-BMT, pre-engraftment, and post-engraftment. We found decreased NET formation by PMNs isolated from patients prior to BMT and during the pre-engraftment and post-engraftment phases, with decreased NET formation compared with healthy control PMNs detected even out to 199 days after their BMT. This decrease in NET formation after BMT did not result from neutrophil developmental immaturity as we demonstrated that >80% of the PMNs tested using flow cytometry expressed both CD10 and CD16 as markers of terminal differentiation along the neutrophilic lineage. These pilot study results mandate further exploration regarding the mechanisms or factors

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

    SciTech Connect

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

    2010-11-15

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

  5. Peri-transplant clostridium difficile infections in patients undergoing allogeneic hematopoietic progenitor cell transplant.

    PubMed

    Agha, Aya; Sehgal, Alison; Lim, Matthew J; Weber, David; Hou, Jing-Zhou; Farah, Rafic; Raptis, Anastasios; Im, Annie; Dorritie, Kathleen; Marks, Stanley; Agha, Mounzer; Lim, Seah H

    2016-03-01

    Clostridium difficile infections (CDI) remain the leading cause of infectious diarrhea among hospitalized patients in this country. Patients with hematologic malignancies, especially those who undergo hematopoietic progenitor cell transplants are particularly at risk for developing CDI. One hundred and forty seven consecutive allogeneic hematopoietic progenitor cell transplants were analyzed for peri-transplant Clostridium difficile infections (PT-CDI). Sixteen patients (11%) developed PT-CDI (Median time = 7 days after transplant). The probability for developing PT-CDI during the peri-transplant period was 12.3%. History of CDI was strongly associated with the development of PT-CDI (P = 0.008) (OR = 5.48) (P = 0.017). These patients also developed PT-CDI much earlier than in those without a history (median 1 day vs. 8 days, P = 0.03). The probability for developing PT-CDI for those with a history was 39%. There was a trend toward significance (P = 0.065) between matched related donor grafts and the development of PT-CDI (OR = 0.245) (P = 0.08). Age, sex, diagnosis, transplant preparative regimens, Graft-versus-host disease (GVHD) prophylaxis, grade 3/4 acute GVHD, or use of antimicrobials within 8 weeks of transplant were not associated with PT-CDI. Non-CDI-related deaths occurred in one patient in the PT-CDI group and nine in the group without PT-CDI. In the remaining 139 patients, the length of hospital stay for those with PT-CDI was significantly longer than those without (mean 27 days vs. 22 days; P = 0.02). PMID:26661725

  6. CYP2C19 polymorphisms in acute coronary syndrome patients undergoing clopidogrel therapy in Zhengzhou population.

    PubMed

    Guo, Y M; Zhao, Z C; Zhang, L; Li, H Z; Li, Z; Sun, H L

    2016-01-01

    The goal of this study was to explore the polymorphisms of CYP2C19 (CYP2C19*2, CYP2C19*3) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) on clopidogrel therapy in Zhengzhou city for guidance on clinical medication and reduction in the incidence of thromboembolic events. Two hundred and thirty-four ACS patients undergoing PCI were included in the study, including 171 males (average age = 64.13 ± 12 years) and 63 females (average age = 67.86 ± 10.20 years). Pyrosequencing analysis detected CYP2C19*2/*3 genotypes, which were divided into wild-type homozygous C/C, mutant heterozygous C/T, and mutant homozygous T/T. This study further explored the relationship between CYP2C19 polymorphisms and clopidogrel resistance in ACS patients. Gene frequencies of C/C, C/T, and T/T for CYP2C19*2 were 39.74, 50, and 10.26%, respectively, while the frequencies of C/C, C/T, and T/T for CYP2C19*3 were 94.02, 5.55, and 0.43%, respectively. According to platelet aggregation analysis, 203 cases normally responded to clopidogrel (86.8%) and 31 cases were clopidogrel resistant (13.2%). There was a correlation between gender and genotype distribution but none between age and genotype. In addition, patients with clopidogrel resistance were treated with ticagrelor antiplatelet therapy instead of clopidogrel, and only 1 case in all patients suffered thrombotic events during a 3-12 month follow-up. In conclusion, CYP2C19*2/*3 polymorphisms may be associated with clopidogrel resistance. Wild-type homozygote and single mutant heterozygote of CYP2C19*2/*3 can be given a normal dose of clopidogrel, while carriers with single mutant homozygote or double mutant heterozygote require ticagrelor antiplatelet therapy as an alternative. PMID:27323099

  7. Effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer

    PubMed Central

    Lu, Jing; Liu, Zhongkai; Xia, Kunpeng; Shao, Changzhong; Guo, Shengdong; Wang, Shenggang; Li, Kezhong

    2015-01-01

    Objective: To discuss the effect of preemptive analgesia with parecoxib sodium in patients undergoing radical resection of lung cancer. Methods: 115 cases of lung cancer patients with American society of anesthesiologists class (ASA) grade I~II who received selective operation were randomly divided into the research group and the control group. The research group patients were given preoperative parecoxib sodium 40 mg plus postoperative normal saline 2 ml, while the control group patients were treated with preoperative normal saline 2 ml plus postoperative parecoxib sodium 40 mg. The pain condition at postoperative 1, 2, 4, 8, 12, 24 and 48 h were evaluated by visual analogue scale (VAS), and emergence agitation was tested by agitation score. Results: Finally there were 56 cases and 57 cases can be used for evaluation in the research group and control group. The VAS scores after 1, 2, 4, 8, 12, 24 and 48 h in the research group and control group were [2.23±0.45, 2.35±0.48, 2.51±0.51, 2.41±0.45, 2.28±0.42, 2.16±0.39, 2.11±0.40] and [3.80±0.62, 4.01±0.64, 4.31±0.67, 4.10±0.64, 3.65±0.70, 3.12±0.66, 2.46±0.53], respectively. The research group were obviously lower than the control group, the difference were statistically significant (P<0.05). The rate of agitation was 24.44% (11/56) in the research group, significantly lower than the control group of 59.65% (34/57) (P<0.05). Conclusion: Preemptive analgesia with parecoxib sodium can obviously relieve acute pain using in patients undergoing radical resection of lung cancer, and is helpful to reduce the incidence of emergence agitation. PMID:26550379

  8. Patient positioning and prevention of injuries in patients undergoing laparoscopic and robot-assisted urologic procedures.

    PubMed

    Sukhu, Troy; Krupski, Tracey L

    2014-04-01

    Positioning injuries in the perioperative period are one of the inherent risks of surgery, but particularly in robot-assisted urologic surgery, and can result in often unrecognized morbidity. Injuries such as upper or lower extremity peripheral neuropathies occur via neural mechanisms and injuries such as compartment syndrome, rhabdomyolysis, ischemic optic neuropathy, and acute arterial occlusion occur via vascular mechanisms. The risk of injury may be exacerbated by operative and patient-related risk factors. Patient-related risk factors include ASA class and BMI, while surgery-related risk factors include physical orientation of the patient and operative length. These injuries can be prevented or reduced by joint effort of the surgeon, anesthesiologist, and operating room staff.

  9. Effects of nocturnal oxygen therapy on heart function in SDB patients undergoing dialysis.

    PubMed

    Nakajima, Fumitaka; Furumatsu, Yoshiyuki; Yurugi, Takatomi; Amari, Yoshifumi; Iida, Takeshi; Uehara, Mitsuru; Fukunaga, Megumu

    2015-06-01

    There is a close relationship between sleep disordered breathing (SDB) and heart failure. We performed home oxygen therapy (HOT) in patients with SAS undergoing dialysis, and investigated its effects on the heart function. The subjects were 10 SDB patients on dialysis. On retiring at night, oxygen was transnasally administered at 1.0 L/min. The human atrial natriuretic peptide (hANP), brain natriuretic peptide (BNP), total protein, Alb, cholesterol and phosphorus levels were measured before the start of oxygen therapy and after 6 weeks. The mean SpO2 increased from 93.5% [91.5, 97.0] to 96.3% [94.8, 97.4] (median [interquartile range]) (p = 0.015). The hANP (p = 0.0039), BNP (p = 0.0098) and serum Alb (p = 0.015) levels significantly improved. There were no significant changes in the cholesterol, phosphorus or total protein levels. These results suggest that nocturnal oxygen therapy improves indices of heart failure, contributing to the prevention and treatment of heart failure in dialysis patients with SDB.

  10. Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

    PubMed Central

    Hung, Yao-Min; Lin, Shoa-Lin; Hung, Shih-Yuan; Huang, Wei-Chun; Wang, Paul Yung-Pou

    2012-01-01

    Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short- and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography. PMID:22655164

  11. Clinical Assessment of Intraventricular Blood Transport in Patients Undergoing Cardiac Resynchronization Therapy

    NASA Astrophysics Data System (ADS)

    Rossini, Lorenzo; Martinez-Legazpi, P.; Benito, Y.; Perez Del Villar, C.; Gonzalez-Mansilla, A.; Barrio, A.; Yotti, R.; Kahn, A. M.; Shadden, S. C.; Fernandez-Aviles, F.; Bermejo, J.; Del Alamo, J. C.

    2015-11-01

    In the healthy heart, left ventricular (LV) filling generates flow patterns which have been proposed to optimize blood transport by coupling diastole and systole phases. We present a novel image-based method to assess how flow patterns influence LV blood transport in patients undergoing cardiac resynchronization therapy (CRT). Solving the advection equation with time-varying inflow boundary conditions allows to track the transport of blood entering the LV in the different filling waves, as well as the transport barriers which couple filling and ejection. The velocity fields were obtained using echocardiographic color Doppler velocimetry, which provides two-dimensional time-resolved flow maps in the apical long axis three-chamber view of the LV. We analyze flow transport in a group of patients with CRT devices as well as in healthy volunteers. In the patients under CRT, the device programming was varied to analyze flow transport under different values of the atrioventricular (AV) conduction delay and to model tachycardia. This analysis illustrates how CRT influences the transit of blood inside the LV, contributes to conserving kinetic energy and favors the generation of hemodynamic forces that accelerate blood in the direction of the LV outflow tract.

  12. Serum C-Reactive Protein and Procalcitonin Kinetics in Patients Undergoing Elective Total Hip Arthroplasty

    PubMed Central

    Battistelli, Sandra; Fortina, Mattia; Carta, Serafino; Guerranti, Roberto; Nobile, Francesco; Ferrata, Paolo

    2014-01-01

    Background. The sensitivity and the specificity of different methods to detect periprosthetic infection have been questioned. The current study aimed to investigate the kinetics of C-reactive protein (CRP) and procalcitonin (PCT) in patients undergoing uncomplicated elective total hip arthroplasty (THA), to provide a better interpretation of their levels in noninfectious inflammatory reaction. Methods. A total of 51 patients were included. Serum CRP and PCT concentrations were obtained before surgery, on the 1st, 3rd, and 7th postoperative days and after discharge on the 14th and 30th days and at 2 years. Results. Both markers were confirmed to increase after surgery. The serum CRP showed a marked increase on the 3rd postoperative day while the peak of serum PCT was earlier, even if much lower, on the first day. Then, they declined slowly approaching the baseline values by the second postoperative week. PCT mean values never exceed concentrations typically related to bacterial infections. Conclusions. CRP is very sensitive to inflammation. It could be the routine screening test in the follow-up of THA orthopaedic patients, but it should be complemented by PCT when there is the clinical suspicion of periprosthetic infection. PMID:24877114

  13. Clinical performance of cuffed versus uncuffed preformed endotracheal tube in pediatric patients undergoing cleft palate surgery

    PubMed Central

    Mukhopadhyay, S; Mukhopadhyay, S; Bhattacharya, D; Bandyopadhyay, BK; Mukherjee, M; Ganguly, R

    2016-01-01

    Background: Uncuffed endotracheal tubes are commonly used in children but due to several decade preferred in paediatric oral surgery. Due to lack of conclusive evidences in this regard, we have conducted this study to compare post-operative morbidity following use of cuffed and uncuffed endotracheal tubes in paediatric patients undergoing cleft lip-palate surgery. Methods: This randomised controlled trial was conducted on children aged 2 to 12 years.110 patients were allocated in two parallel groups using computer generated list of random numbers. Post operative extubation stridor, sore throat, time to first oral intake and regaining of normal voice were compared between two groups. Results: The incidence of sore throat was significantly more (P value > 0.005) in patients of uncuffed group compared to cuffed group. The time to first oral intake and time to regain normal voice were significantly earlier in cuffed group compared to the other. Conclusion: With standard care, preformed cuffed ET tube has shown reduced incidence of post operative sore throat. Cuffed group has earlier oral intake and normal voice regain compared to uncuffed group. PMID:27051374

  14. QT Interval and QT Dispersion in Patients Undergoing Hemodialysis: Revisiting the Old Theory

    PubMed Central

    Alabd, Mohamed A.; El-Hammady, Walid; Shawky, Ahmed; Nammas, Wail; El-Tayeb, Mohamed

    2011-01-01

    Aims We sought to explore the response of the corrected QT (QTc) interval duration and QT dispersion (QTD) to hemodialysis. Methods We enrolled 50 patients with end-stage renal disease undergoing regular hemodialysis. Blood samples were drawn for measurement of serum electrolytes, and a 12-lead ECG was performed to measure the QTc interval duration and QTD, immediately before and just after dialysis sessions. Results The mean age of the cohort was 42.8 ± 12.2 years (58% males). Both the QTc duration and QTD showed marked variability after hemodialysis. A significant correlation was found between the decrease of both serum potassium and magnesium levels after dialysis and the post-dialysis QTc interval duration, with Pearson's correlation coefficients r = −0.43 and r = −0.34, p = 0.002 and p = 0.01, respectively. Patients with a post-dialysis increase of QTc interval duration had a significantly higher percentage of reduction of serum potassium (p = 0.029), whereas patients with a post-dialysis increase of QTD had a significantly higher percentage of reduction of serum magnesium (p = 0.03). Conclusion Our findings suggest a highly variable response of the QTc interval duration and QTD to hemodialysis. The post-dialysis QTc interval duration inversely correlated with the decrease of both serum potassium and magnesium levels after dialysis. PMID:22470374

  15. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    PubMed Central

    Chen, Tongyu; Xu, Jianjun; Ma, Wen; Zhou, Jia

    2016-01-01

    The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery. PMID:27073400

  16. Spiritual Concerns in Hindu Cancer Patients Undergoing Palliative Care: A Qualitative Study

    PubMed Central

    Simha, Srinagesh; Noble, Simon; Chaturvedi, Santosh K

    2013-01-01

    Aims: Spiritual concerns are being identified as important components of palliative care. The aim of this study was to explore the nature of spiritual concerns in cancer patients undergoing palliative care in a hospice in India. Materials and Methods: The methodology used was a qualitative method: Interpretive phenomenological analysis. A semi-structured interview guide was used to collect data, based on Indian and western literature reports. Certain aspects like karma and pooja, relevant to Hindus, were included. Theme saturation was achieved on interviewing 10 participants. Results: The seven most common spiritual concerns reported were benefit of pooja, faith in God, concern about the future, concept of rebirth, acceptance of one's situation, belief in karma, and the question Why me? No participant expressed four of the concerns studied: Loneliness, need of seeking forgiveness from others, not being remembered later, and religious struggle. Conclusions: This study confirms that there are spiritual concerns reported by patients receiving palliative care. The qualitative descriptions give a good idea about these experiences, and how patients deal with them. The study indicates the need for adequate attention to spiritual aspects during palliative care. PMID:24049350

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

    PubMed Central

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

    2016-01-01

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

  18. In vivo evaluating skin doses for lung cancer patients undergoing volumetric modulated arc therapy treatment.

    PubMed

    Tseng, Hsien-Chun; Pan, Lung-Kang; Chen, Hsin-Yu; Liu, Wen-Shan; Hsu, Chang-Chieh; Chen, Chien-Yi

    2015-01-01

    This study is the first to use 10- to 90-kg tissue-equivalent phantoms as patient surrogates to measure peripheral skin doses (Dskin) in lung cancer treatment through Volumetric Modulated Arc Therapy of the Axesse linac. Five tissue-equivalent and Rando phantoms were used to simulate lung cancer patients using the thermoluminescent dosimetry (TLD-100H) approach. TLD-100H was calibrated using 6 MV photons coming from the Axesse linac. Then it was inserted into phantom positions that closely corresponded with the position of the represented organs and tissues. TLDs were measured using the Harshaw 3500 TLD reader. The ICRP 60 evaluated the mean Dskin to the lung cancer for 1 fraction (7 Gy) undergoing VMAT. The Dskin of these phantoms ranged from 0.51±0.08 (10-kg) to 0.22±0.03 (90-kg) mSv/Gy. Each experiment examined the relationship between the Dskin and the distance from the treatment field. These revealed strong variations in positions close to the tumor center. The correlation between Dskin and body weight was Dskin (mSv) = -0.0034x + 0.5296, where x was phantom's weight in kg. R2 is equal to 0.9788. This equation can be used to derive an equation for lung cancer in males. Finally, the results are compared to other published research. These findings are pertinent to patients, physicians, radiologists, and the public.

  19. Quality-of-life assessment among patients undergoing total knee arthroplasty in Manaus☆

    PubMed Central

    de Souza Leão, Marcos George; Santos Santoro, Erika; Lima Avelino, Rafael; Inoue Coutinho, Lucas; Campos Granjeiro, Ronan; Orlando Junior, Nilton

    2014-01-01

    Objective this study had the aim of assessing the quality of life among patients undergoing total knee arthroplasty (TKA). For this, the SF-36 and WOMAC questionnaires respectively were used to make comparisons with preoperative values. Methods a prospective observational cohort study was conducted, with blinded analysis on the results from 107 TKAs in 99 patients, between June 2010 and October 2011. The present study included 55 knees/patients, among whom 73% were female and 27% were male. The patients’ mean age was 68 years. The SF-36 and WOMAC questionnaires (which have been validated for the Portuguese language) were applied immediately before and six months after the surgical procedure. Results the statistical and graphical analyses indicated that the variables presented normal distribution. From the data, it was seen that all the indices underwent positive changes after the surgery. Conclusions despite the initial morbidity, TKA is a very successful form of treatment for severe osteoarthritis of the knee (i.e. more than two joint compartments affected and/or Ahlback classification greater than 3), from a functional point of view, with improvement of the patients’ quality of life, as confirmed in the present study. This study presented evidence level IV (description of case series), with analysis on the results, without a comparative study. PMID:26229799

  20. Pros and cons of splenectomy in patients with myelofibrosis undergoing stem cell transplantation.

    PubMed

    Li, Z; Deeg, H J

    2001-03-01

    During fetal development, the spleen is a major hemopoietic organ. In the adult human, this task is relinquished to the bone marrow. However, under the stress of certain pathologic conditions, extramedullary hemopoiesis may again occur in the spleen. This is especially true for diseases of the marrow, in particular, myeloproliferative disorders such as agnogenic myeloid metaplasia, which is associated with severe fibrosis of the marrow space. At the same time, the spleen sequesters blood cells and contributes to peripheral blood cytopenias, which may improve following splenectomy. However, success is unpredictable, and the operative mortality of splenectomy is on the order of 10%. As a growing number of patients undergo hemopoietic stem cell transplantation as definitive therapy for myelofibrosis, the decision on splenectomy has additional ramifications since the spleen plays an important role in the kinetics of engraftment of donor cells and in immune reconstitution. We conclude from our analysis of available information that the benefit of splenectomy is difficult to predict, although after transplantation splenectomized patients have faster hemopoietic recovery. It appears that the most important indication for splenectomy in these patients is the relief of symptoms from massive spleen enlargement.

  1. Predictors of non-compliance in autologous hematopoietic SCT patients undergoing out-patient transplants.

    PubMed

    Mumby, P B; Hurley, C; Samsi, M; Thilges, S; Parthasarathy, M; Stiff, P J

    2012-04-01

    Non-compliance has received significant attention in medicine, yet few studies have examined its correlates in autologous hematopoietic SCT (AHSCT) patients. This study examined predictors of non-compliance in a sample of 151 AHSCT patients treated in an outpatient setting. Before AHSCT, participants completed a validated measure of mood and retrospective chart reviews were conducted to assess non-compliance during AHSCT, defined as refusal of oral hygiene, prescribed exercise programs, oral nutrition and/or prescribed medications. We found 121 patients (80%) were non-compliant with an aspect of the AHSCT regimen on 1 or more days; mean percentage of non-compliant days was 16.6 (s.d. 15.6). Men were more likely than women to be non-compliant (P<0.05); as were participants with an elevated depression score (P<0.05). Stepwise regression models identified significant predictors of non-compliance: gender, depression, global distress and nausea and vomiting severity (P-values all <0.01). Further analysis revealed that the interaction of the psychological variables with gender was a more robust predictor of non-compliance (P<0.001). For outpatient AHSCT, our findings suggest the need to broaden conceptualizations of risk factors for non-compliance and the importance of assessing patient barriers to compliance to ensure optimal treatment outcome.

  2. Re-laparotomy After Cesarean Section: Risk, Indications and Management Options

    PubMed Central

    Raagab, Ahmed E; Mesbah, Yasir H.; Brakat, Rafik I; Zayed, Abdelhadi A.; Alsaammani, Mohamed Alkhatim

    2014-01-01

    ABSTRACT Aim: To identify risks, indications and outcomes for relaparotomy after cesarean delivery. Methods: A prospective case-controlled study conducted at Mansoura University Hospital, Egypt from 2009 to 2012. Each case was matched randomly to 2 cases that had delivered by cesarean section during the same period and did not undergo repeated surgical intervention. Information's on indications were obtained to gather information's on risks factors. Results: relaparotomy complicated 1.04 %(n= 26) of the total number of the cesarean section (CS) (n=2500). The principal indications for relaparotomy were internal bleeding (Intra-abdominal bleeding in 41.7% (n=10); rectus sheath hematoma in 29.2% (n=7) and uncontrolled postpartum hemorrhage (PPH) in 29.2 %(n=7) of cases, followed by infections in 7.7% (n=2) of cases. Resulting in 11.5 %(n=3) maternal death. Predictors for relaparotomy after cesarean delivery from univariate logistic model, placenta previa (OR=6.898, 95% CI=1.867- 25.4, P=.004), fetal weight greater than 4 kg (OR=6.409, 95% CI=1.444-28.44,. 015). Previous cesarean section and parity were not a risk for re-laparotomy. Conclusion: In this study, the incidence of relaparotomy after cesarean delivery was very high (1.04%). Associated with high maternal mortality (11.5%). The main predictors were placenta previa and fetal macrosomia. PMID:24783911

  3. Phenylephrine infusion for spinal-induced hypotension in elective cesarean delivery: Does preload make a difference?

    PubMed Central

    Bottiger, Brandi A; Bezinover, Dmitri S; Mets, Berend; Dalal, Priti G; Prozesky, Jansie; Ural, Serdar; Vaida, Sonia

    2016-01-01

    Background and Aims: Patients undergoing elective cesarean delivery (CD) have a high-risk of spinal-induced hypotension (SIH). We hypothesized that a colloid preload would further reduce SIH when compared with a crystalloid preload. Material and Methods: Eighty-two healthy parturients undergoing elective CD were included in the study. Patients were randomly assigned to two groups (41 patients in each group) to receive either Lactated Ringer's solution (1500 ml) or hydroxyethyl starch (6% in normal saline, 500 ml) 30 min prior to placement of spinal anesthesia. All patients were treated with a phenylephrine infusion (100 mcg/min), titrated during the study. Results: There was no statistical difference between groups with regards to the incidence of hypotension (10.8% in the colloid group vs. 27.0% in the crystalloid group, P = 0.12). There was also no difference between groups with respect to bradycardia, APGAR scores, and nausea and vomiting. Significantly less phenylephrine (1077.5 ± 514 mcg) was used in the colloid group than the crystalloid group (1477 ± 591 mcg, P = 0.003). Conclusion: The preload with 6% of hydroxyethyl starch before CD might be beneficial for the prevention of SIH. PMID:27625478

  4. Phenylephrine infusion for spinal-induced hypotension in elective cesarean delivery: Does preload make a difference?

    PubMed Central

    Bottiger, Brandi A; Bezinover, Dmitri S; Mets, Berend; Dalal, Priti G; Prozesky, Jansie; Ural, Serdar; Vaida, Sonia

    2016-01-01

    Background and Aims: Patients undergoing elective cesarean delivery (CD) have a high-risk of spinal-induced hypotension (SIH). We hypothesized that a colloid preload would further reduce SIH when compared with a crystalloid preload. Material and Methods: Eighty-two healthy parturients undergoing elective CD were included in the study. Patients were randomly assigned to two groups (41 patients in each group) to receive either Lactated Ringer's solution (1500 ml) or hydroxyethyl starch (6% in normal saline, 500 ml) 30 min prior to placement of spinal anesthesia. All patients were treated with a phenylephrine infusion (100 mcg/min), titrated during the study. Results: There was no statistical difference between groups with regards to the incidence of hypotension (10.8% in the colloid group vs. 27.0% in the crystalloid group, P = 0.12). There was also no difference between groups with respect to bradycardia, APGAR scores, and nausea and vomiting. Significantly less phenylephrine (1077.5 ± 514 mcg) was used in the colloid group than the crystalloid group (1477 ± 591 mcg, P = 0.003). Conclusion: The preload with 6% of hydroxyethyl starch before CD might be beneficial for the prevention of SIH.

  5. Rethinking general anesthesia for cesarean section.

    PubMed

    Sumikura, Hiroyiki; Niwa, Hidetomo; Sato, Masaki; Nakamoto, Tatsuo; Asai, Takashi; Hagihira, Satoshi

    2016-04-01

    In this review, we describe the current consensus surrounding general anesthetic management for cesarean section. For induction of anesthesia, rapid-sequence induction using thiopental and suxamethonium has been the recommended standard for a long time. In recent years, induction of anesthesia using propofol, rocuronium, and remifentanil have been gaining popularity. To prevent aspiration pneumonia, a prolonged preoperative fasting and an application of cricoid pressure during induction of anesthesia have been recommended, but these practices may require revision. Guidelines for difficult airway management were developed first in obstetric anesthesia, and the use of a supraglottic airway is now recognized as an effective rescue device. After the delivery of a fetus, switching from volatile anesthetics to intravenous anesthetics has been recommended to avoid uterine atony. At the same time, intraoperative awareness should be avoided. The rate of persistent wound pain is higher when only general anesthesia was used during cesarean section than with regional anesthesia, and thus it is necessary to provide a sufficient postoperative analgesia using multimodal analgesia, including intravenous patient-controlled analgesia (IV-PCA), transversus abdominis plane (TAP) block, non-steroidal inflammatory drugs, and acetaminophen. PMID:26585767

  6. Preoperative platelet transfusions and perioperative red blood cell requirements in patients with thrombocytopenia undergoing noncardiac surgery

    PubMed Central

    Warner, Matthew A.; Jia, Qing; Clifford, Leanne; Wilson, Gregory; Brown, Michael J.; Hanson, Andrew C.; Schroeder, Darrell R.; Kor, Daryl J.

    2016-01-01

    BACKGROUND Perioperative hemorrhage impacts patient outcomes and health care resource utilization, yet the risks of transfusion therapies are significant. In patients with preoperative thrombocytopenia, the effects of prophylactic preoperative platelet (PLT) transfusion on perioperative bleeding complications remain uncertain. STUDY DESIGN AND METHODS This is a retrospective cohort study of noncardiac surgical patients between January 1, 2008, and December 31, 2011. Propensity-adjusted analyses were used to evaluate associations between preoperative thrombocytopenia, preoperative PLT transfusion, and the outcomes of interest, with a primary outcome of perioperative red blood cell (RBC) transfusion. RESULTS A total of 13,978 study participants were included; 860 (6.2%) had a PLT count of not more than 100 × 109/L with 71 (8.3%) receiving PLTs preoperatively. Administration of PLTs was associated with higher rates of perioperative RBC transfusion (66.2% vs. 49.1%, p 0.0065); however, in propensity-adjusted analysis there was no significant difference between groups (odds ratio [OR] [95% confidence interval {95% CI}], 1.68 [0.95–2.99]; p =0.0764]. Patients receiving PLTs had higher rates of intensive care unit (ICU) admission (OR [95% CI], 1.95 [1.10–3.46]; p =0.0224) and longer hospital lengths of stay (estimate [95% bootstrap CI], 7.2 [0.8–13.9] days; p =0.0006) in propensity-adjusted analyses. CONCLUSION Preoperative PLT transfusion did not attenuate RBC requirements in patients with thrombocytopenia undergoing noncardiac surgery. Moreover, preoperative PLT transfusion was associated with increased ICU admission rates and hospital duration. These findings suggest that more conservative management of preoperative thrombocytopenia may be warranted. PMID:26559936

  7. Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation.

    PubMed

    Patel, Nileshkumar; Deshmukh, Abhishek; Thakkar, Badal; Coffey, James O; Agnihotri, Kanishk; Patel, Achint; Ainani, Nitesh; Nalluri, Nikhil; Patel, Nilay; Patel, Nish; Patel, Neil; Badheka, Apurva O; Kowalski, Marcin; Hendel, Robert; Viles-Gonzalez, Juan; Noseworthy, Peter A; Asirvatham, Samuel; Lo, Kaming; Myerburg, Robert J; Mitrani, Raul D

    2016-04-01

    Catheter ablation for atrial fibrillation (AF) has emerged as a popular procedure. The purpose of this study was to examine whether there exist differences or disparities in ablation utilization across gender, socioeconomic class, insurance, or race. Using the Nationwide Inpatient Sample (2000 to 2012), we identified adults hospitalized with a principal diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code-37.34). We stratified patients by race, insurance status, age, gender, and hospital characteristics. A hierarchical multivariate mixed-effect model was created to identify the independent predictors of AF ablation. Among an estimated total of 3,508,122 patients (extrapolated from 20% Nationwide Inpatient Sample) hospitalized with a diagnosis of AF in the United States from the year 2000 to 2012, 102,469 patients (2.9%) underwent catheter ablations. The number of ablations was increased by 940%, from 1,439 in 2000 to 15,090 in 2012. There were significant differences according to gender, race, and health insurance status, which persisted even after adjustment for other risk factors. Female gender (0.83 [95% CI 0.79 to 0.87; p <0.001]), black (0.49 [95% CI 0.44 to 0.55; p <0.001]), and Hispanic race (0.64 [95% CI 0.56 to 0.72; p <0.001]) were associated with lower likelihoods of undergoing an AF ablation. Medicare (0.93, 0.88 to 0.98, <0.001) or Medicaid (0.67, 0.59 to 0.76, <0.001) coverage and uninsured patients (0.55, 0.49 to 0.62, <0.001) also had lower rates of AF ablation compared to patients with private insurance. In conclusion we found differences in utilization of catheter ablation for AF based on gender, race, and insurance status that persisted over time. PMID:26899494

  8. Prognostic value of total bilirubin in patients with angina pectoris undergoing percutaneous coronary intervention

    PubMed Central

    Yao, Hai-Mu; Shen, De-Liang; Zhao, Xiao-Yan; Wang, Xiao-Fang; Sun, Tong-Wen; Zhang, Jin-Ying; Li, Ling; Zhao, Luo-Sha

    2015-01-01

    Background: Bilirubin is a potent antioxidant and previous studies have reported the relationship between low serum bilirubin concentration and atherosclerosis. Objective: To evaluate the prognostic value of serum total bilirubin (STB) in patients with angina pectoris undergoing percutaneous coronary intervention (PCI). Methods: In total of 1419 patients (931 men, mean age 60.9±10.5 years) with angina pectoris who had undergone successfully percutaneous coronary intervention (PCI) were included in this study. Patients were divided into 2 groups according to the median baseline STB (0.49 mg/dL in this cohort), which was measured before the PCI. Patients with a STB ≥0.49 mg/dL were classified into the high STB group and those with a STB <0.49 mg/dL were classified into the low STB group. Results: The incidence of in-hospital mortality and myocardial infraction was similar in the two groups. After a mean follow-up of 29.0±7.6 months, the incidence of death/myocardial infarction/stroke was significantly higher in low STB group compared with high STB group. Multivariate Cox regression analysis showed that low STB was an independent predictor of death/myocardial infarction/stroke (hazard ratio (HR) = 1.59, 95% confidence interval (CI) = 1.04-2.41, P = 0.031). The cumulative survival rate free from death/myocardial infarction/stroke was lower in low STB group than in high STB group (P = 0.002). Conclusion: Low STB levels before PCI is an independent predictor of long-term adverse clinical outcomes in patients with angina pectoris. PMID:26629096

  9. Association Between Home Blood Pressure and Body Composition by Bioimpedance Monitoring in Patients Undergoing Peritoneal Dialysis.

    PubMed

    Kurasawa, Naho; Mori, Takefumi; Naganuma, Eri; Sato, Emiko; Koizumi, Kenji; Sato, Shinichi; Oba, Ikuko; Tsuchikawa, Mihoko; Ito, Sadayoshi

    2015-01-01

    Home blood pressure (HBP) is an independent predictor of cardiovascular and renal function. However, no particular guidelines have been established for optimal HBP in peritoneal dialysis (PD) patients. Bioelectrical impedance analysis (BIA) is a beneficial tool for determining body composition. In the present study, we used BIA to determine body composition parameters that might play a role in the regulation of HBP in PD patients, and we compared HBP with office blood pressure (BP). Our study enrolled 15 patients (11 men, 4 women) receiving PD at Tohoku University Hospital, who, for 1 year, agreed to monitor HBP and to undergo body composition analysis. Patients were requested to measure HBP twice daily (morning, night) using a home BP device. A bioimpedance monitor was used to monitor body composition each month. Blood and urine samples were also analyzed each month. The relationships of average morning systolic HBP (sMHBP) with parameters of body composition and of blood and urine analyses were evaluated. The enrolledpatients were 66.3 ± 7.7 years of age and had a PD vintage of 28.3 ± 6.4 months. Overall, their sMHBP was 128 ± 13 mmHg and their office systolic BP was 126 ± 15 mmHg. Although office systolic BP and sMHBP both correlated with body fluid parameters [total body water (TBW)/height2], renal function (renal Kt/V serum creatinine), and heart function (left ventricular mass index), the correlation coefficient for sMHBP and TBW/height2 was highest, with sMHBP being the only independent predictor. Sodium intake was associated only with sMHBP. Our results suggest that body fluid status determined by BIA, heart and renal function, and sodium intake show better associations with sMHBP than with office systolic BP. Monitoring HBP and body composition by BIA are beneficial for the maintenance of volume status in PD patients.

  10. Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass.

    PubMed

    Boldt, J; Knothe, C; Zickmann, B; Andres, P; Dapper, F; Hempelmann, G

    1993-06-01

    The influence of four different kinds of intravascular volume replacement on platelet function was investigated in 60 patients undergoing elective aortocoronary bypass grafting using cardiopulmonary bypass (CPB). In a randomized sequence, high-molecular weight hydroxyethyl starch solution (HMW-HES, mean molecular weight [Mw] 450,000 d), low-molecular weight HES (LMW-HES, Mw 200,000 d), 3.5% gelatin or 5% albumin were infused preoperatively to double reduced filling pressure (pulmonary capillary wedge pressure [PCWP] < 5 mm Hg). Fifteen untreated patients served as a control. Platelet function was assessed by aggregometry using turbidometric technique (inductors: ADP, epinephrine, collagen). Maximum aggregation, maximum gradient of aggregation, and platelet volume were measured before, during, and after CPB until the first postoperative day. HMW-HES 840 +/- 90 mL, LMW 850 +/- 100 mL, gelatin 950 +/- 110 mL, and albumin 810 +/- 100 mL were given preoperatively. Maximum platelet aggregation (ranging from -23% to -44% relative from baseline value) and maximum gradient of platelet aggregation (ranging from -26% to -45% relative from baseline values) were reduced only in the HMW-HES patients. After CPB, aggregometry also was impaired most markedly in these patients. The other volume groups showed less reduction in platelet aggregation and were similar to the untreated control. On the first postoperative day, aggregation variables had returned almost to baseline in all patients. Platelet volume was the same among the groups within the investigation period. Postbypass blood loss was highest in the HMW-HES group (890 +/- 180 mL). There was significant (P < 0.04) correlation in this group between blood loss and change in platelet aggregation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7684579

  11. Determinants of Slow Walking Speed in Ambulatory Patients Undergoing Maintenance Hemodialysis

    PubMed Central

    Matsuzawa, Ryota; Kutsuna, Toshiki; Yamamoto, Shuhei; Yoneki, Kei; Harada, Manae; Ishikawa, Ryoma; Watanabe, Takaaki; Yoshida, Atsushi

    2016-01-01

    Walking ability is significantly lower in hemodialysis patients compared to healthy people. Decreased walking ability characterized by slow walking speed is associated with adverse clinical events, but determinants of decreased walking speed in hemodialysis patients are unknown. The purpose of this study was to identify factors associated with slow walking speed in ambulatory hemodialysis patients. Subjects were 122 outpatients (64 men, 58 women; mean age, 68 years) undergoing hemodialysis. Clinical characteristics including comorbidities, motor function (strength, flexibility, and balance), and maximum walking speed (MWS) were measured and compared across sex-specific tertiles of MWS. Univariate and multivariate logistic regression analyses were performed to examine whether clinical characteristics and motor function could discriminate between the lowest, middle, and highest tertiles of MWS. Significant and common factors that discriminated the lowest and highest tertiles of MWS from other categories were presence of cardiac disease (lowest: odds ratio [OR] = 3.33, 95% confidence interval [CI] = 1.26–8.83, P<0.05; highest: OR = 2.84, 95% CI = 1.18–6.84, P<0.05), leg strength (OR = 0.62, 95% CI = 0.40–0.95, P<0.05; OR = 0.57, 95% CI = 0.39–0.82, P<0.01), and standing balance (OR = 0.76, 95% CI = 0.63–0.92, P<0.01; OR = 0.81, 95% CI = 0.68–0.97, P<0.05). History of fracture (OR = 3.35, 95% CI = 1.08–10.38; P<0.05) was a significant factor only in the lowest tertile. Cardiac disease, history of fracture, decreased leg strength, and poor standing balance were independently associated with slow walking speed in ambulatory hemodialysis patients. These findings provide useful data for planning effective therapeutic regimens to prevent decreases in walking ability in ambulatory hemodialysis patients. PMID:27018891

  12. Organ doses for reference pediatric and adolescent patients undergoing computed tomography estimated by Monte Carlo simulation

    SciTech Connect

    Lee, Choonsik; Kim, Kwang Pyo; Long, Daniel J.; Bolch, Wesley E.

    2012-04-15

    Purpose: To establish an organ dose database for pediatric and adolescent reference individuals undergoing computed tomography (CT) examinations by using Monte Carlo simulation. The data will permit rapid estimates of organ and effective doses for patients of different age, gender, examination type, and CT scanner model. Methods: The Monte Carlo simulation model of a Siemens Sensation 16 CT scanner previously published was employed as a base CT scanner model. A set of absorbed doses for 33 organs/tissues normalized to the product of 100 mAs and CTDI{sub vol} (mGy/100 mAs mGy) was established by coupling the CT scanner model with age-dependent reference pediatric hybrid phantoms. A series of single axial scans from the top of head to the feet of the phantoms was performed at a slice thickness of 10 mm, and at tube potentials of 80, 100, and 120 kVp. Using the established CTDI{sub vol}- and 100 mAs-normalized dose matrix, organ doses for different pediatric phantoms undergoing head, chest, abdomen-pelvis, and chest-abdomen-pelvis (CAP) scans with the Siemens Sensation 16 scanner were estimated and analyzed. The results were then compared with the values obtained from three independent published methods: CT-Expo software, organ dose for abdominal CT scan derived empirically from patient abdominal circumference, and effective dose per dose-length product (DLP). Results: Organ and effective doses were calculated and normalized to 100 mAs and CTDI{sub vol} for different CT examinations. At the same technical setting, dose to the organs, which were entirely included in the CT beam coverage, were higher by from 40 to 80% for newborn phantoms compared to those of 15-year phantoms. An increase of tube potential from 80 to 120 kVp resulted in 2.5-2.9-fold greater brain dose for head scans. The results from this study were compared with three different published studies and/or techniques. First, organ doses were compared to those given by CT-Expo which revealed dose

  13. Adverse events in older patients undergoing ERCP: a systematic review and meta-analysis

    PubMed Central

    Day, Lukejohn W.; Lin, Lisa; Somsouk, Ma

    2014-01-01

    Background and study aims: Biliary and pancreatic diseases are common in the elderly; however, few studies have addressed the occurrence of adverse events in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Our objective was to determine the incidence rates of specific adverse events in this group and calculate incidence rate ratios (IRRs) for selected comparison groups. Patients and methods: Bibliographical searches were conducted in Medline, EMBASE, and Cochrane library databases. The studies included documented the incidence of adverse events (perforation, pancreatitis, bleeding, cholangitis, cardiopulmonary adverse events, mortality) in patients aged ≥ 65 who underwent ERCP. Pooled incidence rates were calculated for each reported adverse event and IRRs were determined for available comparison groups. A parallel analysis was performed in patients aged ≥ 80 and ≥ 90. Results: Our literature search yielded 7429 articles, of which 69 studies met our inclusion criteria. Pooled incidence rates for adverse events (per 1000 ERCPs) in patients aged ≥ 65 were as follows: perforation 3.8 (95 %CI 1.8 – 7.0), pancreatitis 13.1 (95 %CI 11.0 – 15.5), bleeding 7.7 (95 %CI 5.7 – 10.1), cholangitis 16.1 (95 %CI 11.7 – 21.7), cardiopulmonary events 3.7 (95 %CI 1.5 – 7.6), and death 7.1 (95 %CI 5.2 – 9.4). Patients ≥ 65 had lower rates of pancreatitis (IRR 0.3, 95 %CI 0.3 – 0.4) compared with younger patients. Octogenarians had higher rates of death (IRR 2.4, 95 %CI 1.3 – 4.5) compared with younger patients, whereas nonagenarians had increased rates of bleeding (IRR 2.4, 95 %CI 1.1 – 5.2), cardiopulmonary events (IRR 3.7, 95 %CI 1.0 – 13.9), and death (IRR 3.8, 95 %CI 1.0 – 14.4). Conclusions ERCP appears to be safe in elderly patients, except in the very elderly who are at higher risk of some adverse events. These data on adverse

  14. Clinical utility of HER2 assessed by immunohistochemistry in patients undergoing curative resection for gastric cancer

    PubMed Central

    Liu, Xuechao; Xu, Pengfei; Qiu, Haibo; Liu, Jianjun; Chen, Shangxiang; Xu, Dazhi; Li, Wei; Zhan, Youqing; Li, Yuanfang; Chen, Yingbo; Zhou, Zhiwei; Sun, Xiaowei

    2016-01-01

    Purpose We sought to determine whether human epidermal growth factor receptor 2 (HER2) and vascular endothelial growth factor (VEGF) expression were independent prognostic factors for gastric cancer (GC). Patients and methods A total of 678 consecutive patients with GC undergoing curative surgery between October 2010 and December 2012 had resected tissue examined for HER2 and VEGF expression using immunohistochemistry. Immunohistochemical expression of HER2 was analyzed using the DAKO-HercepTest™ and scored according to published reports. VEGF expression was calculated by multiplying the score for the percentage of positive cells by the intensity score. We defined positive expression as a score of 1+, 2+, or 3+, and a score of 0 was defined as negative expression. We compared these results to clinicopathological characteristics, including overall survival (OS). Results Multivariate analysis revealed that HER2 expression was independently associated with shorter OS (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.10–2.18; P=0.01) and with higher tumor–nodes–metastasis stage (HR, 3.88; 95% CI, 2.67–5.64; P<0.001) in patients with GC. VEGF expression was not associated with OS (HR, 1.25; 95% CI, 0.86–1.82; P=0.24). HER2 expression was still identified as an independent prognostic factor in Stage II–III patients treated with surgery and adjuvant chemotherapy (P=0.004) but not in patients who received surgery alone (P=0.61). Among patients with Stage III GC, those without HER2 expression survived longer with adjuvant chemotherapy (median 43.9 vs 32.2 months, respectively; P=0.04), whereas those with HER2 expression did not (median 37.1 vs 33.9 months, respectively; P=0.67). Conclusion HER2 expression is independently associated with OS in GC, especially in patients who are at higher risk and receive adjuvant chemotherapy after curative resection. HER2 expression may have important clinical utility in directing adjuvant treatment for Stage III GC

  15. Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant

    PubMed Central

    Singh, Kalyani

    2016-01-01

    Background Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. Methods We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body. Prevalence and comparison of malnutrition was performed with various clinical variables: aetiology, Child Turcotte Pugh scores and model for end stage liver disease (ESLD) grades, degree of ascites, blood product usage, blood loss during the surgery, mortality, days [intensive care unit (ICU), Ventilator and Hospital], and Bio-impedance analysis [weight, fat mass, fat free mass (FFM), muscle mass and body fat%]. Results Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage, blood loss

  16. Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section

    PubMed Central

    Kothari, Nikhil; Bogra, Jaishri; Chaudhary, Ajay K.

    2011-01-01

    Aims and Context: The objective of the present study was to evaluate the analgesic and adverse effects of intrathecal clonidine with hyperbaric bupivacaine in spinal anesthesia. Settings and Design: Randomized single blind trial. Methods: 210 ASA I-II pregnant females undergoing emergency cesarean section were randomized in a single-blind fashion to one of the three groups. In group I (n=70) patients received 12.5 mg of 0.5% hyperbaric bupivacaine intrathecally. In group II (n=70) patients received intrathecal mixture of 0.5% hyperbaric bupivacaine (8 mg) and clonidine 50 μg. In group III (n=70), patients received 0.5% hyperbaric bupivacaine (10 mg) intrathecally along with 50 μg of clonidine. Statistical Analysis Used: Groups were compared using one-way ANOVA with the Bonferroni multiple comparison post hoc test. The proportion of adverse events was compared using the chi-square test (χ2 =57.2410). Results: On adding 50 μg clonidine, we were able to reduce intrathecal dose of bupivacaine for cesarean section to 8 mg. Patients receiving intrathecal clonidine along with bupivacaine had significantly long lasting analgesia with lower bupivacaine dose [246.21±5.15 min. (group II) vs 146.0±4.55 min (group I), P=0.021; 95% confidence interval: 238.01-257.40, group II and 134.99-157.0 group I]. Conclusions: Addition of intrathecal clonidine causes some sedation in the postoperative period, but it provides adequate analgesia and motor paralysis at lower dose of bupivacaine. It also significantly prolongs postoperative pain relief. PMID:21655013

  17. Impact of neoadjuvant therapy on postoperative complications in patients undergoing resection for rectal adenocarcinoma.

    PubMed

    Turner, Immanuel I; Russell, Gregory B; Blackstock, A William; Levine, Edward A

    2004-12-01

    Surgical resection continues to be the mainstay of treatment for rectal cancer. Neoadjuvant therapy (chemotherapy and radiation) has also been shown to be efficacious. The impact of preoperative chemotherapy and radiation on postoperative complications is unclear. The purpose of this study is to evaluate the relationship of neoadjuvant therapy on postoperative complications in patients undergoing a resection of rectal cancer. A total of 325 patients who underwent curative resection for rectal cancer from 1984 to 2001 were retrospectively reviewed. Only cases with complete data sets who had undergone surgery at this institution were evaluable (257). The patients were divided into groups based on the operative procedure performed; abdominoperineal resection (APR) versus sphincter-sparing (SS) procedures (LAR/Transanal) and whether or not preoperative chemotherapy or radiation was administered. There was no significant difference between complication rates for APR and SS with 19 per cent and 14 per cent, respectively. The preoperative therapy had no effect on complications after APR. However, the SS group showed 21 per cent of the patients who received radiation had complications compared to 11 per cent in those who did not (P = 0.087). Complications in the SS group included leaks, wound infections, abscess, embolism, cardiac dysrhythmias, and myocardial infarctions. The 30-day mortality was 1.9 per cent for the entire cohort with no clear difference between groups. There was no significant difference in complication rate between APR and SS. In the APR group, neoadjuvant therapy had no impact on the incidence of complications. However, the SS group did show a trend between preoperative chemotherapy and radiation and complication rate. However, this may not outweigh the advantages of preoperative therapy in this setting.

  18. Effect of cisatracurium versus atracurium on intraocular pressure in patients undergoing tracheal intubation for general anesthesia

    PubMed Central

    Jabalameli, Mitra; Soltani, Hassan Ali; Hashemi, Jalal; Rahimi, Mojtaba

    2011-01-01

    BACKGROUND: Increase in intraocular pressure (IOP) following tracheal intubation during general anesthesia can be troublesome. We compared the influence of two muscle relaxants, cisatracurium and atracurium, on IOP in patients undergoing general anesthesia. METHODS: This randomized, double-blind, comparative trial was conducted on 90 candidates for elective non-ophthalmic surgery under general anesthesia. Patients were 18 to 60 years old with the American Society of Anesthesiologists (ASA) class of I or II. Anesthesia was induced with fentanyl (1.5 mg/kg) and sodium thiopental (5 mg/kg). Patients received atracurium (0.5 mg/kg) or cisatracurium (0.15 mg/kg) two minutes prior to tracheal intubation. IOP, systolic (SBP) and diastolic blood pressure (DBP), and heart rate (HR) were measured at baseline (before medication), after medication (before intubation), and 2, 5, and 10 minutes after intubation. RESULTS: In both groups IOP decreased after administration of muscle relaxants (-3.3 ± 3.6 mmHg), then increased 2 minutes after intubation (5.5 ± 4.4 mmHg), but decreased 5 (-3.3 ± 3.3 mmHg) and 10 (-0.5 ± 2.6 mmHg) minutes after intubation. IOP and SBP were significantly higher in the atracurium compared with the cisatracurium group after 2 (p < 0.001 and 0.002, respectively), 5 (p < 0.001 and 0.012, respectively), and 10 (p = 0.02 and 0.048, respectively) minutes after intubation. CONCLUSIONS: Compared with atracurium, administration of cisatracurium can better prevent the increase of IOP following tracheal intubation in general anesthesia. The observed difference might be related to different effects on hemodynamic variables. Application of these results in patients under ophthalmic surgery is warranted. PMID:22247724

  19. Validation of 2 Submaximal Cardiorespiratory Fitness Tests in Patients With Breast Cancer Undergoing Chemotherapy

    PubMed Central

    Cardinale, Daniele; Ekblom-Bak, Elin; Sundberg, Carl Johan; Wengström, Yvonne; Rundqvist, Helene

    2016-01-01

    Background: Patients with breast cancer have an impaired cardiorespiratory fitness, in part, due to the toxic effects of anticancer therapy. Physical exercise as a means of rehabilitation for patients with cancer is an emerging area of research and treatment, emphasizing the need for accurate and feasible physical capacity measurements. The purpose of this study was to evaluate the validity of peak oxygen consumption (o2peak) predicted by the Ekblom-Bak test (E-B) and the Åstrand-Rhyming prediction model (A-R). Methods: Eight patients with breast cancer undergoing chemotherapy participated in the study. Submaximal exercise tests were performed at 2 different submaximal workloads. Estimated o2peak values were obtained by inserting the heart rate (HR) from the 2 workloads into the E-B prediction model and the HR of only the higher workload into the Åstrand nomogram. A 20-W incremental cycle test-to-peak effort was performed to obtain o2peak values. Results: Results from A-R overestimated o2peak by 6% (coefficient of variation = 7%), whereas results from E-B overestimated o2peak with 42% (coefficient of variation = 21%) compared with measured o2peak. Pearson's correlation coefficient revealed a significant strong relationship between the estimated o2peak from A-R and the measured o2peak (r = 0.86; P < .05), whereas the relationship between the estimated o2peak from E-B and the measured o2peak resulted in a nonsignificant weak correlation (r = 0.21). Conclusion: In a situation where maximal exercise testing is not practical or undesirable from a patient safety perspective, submaximal exercise testing provides an alternative way of estimating o2peak. The A-R prediction model appears to be a valid submaximal exercise test for determining cardiorespiratory fitness in this population.

  20. Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization

    PubMed Central

    Teixeira Sobrinho, Moises; Guirado, Gabriel Negretti; Silva, Marcos Augusto de Moraes

    2014-01-01

    Introduction The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. Objectives To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. Methods We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Estadual Paulista (UNESP)/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP / Botucatu - SP. Results Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy. Conclusion Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy. PMID:25140472

  1. NCICT: a computational solution to estimate organ doses for pediatric and adult patients undergoing CT scans.

    PubMed

    Lee, Choonsik; Kim, Kwang Pyo; Bolch, Wesley E; Moroz, Brian E; Folio, Les

    2015-12-01

    We developed computational methods and tools to assess organ doses for pediatric and adult patients undergoing computed tomography (CT) examinations. We used the International Commission on Radiological Protection (ICRP) reference pediatric and adult phantoms combined with the Monte Carlo simulation of a reference CT scanner to establish comprehensive organ dose coefficients (DC), organ absorbed dose per unit volumetric CT Dose Index (CTDIvol) (mGy/mGy). We also developed methods to estimate organ doses with tube current modulation techniques and size specific dose estimates. A graphical user interface was designed to obtain user input of patient- and scan-specific parameters, and to calculate and display organ doses. A batch calculation routine was also integrated into the program to automatically calculate organ doses for a large number of patients. We entitled the computer program, National Cancer Institute dosimetry system for CT(NCICT). We compared our dose coefficients with those from CT-Expo, and evaluated the performance of our program using CT patient data. Our pediatric DCs show good agreements of organ dose estimation with those from CT-Expo except for thyroid. Our results support that the adult phantom in CT-Expo seems to represent a pediatric individual between 10 and 15 years rather than an adult. The comparison of CTDIvol values between NCICT and dose pages from 10 selected CT scans shows good agreements less than 12% except for two cases (up to 20%). The organ dose comparison between mean and modulated mAs shows that mean mAs-based calculation significantly overestimates dose (up to 2.4-fold) to the organs in close proximity to lungs in chest and chest-abdomen-pelvis scans. Our program provides more realistic anatomy based on the ICRP reference phantoms, higher age resolution, the most up-to-date bone marrow dosimetry, and several convenient features compared to previous tools. The NCICT will be available for research purpose in the near future.

  2. Jaw mobility changes in patients with upper aerodigestive tract cancer undergoing radiation therapy

    PubMed Central

    Wienandts, Patrícia; Mozzini, Carolina; Pinto, Rosélie; da Motta, Neiro; Jotz, Geraldo

    2015-01-01

    Background Radiation therapy is a therapeutic modality widely used for treatment of upper aerodigestive tract (UADT) neoplasms. However, its action is not restricted to tumor cells, and it may cause a variety of adverse reactions, including reduced jaw mobility. Material and Methods A prospective cohort study was conducted to assess changes in jaw mobility in patients with UADT cancer undergoing radiation therapy. Results Fifty-six patients completed the study. The results showed a significant reduction in mouth opening (p<0.001), right lateral excursion (p=0.038) and left lateral excursion (p=0.035) of the jaw, a significant increase in the presence (p<0.001) and severity of oral mucositis (p<0.001), and a significant decrease in performance status (p<0.001) after radiation therapy. Thirty-six patients (64.3%) exhibited reduction in mouth opening after treatment. The variables significantly associated with mouth opening reduction on bivariate analysis were: modification of diet (p=0.037), radiation field (p=0.024), presence of mucositis (p=0.003), and reduction in performance status (p=0.007). After adjustment by the multivariate model, the only variables that remained significantly associated with reduction in mouth opening were presence of mucositis (p=0.018) and reduction in performance status (p=0.47). Conclusions These findings indicate that patients with upper aerodigestive tract cancer experience reduced jaw mobility after radiation therapy, which is strongly correlated with mucositis and reduced functional ability. Key words:Head and neck neoplasms, vertical dimension, radiation therapy, mucositis, temporomandibular joint, joint range of motion, trismus. PMID:26449427

  3. Effect of clindamycin prophylaxis on the colonic microflora in patients undergoing colorectal surgery.

    PubMed Central

    Kager, L; Liljeqvist, L; Malmborg, A S; Nord, C E

    1981-01-01

    Clindamycin was given intravenously to 15 patients undergoing colorectal surgery in an initial dose of 600 mg, given at induction of anesthesia followed by 6 doses of 600 mg at 8-h intervals. Series of serum samples and fecal specimens were taken for analysis of clindamycin concentrations. Tissue samples from the gut wall were taken at surgery. The highest serum concentrations observed occurred 30 min after administration of clindamycin and varied between 6.8 and 37.9 microgram/ml (mean, 14.8 +/- 2.0 [standard error] microgram/ml). The clindamycin concentrations in the tissue samples were between 1.8 and 13.0 microgram/g. Clindamycin concentration in the fecal samples varied between 2.1 and 460 microgram/g. Fecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. Among the aerobic bacteria, enterococci and streptococci decreased during the prophylaxis period. Anaerobic bacteria also decreased significantly during the same period. After the clindamycin administration period, enterococci, streptococci and anaerobic bacteria proliferated. No anaerobic strains resistant to clindamycin were isolated. Postoperative infections due to Streptococcus faecalis and different enterobacteria such as Escherichia coli, Enterobacter cloacae, Citrobacter freundii, and Klebsiella occurred in five patients. PMID:7325640

  4. Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery.

    PubMed

    Faverani, Leonardo Perez; Ramalho-Ferreira, Gabriel; Fabris, André Luis Silva; Polo, Tárik Ocon Braga; Poli, Guilherme Henrique Souza; Pastori, Cláudio Maldonado; Marzola, Clóvis; Assunção, Wirley Gonçalves; Garcia-Júnior, Idelmo Rangel

    2014-09-01

    Procedures for the surgical correction of dentofacial deformities may produce important complications, whether due to the potential for vascular injury or to prolonged surgery, both of which may lead to severe blood loss