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BACKGROUND: Cerebellar infarcts are encountered commonly in clinical practice; however, they are likely to be misinterpreted. They cannot be adequately evaluated on scales such as the National Institute of Health Stroke Scale (NIHSS), which can have fatal consequences. AIM: To evaluate the baseline features, prognosis, and 6-month survival in patients with cerebellar stroke. METHODS: A total of 200 patients with cerebellar ischemia were included in the study. Patients were analyzed retrospectively from 10 years of data. Both univariate and multivariate analyses were evaluated. RESULTS: Mean age was 68 years old, and men were more frequently affected. The most common symptoms were dysarthria and vertiginous sensations. Ischemic lesions were usually cortical/juxtacortical, multiple, hemispheric, and small (below 1.5 cm). The most commonly affected artery was the medial branch of the posterior inferior cerebellar artery. Cardioembolism was the more frequent etiology. Gait ataxia was associated with a more favorable prognosis and 6-month modified Rankin Scale (mRS) scores (OR: 0.15, 95% CI, P = 0.03). Older age (OR: 1.75, 95%, P = 0.02), female gender (OR: 6.72, 95%, P = 0.02), multiple (OR: 10.92, 95%, P = 0.01) and large lesions (OR: 6.56, 95% CI, P = 0.01), posterior circulation ischemic lesions extra-cerebellum (OR: 8.33, 95% CI, P = 0.01), left ventricular apical hypokinesia or AF (OR: 5.58, 95% CI, P = 0.02), and a high mRS score on admission (OR: 5.21, 95% CI, P < 0.001) was correlated with higher 6-month mRS and a lower survival rates. CONCLUSION: The study found that some baseline clinical, neurovascular imaging findings, and the mRS score on admission are useful predictors of cerebellar stroke prognosis and outcome.
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Isquemia Encefálica , Accidente Cerebrovascular , Masculino , Humanos , Femenino , Anciano , Estudios Transversales , Estudios Retrospectivos , Turquía/epidemiología , Accidente Cerebrovascular/diagnóstico , Pronóstico , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico , Cerebelo , Isquemia/complicaciones , Resultado del TratamientoRESUMEN
Medication safety during care transitions is a significant challenge, especially for older adults prescribed multiple medications. Using a systems approach to understand barriers to and strategies for safe medication management throughout high-risk periods of hospital-to-home transition is one important step in designing effective interventions. Framing the care transition as a collaboration between healthcare and patient "work systems," we conducted semi-structured interviews with 37 clinical team members, representing 10 different professional roles involved in providing transitional care for patients. Thematic analyses identified key strategies used by clinical team members in preparing patients to self-manage medications safely in the home environment: (1) streamlining and coordinating clinical management of medication reconciliation across care settings; (2) building patient capacity and engagement in self-management of medications; and (3) redesigning the transitional process. Our research highlights the value in aligning professionals' care transition goals with patients and caregiver(s) to better prepare them to self-manage medications upon discharge.
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Administración del Tratamiento Farmacológico , Transferencia de Pacientes , Anciano , Humanos , Conciliación de Medicamentos , Alta del Paciente , PercepciónRESUMEN
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalizations. Interventional studies focusing on the hospital-to-home transition for COPD patients are few. In the BREATHE (Better Respiratory Education and Treatment Help Empower) study, we developed and tested a patient and family-centered transitional care program that helps prepare hospitalized COPD patients and their family caregivers to manage COPD at home. METHODS: In the study's initial phase, we co-developed the BREATHE transitional care program with COPD patients, family-caregivers, and stakeholders. The program offers tailored services to address individual patients' needs and priorities at the hospital and for 3months post discharge. We tested the program in a single-blinded RCT with 240 COPD patients who were randomized to receive the program or 'usual care'. Program participants were offered the opportunity to invite a family caregiver, if available, to enroll with them into the study. The primary outcomes were the combined number of COPD-related hospitalizations and Emergency Department (ED) visits per participant at 6months post discharge, and the change in health-related quality of life over the 6months study period. Other measures include 'all cause' hospitalizations and ED visits; patient activation; self-efficacy; and, self-care behaviors. DISCUSSION: Unlike 1month transitional care programs that focus on patients' post-acute care needs, the BREATHE program helps hospitalized COPD patients manage the post discharge period as well as prepare them for long term self-management of COPD. If proven effective, this program may offer a timely solution for hospitals in their attempts to reduce COPD rehospitalizations.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Atención Dirigida al Paciente/organización & administración , Cuidado de Transición/organización & administración , Factores de Edad , Anciano , Servicios de Salud Comunitaria/organización & administración , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Educación del Paciente como Asunto/organización & administración , Proyectos Piloto , Enfermedad Pulmonar Obstructiva Crónica/terapia , Calidad de Vida , Proyectos de Investigación , Autocuidado , Autoeficacia , Factores Sexuales , Método Simple Ciego , Factores SocioeconómicosRESUMEN
BACKGROUND: To our knowledge, no evidence is available on health care professionals' use of electronic personal health records (ePHRs) for their health management. We therefore focused on nurses' personal use of ePHRs using a modified technology acceptance model. OBJECTIVES: To examine (1) the psychometric properties of the ePHR acceptance model, (2) the associations of perceived usefulness, ease of use, data privacy and security protection, and perception of self as health-promoting role models to nurses' own ePHR use, and (3) the moderating influences of age, chronic illness and medication use, and providers' use of electronic health record (EHRs) on the associations between the ePHR acceptance constructs and ePHR use. METHODS: A convenience sample of registered nurses, those working in one of 12 hospitals in the Maryland and Washington, DC areas and members of the nursing informatics community (AMIA and HIMSS), were invited to respond to an anonymous online survey; 847 responded. Multiple logistic regression identified associations between the model constructs and ePHR use, and the moderating effect. RESULTS: Overall, ePHRs were used by 47%. Sufficient reliability for all scales was found. Three constructs were significantly related to nurses' own ePHR use after adjusting for covariates: usefulness, data privacy and security protection, and health-promoting role model. Nurses with providers that used EHRs who perceived a higher level of data privacy and security protection had greater odds of ePHR use than those whose providers did not use EHRs. Older nurses with a higher self-perception as health-promoting role models had greater odds of ePHR use than younger nurses. CONCLUSIONS: Nurses who use ePHRs for their personal health might promote adoption by the general public by serving as health-promoting role models. They can contribute to improvements in patient education and ePHR design, and serve as crucial resources when working with their individual patients.
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Actitud del Personal de Salud , Registros Electrónicos de Salud/estadística & datos numéricos , Salud , Enfermeras y Enfermeros/psicología , Encuestas y Cuestionarios , Adulto , Factores de Edad , Anciano , Enfermedad Crónica , Seguridad Computacional , Confidencialidad , Estudios Transversales , Femenino , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Adulto JovenRESUMEN
BACKGROUND: Surgical treatment of T4 non-small cell lung carcinoma (NSCLC) is controversial. METHODS: Between 1998 and 2011, 70 patients undergoing pulmonary resection for T4 NSCLC were evaluated. The patients were divided into four groups: the large vessels group (n = 28), the carinal group (n = 20), the separate tumor nodules group (n = 13) and the mediastinal fat group (n = 9). RESULTS: Overall mortality and morbidity were 12.9% (n = 9) and 35.7% (n = 25), respectively and there was no significant differences between the four groups (p = 0.961, p = 0.750). Complete resection was possible in 47 patients (67.1%). The pathological nodal status was as follows: N0/1 in 58 patients and N2 in 12 patients. Five-year survival rate was 28.9% for all patients and 49.6%, 18.5%, 0% and 20.5% in the carinal, large vessels, mediastinal fat and separate tumor nodule groups, respectively. The carinal group was significantly different from the other groups in terms of survival (p = 0.05). By multivariate analysis, only two factors significantly and independently influenced survival: nodal status (N0/N1 versus N2; p = 0.01) and complete resection (R0 versus R1; p = 0.06). CONCLUSION: Resection is not a suitable approach for T4 NSCLC patients with N2 disease or incomplete resection. Resectable T4 NSCLC patients with carinal or tracheal involvement have better survival than do other T4 sub-groups.
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Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Estadificación de Neoplasias , Neumonectomía , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Turquía/epidemiologíaRESUMEN
Mediastinal lymphangioma is one of the rarest benign mediastinal masses. We report the successful minimally invasive surgical treatment of multiple cystic lymphangiomas in a middle-aged man with a familial history of lung cancer. This case report describes cystic lymphangioma as a rare differential diagnosis for a mediastinal mass in an adult.
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Linfangioma Quístico/cirugía , Neoplasias del Mediastino/cirugía , Cirugía Torácica Asistida por Video , Humanos , Linfangioma Quístico/diagnóstico , Imagen por Resonancia Magnética , Masculino , Neoplasias del Mediastino/diagnóstico , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: The purpose of this study was to investigate the results of minimally invasive treatment modalities in early stage multiloculated empyema thoracis. METHODS: The minimally invasive treatment modalities of 114 patients with Class 5 thoracic empyema were retrospectively reviewed. The patients' demographics, symptoms, diagnostic studies, treatment options and complications were evaluated. RESULTS: A total of 47 patients underwent tube thoracostomy, 23 patients underwent fibrinolytic therapy with streptokinase and 44 patients underwent video-assisted thoracoscopic surgery (VATS) deloculation and debridement. No statistical differences were found in the patients' age, gender, Gram stain and antibiotherapy before intervention among the groups. Illness days before intervention was significantly longer in the tube thoracostomy group than in the others. The VATS group had a shorter drainage time and hospital stay than the others. The VATS and fibrinolytic therapy groups had lower complication rates and less open decortication requirements than the tube thoracostomy group. Success rates were 66, 95 and 100 percent in the tube thoracostomy, fibrinolytic therapy and VATS groups, respectively. In total, there were 35 patients with complications. The most frequent complication was air space. Two inhospital mortalities occurred. CONCLUSION: In patients with early stage multiloculated empyema, VATS deloculation and debridement is superior to tube thoracostomy alone and fibrinolitic therapy in reducing drainage time and hospital stay. It has a relatively high success rate without significant morbidity. Therefore, VATS decortication may be recommended as a first-line therapy in early stage multiloculated empyema thoracis.
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Empiema Pleural/cirugía , Fibrinolíticos/uso terapéutico , Estreptoquinasa/uso terapéutico , Cirugía Torácica Asistida por Video , Toracostomía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Tubos Torácicos , Empiema Pleural/tratamiento farmacológico , Empiema Pleural/terapia , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Retrospectivos , Toracostomía/instrumentación , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The current staging system provides an anatomical classification of lung tumors; its secondary purpose is to allow the prognostic stratification of patients into homogeneous groups after surgery. In this work, intratumoral perineural invasion, lymphatic and blood vessel invasion together with the necrosis content of the tumor exclusive of the non-small cell cancer staging system were studied. METHODS: During a 4-year period, 152 patients operated for non-small cell lung cancer (NSCLC) at our hospital were analyzed. Mean age of patients was 55.7 +/- 10.1 years. RESULTS: Overall 5-year survival was 42.2 %. Mediastinal lymph node involvement, tumor size, incomplete resection, pneumonectomy, presence of necrosis and perineural invasion were significant prognosticators ( P = 0.03, 0.04, 0.0001, 0.046, 0.0246, < 0.0001, respectively). Multivariate analysis revealed that N status, perineural invasion, and the presence of necrosis were independent prognostic factors ( P = 0.006, P = 0.001, P = 0.001, respectively). Patients who had stage I tumor with necrosis and perineural invasion had a lower survival rate than those with stage IIIA tumor without these histopathological features ( P = 0.04). The presence of these histopathological characteristics in stage IIIA patients was a sign of a poorer prognosis ( P = 0.0001). CONCLUSIONS: Perineural invasion and the presence of necrosis independently indicated a dismal prognosis and their prognostic power is comparable to those of the TNM classification. These factors could be candidates for better survival stratification and the indicators of the need for adjuvant therapy in early stage lung cancer patients.
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Carcinoma de Pulmón de Células no Pequeñas/patología , Neoplasias Pulmonares/patología , Nervios Periféricos/patología , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/cirugía , Metástasis Linfática , Persona de Mediana Edad , Necrosis , Invasividad Neoplásica , Estadificación de Neoplasias , Neumonectomía , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: This study aims to investigate the treatment modalities and factors influencing survival in surgically treated superior sulcus tumors. PATIENTS AND METHOD: Sixty-five cases of surgically treated non-small cell carcinoma of the lung occurring as superior sulcus tumors between 1994 and 2007 were retrospectively reviewed. Twenty-five patients underwent induction radiotherapy (RT), 10 had induction chemoradiotherapy (CT/RT). In thirty patients surgery was performed directly. The mortality rate was 6.2 %. Pathological stage was T3 in 55, T4 in 10, N0 in 52, and N1 in 5 and N2 in 8 patients. RESULTS: Overall 5- and 10-year survival rates were 31 % and 28 %, respectively. Complete resection rate was 90 % for patients who received induction CT/RT and 80 % for patients who either received induction RT alone or patients in whom surgery was performed directly. In patients who received neoadjuvant therapy with complete tumor resection, the median survival time was 33 months (28 months for patients who received induction RT alone and 36 months for patients who received induction CT/RT), and the 5-year survival rate was 41 %. Median survival time and 5-year survival rate of patients treated by direct surgery with complete resection was 24 months and 37 %, respectively ( P = 0.87). Five-year survival and 10-year survival rates were significantly higher after complete resection than after incomplete resection (38 % and 34 % vs. 0 %, P = 0.0001). In multivariate analysis, only N2 disease ( P = 0.04) and incomplete resection ( P = 0.03) were found to be poor prognostic factors. CONCLUSION: The presence of N2 disease and incomplete resection are the two most important factors affecting survival. Induction CT/RT may increase the ability to achieve complete surgical resection.
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Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Quimioterapia Adyuvante , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Consistent compliance with evidence-based guidelines is challenging yet critical to patient safety. We conducted a qualitative study to explore the underlying causes for non-compliance with evidence-based guidelines aimed at preventing four types of healthcare-associated infections in the surgical intensive care unit (SICU) setting. METHODS: Twenty semistructured interviews were conducted with attending physicians (3), residents (2), nurses (6), quality improvement coordinators (3), infection control practitioners (2), respiratory therapists (2) and pharmacists (2) in two SICUs. Using a grounded theory approach, we performed thematic analyses of the interviews. RESULTS: The concept of systems ambiguity to explain non-compliance with evidence-based guidelines emerged from the data. Ambiguities hindering consistent compliance were related to tasks, responsibilities, methods, expectations and exceptions. Strategies reported to reduce ambiguity included clarification of expectations from care providers with respect to guideline compliance through education, use of visual cues to indicate the status of patients with respect to a particular guideline, development of tools that provide an overview of information critical for guideline compliance, use of standardised orders, clarification of roles of care providers and use of decision-support tools. CONCLUSIONS: The concept of systems ambiguity is useful to understand causes of non-compliance with evidence-based guidelines aimed at reducing healthcare-associated infections. Multi-faceted interventions are needed to reduce different ambiguity types, hence to improve guideline compliance.
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Infección Hospitalaria/prevención & control , Adhesión a Directriz , Unidades de Cuidados Intensivos/normas , Cuerpo Médico de Hospitales/psicología , Guías de Práctica Clínica como Asunto , Actitud del Personal de Salud , Medicina Basada en la Evidencia , Investigación sobre Servicios de Salud , Hospitales de Veteranos , Humanos , Entrevistas como Asunto , Cuerpo Médico de Hospitales/normas , Cuerpo Médico de Hospitales/estadística & datos numéricos , Admisión del Paciente/normas , Investigación Cualitativa , Estados Unidos , Recursos HumanosRESUMEN
BACKGROUND: Chronic empyema is not a rare complication of pulmonary tuberculosis. Various treatment modalities ranging from open drainage to pneumonectomy, depending on the status of the disease, have been used to treat this complication. However, the best strategy for this disease remains unknown. This study examined the results of different treatment strategies for chronic tuberculous empyema. METHODS: Between January 1993 and December 2002, 36 patients (29 male and 7 female) with an average age of 29.3 years (range 13 - 52 years) presented with chronic tuberculous empyema characterized by empyema cavity and persistent pleural infections that were secondary to tuberculosis. The series consisted of patients who had had tube thoracostomy and underwater drainage without complete re-expansion. All patients were treated with open drainage. Of these, 6 patients had Eloesser flap for complete drainage of pleural pus and resolution of pleural infection. RESULTS: Eloesser-flap drainage resulted in a higher morbidity compared to the open-drainage-only method ( P = 0.011). Pneumonectomy, used as a final therapeutic option, resulted in more complications postoperatively ( P = 0.034). Antituberculosis therapy lasting six months or longer reduced the morbidity rate (54 % vs. 33.3 %), but the difference was not significant. CONCLUSIONS: Our findings indicate that open drainage leads to better results compared to those of Eloesser flap in patients with chronic tuberculous empyema. Patients who underwent pneumonectomy were expected to have higher complication rates and the procedure must therefore be avoided when possible.
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Drenaje/métodos , Empiema Tuberculoso/terapia , Adolescente , Adulto , Enfermedad Crónica , Empiema Tuberculoso/cirugía , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neumonectomía , Complicaciones Posoperatorias/epidemiología , Resultado del TratamientoRESUMEN
This study aims to investigate the treatment of paper mill effluents using electrocoagulation. Removal of lignin, phenol, chemical oxygen demand (COD) and biological oxygen demand (BOD) from paper mill effluents was investigated at various current intensities by using different electrodes (Al and Fe) and at various electrolysis times (1.0, 2.5, 5.0 and 7.5min). It was observed that the experiments carried out at 12V, an electrolysis time of 2min and a current intensity of 77.13mA were sufficient for the removal of these pollutants with each electrode. The removal capacities of the process using an Al electrode were 80% of lignin, 98% of phenol, 70% of BOD, and 75% of COD after 7.5min. Using an Fe electrode the removal capacities were 92%, 93%, 80% and 55%, respectively. In addition, it was found that removal of lignin, phenol, BOD and COD increased with increasing current intensity. In the experiments carried out at different current intensities, higher removal can be explained through a decrease in intra-resistance of solution and consequently an increase at the transfer speed of organic species to electrodes. It was also found that Al electrode performs higher efficiency than Fe electrode except for COD removal. However, the time required for removal of BOD was more than that of COD. The results suggest that electrocoagulation could be considered as an effective alternative to paper mill effluents treatment.
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Electrocoagulación/métodos , Lignina/aislamiento & purificación , Papel , Fenol/aislamiento & purificación , Eliminación de Residuos Líquidos/métodos , Contaminantes Químicos del Agua/aislamiento & purificación , Aluminio/química , Electrodos , Residuos Industriales , Hierro/química , Oxígeno/química , Oxígeno/metabolismo , Factores de TiempoRESUMEN
We report the case of a pulmonary sclerosing haemangioma radiologically presenting as a cystic lesion. The patient was found to have specific anti-echinococcus immunoglobulin E and therefore the preoperative diagnosis was that of pulmonary hydatid cyst. A surgical resection was performed. Although rarely encountered, pulmonary sclerosing haemangioma may show radiological and serological similarities to a pulmonary hydatid cyst. Both entities necessitate complete removal of the lesion without parenchymal resection.
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Equinococosis Pulmonar/diagnóstico por imagen , Hemangioma Esclerosante Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Animales , Biomarcadores de Tumor/análisis , Diagnóstico Diferencial , Equinococosis Pulmonar/cirugía , Echinococcus/inmunología , Femenino , Humanos , Inmunoglobulina E/sangre , Pulmón/patología , Masculino , Neumonectomía , Hemangioma Esclerosante Pulmonar/patología , Hemangioma Esclerosante Pulmonar/cirugíaRESUMEN
Generally, the operative procedures for the diagnosis or treatment of mediastinal, intrathoracic and/or chest wall lesions requiring rib resection are performed under general anesthesia. Although evidence suggests that thoracoscopy can be performed under local anesthesia, no report has indicated that some major thoracic procedures can be accomplished without general anesthesia. In our study, we advocate that certain surgical procedures could be performed under local anesthesia with a performance similar to that of general anesthesia. Thirty patients underwent thoracic procedures with local anesthesia and sedation for diagnosis and treatment. Seventeen of the patients were men, and the mean age of the patients was 49.6 years (range 16 to 71 years). There were 13 diagnostic procedures, and 17 procedures were for treatment purposes. The operative procedures performed using only local anesthesia were mini-thoracotomy (n = 9), mediastinotomy (n = 4), revision of a full-thickness posterolateral thoracic incision (n = 7), resection of the chondroma (n = 4), Eloesser flap (n = 1), metastasectomy of the chest wall (n = 3), empyectomy (n = 1), and video-assisted thoracoscopy (n = 2). Severity of pain was evaluated by VAS. There were no oral or intravenous analgesic requirements in the early postoperative period. No complications attributable to the procedure were observed. Thoracic surgical procedures for diagnosis and treatment performed under local anesthesia are simple, effective, economical and comfortable for the patient.
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Anestesia Local , Enfermedades Torácicas/diagnóstico , Enfermedades Torácicas/cirugía , Procedimientos Quirúrgicos Torácicos/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , ToracotomíaRESUMEN
BACKGROUND: Insufficient relief of postthoracotomy pain is a major cause of increased rates of postoperative complications including inadequate coughing, mucous plugging, hypoxia, compromised ventilation or even bacterial lung infection. We aimed to assess the efficacy of transcutaneous electric nerve stimulation (TENS) in patients with postthoracotomy pain. METHODS: Forty patients scheduled to undergo posterolateral thoracotomy were randomly allocated to receive either TENS or patient-controlled intravenous morphine. Postoperative pain was evaluated using a visual analogue scale (VAS) and the Prince Henry pain scale. Pulmonary function was evaluated and an intergroup comparison was done. RESULTS: On the first three days following surgery, the VAS intensity of the TENS group did not differ significantly from that of the morphine group ( P > 0.05), and on the first two days following thoracotomy, the Prince Henry scale of the TENS group was not statistically significantly different. However, the VAS intensity was significantly lower than that of the control group on the fourth ( P = 0.044), fifth ( P = 0.016), sixth ( P = 0.009), seventh ( P = 0.008), eighth ( P = 0.004), ninth ( P = 0.002), tenth ( P = 0.001), fifteenth ( P = 0.002), thirtieth ( P < 0.001), forty-fifth ( P < 0.001) and sixtieth ( P < 0.001) days. The Prince Henry scale of the TENS group was found to be significantly diminished from the 3rd to the 60th day. TENS significantly reduced the analgesic requirements from day 5 to 60 ( P < 0.01). No noticeable side effect was observed in the TENS group during the study period. CONCLUSION: This study demonstrated that TENS provided a better pain relief and comfort compared to PCA from the fourth postoperative day onwards, and this pain-reducing effect continued for at least two months postoperatively.
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Dolor Postoperatorio/terapia , Toracotomía , Estimulación Eléctrica Transcutánea del Nervio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: The extent and the necessity of lymph node dissection has yet to be defined after resectional surgery for lung cancer. We aimed to analyze the lobe-specific extent of lymph node positivity in patients who underwent preoperative mediastinoscopy as a routine strategy. METHODS: A total of 280 patients with non-small cell lung cancer with negative mediastinoscopy were operated on in our center between January 1997 and June 2003. Hilar and mediastinal lymphadenectomy was performed in every patient. RESULTS: The most commonly involved lymph nodes were found to be paratracheal station lymph nodes (n = 83; 96.5 %) for right upper lobe tumors, subcarinal station lymph nodes (n = 52; 88.1 %) for right lower lobe carcinomas, aorticopulmonary lymph nodes (n = 62; 92.5 %) for left upper lobe and subcarinal station lymph nodes (n = 49; 96.0 %) for left lower lobe tumors. In the patients with right upper lobe, right lower lobe and left lower lobe tumors, the presence of a tumor at these stations was found to be an indicator for poor prognosis ( P = 0.033, P = 0.0038 and P = 0.0016, respectively). Patients with multiple station N2 disease did not survive beyond 3 years. CONCLUSIONS: In patients who underwent routine mediastinoscopy, lobe-specific lymph node dissection could be recommended. Patients with multilevel N2 involvement did not seem to benefit from resectional surgery.
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Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/cirugía , Mediastinoscopía , Adenocarcinoma/secundario , Carcinoma de Células Grandes/secundario , Carcinoma de Células Escamosas/secundario , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Neoplasias del Mediastino/secundario , Persona de Mediana Edad , Estadificación de Neoplasias , Neumonectomía , Pronóstico , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela , Análisis de Supervivencia , Resultado del Tratamiento , TurquíaRESUMEN
BACKGROUND: The aim of this study was to investigate the factors influencing the morbidity and mortality of the non-small cell lung cancer (NSCLC) cases where pneumonectomy was performed. MATERIAL & METHODS: All 101 patients who had underwent a pneumonectomy for NSCLC between 1994-2001 in our hospital were included in the retrospective study. There were 97 males and 4 females with a mean age of 56+/-9.6. Factors affecting morbidity and mortality were analysed by univariate and multivariate analysis. RESULTS: The morbidity rate was 53% and the mortality rate was 9%. Morbidity was related to cardiopulmonary complications in 40% of the cases. The risk factors for cardiopulmonary morbidity with univariate analysis were age > 60 years (p = 0.004), FEV1 < 2 lt (p = 0.016), early bronchopleural fistula (p = 0.0001), tumour size > 4 cm (p = 0.033), vital capacity < 3.7 lt (p = 0.016), forced vital capacity < 3.5 lt (p = 0.033).. With multivariate analysis the risk factors cardiopulmonary morbidity were age (60 >) (p = 0.012) and tumour size > 4 cm (p = 0.043). The risk factors mortality with univariate analysis were right pneumonectomy (p = 0.025), respiratory morbidity (p = 0.0001), cardiac morbidity (p = 0.002), cell type (Epidermoid CA) (0.047), tumour size > 6 cm (p = 0.036), fluid infusion (p = 0.009), forced vital capacity < 78% (p = 0.039), forced expiratory volume in 1 second < 75% (p = 0.039), PO2 (p = 0.037), PCO2 > 42 mmHg (p = 0.023). CONCLUSION: Among the pneumonectomies performed for NSCLC, the causes of postoperative morbidity were multifactorial, however, multivariate analysis did not show any significant factor affecting the mortality, related to this procedure.
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Carcinoma de Células Pequeñas/cirugía , Procedimientos Quirúrgicos Electivos , Neoplasias Pulmonares/cirugía , Neumonectomía , Adulto , Anciano , Carcinoma de Células Pequeñas/mortalidad , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones PosoperatoriasRESUMEN
Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described.
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Ergonomía/normas , Garantía de la Calidad de Atención de Salud , Administración de la Seguridad/normas , Centros Quirúrgicos/normas , Humanos , Errores Médicos/prevención & control , Modelos Teóricos , Evaluación de Resultado en la Atención de Salud , Análisis de Sistemas , Análisis y Desempeño de Tareas , Estados UnidosRESUMEN
Chylomediastinum is a rare but serious complication following thoracic procedures. A 70-year-old woman underwent tracheal resection through median sternotomy. Sternal dehiscence and chylous drainage appeared on the second postoperative week. Oral intake was stopped and total parenteral nutrition was started. Drainage stopped after two weeks. The region was ligated with a purse string suture during revision of sternotomy. A minimal lymph leakage was determined on control Tc-99 lymphoscintigraphy, which indicated injury of the thoracic duct. The patient has been problem-free for 9 months.
Asunto(s)
Quilotórax/etiología , Enfermedades del Mediastino/etiología , Traqueotomía/efectos adversos , Anciano , Quilotórax/diagnóstico por imagen , Quilotórax/terapia , Femenino , Humanos , Enfermedades del Mediastino/diagnóstico por imagen , Enfermedades del Mediastino/terapia , Cintigrafía , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/terapia , Conducto Torácico/lesiones , Neoplasias de la Tráquea/cirugíaRESUMEN
An activated carbon was developed from Rosa canina sp. seeds, characterized and used for the removal of methylene blue (basic dye) from aqueous solutions. Adsorption studies were carried out at 20 degrees C and various initial dye concentrations (20, 40, 60, 80, and 100 mg/L) for different times (15, 30, 60, and 120 min). The adsorption isotherm was obtained from data. The results indicate that the adsorption isotherm of methylene blue is typically S-shaped. The shape of isotherm is believed to reflect three distinct modes of adsorption. In region 1, the adsorption of methylene blue is carried out mainly by ion exchange. In region 2 by polarizations of pi-electrons established at cyclic parts of the previously adsorbed methylene blue molecules is occurred. However, it is not observed any change at the sign of the surface charge although zeta potential value is decreased with increase of amount adsorbed. In region 3, the slope of the isotherm is reduced, because adsorption now must overcome electrostatic repulsion between oncoming ions and the similarly charged solid. Adsorption in this fashion is usually complete when the surface is covered with a monolayer of methylene blue. To reveal the adsorptive characteristics of the produced active carbon, porosity and BET surface area measurements were made. Structural analysis was performed using SEM-EDS. The produced active carbon has the specific surface area of 799.2 m2 g-1 and the iodine number of 495 mg/g.