Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.388
Filtrar
1.
Ceska Gynekol ; 85(1): 11-14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32414279

RESUMO

OBJECTIVE: Description of punction of follicular fluid in a patient after ovarian transposition. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and the General Faculty Hospital, Prague. CASE REPORT: We present a case of IVF treatment in a patient with ovarian transposition undergoing punction of follicular fluid and difficulties during this procedure acording to transabdominal route. CONCLUSION: Transabdominal punction od follicular fluid is possible, but with technical difficulities and smaller amount of obtained oocytes. We recomend to aplicate IVF procedures prior to surgical solution.


Assuntos
Cavidade Abdominal/cirurgia , Fertilização In Vitro , Líquido Folicular/química , Procedimentos Cirúrgicos em Ginecologia/métodos , Recuperação de Oócitos/métodos , Folículo Ovariano/cirurgia , Feminino , Humanos , Oócitos , Gravidez
2.
Am Surg ; 86(3): 228-231, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223802

RESUMO

Estimated blood loss (EBL) is an increasingly important factor used to predict outcomes, such as morbidity and mortality, length of stay, and readmissions, after major abdominal operations. However, blood loss is difficult to estimate, with frequent under- and overestimations, consequences of which can be potentially dangerous for individual patients and confounding for scoring systems relying on EBL. We hypothesized that EBL is often inaccurate and have prospectively enrolled consecutive patients undergoing major elective intra-abdominal operations. Actual hemoglobin levels were measured and used to calculate the measured blood loss (MBL), which was compared with the EBL, as estimated both by surgeons (sEBL) and anesthesiologists (aEBL). Of 23 eligible cases at interim analysis, pancreaticoduodenectomy (n = 8) was the most common, followed by colectomy (n = 3), hepatectomy (n = 3) and gastrectomy (n = 2), biliary excision and reconstruction (n = 2), combined gastrectomy + colectomy (n = 1), radical nephrectomy (n = 1), open cholecystectomy (n = 1), pancreatic debridement (n = 1), and exploratory laparotomy (n = 1). aEBL overestimated MBL by 192 mL (143%) on average. The aEBL was significantly greater than the MBL (P = 0.004), whereas the sEBL was significantly less than the MBL (P = 0.009). In conclusion, surgeons significantly underestimate and anesthesiologists significantly overestimate EBL. This finding impacts not only immediate patient care but also the interpretation of scoring systems relying on EBL.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Causas de Morte , Neoplasias do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Melhoria de Qualidade , Cavidade Abdominal/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica/mortalidade , Estudos de Coortes , Neoplasias do Sistema Digestório/mortalidade , Neoplasias do Sistema Digestório/patologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Análise de Sobrevida
3.
Ann Rheum Dis ; 79(5): 573-580, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32209540

RESUMO

OBJECTIVES: The impact of immunosuppression on postoperative outcomes has primarily been studied in patients undergoing joint replacement surgery. We aimed to evaluate the impact of biologics and glucocorticoids on outcomes after other major surgeries. METHODS: This retrospective cohort study used Medicare data 2006-2015 to identified adults with rheumatoid arthritis undergoing hip fracture repair, abdominopelvic surgery (cholecystectomy, hysterectomy, hernia, appendectomy, colectomy) or cardiac surgery (coronary artery bypass graft, mitral/aortic valve). Logistic regression with propensity-score-based inverse probability weighting compared 90-day mortality and 30-day readmission in patients receiving methotrexate (without a biologic or targeted synthetic disease-modifying antirheumatic drug (tsDMARD)), a tumour necrosis factor inhibitor (TNFi) or a non-TNFi biologic/tsDMARD <8 weeks before surgery. Similar analyses evaluated associations between glucocorticoids and outcomes. RESULTS: We identified 10 777 eligible surgeries: 3585 hip fracture, 5025 abdominopelvic and 2167 cardiac surgeries. Compared with patients receiving methotrexate, there was no increase in the risk of 90-day mortality or 30-day readmission among patients receiving a TNFi (mortality adjusted OR (aOR) 0.83 (0.67 to 1.02), readmission aOR 0.86 (0.75 to 0.993)) or non-TNFi biologic/tsDMARD (mortality aOR 0.78 (0.49 to 1.22), readmission aOR 1.02 (0.78 to 1.33)). Analyses stratified by surgery category were similar. Risk of mortality and readmission was higher with 5-10 mg/day of glucocorticoids (mortality aOR 1.41 (1.08 to 1.82), readmission aOR 1.26 (1.05 to 1.52)) or >10 mg/day (mortality aOR 1.64 (1.02 to 2.64), readmission aOR 1.60 (1.15 to 2.24)) versus no glucocorticoids, although results varied when stratifying by surgery category. CONCLUSIONS: Recent biologic or tsDMARD use was not associated with a greater risk of mortality or readmission after hip fracture, abdominopelvic or cardiac surgery compared with methotrexate. Higher dose glucocorticoids were associated with greater risk.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Procedimentos Cirúrgicos Cardíacos/mortalidade , Fraturas do Quadril/mortalidade , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/efeitos adversos , Readmissão do Paciente/estatística & dados numéricos , Cavidade Abdominal/cirurgia , Adulto , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Artrite Reumatoide/mortalidade , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos de Coortes , Feminino , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Humanos , Imunossupressores/uso terapêutico , Revisão da Utilização de Seguros , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Pelve/fisiopatologia , Pelve/cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Estados Unidos
5.
Medicine (Baltimore) ; 99(9): e19323, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118762

RESUMO

BACKGROUND: Low intra-abdominal pressure (IAP) and deep neuromuscular blockade (NMB) are frequently used in laparoscopic abdominal surgery to improve surgical space conditions and decrease postoperative pain. The evidence supporting operations using low IAP and deep NMB is open to debate. METHODS: The feasibility of the routine use of low IAP +deep NMB during laparoscopic surgery was examined. A meta-analysis is conducted with randomized controlled trials (RCTs) to compare the influence of low IAP + deep NMB vs. low IAP + moderate NMB, standard IAP +deep NMB, and standard IAP + moderate NMB during laparoscopic procedures on surgical space conditions, the duration of surgery and postoperative pain. RCTs were identified using the Cochrane, Embase, PubMed, and Web of Science databases from initiation to June 2019. Our search identified 9 eligible studies on the use of low IAP + deep NMB and surgical space conditions. RESULTS: Low IAP + deep NMB during laparoscopic surgery did not improve the surgical space conditions when compared with the use of moderate NMB, with a mean difference (MD) of -0.09 (95% confidence interval (CI): -0.55-0.37). Subgroup analyses showed improved surgical space conditions with the use of low IAP + deep NMB compared with low IAP + moderate NMB, (MD = 0.63 [95% CI:0.06-1.19]), and slightly worse conditions compared with the use of standard IAP + deep NMB and standard IAP + moderate NMB, with MDs of -1.13(95% CI:-1.47 to 0.79) and -0.87(95% CI:-1.30 to 0.43), respectively. The duration of surgery did not improve with low IAP + deep NMB, (MD = 1.72 [95% CI: -1.69 to 5.14]), and no significant reduction in early postoperative pain was found in the deep-NMB group (MD = -0.14 [95% CI: -0.51 to 0.23]). CONCLUSION: Low IAP +deep NMB is not significantly more effective than other IAP +NMB combinations for optimizing surgical space conditions, duration of surgery, or postoperative pain in this meta-analysis. Whether the use of low IAP + deep NMB results in fewer intraoperative complications, enhanced quality of recovery or both after laparoscopic surgery should be studied in the future.


Assuntos
Cavidade Abdominal/fisiopatologia , Bloqueio Neuromuscular/efeitos adversos , Pressão/efeitos adversos , Cavidade Abdominal/irrigação sanguínea , Humanos , Complicações Intraoperatórias , Laparoscopia/métodos , Bloqueio Neuromuscular/métodos
6.
Urology ; 136: 255-256, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32033676
7.
J Parasitol ; 106(1): 25-29, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31971483

RESUMO

The prevalence and intensity of the trematode, Otodistomum hydrolagi, were determined for the first time in Spotted Ratfish, Hydrolagus colliei. Spotted Ratfish specimens were collected during bottom-trawl surveys in Queen Charlotte Sound (QCS, n = 31) and off the west coast of Vancouver Island (WCVI, n = 242). In all instances, the flukes were found within the abdominal cavity. Most flukes were mature (intrauterine eggs were present) and ranged in length from 9.1 to 61.5 mm, with a mean ± SD length of 28.5 ± 12.1 mm (n = 52). Fluke length was positively correlated with Spotted Ratfish precaudal length (PCL), and no Spotted Ratfish smaller than 247-mm PCL was infected by O. hydrolagi. The overall prevalence (95% confidence interval [CI]) and mean intensity (95% CI) of O. hydrolagi were 27.8% (22.6-33.6) and 1.24 (1.09-1.43), respectively. Neither prevalence nor mean intensity differed between host location or host sex. The majority (86%) of infected hosts harbored a single fluke (range 1-5), but 4 Spotted Ratfish were infected with 3 or more flukes, which accounted for 16% of all observed O. hydrolagi. The fluke population exhibited an aggregated distribution with 80% of individuals found in 21% of the hosts, but among infected hosts there was low variability in the intensity of infection. This is the first ecological study of O. hydrolagi from its Spotted Ratfish host, and the first record of this trematode in Canadian waters, which extends the range of O. hydrolagi to include Canadian coastal Pacific waters.


Assuntos
Doenças dos Peixes/epidemiologia , Doenças dos Peixes/parasitologia , Trematódeos/crescimento & desenvolvimento , Infecções por Trematódeos/veterinária , Cavidade Abdominal/parasitologia , Animais , Colúmbia Britânica/epidemiologia , Feminino , Peixes , Masculino , Oceano Pacífico , Prevalência , Infecções por Trematódeos/epidemiologia , Infecções por Trematódeos/parasitologia
8.
AJR Am J Roentgenol ; 214(3): 636-640, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31939701

RESUMO

OBJECTIVE. A common goal in patients with newly discovered brain lesions is to determine if the lesions are primary malignant brain neoplasms, metastases, or benign entities. Such patients often undergo CT of the chest, abdomen, and pelvis (CT CAP) to identify a primary neoplasm that may have metastasized to the brain. The aim of this study is to determine the frequency of finding a primary cancer on CT CAP. MATERIALS AND METHODS. A large academic hospital imaging database was searched for cases of new intracranial lesions with subsequent CT CAP performed for metastatic workup. The frequency of primary neoplasms diagnosed in the chest versus abdominal and pelvic portions of CT scans was determined in patients with newly identified intraaxial and extraaxial brain lesions. Lesion characteristics were recorded including size, number, and the presence of enhancement and hemorrhage. Ancillary signs of an abdominopelvic neoplasm were also recorded. RESULTS. A total of 227 of 287 (79%) cases of newly discovered intracranial lesions were malignant (primary or metastatic) and 60 (21%) were benign. Of the 227 malignant cases, 136 (60%) were primary brain neoplasms and 91 (40%) were brain metastases, and 68 of the 91 (75%) lung primary. Chest CT (CTC) identified a primary neoplasm in 65 of 287 (23%) cases; 63 of those 65 (96%) neoplasms arose in the lungs. CT of the abdomen and pelvis (CTAP) identified a primary neoplasm in only 3 of 287 (1%) cases. In 26 cases in which the intracranial lesions did not enhance, only one was metastatic. CONCLUSION. In patients with newly discovered brain lesions, CTC is warranted, but CTAP is unlikely to be useful in patients without ancillary signs of abdominopelvic neoplasm.


Assuntos
Cavidade Abdominal/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Metástase Neoplásica/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Pelve/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Vet Radiol Ultrasound ; 61(1): 58-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31794122

RESUMO

Veiled chameleons (Chamaeleo calyptratus) and panther chameleons (Furcifer pardalis) are the most popular chameleons over the world, and consequently, two of the most frequent species presenting to veterinary practices. However, published studies on normal ultrasonographic anatomy for these lizards are currently lacking. The objectives of this prospective anatomic study were to develop an ultrasound protocol for evaluation of the coelomic cavity in these species and describe the normal ultrasonographic anatomy of the coelomic organs. Seventeen healthy veiled chameleons and 15 healthy panther chameleons were included. A linear 18 MHz transducer was used. Chameleons were sedated and restrained in right lateral recumbency by an assistant. Longitudinal and transverse images were acquired, and authors recorded qualitative and quantitative ultrasonographic characteristics of the coelomic structures. The kidneys, liver, caudal vena cava, hepatic veins, portal vein, gallbladder, wall of the stomach and intestine, gonads and, when distended, urinary bladder could be visualized during ultrasonography of the coelomic cavity in both species. The spleen, pancreas, and adrenal glands could not be identified. Findings from the current study supported the use of ultrasonography for veiled chameleons (Chamaeleo calyptratus) and panther chameleons (Furcifer pardalis) with suspected intracoelomic diseases and provided normal reference information for future studies of these chameleon species.


Assuntos
Cavidade Abdominal/diagnóstico por imagem , Lagartos/anatomia & histologia , Ultrassonografia/veterinária , Animais , Feminino , Masculino , Estudos Prospectivos , Especificidade da Espécie , Ultrassonografia/métodos
10.
J Surg Res ; 245: 500-509, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446192

RESUMO

BACKGROUND: Abdominal surgery may increase the risk of splanchnic vein thrombosis (SVT). We determined the incidence of SVT after abdominal surgery and identified groups at highest risk. MATERIALS AND METHODS: MEDLINE and Embase were searched for clinical studies evaluating the incidence of postoperative SVT after abdominopelvic surgery. Study selection, data abstraction, and risk of bias assessment were carried out independently by two reviewers. Clinical heterogeneity was explored by subgroup analyses (i.e., type of intra-abdominal procedure and organ group). RESULTS: Of 5549 abstracts screened, 48 were analyzed. Pooled incidence of SVT (n = 50,267) was 2.68% [95% confidence interval (CI), 2.24 to 3.11] (1347 events), I2 = 96%. Pooled incidence of SVT in high-risk procedures were splenectomy with devascularization (24%), hepatectomy in patients with cirrhosis (9%), and pancreatectomy with venous resection (5%). Pooled incidence of symptomatic and asymptomatic SVT was 1.02% (95% CI: 0.97% to 1.07%) and 0.98% (95% CI 0.88% to 1.07%), respectively. Most common causes of SVT-related mortality were irreversible thrombosis, bowel ischemia, liver failure, and gastrointestinal bleed. Most studies included were at a high risk of bias due to lack of prospective data collection and lack of SVT screening for all participants. CONCLUSIONS: Incidence of SVT after abdominal surgery is low but remains a relevant complication. Patients undergoing procedures involving surgical manipulation of the venous system and splenectomy are at the highest risk. Given the life-threatening risks associated with SVT, there is a need for larger prospective studies on the incidence and impact of SVT after abdominal surgery.


Assuntos
Cavidade Abdominal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Circulação Esplâncnica , Trombose Venosa/epidemiologia , Hepatectomia/efeitos adversos , Humanos , Incidência , Pancreatectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Esplenectomia/efeitos adversos , Trombose Venosa/etiologia
12.
Am J Vet Res ; 81(1): 77-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887092

RESUMO

OBJECTIVE: To assess the effects of 3 intra-abdominal pressures (IAPs) on pneumoperitoneal (laparoscopic working space) volume in domestic rabbits (Oryctolagus cuniculus). ANIMALS: 6 female New Zealand White rabbits. PROCEDURES: A Latin-square design was used to randomly allocate sequences of 3 IAPs (4, 8, and 12 mm Hg) to each rabbit in a crossover study. Rabbits were anesthetized, subumbilical cannulae were placed, and CT scans were performed to obtain baseline measurements. Each IAP was achieved with CO2 insufflation and maintained for ≥ 15 minutes; CT scans were performed with rabbits in dorsal, left lateral oblique, and right lateral oblique recumbency. The abdomen was desufflated for 5 minutes between treatments (the 3 IAPs). Pneumoperitoneal volumes were calculated from CT measurements with 3-D medical imaging software. Mixed linear regression models evaluated effects of IAP, rabbit position, and treatment order on working space volume. RESULTS: Mean working space volume at an IAP of 8 mm Hg was significantly greater (a 19% increase) than that at 4 mm Hg, and was significantly greater (a 6.9% increase) at 12 mm Hg than that at 8 mm Hg. Treatment order, but not rabbit position, also had a significant effect on working space. Minor adverse effects reported in other species were observed in some rabbits. CONCLUSIONS AND CLINICAL RELEVANCE: A nonlinear increase in abdominal working space was observed with increasing IAP. Depending on the type of procedure and visual access requirements, IAPs > 8 mm Hg may not provide a clinically important benefit for laparoscopy in rabbits.


Assuntos
Cavidade Abdominal/anatomia & histologia , Cavidade Abdominal/cirurgia , Laparoscopia/veterinária , Pressão , Cavidade Abdominal/diagnóstico por imagem , Animais , Estudos Cross-Over , Feminino , Injeções Intraperitoneais , Insuflação , Coelhos , Distribuição Aleatória
13.
Swiss Med Wkly ; 149: w20143, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31869427

RESUMO

BACKGROUND: Transplantation of kidneys from deceased donors is still associated with a high rate of postoperative renal dysfunction. During implantation into the recipient, the kidney rewarms. This second warm ischaemia time, which is not monitored, is harmful especially if prolonged. We recently developed an intra-abdominal cooling device that efficiently prevents kidney rewarming during robotic transplantation, and prevents ischaemia-reperfusion injuries. We tested the benefits of this cooling device during open kidney transplantation in pigs. METHODS: Kidneys were procured from large pigs by open bilateral nephrectomy. Following procurement, kidneys were flushed with 4°C Institut Georges Lopez-1 preservation solution, and placed on ice. Animals then underwent double sequential autologous open renal transplantation with (n = 7) and without (n = 6) intra-abdominal cooling. RESULTS: Mean anastomosis time was similar between groups (43.9 ± 13 minutes). At reperfusion, the renal cortex temperature was lower in the group with cooling (4.3 ± 1.1°C vs 26.5 ± 5.5°C, p <0.001). The cooled kidneys tended to be protected from injury, including some histopathological ischaemia-reperfusion lesions. With the device, kidneys had a better immediate postoperative urine output (p = 0.05). CONCLUSION: Our results indicate that the intra-abdominal cooling device significantly reduced second warm ischaemic time during transplantation, is technically safe and does not prolong anastomotic time.


Assuntos
Hipotermia Induzida/instrumentação , Transplante de Rim/métodos , Traumatismo por Reperfusão/prevenção & controle , Isquemia Quente , Cavidade Abdominal , Animais , Temperatura Corporal , Rim/patologia , Modelos Animais , Período Pós-Operatório , Procedimentos Cirúrgicos Robóticos , Suínos , Urina
14.
Pol Przegl Chir ; 91(6): 35-40, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31849358

RESUMO

INTRODUCTION: Leaving a foreign object (retained surgical item, or RSI) during surgery involving the abdominal cavity and pelvis minor is a relatively frequent, underestimated phenomenon which is dangerous to the health of the patient and the legal security of the medical personnel. These adverse events are easy to avoid through the use of appropriate means of prevention. The aim of the present paper is the collection of epidemiological data and determination of risk factors, symptomatology, health effects, and prevention methods associated with RSIs. MATERIAL AND METHODS: Analysis of global scientific publications in the databases PubMed, ClinicalKey, Google Scholar, ScienceDirect, and Scopus related to the subject of RSIs. RESULTS: The frequency of RSI incidents ranges from 1 to 10 in 10,000 surgeries, which results in at least one case in an average multispeciality hospital on a yearly basis. The items most frequently left behind include soft foreign objects, such as swabs and bandages (90%). Risk factors include emergency surgical procedures, high patient BMI, significant loss of blood during surgery, and neglect in counting the material and surgical tools. The postoperative course, although in many cases asymptomatic, may be complicated by inflammation, bleeding, or perforation, leading to the necessity of a second operation and, in 2 to 4% of cases, even ending in death. Imaging tests are effective diagnostic tools. Effective methods of preventing RSIs are based on checklists and systems for counting and monitoring the location of material and tools. CONCLUSIONS: The globally occurring problem of RSIs requires education of the operating block personnel regarding risk factors and identification with elimination of adverse events of this type. Diagnostics based on imaging should take into account non-specific complaints resulting from a possible oligosymptomatic course. An RSI should not be regarded as a medical error. Changes in the perception of the phenomenon aim aimed at minimising the legal liability of the staff in the event of leaving a foreign object in a patient's body.


Assuntos
Cavidade Abdominal/cirurgia , Corpos Estranhos/epidemiologia , Erros Médicos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Corpos Estranhos/prevenção & controle , Humanos , Erros Médicos/prevenção & controle , Equipe de Assistência ao Paciente , Fatores de Risco , Instrumentos Cirúrgicos
15.
Surgery ; 166(6): 1055-1060, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31526584

RESUMO

BACKGROUND: Opioid tolerant patients have been shown to have poor postoperative outcomes. Enhanced recovery pathways are evidence-based interventions that focus on optimizing recovery, and their effectiveness depends on the degree of compliance with the pathway. We wish to determine pathway compliance and its impact on postoperative outcomes in opioid tolerant patients undergoing abdominal surgery on an enhanced recovery pathway. METHODS: From December 2014 to June 2017, 646 patients undergoing major abdominal surgery on an enhanced recovery pathway were included. Patients <18 years and having emergency surgery were excluded. Compliance was measured to 14 perioperative pathway standards and high-compliance was defined as adhering to ≥75% standards. Opioid tolerance was defined as any patient taking a prescribed opioid medication equivalent to 60 mg of oral morphine per day for 1 week prior to surgery. The Colorectal Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity was used for risk-adjusted analyses. Outcomes of interest include length of stay, major complications (Clavien-Dindo ≥2), 30-day readmission rates, and mortality. RESULTS: Overall, 114 (18%) patients were opioid tolerant and 532 (82%) were not opioid tolerant. Opioid tolerant patients were less likely to be highly compliant with enhanced recovery pathway standards than non-tolerant patients (35% vs 54%; P < .001); particularly postoperative care standards. On adjusted analysis, opioid tolerance was associated with a 2-fold increase in readmissions following major abdominal surgery. Examining only those patients with opioid tolerance, adjusted analysis demonstrated that high compliance with the enhanced recovery pathway standards was independently associated with a 26% reduction in length of stay, over a 90% reduction in major complications, and mitigated the effect on readmissions. CONCLUSION: The authors provide evidence that opioid tolerance is associated with less favorable outcomes in patients undergoing major abdominal surgery on an enhanced recovery pathway, and this is likely due to a lack of pathway compliance. Establishing strategies to improve compliance in this challenging patient cohort may serve to mitigate the negative impact of opioid tolerance.


Assuntos
Analgésicos Opioides/farmacologia , Tolerância a Medicamentos , Recuperação Pós-Cirúrgica Melhorada/normas , Cooperação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Cavidade Abdominal/cirurgia , Idoso , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Estudos Retrospectivos
16.
Surg Endosc ; 33(10): 3503-3510, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31372889

RESUMO

BACKGROUND: In the last 20 years, intraperitoneal chemotherapy (IPC) has been explored as a modality for the management of peritoneal metastases of gynecologic, gastrointestinal, and primary peritoneal tumors. Direct delivery of chemotherapeutic agents to the peritoneal cavity space has proved superior to systemic chemotherapy when evaluating characteristics such as drug concentration reached in the peritoneal space, penetration into peritoneal metastases, and chemotherapy-related toxicity. Traditionally, IPC is delivered by peritoneal lavage with a liquid solution. This form of delivery has limitations, including inhomogeneous intraperitoneal distribution and limited ability to penetrate tissues and metastatic nodules. An alternative mode of delivery is so-called pressurized intraperitoneal aerosol chemotherapy (PIPAC). Within this context, the present study sought to identify the pattern of spatial distribution of therapeutic solutions aerosolized into the peritoneal space using a single-port PIPAC device and ascertain whether the aerosolized method is superior to the traditional (liquid) mode of IPC delivery. METHODS: Analysis of the rate of intra-abdominal staining with aerosolized 2% silver nitrate in five porcine models. RESULTS: Assessment of differences in stain impregnation between the upper, middle, and lower abdomen did not reveal significant differences (p = 0.42). The median sum scores were 1 for the upper abdomen and 3 for the middle and lower abdomen. CONCLUSIONS: Aerosolization does not reach all regions of the abdomen homogeneously. However, adequate exposure of the upper abdomen, mid-abdomen, and lower abdomen to chemotherapeutic agents can be achieved with PIPAC.


Assuntos
Antineoplásicos/administração & dosagem , Tratamento Farmacológico/instrumentação , Neoplasias Peritoneais , Cavidade Abdominal/patologia , Aerossóis/administração & dosagem , Aerossóis/farmacologia , Animais , Antineoplásicos/farmacologia , Tratamento Farmacológico/métodos , Desenho de Equipamento , Injeções Intraperitoneais/instrumentação , Injeções Intraperitoneais/métodos , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Peritônio/efeitos dos fármacos , Suínos
17.
Khirurgiia (Mosk) ; (8): 79-84, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464280

RESUMO

Clinical symptoms and localization of echinococcosis are various. Clinical observation of successful surgical treatment of secondary multiple abdominal lesion with echinococcosis is presented in the article. Certain features of diagnosis and surgical treatment are described.


Assuntos
Cavidade Abdominal/parasitologia , Cavidade Abdominal/cirurgia , Equinococose/diagnóstico , Equinococose/cirurgia , Equinococose/complicações , Humanos
18.
J Minim Invasive Gynecol ; 26(5): 973-976, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256782

RESUMO

The first port entry in patient who underwent previous abdominal surgery. Palmer's point can be used in patients with suspected periumbilical adhesions, a history of an umbilical hernia, or multiple failed attempts of insufflations at the umbilicus. Palmer's point has its limitations in cases of left upper quadrant surgery, splenomegaly, portal hypertension, and improper nasogastric tube placement giving rise to a bloated stomach. In such cases, a new and safe point for laparoscopic entry is needed. In the present case of a patient who underwent previous upper abdominal surgery with the chevron incision obscuring Palmer's point, laparoscopic entry was made through a novel point that was found to be safe in such cases and can be used in similar cases of previously scarred abdomens.


Assuntos
Abdome/cirurgia , Cicatriz/etiologia , Cicatriz/cirurgia , Laparoscopia , Laparotomia/efeitos adversos , Hemorragia Uterina/cirurgia , Abdome/patologia , Cavidade Abdominal/cirurgia , Adulto , Cicatriz/patologia , Equinococose Hepática/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Instrumentos Cirúrgicos/efeitos adversos , Aderências Teciduais/cirurgia , Hemorragia Uterina/patologia
20.
Crit Care Med ; 47(8): e639-e647, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31306258

RESUMO

OBJECTIVES: To compare the passive leg raising test ability to predict fluid responsiveness in patients with and without intra-abdominal hypertension. DESIGN: Observational study. SETTING: Medical ICU. PATIENTS: Mechanically ventilated patients monitored with a PiCCO2 device (Pulsion Medical Systems, Feldkirchen, Germany) in whom fluid expansion was planned, with (intra-abdominal hypertension+) and without (intra-abdominal hypertension-) intra-abdominal hypertension, defined by an intra-abdominal pressure greater than or equal to 12 mm Hg (bladder pressure). INTERVENTIONS: We measured the changes in cardiac index during passive leg raising and after volume expansion. The passive leg raising test was defined as positive if it increased cardiac index greater than or equal to 10%. Fluid responsiveness was defined by a fluid-induced increase in cardiac index greater than or equal to 15%. MEASUREMENTS AND MAIN RESULTS: We included 60 patients, 30 without intra-abdominal hypertension (15 fluid responders and 15 fluid nonresponders) and 30 with intra-abdominal hypertension (21 fluid responders and nine fluid nonresponders). The intra-abdominal pressure at baseline was 4 ± 3 mm Hg in intra-abdominal hypertension- and 20 ± 6 mm Hg in intra-abdominal hypertension+ patients (p < 0.01). In intra-abdominal hypertension- patients with fluid responsiveness, cardiac index increased by 25% ± 19% during passive leg raising and by 35% ± 14% after volume expansion. The passive leg raising test was positive in 14 patients. The passive leg raising test was negative in all intra-abdominal hypertension- patients without fluid responsiveness. In intra-abdominal hypertension+ patients with fluid responsiveness, cardiac index increased by 10% ± 14% during passive leg raising (p = 0.01 vs intra-abdominal hypertension- patients) and by 32% ± 18% during volume expansion (p = 0.72 vs intra-abdominal hypertension- patients). Among these patients, the passive leg raising test was negative in 15 patients (false negatives) and positive in six patients (true positives). Among the nine intra-abdominal hypertension+ patients without fluid responsiveness, the passive leg raising test was negative in all but one patient. The area under the receiver operating characteristic curve of the passive leg raising test for detecting fluid responsiveness was 0.98 ± 0.02 (p < 0.001 vs 0.5) in intra-abdominal hypertension- patients and 0.60 ± 0.11 in intra-abdominal hypertension+ patients (p = 0.37 vs 0.5). CONCLUSIONS: Intra-abdominal hypertension is responsible for some false negatives to the passive leg raising test.


Assuntos
Reações Falso-Negativas , Hipertensão Intra-Abdominal/fisiopatologia , Perna (Membro)/fisiopatologia , Monitorização Fisiológica/métodos , Cavidade Abdominal/fisiopatologia , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA