Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 363.900
Filtrar
1.
Cir. Esp. (Ed. impr.) ; 98(5): 251-259, mayo 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-187152

RESUMEN

Debido a la actual pandemia de enfermedad respiratoria denominada enfermedad por coronavirus 2019 (COVID-19) causada por el virus denominado SARS-CoV-2, numerosos pacientes con confirmación o sospecha de COVID-19 precisarán tratamiento quirúrgico electivo inaplazable o urgente. Estas situaciones requieren la adopción de medidas especiales da cara a minimizar la posibilidad de contagio entre pacientes, la exposición del personal sanitario y el desarrollo de complicaciones postoperatorias. En el presente documento se explican las principales medidas a tener en cuenta en caso de atención a pacientes COVID-19 o sospecha tanto durante su evaluación como en caso de requerir tratamiento quirúrgico


Due to the current pandemic of respiratory disease known as coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus, many patients with confirmed or suspected COVID-19 infection will require elective surgery, surgery that cannot be postponed, or emergency surgical treatment. In these situations, special measures need to be adopted in order to minimize the possibility of transmission between patients, exposure of healthcare personnel and the development of postoperative complications. This document explains the main principles to consider when managing confirmed or suspected COVID-19 patients during evaluation as well as when surgical treatment is required


Asunto(s)
Humanos , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/normas , Centros Quirúrgicos/normas , Equipos de Seguridad/normas , Procedimientos Quirúrgicos Operativos/normas , Betacoronavirus , Sociedades Médicas , España
2.
Anticancer Res ; 40(5): 2751-2755, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32366420

RESUMEN

BACKGROUND/AIM: Non-vascularized methods to reconstruct bone defects following tumor resection are associated with complications. As a result, the free vascularized fibular flap (FVF) has become a mainstay for reconstruction. The purpose of this study was to analyze FVF reconstruction in the upper extremity. PATIENTS AND METHODS: We reviewed 28 (14 female and 14 male, mean age of 29±20 years) patients reconstructed with an FVF in the upper extremity following tumor resection. Reconstruction most commonly involved the humerus (n=17, 61%) and a malignant (n=23, 82%) tumor. RESULTS: The limb salvage rate was 93% (n=26), with primary union occurring in 71% (n=20) of patients. Following bone grafting the overall union was 96% (n=27) at a mean 13±11 months. At most recent follow-up the mean MSTS93 rating was 82±22%. CONCLUSION: FVF effectively provided a functional reconstruction following tumor resection. Although, one in four patients will need additional bone grafting, the overall union rate is high.


Asunto(s)
Neoplasias Óseas/cirugía , Peroné/irrigación sanguínea , Peroné/cirugía , Procedimientos Quirúrgicos Reconstructivos , Colgajos Quirúrgicos/irrigación sanguínea , Extremidad Superior/patología , Extremidad Superior/cirugía , Adulto , Neoplasias Óseas/diagnóstico por imagen , Supervivencia sin Enfermedad , Femenino , Humanos , Recuperación del Miembro , Masculino , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Extremidad Superior/diagnóstico por imagen
3.
Khirurgiia (Mosk) ; (4): 88-94, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32352676

RESUMEN

OBJECTIVE: Is to evaluate the advantage of Contractubex gel with regards to influence on vascularisation, pigmentation, thickness, surface size, configuration, and elisticity of postsurgical scars of children (after cheilorinoplasty) in comparison to absence of systematized topical treatment. MATERIAL AND METHODS: Into the prospective, non-interventional, observational, multi-centered, in parallel groups, open, controlled study were included 60 patients aged 2,5 months and older with postsurgical scars after first cheilorinoplasty after 7-14 day after operation. Patients were randomized into 2 groups of 30 patients in each. I group - patients get applications of Contractubex gel 3 times a day (in the morning, in the afternoon, in the evening) in accordance with patient information leaflet. II group - control group with no regular therapy of of postsurgical scars (without treatment or without application of oils and gels with anticsarring action). The period of medicine usage - 9 months and more for each patient, the each patient observation duration is 18 months. RESULTS: After analysis of the primary as well as secondary efficacy criteria (total grade based on POSAS scale, reported by investigator/parent) after 3, 6, 12, 18 months of observation in both groups a positive statistically significant dynamics was registered. At the same time in the Contractubex group results were statistically significantly better than in the control group. Positive dynamics was achieved quickier in the main group than in the contol group and was to observe already after 3 months of therapy, during the whole treatment and observation phase, and after 18 months of therapy. Additionally conducted photodocumentation of postsurgical scar development dynamics in terms of the study confirms positive effect of surgery and absence of visual data regarding keloids or hyperthrophic scars formation in patients in both groups. Adverse events, i. a. pain, itch, burning, long-run hyperemia were not registered during the whole period os study. CONCLUSION: The conducted study has shown high efficacy and safety of Contractubex usage for the treatment of postsurgical scars of children with with congenital cleft lip and palate (from 2,5 months old). The statistically significant advantage of the therapy with Contractubex was demonstrated in comparison with the control group (with no regular topical treatment). The obtained results allow to recommend Contractubex gel as an effective and safe medicine for the treatment of scarring after surgeries for kids directly after sutures removal.


Asunto(s)
Alantoína/administración & dosificación , Cicatriz/tratamiento farmacológico , Labio Leporino/cirugía , Fisura del Paladar/cirugía , Fármacos Dermatológicos/administración & dosificación , Heparina/administración & dosificación , Extractos Vegetales/administración & dosificación , Cicatriz/etiología , Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Combinación de Medicamentos , Geles/administración & dosificación , Humanos , Lactante , Complicaciones Posoperatorias/tratamiento farmacológico , Estudios Prospectivos , Resultado del Tratamiento
4.
Heart Surg Forum ; 23(2): E231-E233, 2020 04 21.
Artículo en Inglés | MEDLINE | ID: mdl-32364920

RESUMEN

While the focus of the medical community is on the management of COVID-19 and its associated complex presentations, it is critical to recognize that patients will continue to present with other medical problems that require urgent therapeutic interventions. There is growing concern that such interventions might have an impact on the natural history of COVID-19. We present a case of a patient who presented with unstable angina and multivessel coronary artery disease for which coronary artery bypass surgery was indicated and performed. Unfortunately, he succumbed to respiratory complications attributed to COVID-19. Our experience suggests concern about adverse outcomes in patients undergoing cardiac surgery who might be infected with COVID-19. Clearly, additional investigations and experience are needed.


Asunto(s)
Angina Inestable/cirugía , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Complicaciones Posoperatorias , Betacoronavirus , Puente de Arteria Coronaria/efectos adversos , Infecciones por Coronavirus/complicaciones , Humanos , Masculino , Pandemias , Neumonía Viral/complicaciones , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 99(19): e19982, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384450

RESUMEN

Unplanned reoperations have not been studied extensively in pediatric patients, especially concerning risk factors. We aim to estimate the rate of unplanned reoperations and to determine the associated factors in pediatric general surgical specialties.This analysis included a retrospective case-control study of unplanned reoperations from July 1, 2010 to June 30, 2017 in the general surgical specialties. For each case, we identified approximately 2 randomly selected controls who underwent the same type of operation. The factors involved in the unplanned reoperations were investigated using univariate and multivariate analysis.Of the 3263 patients who underwent surgery, unplanned reoperations were performed in 139 patients (4.3%). The main indications for unplanned reoperations were wound complications (n = 52, 42.6%), followed by postoperative ileus (n = 12, 9.8%), postoperative bleeding (n = 8, 6.6%), and intraabdominal infection (n = 13, 10.7%). Following multivariate analysis, 2 factors remained significantly associated with unplanned reoperation: higher initial surgery-related risk level (P = .007, risk ratio (RR) = 0.48; 95% confidence interval (CI) = 0.27-0.82) and operation performed outside working hours (P = .031, RR = 0.52; 95% CI = 0.30-0.89).Various patient- and procedure-related factors were associated with unplanned reoperations. This information might be helpful for the optimization of treatment planning and resource allocation.


Asunto(s)
Complicaciones Posoperatorias/cirugía , Indicadores de Calidad de la Atención de Salud , Reoperación , Procedimientos Quirúrgicos Operativos/efectos adversos , Estudios de Casos y Controles , Preescolar , China/epidemiología , Femenino , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Reoperación/métodos , Reoperación/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos
6.
Medicine (Baltimore) ; 99(19): e20018, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384460

RESUMEN

BACKGROUND: Parkinson disease (PD) is a progressive neuromuscular disease associated with bradykinesia, tremor, and postural instability. We aimed to compare outcomes and complications of total hip arthroplasty (THA) between patients with PD and those without. METHODS: A single institution retrospective cohort from 2000 to 2018 was reviewed. PD patients were matched 1:2 with non-PD control patients for age, gender, American Society of Anesthesiologists score, and body mass index using a propensity score matching procedure. The primary outcome measures were postoperative complications and revision between PD and cohort groups. Secondary outcome measures were Harris Hip Score, hip range of motion, patient satisfaction, and surgery time. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS: Using prospectively collated data, we identified 35 PD patients after primary THA. A control cohort of 70 primary THA patients was matched. CONCLUSION: Our hypothesis was that PD would have adverse impact on complication rates, range of movement, or improvement in functional outcome after subsequent THA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5446).


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Osteoartritis de la Cadera , Enfermedad de Parkinson/complicaciones , Complicaciones Posoperatorias , Recuperación de la Función , Reoperación , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Protocolos Clínicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/cirugía , Evaluación de Resultado en la Atención de Salud , Prioridad del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Rango del Movimiento Articular , Reoperación/métodos , Reoperación/estadística & datos numéricos
7.
Z Gastroenterol ; 58(5): 456-460, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32392607

RESUMEN

Clostridium (C.) ventriculi (known as Sarcina ventriculi) is a ubiquitous gram-positive, anaerobic, acidophilic coccus found in patients with gastric motility disorders. The microorganisms can be identified histologically by their characteristic presentation in tetrads or packets of 8 in hematoxylin and eosin stains. Severe cases of emphysematous gastritis or gastric perforation have been described. Nevertheless, the significance of C. ventriculi in an upper gastrointestinal tract and its pathogenic character remain unclear. We present a 67-year-old woman who underwent hiatoplasty with gastropexy. After 3 months, she underwent a gastroscopy showing gastroesophageal reflux. Biopsies showed ulcerative reflux esophagitis with presence of C.ventriculi, subsequently confirmed by 16S ribosomal RNA gene amplicon sequencing. The barium swallow study revealed an atonic stomach with delayed gastric emptying. The patient was treated with PPI and domperidone. On follow up, 15 months post-operatively, a control gastroscopy showed a stomach with food residues and reflux-associated small erosions. The Clostridium organisms were detected only in oxyntic mucosa biopsies without erosions or ulcerations. We speculate that the recognition of the organisms in the biopsy material is important and suggests dysmotility disorder. However, in our opinion, the presence of C. ventriculi, even in combination with mucosal damage, does not necessarily prompt antibiotic treatment since no complications occurred and inflammation as well as gastric function improved under PPI and prokinetic therapy in our patient. Larger study groups with long-term follow-up are needed to understand whether these organisms could behave as pathogens or are only bystanders in the setting of delayed gastric emptying.


Asunto(s)
Clostridium/aislamiento & purificación , Domperidona/uso terapéutico , Esofagitis Péptica/tratamiento farmacológico , Esofagitis Péptica/microbiología , Reflujo Gastroesofágico/complicaciones , Complicaciones Posoperatorias/microbiología , Anciano , Antibacterianos/uso terapéutico , Antieméticos/uso terapéutico , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/microbiología , Esofagitis Péptica/diagnóstico , Femenino , Reflujo Gastroesofágico/diagnóstico por imagen , Gastropexia , Gastroscopía , Humanos , Inhibidores de la Bomba de Protones/uso terapéutico , Estómago/cirugía
8.
Bone Joint J ; 102-B(5): 646-652, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32349589

RESUMEN

AIMS: The use of frozen tumour-bearing autograft combined with a vascularized fibular graft (VFG) represents a new technique for biological reconstruction of massive bone defect. We have compared the clinical outcomes between this technique and Capanna reconstruction. METHODS: From June 2011 to January 2016 a retrospective study was carried out of patients with primary osteosarcoma of lower limbs who underwent combined biological intercalary reconstruction. Patients were categorized into two groups based on the reconstructive technique: frozen tumour-bearing autograft combined with concurrent VFG (Group 1) and the Capanna method (Group 2). Demographics, operating procedures, oncological outcomes, graft union, limb function, and postoperative complications were compared. RESULTS: A total of 23 patients were identified for analysis: eight in Group 1 and 15 in Group 2. There was no difference in the demographics (age, sex, and affected site) and operating procedures (resection length, duration of surgery, and blood loss) between the two groups. No significant difference was found in local recurrence in Group 1 versus Group 2 (p = 0.585). Mean union time for the frozen autograft-host junction was 8.4 months (7.0 to 11.0), significantly earlier than for the allograft-host junction in Group 2 (mean 14.1 months (10.0 to 28.0); p < 0.001). Mean Musculoskeletal Tumor Society scores in groups 1 and 2 were 90.3% (SD 7.4%) and 88.0% (SD 9.0%), respectively, with no significant statistical difference (p = 0.535). In terms of complications, infection (n = 1, 6.7%) and delayed union (n = 2, 13.3%) occurred in Group 2, but no such complications were observed in Group 1. CONCLUSION: Frozen tumour-bearing autograft in combination with VFG can be used as an alternative to the Capanna reconstruction in properly selected patients with osteosarcoma. Cite this article: Bone Joint J 2020;102-B(5):646-652.


Asunto(s)
Trasplante Óseo/métodos , Neoplasias Femorales/cirugía , Peroné/irrigación sanguínea , Peroné/trasplante , Osteosarcoma/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Tibia/cirugía , Adolescente , Autoinjertos , Criopreservación , Femenino , Humanos , Masculino , Complicaciones Posoperatorias , Estudios Retrospectivos , Tibia/patología
9.
Bone Joint J ; 102-B(5): 568-572, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32349598

RESUMEN

Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient outcomes, can be assisted by the deployment of advanced technologies including navigation, intraoperative CT imaging, and surgical robots. The latest generation of robotic surgical systems allows the simultaneous application of a range of digital features that provide the surgeon with an improved view of the surgical field, often through a narrow portal. There is emerging evidence that procedure-related complications and intraoperative blood loss can be reduced if the new technologies are used by appropriately trained surgeons. Acceptance of the role of surgical robots has increased in recent years among a number of surgical specialities including general surgery, neurosurgery, and orthopaedic surgeons performing major joint arthroplasty. However, ethical challenges have emerged with the rollout of these innovations, such as ensuring surgeon competence in the use of surgical robotics and avoiding financial conflicts of interest. Therefore, it is essential that trainees aspiring to become spinal surgeons as well as established spinal specialists should develop the necessary skills to use robotic technology safely and effectively and understand the ethical framework within which the technology is introduced. Traditional and more recently developed platforms exist to aid skill acquisition and surgical training which are described. The aim of this narrative review is to describe the role of surgical robotics in spinal surgery, describe measures of proficiency, and present the range of training platforms that institutions can use to ensure they employ confident spine surgeons adequately prepared for the era of robotic spinal surgery. Cite this article: Bone Joint J 2020;102-B(5):568-572.


Asunto(s)
Competencia Clínica , Procedimientos Quirúrgicos Robotizados/educación , Procedimientos Quirúrgicos Robotizados/normas , Enfermedades de la Columna Vertebral/cirugía , Humanos , Complicaciones Intraoperatorias/prevención & control , Complicaciones Posoperatorias/prevención & control
10.
Isr Med Assoc J ; 22(5): 285-288, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32378819

RESUMEN

BACKGROUND: Heart transplantation (HT) success rate is limited by a high incidence of cancer post-HT. Data on kidney cancer following solid organ transplantation, especially HT, are limited, and only a few cases have been reported. OBJECTIVES: To report a unique case series of detected kidney cancer following HT. METHODS: Between 1997 and 2018, 265 patients who underwent HT were enrolled and prospectively followed in the HT registry of the Sheba Medical Center. RESULTS: The series included 5 patients, 4 men and a woman (age range 35-50 years at HT). The patients were diagnosed with kidney tumors 6-11 years after HT (age range at diagnosis 40-72 years). Two of the men were identical twin brothers. At HT four patients received induction therapy with anti-thymocyte globulin and all received an initial immunosuppressive regimen based on cyclosporine. All male HT recipients had a history of heavy smoking. Two male patients developed allograft vasculopathy, but all had preserved heart function. The 72-year-old woman developed a kidney tumor of the native kidney 5 years after re-HT and kidney transplantation. Two patients had features of multifocal papillary renal cell carcinoma (RCC) and eventually underwent bilateral nephrectomy, while another patient underwent left partial nephrectomy with preserved renal function. CONCLUSIONS: To the best of our knowledge, this is the first case series study describing kidney tumors following HT. With the improving outcomes and life expectancy of HT patients, a better understanding of the factors that determine cancer risk is of the utmost importance and may have a major impact on the non-cardiac surveillance.


Asunto(s)
Trasplante de Corazón , Neoplasias Renales/epidemiología , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
11.
Isr Med Assoc J ; 22(5): 294-298, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32378821

RESUMEN

BACKGROUND: Bariatric surgery has become the most common and effective therapeutic option for obesity. However, it is associated with morbidity and complications. Identification of predictors for surgical complications is an unmet need. OBJECTIVES: To determine a simple non-invasive parameter that predicts early postoperative complications following bariatric surgery. METHODS: In this retrospective study of all patients who underwent elective bariatric surgery at Nazareth Hospital EMMS during a 4-year period (2015-2018). We collected clinical and laboratory parameters and determined predictors of complications. RESULTS: A total of 345 patients underwent bariatric surgery during the study period. Of the patients, 51 experienced early post-bariatric surgery complications as compared to 294 patients who had no complications. Univariate analysis revealed that neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] 1.912, P < 0.0001) and platelet to lymphocyte ratio (OR 1.015, P < 0.0001) were associated with post-bariatric surgery complications. In a multivariate logistic regression analysis, only NLR remained a significant predictor (OR 1.751, 95% confidence interval 1.264-2.425, P = 0.0008) with a receiver operating characteristic curve for NLR of 0.8404. CONCLUSIONS: We found that the NLR predicts post bariatric surgery early complications. Further prospective studies are needed to validate our findings.


Asunto(s)
Cirugía Bariátrica , Linfocitos , Neutrófilos , Obesidad/sangre , Obesidad/cirugía , Complicaciones Posoperatorias/sangre , Adulto , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Estudios Retrospectivos
12.
Isr Med Assoc J ; 22(5): 315-319, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32378825

RESUMEN

BACKGROUND: Buried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported, and the treatment of this condition is still unclear. OBJECTIVES: To evaluate the Seldinger technique for treatment of early BBS after PEG insertion. METHODS: We report two cases of early BBS in two consecutive patients who underwent PEG insertion to maintain oral intake. The first patient was an 83-year-old woman showing Alzheimer type dementia, while the other one was a 76-year-old man who presented with maxillary cancer and treated with radiotherapy followed by left maxillectomy. Post-surgery, he developed progressive difficulty of swallowing due to mouth deformation and treatment related nerve toxicity. The first patient presented with fever and purulent discharge from the gastrostomy insertion site, without ability to rotate or slide the tube through the stoma 10 days after the PEG insertion. The man was admitted to the hospital 5 days following PEG insertion due to a fever of 38°C and peritubal swelling with purulent discharge. In addition, the tube could not rotate or slide through the stoma. RESULTS: Buried bumper syndrome was demonstrated by computed tomography scan. Gastroscopy and gastrostomy tube replacement was performed successfully according to the Seldinger technique (replacement over guidewire) in both cases. Correct intragastric tube positioning was demonstrated radiographically before resuming tube feeding. The two patients were discharged in good physical condition several days later. CONCLUSIONS: External replacement over guide wire should be considered in such cases.


Asunto(s)
Nutrición Enteral/instrumentación , Gastrostomía/instrumentación , Complicaciones Posoperatorias/cirugía , Anciano , Anciano de 80 o más Años , Remoción de Dispositivos/métodos , Femenino , Humanos , Masculino , Sistemas de Atención de Punto , Retratamiento , Factores de Tiempo
13.
Medicine (Baltimore) ; 99(19): e19855, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384430

RESUMEN

The endoscopic endonasal transsphenoidal approach (EETA) is the primary treatment for growth hormone (GH) adenoma. This study aimed to investigate the outcomes of EETA in 33 patients with GH-secreting pituitary adenoma (PA).Thirty-three patients who underwent EETA in Eighth People's Hospital of Shenzhen between January 2013 and December 2017 were included in the comprehensive analysis. Factors affecting the extent of resection and postoperative remission rates were also reviewed.The total cut rate was 63.6% (21), and the total remission rate was 66.7% (22) in all patients after surgery. The cure rate was 60.6% (20) for 33 patients. The total removal rate and remission rate were significantly different (P = .01, P = .007) for microadenomas, macroadenomas, and giant adenomas. In addition, the total removal rate and remission rate were significantly different (P = .004, P = .007) for patients with noninvasive and invasive GH-secreting PAs. Furthermore, there were significant differences (P = .003, P = .005) in the total removal rate and remission rate of patients with different preoperative GH levels. All patients with hypertension and diabetes mellitus were normalized. Three patients exhibited recurrence after surgery. Several patients suffered from postoperative complications, including transient diabetes insipidus in 3 (9.1%) patients and postoperative transient cerebrospinal fluid leakage in 2 (6.1%) patients.EETA is an effective therapeutic approach for treating patients with GH-secreting PA with high remission and low complication rates. Therefore, EETA should be considered a primary treatment for patients with GH-secreting PA.


Asunto(s)
Adenoma/cirugía , Endoscopía/métodos , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Nariz/cirugía , Hueso Esfenoides/cirugía , Adulto , Anciano , Endoscopía/efectos adversos , Femenino , Hormona del Crecimiento/sangre , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
14.
Medicine (Baltimore) ; 99(19): e20089, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384480

RESUMEN

To investigate the costs associated with postoperative complications following rectal resection.Rectal resection is a major surgical procedure that carries a significant risk of complications. The occurrence of complications following surgery has both health and financial consequences. There are very few studies that examine the incidence and severity of complications and their financial implications following rectal resection.We identified 381 consecutive patients who underwent a rectal resection within a major university hospital. Patients were included using the International Classification of Diseases (ICD) codes. Complications in the postoperative period were reported using the validated Clavien-Dindo classification system. Both the number and severity of complications were recorded. Activity-based costing methodology was used to report financial outcomes. Preoperative results were also recorded and assessed.A 76.9% [95% CI: 68.3:86.2] of patients experienced one or more complications. Patients who had a complication had a median total cost of $22,567 [IQR 16,607:33,641]. Patients who did not have a complication had a median total cost of $15,882 [IQR 12,971:19,861]. The adjusted additional median cost for patients who had a complication was $5308 [95% CI: 2938:7678] (P < .001). Patients who experienced a complication tended to undergo an open procedure (P = .001), were emergent patients (P = .003), preoperatively had lower albumin levels (36 vs 38, P = .0003) and were anemic (P = .001).Complications following rectal resection are common and are associated with increased costs. Our study highlights the importance of evaluating and preventing complications in the postoperative period.


Asunto(s)
Costo de Enfermedad , Costos de la Atención en Salud , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/terapia , Proctectomía , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
15.
Ann R Coll Surg Engl ; 102(5): 383-390, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32233869

RESUMEN

INTRODUCTION: Cardiopulmonary exercise testing (CPET) and transthoracic echocardiography (TTE) are common preparative investigations prior to elective endovascular aneurysm repair (EVAR). Whether these investigations can predict survival following EVAR and contribute to shared decision making is unknown. METHODS: Patients who underwent EVAR at a tertiary centre between June 2007 and December 2014 were identified from the National Vascular Registry. Variables obtained from preoperative investigations were assessed for their association with survival at three years. Regression analysis was used to determine variables that independently predicted survival at three years. RESULTS: A total of 199 patients underwent EVAR during the study period. Of these, 120 had preoperative CPET and 123 had TTE. Lower forced expiratory ventilation (FEV1), ratio of FEV1 to forced vital capacity, work at peak oxygen consumption and higher ventilatory equivalent for carbon dioxide were associated with increased mortality. Variables obtained from TTE were not associated with survival at three years although there was a low incidence of left ventricular systolic dysfunction and significant valvular disease in this cohort. CONCLUSIONS: CPET might be a useful adjunct to assist in shared decision making in patients undergoing elective EVAR and may influence anaesthetic technique. TTE does not appear to be able to discriminate between high and low risk individuals. However, a low rate of significant ventricular dysfunction and valvular disease in patients undergoing elective EVAR may account for these findings.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Prueba de Esfuerzo , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/métodos , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/mortalidad , Ecocardiografía , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Endovasculares/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Cuidados Preoperatorios/normas , Sistema de Registros/estadística & datos numéricos , Medición de Riesgo/métodos , Medición de Riesgo/normas , Factores de Riesgo , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
16.
Zhonghua Yi Xue Za Zhi ; 100(12): 928-932, 2020 Mar 31.
Artículo en Chino | MEDLINE | ID: mdl-32234168

RESUMEN

Objective: To analyze the influencing factors of acute kidney injury (AKI) in patients after cardiac surgery using levosimendan or dobutamine, and explore the effect of positive inotropic drugs on AKI. Methods: The clinical data of 417 patients undergoing cardiac surgery from January to June 2018 in Beijing Anzhen Hospital and treated with levosimendan or dobutamine during perioperative period were retrospectively reviewed and collected. Patients were divided into AKI group and non-AKI group according to whether AKI occurred. Univariate logistic regression analysis was used to analyze the factors related to the occurrence of AKI. The statistically significant factors (P<0.05) were further included in the multivariate logistic regression analysis. Results: Totally, 417 patients were enrolled in the study, with a mean age of (58.2±10.4) years old and a male rate of 65.0% (n=271), and the AKI incidence rate was 25.2% (105/417). Univariate logistic regression analysis showed that male, chronic kidney disease, high serum creatinine level in preoperative period, aortic obstruction time ≥ 120 minutes and extracorporeal circulation time ≥ 120 minutes were risk factors for AKI (all P<0.05). Vasodilator and levosimendan treatment during perioperative period were protective factors (P<0.05). Multivariate logistic regression analysis showed that chronic kidney disease (OR=17.291, 95%CI: 4.335-68.960, P<0.001) and high serum creatinine level (OR=1.097, 95%CI: 1.074-1.121, P<0.001) in preoperative period were independent risk factors for AKI. Perioperative application of levosimendan (OR=0.533, 95%CI: 0.288-0.984, P=0.044) was an independent protective factor. Conclusions: Risk factors for AKI after cardiac surgery include chronic kidney disease and high serum creatinine level in preoperative period. The use of levosimendan during preoperative period has the potential effect to protect against AKI.


Asunto(s)
Lesión Renal Aguda , Procedimientos Quirúrgicos Cardíacos , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Riesgo
18.
Yonsei Med J ; 61(4): 284-290, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32233170

RESUMEN

PURPOSE: We evaluated whether adding bevacizumab to current platinum-based chemotherapy could improve clinical outcomes without affecting safety. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients with pathologically confirmed ovarian cancer who received neoadjuvant chemotherapy (NAC) at Yonsei Cancer Hospital. We divided the patients into groups based on the use of bevacizumab for NAC (CP group: carboplatin+paclitaxel vs. BCP group: bevacizumab+carboplatin+paclitaxel) and compared patient characteristics, responses to NAC, and surgical and survival outcomes between the two groups. Overall, 88 patients in the CP group and 16 patients in the BCP group received NAC. The primary endpoint was survival outcomes. Complete resection rate after interval debulking surgery (IDS), cancer antigen 125 (CA-125) normalization after NAC, and chemotherapy response score were secondary endpoints. RESULTS: After NAC treatment, all patients underwent IDS. There were no significant differences in adverse events during NAC or postoperative complications between the two groups (p=0.293 and p=0.485, respectively). There were also no significant differences in CA-125 normalization after NAC (42.0% vs. 43.8%, p=0.899) or complete resection rate after IDS (47.7% vs. 56.3%, p=0.530). However, although the BCP group did not show longer overall survival (OS) (log-rank p=0.854), they had significantly longer progression-free survival (PFS) than the CP group (log-rank p=0.048). CONCLUSION: Bevacizumab-containing NAC might be safe and provide longer PFS than chemotherapy alone in patients with advanced ovarian cancer. However, further study is necessary to investigate the impact of bevacizumab-containing NAC on OS.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/uso terapéutico , Carcinoma Epitelial de Ovario/terapia , Terapia Neoadyuvante , Neoplasias Ováricas/terapia , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Bevacizumab/administración & dosificación , Antígeno Ca-125 , Carboplatino/administración & dosificación , Carboplatino/uso terapéutico , Carcinoma Epitelial de Ovario/mortalidad , Carcinoma Epitelial de Ovario/patología , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Procedimientos Quirúrgicos de Citorreducción/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Paclitaxel/administración & dosificación , Paclitaxel/uso terapéutico , Complicaciones Posoperatorias , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento
19.
Anticancer Res ; 40(4): 2297-2301, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234929

RESUMEN

BACKGROUND/AIM: Pancreatic surgery is associated with a high risk of developing deep venous thrombosis (DVT) and malnutrition. We aimed to evaluate the factors predicting the development of DVT, focusing on nutrition assessment tools. PATIENTS AND METHODS: One hundred patients who underwent pancreatic surgery were postoperatively examined for DVT. We assessed the risk factors for the development of DVT after surgery. RESULTS: Postoperative DVT was detected in 11 patients (11%). Patients who developed DVT after surgery were significantly older (p=0.016) and had higher preoperative D-dimer levels (p=0.005) than those who did not. The preoperative prognostic nutritional index (PNI) was mostly associated with the development of DVT (p=0.079). Furthermore, PNI ≤44.3, BUN >20 mg/dl, D-dimer ≥1.9 µg/ml were independent predictors for the development of DVT after surgery. CONCLUSION: A poor nutrition status and dehydration should be preoperatively improved for patients who are identified, as having a high risk of developing DVT after pancreatic surgery.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Evaluación Nutricional , Pancreatectomía/métodos , Complicaciones Posoperatorias/diagnóstico , Trombosis de la Vena/diagnóstico , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Masculino , Persona de Mediana Edad , Pancreatectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Pronóstico , Factores de Riesgo , Trombosis de la Vena/etiología
20.
Anticancer Res ; 40(4): 2337-2342, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234935

RESUMEN

AIM: To clarify the benefits of robotic-assisted laparoscopic surgery (RALS) regarding short-term outcomes in patients with technically demanding rectal cancer (TDRC). PATIENTS AND METHODS: Between April 2015 and September 2019, 88 TDRC cases were identified from our database, and divided into the RALS (n=32) and conventional laparoscopic surgery (CLS) (n=56) groups. TDRC was defined as mid-rectal tumors presenting at least one of the following risk factors: Male sex, high body mass index, T4 stage, bulky tumor, or low rectal tumor. RESULTS: Patient baseline characteristics were similar in both groups. One and 15 patients developed anastomotic leakage in the RALS and CLS groups (3% vs. 27%, p<0.01), respectively. The postoperative complication rate was lower in the RALS group (19% vs. 43%, p=0.03). Multivariate analysis showed the surgical approach to be an independent predictor for anastomotic leakage. CONCLUSION: RALS has potential advantages to prevent anastomotic leakage complications in patients with TDRC.


Asunto(s)
Laparoscopía/métodos , Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Adulto , Anciano , Anciano de 80 o más Años , Fuga Anastomótica/diagnóstico , Fuga Anastomótica/etiología , Índice de Masa Corporal , Femenino , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Neoplasias del Recto/patología , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA