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1.
Curr Opin Anaesthesiol ; 34(3): 381-386, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33935187

RESUMEN

PURPOSE OF REVIEW: After successfully reducing mortality in the operating room, the time has come for anesthesiologists to conquer postoperative complications. This review aims to raise awareness about myocardial injury after noncardiac surgery (MINS), its definition, diagnosis, clinical importance, and treatment. RECENT FINDINGS: MINS, defined as an elevated postoperative troponin judged to be due to myocardial ischemia (with or without ischemic features), occurs in up to one in five patients having noncardiac surgery and is responsible for 16% of all postoperative deaths within 30 days of surgery. New evidence on risk factors, etiology, potential prevention strategies, treatment options, and the economic impact of MINS highlights the actionability of perioperative clinicians in caring for adult patients who are considered to be at risk of cardiovascular complications. SUMMARY: Millions of patients safely going through surgery suffer MINS and die shortly after the procedure every year. Without a structured approach to predicting, preventing, diagnosing, and treating MINS, we lose the opportunity to provide our patients with the best chance of deriving benefit from noncardiac surgery. The perioperative community needs to come together, appreciate the clinical relevance of MINS, and step up with high-quality research in the future.


Asunto(s)
Isquemia Miocárdica , Procedimientos Quirúrgicos Operativos , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Factores de Riesgo , Procedimientos Quirúrgicos Operativos/efectos adversos , Troponina
2.
Vestn Oftalmol ; 137(2): 123-131, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33881273

RESUMEN

Results of clinical use of the radial keratotomy (RK) surgery are presented in the format of a lecture and a summary. The analysis encompasses the mechanism of changes in corneal refraction, immediate intra- and postoperative complications, so-called secondary symptoms and long-term effects (addition of various pathological processes, influence of corneal changes on the results of diagnostic tests and treatment methods) of the surgery.


Asunto(s)
Queratotomía Radial , Miopía , Córnea/cirugía , Humanos , Queratotomía Radial/efectos adversos , Miopía/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Refracción Ocular , Pruebas de Visión
3.
Medicine (Baltimore) ; 100(17): e25583, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907109

RESUMEN

RATIONALE: Subdural contrast extravasation (SCE) is a rare and possible complication following the intravascular injection of a contrast agent. We report a case of interhemispheric SCE detected by computed tomography (CT) after percutaneous coronary intervention. PATIENT CONCERNS: A 71-year-old man suddenly lost consciousness and fainted 2 hours prior with a head trauma history. Percutaneous coronary intervention was performed on the second day. DIAGNOSES: Head CT findings showed that the anterior longitudinal fissure of the brain was banded with high density and was uneven in thickness. The edge of the falx side of the brain was straight, smooth, and sharp, and the edge of the brain parenchyma was clear, without obvious edema or a space-occupying effect. INTERVENTIONS: Ticagrelor was given as an antiplatelet therapy; analgesic, antispasmodic symptomatic and supportive treatment was also administered. OUTCOMES: Two days later, the band-like high density between cerebral hemispheres was completely absorbed, and the patient's condition improved and his headache resolved. LESSONS: SCE is relatively uncommon during or after the intravascular injection of contrast media. Familiarity with the clinical features and CT findings of SCE may increase clinicians' awareness of this disease, thus avoiding potential misdiagnosis and mistreatment.


Asunto(s)
Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico , Hematoma Subdural Agudo/diagnóstico , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Anciano , Diagnóstico Diferencial , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Espacio Subdural
4.
Anticancer Res ; 41(4): 2017-2024, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813408

RESUMEN

BACKGROUND/AIM: Synthetic meshes (SMs) and acellular dermal matrices (ADMs) are used in reconstructive breast surgery. In the absence of prospective comparative studies, the identification of differences relies on retrospective analyses. PATIENTS AND METHODS: Our analysis focused on the impact of pre- and postoperative radiotherapy (RTX) and material-related differences. The analysis included 281 breast cancer patients (362 breasts) after nipple- and skin-sparing mastectomy with subpectoral implant insertion. RESULTS: Overall, the implant loss rate was 23.1% using porcine ADM, 7% using partially resorbable SM (prSM), and 5.6% using non-resorbable SM (nrSM). After RTX, the implant loss rate was 56.3% with ADM, 13% with prSM and 13.2% with nrSM. The ADM group showed a significant effect of RTX on the postoperative seroma rate, wound infections, and implant loss rate. When prSM was used, RTX showed no significant effect. When using the nrSM, RTX significantly influenced complication rates regarding wound infections and implant loss. CONCLUSION: In material-assisted breast reconstructions with pre- or post-operative RTX, there is a significantly higher implant loss rate when using porcine ADM compared to SM.


Asunto(s)
Dermis Acelular , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Mamoplastia , Radioterapia Ayuvante/efectos adversos , Mallas Quirúrgicas , Adulto , Anciano , Implantación de Mama/instrumentación , Implantación de Mama/métodos , Implantes de Mama , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Femenino , Humanos , Mamoplastia/instrumentación , Mamoplastia/métodos , Mastectomía Segmentaria/instrumentación , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
7.
Vasc Health Risk Manag ; 17: 135-143, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33854322

RESUMEN

Purpose: To determine the incidence and risk factor of postoperative venous thromboembolism (VTE) in Thai populations and to evaluate morbidity, mortality, bleeding complications and the benefit of thromboprophylaxis in real-world practice. Patients and Methods: We performed a retrospective, single-center, cohort study of patients from all age groups who underwent elective open or laparoscopic major abdomino-pelvic surgery between January 2008 and December 2018 at Chulabhorn Hospital, Bangkok, Thailand. We collected general medical information and specific data based on items from the Caprini risk scoring system. Results: A total of 2462 major abdomino-pelvic surgeries were included. The study population consisted of 742 males (30.1%) and 1720 females (69.9%) aged 54.59 ± 13.27 years. The incidence of VTE in Thai patients that underwent major abdominal surgery was 0.48%. The most frequent influencing factor for VTE was a history of pulmonary embolism, which increased the risk of VTE 98.28-fold, whereas a history of deep vein thrombosis increased the risk of VTE by 12.34-fold. Other factors influencing VTE development were obesity, anticoagulant use, postoperative chemotherapy, preoperative chemotherapy, endometrium cancer, tumor-node-metastasis (TNM) stage 4 and American College of Chest Physicians (ACCP) class 4. Protective factors included no history of VTE, laparoscopic surgery, TNM stage 0 and benign disease and BMI<30. VTE significantly increased mortality whereas following ACCP guideline reduced mortality. Conclusion: Post-operative VTE incidence in Thai patients undergoing major abdomino-pelvic surgery was lower compared with Western patients. Factors influencing for VTE were history of VTE, anticoagulant use, postoperative chemotherapy, preoperative chemotherapy, endometrium cancer, TNM stage 4 and ACCP class 4. Following ACCP guideline reduced the incidence of mortality.


Asunto(s)
Abdomen/cirugía , Pelvis/cirugía , Complicaciones Posoperatorias/epidemiología , Tromboembolia/epidemiología , Adulto , Anciano , Anticoagulantes/uso terapéutico , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/prevención & control , Factores Protectores , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Centros de Atención Terciaria , Tailandia/epidemiología , Tromboembolia/diagnóstico , Tromboembolia/mortalidad , Tromboembolia/prevención & control , Adulto Joven
8.
Medicine (Baltimore) ; 100(16): e25466, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879679

RESUMEN

RATIONALE: Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) has become the norm for the diagnosis of pancreatic solid lesions. EUS-TA is relatively safe, but various complications can occur. Infected pancreatic necrosis (IPN) is a rare but serious complication. The latest guidelines suggest that all invasive interventions in patients with IPN should be delayed until walled-off necrosis appears. PATIENT CONCERNS: A 73-year-old man was referred to our hospital with double primary cancers including gallbladder and pancreas. We performed EUS-TA on metastatic pancreatic tail cancer to confirm histologic diagnosis. Six days after the procedure, he developed abdominal pain and fever. DIAGNOSES: The patient's laboratory findings showed leukocytosis and C-reactive protein elevation. Fluid collection around pancreas tail and stomach was detected in computed tomography (CT) scan, and the patient was diagnosed with IPN. INTERVENTIONS AND OUTCOMES: EUS-guided endoscopic transmural drainage (EUS-TD) was performed for the treatment of IPN. Two days after the procedure with antibiotics, his CRP level decreased abruptly, and he received chemotherapy for the treatment of pancreatic ductal adenocarcinoma (PDAC) 5 days after the procedure. He was discharged from our hospital without complications 15 days after chemotherapy. LESSONS: In selected patients with PDAC, early endoscopic drainage may be recommended as treatment for IPN resulting from complications of EUS-TA.


Asunto(s)
Carcinoma Ductal Pancreático/diagnóstico , Drenaje/métodos , Neoplasias Pancreáticas/diagnóstico , Pancreatitis Aguda Necrotizante/cirugía , Complicaciones Posoperatorias/cirugía , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia/efectos adversos , Biopsia/métodos , Carcinoma Ductal Pancreático/tratamiento farmacológico , Carcinoma Ductal Pancreático/patología , Drenaje/instrumentación , Endosonografía/efectos adversos , Endosonografía/instrumentación , Endosonografía/métodos , Fluorouracilo/uso terapéutico , Humanos , Irinotecán/uso terapéutico , Leucovorina/uso terapéutico , Masculino , Oxaliplatino/uso terapéutico , Páncreas/diagnóstico por imagen , Páncreas/patología , Páncreas/cirugía , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/patología , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Stents , Resultado del Tratamiento , Ultrasonografía Intervencional/efectos adversos , Ultrasonografía Intervencional/métodos
9.
Anticancer Res ; 41(4): 2123-2132, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813423

RESUMEN

BACKGROUND/AIM: Surgical stress has been correlated with higher rate of postoperative complications. Breast implants' surfaces (textured or smooth) represent an immunological stimulus. Our prospective study (BIAL2.20) evaluated post-operative leukocytes response at baseline and postoperative day (POD) 1 and 2 after implant-based breast reconstruction. PATIENTS AND METHODS: Between January and July 2020, 41 patients underwent reconstruction with textured (n=23) or smooth (n=18) implants. A full blood count and lymphocyte subsets were collected before surgery, on POD1 and POD2. Data were evaluated as difference and relative difference from baseline by two-way analysis of variance test (2-way-ANOVA). Mann-Whitney U-test was performed at each POD, whenever between-group 2-way-ANOVA reached statistical significance. RESULTS: Within-group-analysis showed statistically significant total leukocytosis in both groups. Within-group-analysis of lymphocytes subsets demonstrated statistically significant lymphopenia in the textured group for T-lymphocytes, and T-helper cells. Between-group-analysis showed statistically significant lymphopenia in T-helper subsets in the textured group at POD1 and POD2, when compared with the smooth group. CONCLUSION: Textured implants demonstrated a statistically significant impairment of T-helper trend during POD1 and POD2 when compared to smooth implants by between-group 2-way-ANOVA.


Asunto(s)
Implantación de Mama , Implantes de Mama/efectos adversos , Linfopenia/etiología , Mamoplastia , Complicaciones Posoperatorias/inmunología , Linfocitos T Colaboradores-Inductores/patología , Adulto , Anciano , Implantación de Mama/efectos adversos , Implantación de Mama/instrumentación , Implantación de Mama/métodos , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Diseño de Equipo/efectos adversos , Femenino , Humanos , Linfopenia/diagnóstico , Linfopenia/inmunología , Mamoplastia/efectos adversos , Mamoplastia/instrumentación , Mamoplastia/métodos , Mastectomía/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/patología , Periodo Posoperatorio , Estudios Prospectivos , Factores de Tiempo
10.
Anticancer Res ; 41(4): 2197-2201, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813434

RESUMEN

BACKGROUND/AIM: To evaluate complications and risk factors associated with transumbilical incision as an organ removal site in laparoscopic pancreatectomy (LP). PATIENTS AND METHODS: In total, 52 patients who underwent LP between 2009 and 2017 were included in this study. The development of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia was recorded. RESULTS: None of the patients had SSI. However, three (5.77%) presented with transumbilical incisional hernia. No variables were significantly associated with the risk of transumbilical incisional hernia. CONCLUSION: No evident risk factors correlated with hernia formation. Hence, incisional hernia might have occurred at a certain probability. In some cases, it was caused by technical problems. However, the use of transumbilical incision as an organ removal site was feasible, and a new incision for organ removal alone was not required.


Asunto(s)
Laparoscopía/métodos , Páncreas/patología , Pancreatectomía/métodos , Enfermedades Pancreáticas/cirugía , Ombligo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Hernia Incisional/diagnóstico , Hernia Incisional/epidemiología , Hernia Incisional/etiología , Japón/epidemiología , Laparoscopía/efectos adversos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Páncreas/cirugía , Pancreatectomía/efectos adversos , Pancreatectomía/estadística & datos numéricos , Enfermedades Pancreáticas/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Manejo de Especímenes/efectos adversos , Manejo de Especímenes/métodos , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Ombligo/patología , Adulto Joven
11.
Angiol Sosud Khir ; 27(1): 191-198, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33825748

RESUMEN

According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.


Asunto(s)
Insuficiencia de la Válvula Aórtica , Estenosis de la Válvula Aórtica , Procedimientos Quirúrgicos Cardíacos , Implantación de Prótesis de Válvulas Cardíacas , Adulto , Aorta/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Niño , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Trasplante Autólogo , Resultado del Tratamiento
14.
Anticancer Res ; 41(3): 1507-1514, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33788743

RESUMEN

BACKGROUND/AIM: Postoperative pneumonia is a serious complication of major oesophageal surgery. We aimed to clarify the association between the degree of improvement in oral hygiene by perioperative oral care and postoperative pneumonia in oesophageal cancer patients. PATIENTS AND METHODS: Oesophageal cancer patients (n=129) who underwent esophagectomy received perioperative oral care. Their oral hygiene was evaluated using the Oral Assessment Guide (OAG). The relationship between perioperative OAG scores and postoperative complications was analysed. RESULTS: The average OAG scores before starting oral care, pre-operation, and post-operation were 11.0±1.7, 9.1±1.5, and 11.2±3.0, respectively (p<0.001). An increase in preoperative OAG scores was independently associated with postoperative pneumonia on multivariate analysis (p=0.027). CONCLUSION: Preoperative oral care improves oral hygiene in patients undergoing oesophageal cancer surgery. No improvement in oral hygiene despite preoperative oral care was an independent predictor of postoperative pneumonia.


Asunto(s)
Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Higiene Bucal/métodos , Neumonía/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Anciano , Esofagectomía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Atención Perioperativa/métodos , Neumonía/etiología , Complicaciones Posoperatorias/etiología , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Sensibilidad y Especificidad
15.
Ann R Coll Surg Engl ; 103(4): e114-e115, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33661045

RESUMEN

Neuropathic bladder may be a co-associated morbidity in newborn babies following resection of a sacrococcygeal teratoma. We report a case of a male newborn showing features of incomplete urinary voiding requiring intermittent catheterisation after operation for bladder emptying. Videourodynamic assessment excluded neuropathic bladder and posterior urethral valves were demonstrated on micturating cystography. Urology outcomes have been excellent following curative valve ablation. This report highlights the crucial importance of being aware of the rare coexistence of lower urinary tract pathology in male babies with sacrococcygeal teratoma. Routine urodynamic assessment should be considered in all children following sacrococcygeal teratoma resection.


Asunto(s)
Complicaciones Posoperatorias/diagnóstico , Teratoma/cirugía , Uretra/anomalías , Vejiga Urinaria Neurogénica/diagnóstico , Anomalías Urogenitales/diagnóstico , Cistografía , Diagnóstico Diferencial , Humanos , Recién Nacido , Masculino , Región Sacrococcígea , Teratoma/complicaciones , Teratoma/diagnóstico , Uretra/diagnóstico por imagen , Anomalías Urogenitales/etiología
16.
Ann R Coll Surg Engl ; 103(4): e120-e123, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682448

RESUMEN

Xanthogranulomatous pyelonephritis is a rare, painful inflammatory subtype of chronic renal infection, which can lead to severe parenchymal destruction. It imitates virtually every other renal inflammatory disease. We report a 51-year-old male presenting with left flank pain, on evaluation found to have a renal mass with a history of nephron-sparing surgery in the same kidney performed 6 months previously. Radical nephrectomy was carried out and histopathology was suggestive of xanthogranulomatous pyelonephritis rather than renal cell cancer recurrence.


Asunto(s)
Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/diagnóstico , Riñón/cirugía , Recurrencia Local de Neoplasia/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Pielonefritis Xantogranulomatosa/diagnóstico , Carcinoma de Células Renales/cirugía , Diagnóstico Diferencial , Humanos , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Nefrectomía , Pielonefritis Xantogranulomatosa/etiología
17.
Ann R Coll Surg Engl ; 103(4): e131-e135, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682478

RESUMEN

Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.


Asunto(s)
Absceso Abdominal/diagnóstico , Trasplante de Riñón , Mucormicosis/diagnóstico , Trasplante de Páncreas , Complicaciones Posoperatorias/diagnóstico , Rhizomucor/aislamiento & purificación , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Adulto , Hepatectomía , Humanos , Hepatopatías/diagnóstico , Hepatopatías/etiología , Hepatopatías/cirugía , Masculino , Mucormicosis/etiología , Mucormicosis/cirugía , Complicaciones Posoperatorias/cirugía , Esplenectomía , Enfermedades del Bazo/diagnóstico , Enfermedades del Bazo/etiología , Enfermedades del Bazo/cirugía
18.
Rev Med Liege ; 76(3): 179-185, 2021 Mar.
Artículo en Francés | MEDLINE | ID: mdl-33682387

RESUMEN

Anesthesia remains a high-risk specialty, even though the discipline has evolved considerably over the last few decades. Independently of postoperative complications, some risks are inherent to the perioperative period itself. In this narrative review of the literature, we describe these risks and the predictive scores, allowing an assessment of these complications. All these scores are designed to detect high-risk patients and to promote personalized medicine and individualized anesthesia. They also increase the objectivity of the preoperative assessment. Finally, using these scores, the practitioner can more accurately respond to the patient who presents anxiety regarding the perioperative period.


Asunto(s)
Anestesia , Anestésicos , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Medición de Riesgo
19.
Ann Transplant ; 26: e929279, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33707409

RESUMEN

Coronavirus disease 19 (COVID-19) has been an ongoing pandemic since December 2019. Unfortunately, kidney transplant recipients are a high-risk group during the disease course, and scientific data are still limited in this patient group. Beyond the dosage of immunosuppressive drugs, pharmacological immunosuppression may also alter the infection response in the COVID-19 course. The effects of immunosuppressive agents on the development and process of infection should not be decided only by determining how potent they are and how much they suppress the immune system; it is also thought that the direct effect of the virus, increased oxidative stress, and cytokine storm play a role in the pathogenesis of COVID-19 disease. There are data about immunosuppressive drugs like calcineurin inhibitors (CNI) or mammalian target of rapamycin inhibitors (mTORi) therapy related to their beneficial effects during any infection course. Limited data suggest that the use of CNI or mTORi may have beneficial effects on the process. In this hypothetical review, the probable impacts of CNI and mTORi on the pathogenesis of the COVID-19 were investigated.


Asunto(s)
/inmunología , Inhibidores de la Calcineurina/uso terapéutico , Rechazo de Injerto/prevención & control , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Complicaciones Posoperatorias/inmunología , Inhibidores de Proteínas Quinasas/uso terapéutico , Inmunidad Adaptativa/efectos de los fármacos , Inhibidores de la Calcineurina/farmacología , Síndrome de Liberación de Citoquinas/inmunología , Síndrome de Liberación de Citoquinas/prevención & control , Síndrome de Liberación de Citoquinas/virología , Rechazo de Injerto/inmunología , Humanos , Inmunidad Innata/efectos de los fármacos , Huésped Inmunocomprometido , Inmunosupresores/farmacología , Estrés Oxidativo/efectos de los fármacos , Estrés Oxidativo/inmunología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/virología , Inhibidores de Proteínas Quinasas/farmacología , Serina-Treonina Quinasas TOR/antagonistas & inhibidores
20.
Int J Mol Sci ; 22(4)2021 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-33670461

RESUMEN

Peripheral artery disease (PAD) is a manifestation of atherosclerosis, which may affect arteries of the lower extremities. The most dangerous PAD complication is chronic limb-threatening ischemia (CLTI). Without revascularization, CLTI often causes limb loss. However, neither open surgical revascularization nor endovascular treatment (EVT) ensure long-term success and freedom from restenosis and revascularization failure. In recent years, EVT has gained growing acceptance among all vascular specialties, becoming the primary approach of revascularization in patients with CLTI. In clinical practice, different clinical outcomes after EVT in patients with similar comorbidities undergoing the same procedure (in terms of revascularization technique and localization of the disease) cause unsolved issues that need to be addressed. Nowadays, risk management of revascularization failure is one of the major challenges in the vascular field. The aim of this literature review is to identify potential predictors for lower extremity endovascular revascularization outcomes and possible prevention strategies.


Asunto(s)
Procedimientos Endovasculares/métodos , Isquemia/prevención & control , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Complicaciones Posoperatorias/prevención & control , Procedimientos Endovasculares/efectos adversos , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
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