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1.
Medicine (Baltimore) ; 99(29): e20799, 2020 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-32702823

RESUMEN

Sessile serrated adenomas (SSAs) are precursors of colorectal cancer (CRC). However, there are limited data on detection rates of this premalignant lesion during colonoscopy surveillance in patients with a history of left side colonic resection for cancer. We aimed to identify the incidence and risk factors of SSAs in post-left side colectomy patients.We retrospectively reviewed the medical records of patients who had undergone left side colectomy for colon and rectal cancer between September 2009 and September 2016 and had at least 1 follow-up colonoscopy. Patient baseline characteristics, SSA diagnoses and characteristics, and colonoscopy information were collected.In total, 539 patients were enrolled. At the first follow-up (mean duration 11.5 months), 98 SSAs were identified (22.2%). At the second follow-up (mean duration 25.8 months), 51 SSAs were identified in 212 patients (24.0%). Multivariate analysis showed that alcohol intake (hazard ratio [HR] 1.524; 95% confidence interval [CI] .963-2.411, P = .041), excellent bowel preparation (HR 2.081; 95% CI 1.214-3.567, P = .049), and use of a transparent cap (HR 1.702; 95% CI 1.060-2.735, P = .013) were associated with higher SSA incidence in the first surveillance colonoscopy, while body mass index (BMI) ≥ 25.0 (HR 1.602; 95% CI 1.060-2.836) was associated with a significantly increased risk of SSAs in the second surveillance.Considering the endoscopic appearance of SSAs, adequate bowel preparation and use of transparent caps during postoperative surveillance colonoscopy can increase the diagnosis rate. Modification of alcohol intake and BMI may reduce the incidence of SSAs in left side colon cancer patients.


Asunto(s)
Adenoma/epidemiología , Adenoma/patología , Neoplasias Colorrectales/cirugía , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Índice de Masa Corporal , Catárticos/efectos adversos , Colectomía/efectos adversos , Colonoscopía/métodos , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/patología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Cuidados Posoperatorios/métodos , Estudios Retrospectivos , Factores de Riesgo
2.
Rev Col Bras Cir ; 47: e20202356, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32555960

RESUMEN

OBJECTIVE: To investigate the use of "ultra-early" postoperative feeding (oral liquid diet offered in the post-anesthetic recovery room) in patients undergoing common general surgical procedures and to assess the volume of intravenous fluids, as well as the rate of complications and the length of hospital stay. METHODS: Prospective, observational study, which assessed the compliance with the "ultra-early" feeding, the reduction of preoperative fasting time, the perioperative venous hydration volume, the length of stay and the operative morbidity. RESULTS: 154 patients with a mean age of 46 ± 15 years were followed. "Ultra-early" feeding was performed in 144 cases (93.5%). Patients who did not receive the "ultra-early" feeding received a significantly greater volume of postoperative intravenous fluids (500mL versus 200mL, p = 0.018). The length of stay was 2.4 ± 2.79 days (conventional feeding) versus 1.45 ± 1.83 days ("ultra-early" feeding), with no statistical difference (p = 0.133). There was no difference in the percentage of general complications (p = 0.291), vomiting (p = 0.696) or surgical infection (p = 0.534). CONCLUSION: "Ultra-early" feeding had a high adherence by patients undergoing common general surgical procedures, and it was related to decreased infusion of postoperative fluids. Complication rates and the length of stay were similar between groups.


Asunto(s)
Ingestión de Líquidos , Ingestión de Alimentos , Procedimientos Quirúrgicos Electivos , Cuidados Posoperatorios/métodos , Adulto , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Factores de Tiempo
3.
Bone Joint J ; 102-B(6_Supple_A): 66-72, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475279

RESUMEN

AIMS: Postoperative range of movement (ROM) is an important measure of successful and satisfying total knee arthroplasty (TKA). Reduced postoperative ROM may be evident in up to 20% of all TKAs and negatively affects satisfaction. To improve ROM, manipulation under anaesthesia (MUA) may be performed. Historically, a limited ROM preoperatively was used as the key harbinger of the postoperative ROM. However, comorbidities may also be useful in predicting postoperative stiffness. The goal was to assess preoperative comorbidities in patients undergoing TKA relative to incidence of postoperative MUA. The hope is to forecast those who may be at increased risk and determine if MUA is an effective form of treatment. METHODS: Prospectively collected data of TKAs performed at our institution's two hospitals from August 2014 to August 2018 were evaluated for incidence of MUA. Comorbid conditions, risk factors, implant component design and fixation method (cemented vs cementless), and discharge disposition were analyzed. Overall, 3,556 TKAs met the inclusion criteria. Of those, 164 underwent MUA. RESULTS: Patients with increased age and body mass index (BMI) had decreased likelihood of MUA. For every one-year increase in age, the likelihood of MUA decreased by 4%. Similarly, for every one-unit increase in BMI the likelihood of MUA decreased by 6%. There were no differences in incidence of MUA between component type/design or fixation method. Current or former smokers were more likely to have no MUA. Surprisingly, patients discharged to home health service or skilled nursing facility were approximately 40% and 70% less likely than those discharged home with outpatient therapy to be in the MUA group. MUA was effective, with a mean increased ROM of 32.81° (SD 19.85°; -15° to 90°). CONCLUSION: Younger, thinner patients had highest incidence of MUA. Effect of discharge disposition on rate of MUA was an important finding and may influence surgeons' decisions. Interestingly, use of cement and component design (constraint) did not impact incidence of MUA. Level of Evidence II: Prospective cohort study. Cite this article: Bone Joint J 2020;102-B(6 Supple A):66-72.


Asunto(s)
Anestesia , Artroplastia de Reemplazo de Rodilla , Manipulación Ortopédica , Cuidados Posoperatorios/métodos , Rango del Movimiento Articular , Anciano , Femenino , Humanos , Masculino , Manipulación Ortopédica/métodos , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo
6.
Aesthetic Plast Surg ; 44(3): 1014-1042, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32410196

RESUMEN

BACKGROUND: The worldwide spread of a novel coronavirus disease (COVID-19) has led to a near total stop of non-urgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the self-imposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. METHODS: We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19-positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of cross-contamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. CONCLUSION: The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a risk-minimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare the elective surgical specialties better for a possible second wave of the pandemic. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Procedimientos Quirúrgicos Electivos/métodos , Control de Infecciones/métodos , Pandemias/prevención & control , Seguridad del Paciente , Neumonía Viral/prevención & control , Cirugía Plástica/métodos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Técnicas de Laboratorio Clínico/métodos , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Manejo de la Enfermedad , Estudios de Factibilidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Salud Laboral , Equipo de Protección Personal/estadística & datos numéricos , Neumonía Viral/epidemiología , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Factores Sexuales
7.
Lancet Diabetes Endocrinol ; 8(7): 640-648, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32386567

RESUMEN

The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.


Asunto(s)
Cirugía Bariátrica/métodos , Betacoronavirus , Infecciones por Coronavirus/cirugía , Obesidad/cirugía , Pandemias , Neumonía Viral/cirugía , Cuidados Posoperatorios/métodos , Cirugía Bariátrica/tendencias , Infecciones por Coronavirus/epidemiología , Manejo de la Enfermedad , Humanos , Obesidad/epidemiología , Neumonía Viral/epidemiología , Cuidados Posoperatorios/tendencias , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control
8.
Med. intensiva (Madr., Ed. impr.) ; 44(4): 216-225, mayo 2020. graf, tab
Artículo en Inglés | IBECS | ID: ibc-190573

RESUMEN

OBJECTIVE: The impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities. DESIGN: A retrospective cohort study was carried out. SETTING: University hospital. PATIENTS: Surgical patients with severe comorbidities. Intervention: The outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs. non-ICU group) were reviewed for poor outcomes (i. e. , no discharge or death). A propensity score analysis was used to generate 248 matched pairs of ICU-admitted patients and controls. Variables of interest: Poor outcome rates on postoperative day 90 and mortality on postoperative days 30 and 90. RESULTS: No significant between-group differences were observed in terms of poor outcomes on postoperative day 90 [ICU vs. non-ICU: 33/248 (13%) vs.28/248 (11%), respectively; ICU odds ratio (OR): 1.19, 95% confidence interval (CI), 0.71-2.01, p = 0.596] or in between-group differences in terms of mortality on postoperative days 30 and 90 [ICU vs. non-ICU: 4/248 (1.6%) vs.2/248 (0.8%) on postoperative day 30 and 5/248 (2.0%) vs.3/248 (1.2%) on day 90, respectively; ICU OR (95% CI), 2.00 (0.37-10.9) and 1.67 (0.40-6.97) for postoperative 30- and 90-day mortality, respectively (p = 0.683 and 0.724)]. Low preoperative body weight was negatively correlated to patient outcomes [OR (95% CI): 0.82/10 kg (0.70-0.97), p = 0.019], whereas regional analgesia combined with general anesthesia was positively correlated to patient outcomes [OR (95% CI): 0.39 (0.69-0.96), p = 0.006]. Extra ICU admission was correlated to poor patient outcomes [OR (95% CI): 4.18 (2.23-7.81), p < 0.0001]. CONCLUSIONS: Postoperative ICU admission failed to demonstrate any meaningful benefits in patients with severe comorbidities undergoing miscellaneous elective surgeries


OBJETIVO: Se evaluó el impacto de los cuidados intensivos postoperatorios sobre los desenlaces de los pacientes investigando de forma retrospectiva la tasa de desenlaces desfavorables en un grupo variado de pacientes con comorbilidades graves que se sometieron a cirugías programadas. DISEÑO: Estudio retrospectivo de cohortes. Ámbito: Hospital universitario. PACIENTES: Pacientes quirúrgicos con comorbilidades graves. INTERVENCIONES: Se revisaron los desenlaces de 1.218 pacientes quirúrgicos tratados en unidades de cuidados intensivos (UCI) y plantas posquirúrgicas (grupo UCI frente a grupo no UCI) en busca de desenlaces desfavorables (esto es, ausencia de alta o muerte). Se llevó a cabo un análisis de puntuación de la propensión para generar 248 parejas de pacientes ingresados en la UCI y sus respectivos pacientes de control. Variables de interés: Tasas de desenlaces desfavorables al día 90 tras la intervención y mortalidad a los 30 y 90 días de la intervención. RESULTADOS: No se observaron diferencias significativas entre los grupos en cuanto a desenlaces desfavorables el día 90 tras la intervención (UCI frente a no UCI: 33/248 [13%] frente a 28/248 [11%], respectivamente; oportunidad relativa [OR]: 1,19; intervalo de confianza [IC] del 95%: 0,71-2,01; p = 0,596) ni diferencias entre los grupos en términos de mortalidad al cabo de 30 y 90 días tras la intervención (UCI frente a no UCI: 4/248 [1,6%] frente a 2/248 [0,8%] el día 30 tras la intervención y 5/248 [2,0%] frente a 3/248 [1,2%] el día 90, respectivamente; OR UCI [IC del 95%]: 2,00 [0,37-10,9] y 1,67 [0,40-6,97] para la mortalidad a los 30 y 90 días de la intervención, respectivamente [p = 0,683 y 0,724]). El bajo peso preoperatorio presentó una correlación negativa con los desenlaces de los pacientes (OR [IC del 95%]: 0,82/10 kg [0,70-0,97]; p = 0,019), mientras que la analgesia regional combinada con anestesia general y el ingreso fuera de la UCI presentó una correlación positiva con los desenlaces de los pacientes (OR [IC del 95%]: 0,39 [0,69-0,96]; p = 0,006). El ingreso extra en la UCI se correlacionó con malos resultados para el paciente (OR [IC del 95%]: 4,18 [2,23-7,81], p < 0,0001). CONCLUSIONES: El ingreso posoperatorio en la UCI no demostró asociarse con ningún beneficio significativo en un grupo variado de pacientes con comorbilidades graves sometidos a cirugías programadas


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Evaluación del Resultado de la Atención al Paciente , Cuidados Posoperatorios/métodos , Comorbilidad , Estudios de Cohortes , Puntaje de Propensión , Unidades de Cuidados Intensivos , Estudios Retrospectivos , Hospitales Universitarios
9.
Head Neck ; 42(6): 1243-1247, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32338790

RESUMEN

The 2019 novel coronavirus (COVID-19) pandemic has created significant challenges to the delivery of care for patients with advanced head and neck cancer requiring multimodality therapy. Performing major head and neck ablative surgery and reconstruction is a particular concern given the extended duration and aerosolizing nature of these cases. In this manuscript, we describe our surgical approach to provide timely reconstructive care and minimize infectious risk to the providers, patients, and families.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Neoplasias de Cabeza y Cuello/cirugía , Evaluación de Resultado en la Atención de Salud , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Procedimientos Quirúrgicos Reconstructivos/métodos , Centros Médicos Académicos , Toma de Decisiones Clínicas , Infecciones por Coronavirus/prevención & control , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Comunicación Interdisciplinaria , Masculino , Disección del Cuello/métodos , Salud Laboral , Pandemias/prevención & control , Seguridad del Paciente , Selección de Paciente , Pennsylvania , Neumonía Viral/prevención & control , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Medición de Riesgo , Colgajos Quirúrgicos/trasplante
10.
Medicine (Baltimore) ; 99(15): e19712, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282727

RESUMEN

Pelvic mass onset following a hysterectomy due to benign disease is not rarely seen. Appropriate diagnosis and treatment are of great importance.This study aims to analyze the clinicopathological features of patients who have received surgery for pelvic mass following hysterectomy due to gynecological benign disease, especially endometriosis or adenomyosis.This study retrospectively analyzed the patients undergone reoperation for pelvic mass subsequently to hysterectomy from January 2012 to December 2016 in a tertiary teaching hospital.A total of 247 patients were enrolled in this study. There is a significant difference between the patients with or without a history of endometriosis/adenomyosis. Multivariate analysis showed that the pelvic mass had a higher risk of being ovarian endometrioid carcinoma, ovarian clear cell carcinoma, ovarian endometriosis, and ovarian physiological cysts in patients with a history of adenomyosis/endometriosis.The pathology of the subsequent pelvic mass inclines to be benign, includes ovarian endometriosis, ovarian physiological cysts, and pelvic encapsulated effusion. Postoperative adjuvant therapy for those received hysterectomy due to endometriosis/adenomyosis, like gonadotropin releasing hormone agonists (GnRHa), may contribute to the prevention of benign pelvic mass. Patients with a history of hysterectomy due to endometrisos/adenomyosis tend to have a shorter time interval between hysterectomy and pelvic malignant tumors onset.


Asunto(s)
Adenomiosis/cirugía , Endometriosis/cirugía , Hormona Liberadora de Gonadotropina/agonistas , Histerectomía/efectos adversos , Neoplasias Pélvicas/cirugía , Adenomiosis/patología , Adulto , Anciano , Quimioterapia Adyuvante/métodos , Endometriosis/patología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias/patología , Neoplasias Ováricas/patología , Neoplasias Ováricas/prevención & control , Neoplasias Ováricas/cirugía , Neoplasias Pélvicas/epidemiología , Neoplasias Pélvicas/patología , Cuidados Posoperatorios/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo
11.
Eur J Vasc Endovasc Surg ; 60(1): 108-117, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32278637

RESUMEN

OBJECTIVE: Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). METHODS: This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. RESULTS: In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2-C6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n = 47) and 98% (n = 45), respectively (p = 1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference -1, 95% CI -2 - 3, p = .57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI -1 - 2, p = .46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p = .72) and pain score 2.0 vs. 2.0 (p = .92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p = 1.0 for above the knee and p = 1.0 for below the knee). CONCLUSION: The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.


Asunto(s)
Vendajes de Compresión , Ablación por Radiofrecuencia , Várices/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Ablación por Radiofrecuencia/métodos , Resultado del Tratamiento , Adulto Joven
14.
Int J Sports Med ; 41(7): 484-491, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32252100

RESUMEN

This prospective experimental study aimed to compare effects of 3 different home-based postoperative respiratory muscle training protocols - inspiratory, expiratory and combined, in the patients' postoperative recovery, regarding safety and respiratory muscle function, pulmonary function, physical fitness, physical activity (PA), dyspnoea and quality of life (QoL). Patients were divided in four groups Usual Care (UCare), inspiratory (IMT), expiratory (EMT) or combined muscle training (CombT) according to group allocation. Significant treatment*time interactions were found for maximal inspiratory pressure (MIP) (p=0.014), sedentary PA (SEDPA) (p=0.003), light PA (LIGPA) (p=0.045) and total PA (p=0.035). Improvements were observed for MIP in CombT (p=0.001), IMT (p=0.001), EMT (p=0.050). SEDPA reduced in EMT (p=0.001) and IMT (p=0.006), while LIGPA increased in both groups (p=0.001), as well as Total PA (p=0.005 and p=0.001, respectively). In UCare, CombT, and EMT, QoL improved only for Usual Activities. In conclusion, the addition of respiratory muscle training to physiotherapy usual care is safe and effective to increase MIP and contribute to improve physical activity. The CombT showed greater improvement on MIP, while IMT compared to EMT, was more effective to improve physical activity.


Asunto(s)
Ejercicios Respiratorios/métodos , Neoplasias Pulmonares/cirugía , Toracotomía/rehabilitación , Anciano , Capacidad Cardiovascular , Ejercicio Físico , Espiración/fisiología , Femenino , Humanos , Inhalación/fisiología , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Estudios Prospectivos , Calidad de Vida
15.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(3): 167-169, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32307265

RESUMEN

Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Traqueostomía/métodos , Traqueostomía/normas , Betacoronavirus/aislamiento & purificación , Consenso , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/cirugía , Francia/epidemiología , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Intubación Intratraqueal/normas , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/cirugía , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/normas , Ventilación/métodos , Ventilación/normas
16.
Bone Joint J ; 102-B(4): 524-529, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228068

RESUMEN

AIMS: The consensus is that bipolar hemiarthroplasty (BHA) in allograft-prosthesis composite (APC) reconstruction of the proximal femur following primary tumour resection provides more stability than total hip arthroplasty (THA). However, no comparative study has been performed. In this study, we have compared the outcome and complication rates of these two methods. METHODS: In a retrospective study, 57 patients who underwent APC reconstruction of proximal femur following the primary tumour resection, either using BHA (29) or THA (28), were included. Functional outcome was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system and Harris Hip Score (HHS). Postoperative complications of the two techniques were also compared. RESULTS: The mean follow-up of the patients was 8.3 years (standard deviation (SD) 5.5) in the BHA and 6.9 years (SD 4.7) in the THA group. The mean HHS was 65 (SD 16.6) in the BHA group and 88 (SD 11.9) in the THA group (p = 0.036). The mean MSTS score of the patients was 73.3% (SD 16.1%) in the BHA and 86.7% (SD 12.2%) in the THA group (p = 0.041). Limping was recorded in 19 patients (65.5%) of the BHA group and five patients (17.8%) of the THA group (p < 0.001). Dislocation occurred in three patients (10.3%) of the BHA group and two patients (7.1%) of the THA group. CONCLUSION: While the dislocation rate was not higher in THA than with BHA, the functional outcome was significantly superior. Based on our results, we recommend THA in APC reconstruction of the proximal femur. Cite this article: Bone Joint J 2020;102-B(4):524-529.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Neoplasias Femorales/cirugía , Fémur/cirugía , Hemiartroplastia/métodos , Prótesis de Cadera , Adolescente , Adulto , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Neoplasias Femorales/diagnóstico por imagen , Fémur/diagnóstico por imagen , Estudios de Seguimiento , Hemiartroplastia/efectos adversos , Luxación de la Cadera/etiología , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
17.
Plast Reconstr Surg ; 145(6): 1022e-1028e, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32195861

RESUMEN

BACKGROUND: Reduction mammaplasty is a well-established procedure. Studies have shown benefits of using antibiotics in this procedure. Nevertheless, there is no solid evidence to support postoperative antibiotic prophylaxis. The authors evaluated the influence of postoperative antibiotic delivery on infection rates after reduction mammaplasty. METHODS: The authors conducted a randomized trial of noninferiority, with two parallel groups, with triple blinding. The participants were 124 women with breast hypertrophy, with reduction mammaplasty already scheduled, selected consecutively. All patients underwent reduction mammaplasty, performed by the same surgical team, using the superomedial pedicle technique for ascending the nipple-areola complex. All patients received cephalothin (1 g) intravenously at the anesthetic induction and every 6 hours for 24 hours. At hospital discharge, they were assigned randomly to either the placebo (n = 62) or antibiotic group (n = 62) and were instructed to take identical capsules containing 500 mg of cephalexin or placebo, respectively, every 6 hours, for 7 days. Patients were assessed weekly, for 4 weeks, regarding the occurrence of surgical-site infection, by a surgeon who was unaware of the allocation. The criteria and definitions of the Centers for Disease Control and Prevention were adopted. RESULTS: There was no statistical difference between groups regarding age, body mass index, or resected breast tissue weight. The overall surgical-site infection rate was 0.81 percent. Only one patient, allocated to the antibiotic, presented infection, classified as superficial incisional (p = 1.00). In the placebo group, surgery time was higher (p = 0.003). CONCLUSION: The maintenance of antibiotics in the postoperative period of reduction mammaplasty did not influence the rates of surgical-site infection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.


Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Mamoplastia/efectos adversos , Cuidados Posoperatorios/métodos , Infección de la Herida Quirúrgica/epidemiología , Adulto , Mama/anomalías , Mama/cirugía , Cefalotina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Hipertrofia/cirugía , Incidencia , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Resultado del Tratamiento
18.
Plast Reconstr Surg ; 145(4): 818e-828e, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32221232

RESUMEN

During the past 10 years, academic publications that address facial feminization surgery have largely examined the technical aspects of the different surgical procedures involved and clinical evaluations of postoperative results. This Special Topic article focuses on aspects that are underdeveloped to date but useful with regard to taking the correct therapeutic approach to transgender patients who are candidates for facial gender confirmation surgery. The authors propose a protocolized sequence, from the clinical evaluation to the postoperative period, based on a sample size of more than 1300 trans feminine patients, offering facial gender confirmation surgery specialists standardized guidelines to handle their patients' needs in a way that is both objective and reproducible.


Asunto(s)
Protocolos Clínicos , Cara/cirugía , Disforia de Género/cirugía , Cirugía de Reasignación de Sexo/métodos , Personas Transgénero/psicología , Femenino , Feminidad , Disforia de Género/diagnóstico , Disforia de Género/psicología , Humanos , Masculino , Masculinidad , Planificación de Atención al Paciente/normas , Selección de Paciente , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/normas , Periodo Posoperatorio , Cirugía de Reasignación de Sexo/psicología , Cirugía de Reasignación de Sexo/normas , Resultado del Tratamiento
19.
Bone Joint J ; 102-B(3): 336-344, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114816

RESUMEN

AIMS: In the absence of an identified organism, single-stage revision is contraindicated in prosthetic joint infection (PJI). However, no studies have examined the use of intra-articular antibiotics in combination with single-stage revision in these cases. In this study, we present the results of single-stage revision using intra-articular antibiotic infusion for treating culture-negative (CN) PJI. METHODS: A retrospective analysis between 2009 and 2016 included 51 patients with CN PJI who underwent single-stage revision using intra-articular antibiotic infusion; these were compared with 192 culture-positive (CP) patients. CN patients were treated according to a protocol including intravenous vancomycin and a direct intra-articular infusion of imipenem and vancomycin alternately used in the morning and afternoon. In the CP patients, pathogen-sensitive intravenous (IV) antibiotics were administered for a mean of 16 days (12 to 21), and for resistant cases, additional intra-articular antibiotics were used. The infection healing rate, Harris Hip Score (HHS), and Hospital for Special Surgery (HSS) knee score were compared between CN and CP groups. RESULTS: Of 51 CN patients, 46 (90.2%) required no additional medical treatment for recurrent infection at a mean of 53.2 months (24 to 72) of follow-up. Impaired kidney function occurred in two patients, and one patient had a local skin rash. No significant difference in the infection control rate was observed between CN and CP PJIs (90.2% (46/51) versus 94.3% (181/192); p = 0.297). The HHS of the CN group showed no substantial difference from that of CP cases (79 versus 81; p = 0.359). However, the CN group showed a mean HSS inferior to that of the CP group (76 versus 80; p = 0.027). CONCLUSION: Single-stage revision with direct intra-articular antibiotic infusion can be effective in treating CN PJI, and can achieve an infection control rate similar to that in CP patients. However, in view of systemic toxicity, local adverse reactions, and higher costs, additional strong evidence is needed to verify these treatment regimens. Cite this article: Bone Joint J 2020;102-B(3):336-344.


Asunto(s)
Artritis Infecciosa/tratamiento farmacológico , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Imipenem/administración & dosificación , Cuidados Posoperatorios/métodos , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Vancomicina/administración & dosificación , Antibacterianos/administración & dosificación , Bacterias/aislamiento & purificación , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Articulación de la Cadera , Humanos , Inyecciones Intraarticulares , Articulación de la Rodilla , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
20.
Br J Anaesth ; 124(5): 638-647, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32139134

RESUMEN

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been shown to benefit recovery after several operations. However, large-scale data on the association between the level of ERAS use and perioperative complications are scarce, particularly in surgeries with increasing ERAS uptake, including total hip (THA) and knee arthroplasty (TKA). Using US national data, we examined the relationship between the number of ERAS components implemented ('level') and perioperative outcomes. METHODS: After ethics approval, we included 1 540 462 elective THA/TKA procedures (2006-2016, as recorded in the Premier Healthcare claims database) in this retrospective cohort study. Main outcomes were any complication, cardiopulmonary complications, mortality, blood transfusions, and length of stay. Eight commonly used ERAS components were included. Mixed-effects models measured associations between ERAS level and outcomes, with odds ratios (OR) and confidence intervals (CI) reported. RESULTS: ERAS use increased over time; overall, 21.6% (n=324 437), 62.7% (n=965 953), and 18.0% (n=250 072) of cases were classified as 'High', 'Medium', or 'Low' ERAS. 'High ERAS', 'Medium ERAS', and 'Low ERAS' level of use were defined as such if they received either >6, 5-6, or <5 ERAS components, respectively. After adjustment for relevant covariates, higher levels of ERAS use were associated with incremental reductions in 'any complication': 'Medium' vs 'Low' (OR=0.84; CI, 0.82-0.86) and 'High' vs 'Low' (OR=0.71; CI, 0.68-0.74). Similar patterns were found for the other study outcomes. Individual ERAS components with the strongest effect estimates were early physical therapy, avoidance of a urinary catheter, and tranexamic acid administration. CONCLUSIONS: ERAS components were used more frequently over time, and the level of utilisation was independently associated with incrementally improved complication odds and reduced length of stay during the primary admission. Possible indication bias limits the certainty of these findings.


Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Recuperación Mejorada Después de la Cirugía/normas , Adulto , Anciano , Analgesia/métodos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Manejo del Dolor , Modalidades de Fisioterapia/normas , Modalidades de Fisioterapia/estadística & datos numéricos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Estados Unidos/epidemiología
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