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1.
Medicine (Baltimore) ; 99(11): e19186, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176045

RESUMEN

Obese individuals are apt to develop Stanford A acute aortic dissection (AAD) complicated with acute lung injury (ALI), but the mechanism is still not well defined. We aim to investigate whether oxidative stress and inflammatory are involved in the aortic dissection lung injury caused by obesity.Seventy-nine patients were categorized into AAD with obesity group (n = 17) and AAD without obesity group (n = 62) according to body mass index (BMI). Inflammatory reactions including interleukin 1ß (IL-1ß), tumor necrosis factor-α (TNF-α), IL-6, C-reactive protein (CRP) and white blood cell (WBC) count, and oxidative stress including malondialdehyde (MDA), superoxide dismutase were determined using enzyme-linked immunosorbent assays and chemiluminescence. All the patients received ascending aorta replacement combined with total arch replacement and stented elephant trunk. The postoperative complications were recorded.The incidence of preoperative hypoxemia (94.1% vs 35.5%, P < .01) and postoperative ALI (88.2% vs 40.3%, P < .01) in obese patients was significantly higher than that in non-obese patients. Besides, the ICU stay (119.2 ±â€Š59.2 vs 87.8 ±â€Š31.2 h, P < .01) and hospitalization duration (18.8 ±â€Š8.5 vs 14.3 ±â€Š8.1d, P = .048) were increased in the obese patients with AAD. The expression of IL-1ß, TNF-α, IL-6, CRP, and WBC was remarkably increased (P < .01) in obese group compared with non-obese group.Oxidative stress and inflammatory response may be involved in the process of ALI of aortic dissection caused by obesity, which provides new ideas for the treatment of ALI of the aortic dissection.


Asunto(s)
Lesión Pulmonar Aguda/cirugía , Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Hipoxia/etiología , Obesidad/complicaciones , Lesión Pulmonar Aguda/diagnóstico por imagen , Adulto , Anciano , Aneurisma Disecante/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular/métodos , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Hipoxia/fisiopatología , Modelos Lineales , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Cuidados Preoperatorios , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento
2.
Medicine (Baltimore) ; 99(11): e19196, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176046

RESUMEN

BACKGROUND: To explore the role of preoperative prealbumin levels in predicting the prognosis of patients with gastric cancer. METHODS: A total of 989 gastric cancer patients in the Affiliated Tumour Hospital of Harbin Medical University who underwent gastrectomy were included in this retrospective study. The preoperative prealbumin level, clinicopathological data, and follow-up data were recorded. According to the maximum chi-square survival correlation value, the survival of patients with low preoperative prealbumin (<140 mg/L) and high preoperative prealbumin (≥140 mg/L) were compared using the log-rank test and the Cox proportional hazard regression model. RESULTS: Based on the best cut-off value of 140 mg/L, we divided the patients into the lower prealbumin group (<140 mg/L) and the higher prealbumin group (≥140 mg/L). Compared with the higher prealbumin group, the lower prealbumin group were older and had larger tumor volumes, lower hemoglobin (Hb) levels, and more upper gastric cancer tumors. The univariate analysis showed that prealbumin and other clinicopathological factors, including age, hemoglobin, tumor size, macroscopic type, cell differentiation, liver metastasis, operation type, N stage, and T stage, were significant prognostic factors. The multivariable analysis showed that age, prealbumin, macroscopic type, location, T stage, and N stage were independent prognostic factors. CONCLUSIONS: The preoperative prealbumin level was an independent prognostic factor for patients with gastric cancer. The preoperative prealbumin level can be used to predict the prognosis of patients with gastric cancer and guide clinical practice.


Asunto(s)
Biomarcadores de Tumor/sangre , Gastrectomía/mortalidad , Prealbúmina/metabolismo , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , China , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Gastrectomía/métodos , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cuidados Preoperatorios/métodos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Neoplasias Gástricas/patología , Análisis de Supervivencia , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 99(11): e19251, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176049

RESUMEN

Lymph nodes (LN) metastasis differentiation from computed tomography (CT) images is a challenging problem. This study aims to investigate the association between radiomics image parameters and LN metastasis in colorectal mucinous adenocarcinoma (MAC).Clinical records and CT images of 15 patients were included in this study. Among them, 1 patient was confirmed with all metastatic LNs, the other 14 were confirmed with all non-metastatic LNs. The regions of the LNs were manually labeled on each slice by experienced radiologists. A total of 1054 LN regions were obtained. Among them, 164 were from metastatic LNs. One hundred nine image parameters were computed and analyzed using 2-sample t test method and logistic regression classifier.Based on 2 sample t test, image parameters between the metastatic group and the non-metastatic group were compared. A total of 73 parameters were found to be significant (P < .01). The selected shape parameters demonstrate that non-metastatic LNs tend to have smaller sizes and more circle-like shapes than metastatic LNs, which validates the common agreement of LN diagnosis using computational method. Besides, several high order parameters were selected as well, which indicates that the textures vary between non-metastatic LNs and metastatic LNs. The selected parameters of significance were further used to train logistic regression classifier with L1 penalty. Based on receiver operating characteristic (ROC) analysis, large area under curve (AUC) values were achieved over 5-fold cross validation (0.88 ±â€Š0.06). Moreover, high accuracy, specificity, and sensitivity values were observed as well.The results of the study demonstrate that some quantitative image parameters are of significance in differentiating LN metastasis. Logistic regression classifiers showed that the parameters are with predictive values in LN metastasis, which may be used to assist preoperative diagnosis.


Asunto(s)
Adenocarcinoma Mucinoso/diagnóstico por imagen , Adenocarcinoma Mucinoso/patología , Neoplasias Colorrectales/patología , Ganglios Linfáticos/patología , Metástasis Linfática/patología , Tomografía Computarizada por Rayos X/métodos , Absorciometría de Fotón/métodos , Adenocarcinoma Mucinoso/cirugía , Adulto , Anciano , Estudios de Cohortes , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Modelos Logísticos , Metástasis Linfática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Cuidados Preoperatorios , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad
4.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(1): 0, 2020 May 25.
Artículo en Chino | MEDLINE | ID: mdl-32207592

RESUMEN

Since the corona virus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management in the cesarean section for the patients, as well as the protection for medical staff is significantly different from that in ordinary surgical operation. This paper reports a pregnant woman with COVID-19, for whom a cesarean section was successfully performed in our hospital on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the patients during the operation are discussed. Importance should be attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For ordinary COVID-19 patients intraspinal anesthesia is preferred in cesarean section, and the influence on respiration and circulation in both maternal and infant should be reduced; while for severe or critically ill patients general anesthesia with endotracheal intubation should be adopted. The safety of medical environment should be ensured, and level-Ⅲ standard protection should be taken for anesthetists. Special attention and support should be given to maternal psychology. It is important to give full explanation before operation to reduce anxiety; to relieve the discomfort during operation to reduce tension; to avoid the bad mood of patients due to pain after operation.


Asunto(s)
Anestesia , Cesárea , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Femenino , Humanos , Lactante , Inyecciones Espinales , Neumonía Viral/complicaciones , Embarazo , Resultado del Embarazo , Cuidados Preoperatorios
5.
R I Med J (2013) ; 103(2): 18-20, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32122094

RESUMEN

Hospital antibiograms, because they are typically derived from samples obtained from hospitalized patients, may overestimate the prevalence of methicillin resistance in S. aureus in individuals presenting to the hospital for surgery. Because hospital antibiograms are commonly used to justify empiric perioperative prophylactic antibiotic selection prior to surgery, this may lead to unnecessary treatment with broad-spectrum antibiotics such as vancomycin. In a single-institution study, we observed that in our hospital antibiogram the proportion of S. aureus that are methicillin-resistant (MRSA) was significantly higher (45%) than isolates in preoperative nasal cultures obtained at the same hospital in outpatients prior to their lower extremity joint replacement surgery (13%): mean difference 0.32, [95% CI 0.25, 0.39], p <0.0001. These data suggest that hospital antibiograms may overstate the true prevalence of MRSA in those at risk for MRSA surgical site infections who present from the outpatient setting.


Asunto(s)
Antibacterianos/farmacología , Portador Sano/microbiología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Cavidad Nasal/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Portador Sano/epidemiología , Femenino , Humanos , Masculino , Resistencia a la Meticilina , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Cuidados Preoperatorios , Periodo Preoperatorio , Prevalencia , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/clasificación , Staphylococcus aureus/efectos de los fármacos
8.
Orthop Clin North Am ; 51(2): 265-277, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138864

RESUMEN

Distal humerus hemiarthroplasty is a good surgical option for nonreconstructable intraarticular distal humerus fractures in selected lower-demand patients. The lifetime activity restrictions have not been determined, but are likely less than a total elbow arthroplasty. From a technical standpoint, distal humeral prostheses should be implanted at the correct depth and rotation. The collateral ligaments, condyles, and epicondyles should be preserved and/or repaired to maintain joint stability. Short- to midterm retrospective studies have shown promising results.


Asunto(s)
Artroplastia de Reemplazo de Codo , Articulación del Codo/cirugía , Hemiartroplastia , Fracturas del Húmero/cirugía , Fracturas Intraarticulares/cirugía , Humanos , Prótesis Articulares , Cuidados Posoperatorios , Cuidados Preoperatorios , Resultado del Tratamiento
9.
Medicine (Baltimore) ; 99(5): e19024, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000448

RESUMEN

To assess the feasibility of using contrast-enhanced spectral mammography (CESM) for operative planning of patients with breast cancers who were initially diagnosed by sonographic guided biopsy.With the approval of the Institutional Review Board of our hospital, we retrospectively reviewed the data on patients with breast cancers who underwent CESM and contrast-enhanced magnetic resonance imaging (CE-MRI) prior to operation and were followed up for at least 5 years postoperatively. The patients with breast cancer diagnosed by sonographic guided biopsy without mammography were included for analysis. The size and number of cancers on low-energy mammograms (LE-MG), recombined subtracted mammograms (RSM), and CE-MRI were recorded and compared with microscopic histopathologic data and at least 5 years of clinical follow-up data.Fifty-one cancerous breasts of 46 patients were included in the analysis. All the principal cancers could be detected by RSM or CE-MRI; however, only 45 were by LE-MG. The Pearson correlation coefficients for the size on microscopy were 0.44 for LE-MG, 0.77 for RSM, and 0.84 for CE-MRI (all P-values ≤.001). Regarding the microscopic reports, RSM or CE-MRI had sensitivities of 100% and a positive predictive value of 63.6% for multicentric cancers. One breast cancer with partial mastectomy recurred after 3 years of follow-up.CESM was feasible for assessing the cancer extension and multicentric cancers as secondary examination in patients with diagnosed breast cancers after sonographic biopsy.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Imagen por Resonancia Magnética , Mamografía , Ultrasonografía Mamaria , Adulto , Anciano , Neoplasias de la Mama/cirugía , Medios de Contraste , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Gadolinio DTPA , Humanos , Biopsia Guiada por Imagen , Yohexol , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Retrospectivos , Sensibilidad y Especificidad
10.
Medicine (Baltimore) ; 99(3): e18718, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011448

RESUMEN

BACKGROUND AND AIM: Biliary obstruction can impair the effectiveness of neo-adjuvant chemotherapy. This study was designed to compare biliary stenting with covered self-expandable metal stents (FCSEMS) and plastic stents (PS) in patients with biliary obstruction caused by borderline resectable pancreatic cancer (BRPC) who were undergoing neo-adjuvant chemotherapy during preoperative biliary drainage. METHODS: This single-center, comparative, randomized, superiority study was designed to compare FCSEMS with PS for drainage of biliary obstruction of BRPC. Twenty two eligible patients providing informed consent will be randomized 1:1 by computer to either FCSEMS or PS for endoscopic retrograde biliary drainage (ERBD). All subsequent clinical interventions, including crossover to alternative procedures, will be at the discretion of the treating physician based on standard clinical care. The primary outcomes will be the rates and causes of stent dysfunction during preoperative biliary drainage. Other outcomes include time required for ERBD, adverse events related to ERBD, period from ERBD to surgery, percentage of patients able to undergo surgery, operation time, intraoperative bleeding volume, postoperative adverse events, and postoperative hospitalization. Subjects, treating clinicians, and outcome assessors will not be blinded to assignment. DISCUSSION: This study is intended to determine whether FCSEMS or PS is the better biliary stent for ERBD for management of patients with biliary obstruction of BRPC, a common clinical dilemma that has not yet been investigated in randomized trials. TRIALS REGISTRATION: UMIN-CTR, Identifier: UMIN000030473. Registered July 10, 2017, Wakayama Medical University Hospital.


Asunto(s)
Colestasis/etiología , Colestasis/cirugía , Neoplasias Pancreáticas/complicaciones , Stents , Procedimientos Quirúrgicos del Sistema Biliar , Quimioterapia Adyuvante , Humanos , Neoplasias Pancreáticas/terapia , Plásticos , Cuidados Preoperatorios , Estudios Prospectivos , Proyectos de Investigación , Stents Metálicos Autoexpandibles , Método Simple Ciego
11.
Can Assoc Radiol J ; 71(1): 5-11, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32063001

RESUMEN

PURPOSE: To explore the value of the apparent diffusion coefficient (ADC) in assessing preoperative T staging of low rectal cancer and the correlation between ADC value and Ki-67 expression. METHODS: Data on 77 patients with a proven pathology of low rectal cancer were retrospectively analyzed. All patients underwent a magnetic resonance imaging scan 1 week prior to operation, and the mean ADC value was measured. All tumors were fully removed, and pathologic staging was determined. The Ki-67 expression was determined using immunohistochemical methods in all patients. The correlation between Ki-67 expression and ADC features was studied. RESULTS: A total of 77 patients with low rectal cancer were included in the study. The pathology type was adenocarcinoma. The numbers of patients with pathological stages T1, T2, T3, and T4 were 9, 23, 32, and 13, respectively. The ADC value of all tumors ranged from 0.60 to 1.20 mm2/s. The average Ki-67 proliferation index was 55.3% ± 20.2%. A significant difference was observed between the preoperative ADC value and pathological T staging of low rectal cancer (P < .01). The more advanced the T stage, the lower the detected ADC values were. A negative correlation was noted between the preoperative ADC value and Ki-67 proliferation index of rectal cancer (r = -0.71, P < .01). When the Ki-67 proliferation index increased, lower ADC values were detected. CONCLUSION: The ADC values can provide useful information on preoperative tumor staging and may facilitate evaluation of the biological behavior of low rectal cancer. The ADC values should be considered a sensitive image biomarker of rectal cancer.


Asunto(s)
Adenocarcinoma/patología , Imagen de Difusión por Resonancia Magnética/métodos , Antígeno Ki-67/análisis , Neoplasias del Recto/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados Preoperatorios , Neoplasias del Recto/cirugía , Estudios Retrospectivos
12.
Medicine (Baltimore) ; 99(8): e19259, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080133

RESUMEN

BACKGROUND: The aim of this study was to evaluate the effectiveness and safety of surgical treatment of intra-articular distal radius fractures (DRFs) with the assistance of three-dimensional (3D) printing technique. METHODS: Patients with intra-articular DRFs in our hospital from February 2017 to November 2018 were enrolled in this study, and were randomly assigned to 2 parallel groups to receive surgical treatment with the assistance of 3D printing technique or not. For patients in the 3D printing group, the surgical procedure was simulated with 3D physical model before surgery. Volar plate and K-wire fixation were performed in all patients. Patients in the 2 groups were compared in terms of intraoperative indexes and postoperative function. RESULTS: A total of 32 patients were included in our study. During surgery, mean operation time in the 3D model group was significantly lower than that in the routine group (P < .001). Besides, significantly less blood was lost in the 3D model group than that in the routine group (P < .001). Furthermore, the 3D model group had a significantly less times of intraoperative fluoroscopy than that in the routine group (P = .002). However, the 3D model group showed no significant difference in visual analog scale (VAS) score, the disabilities of the arm, shoulder, and hand (DASH) score, or active wrist range of motion (ROM) in comparison with the routine group (P > .05). CONCLUSION: With the assistance of 3D printing technique, the operation time, amount of intraoperative bleeding, and times of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with volar plating and K-wire fixation. This technique is safe and effective, and is worth spreading in other orthopedic surgeries.


Asunto(s)
Simulación por Computador , Fijación Interna de Fracturas/métodos , Fracturas Intraarticulares/cirugía , Impresión Tridimensional , Fracturas del Radio/cirugía , Adulto , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Placas Óseas , Hilos Ortopédicos , Evaluación de la Discapacidad , Femenino , Fluoroscopía/estadística & datos numéricos , Humanos , Fracturas Intraarticulares/diagnóstico por imagen , Masculino , Tempo Operativo , Cuidados Preoperatorios , Fracturas del Radio/diagnóstico por imagen , Rango del Movimiento Articular , Tomografía Computarizada por Rayos X , Escala Visual Analógica
13.
Urology ; 137: 26-32, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31893532

RESUMEN

OBJECTIVE: To improve the tolerability of transrectal ultrasound guided prostate biopsy through use of diaphragmatic breathing. METHODS: Forty-seven patients, aged 52-79 years, who were scheduled for a transrectal ultrasound guided prostate biopsy with or without MRI guidance, were recruited at a single Veterans Affairs medical center for the diagnosis or evaluation of prostate cancer. Patients either met with a health psychologist for a 1-time, diaphragmatic breathing intervention immediately prior to their biopsy, or received usual care. All biopsies were performed using local anesthetic without sedation or anxiolytic therapy. The primary outcome was the difference in self-reported procedural situational anxiety as measured with the State Trait Anxiety Inventory, assessed both pre- and post-transrectal ultrasound guided prostate biopsy. We also examined secondary outcomes including physiological parameters (heart rate and blood pressure). RESULTS: There were no significant differences in preprocedural anxiety or physiological parameters between patients who received the intervention and those who received usual care. Patients who received the intervention had a significantly larger decrease in situational anxiety from pre- to postprocedure (M = 14.15, SD = 6.64) compared with those who received usual care (M = 3.45, SD = 9.97); t (38) = -4.0, P <.000; d = 1.26. Patients who received the intervention had a significantly larger decrease in heart rate (bpm) from pre- to postprocedure (M = 10.63, SD = 12.21) compared with those who received usual care (M = 0.07, SD = 9.25); t (31) = 2.75 P = 0.010; d = 0.97. CONCLUSION: A guided diaphragmatic breathing intervention reduced procedural anxiety during prostate biopsy and improved patient experience.


Asunto(s)
Ansiedad/psicología , Próstata/patología , Neoplasias de la Próstata/patología , Anciano , Ansiedad/etiología , Diafragma , Humanos , Biopsia Guiada por Imagen/métodos , Biopsia Guiada por Imagen/psicología , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Recto , Respiración , Ultrasonografía Intervencional
14.
Bone Joint J ; 102-B(1): 117-124, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31888372

RESUMEN

AIMS: It is unknown whether kinematic alignment (KA) objectively improves knee balance in total knee arthroplasty (TKA), despite this being the biomechanical rationale for its use. This study aimed to determine whether restoring the constitutional alignment using a restrictive KA protocol resulted in better quantitative knee balance than mechanical alignment (MA). METHODS: We conducted a randomized superiority trial comparing patients undergoing TKA assigned to KA within a restrictive safe zone or MA. Optimal knee balance was defined as an intercompartmental pressure difference (ICPD) of 15 psi or less using a pressure sensor. The primary endpoint was the mean intraoperative ICPD at 10° of flexion prior to knee balancing. Secondary outcomes included balance at 45° and 90°, requirements for balancing procedures, and presence of tibiofemoral lift-off. RESULTS: A total of 63 patients (70 knees) were randomized to KA and 62 patients (68 knees) to MA. Mean ICPD at 10° flexion in the KA group was 11.7 psi (SD 13.1) compared with 32.0 psi in the MA group (SD 28.9), with a mean difference in ICPD between KA and MA of 20.3 psi (p < 0.001). Mean ICPD in the KA group was significantly lower than in the MA group at 45° and 90°, respectively (25.2 psi MA vs 14.8 psi KA, p = 0.004; 19.1 psi MA vs 11.7 psi KA, p < 0.002, respectively). Overall, participants in the KA group were more likely to achieve optimal knee balance (80% vs 35%; p < 0.001). Bone recuts to achieve knee balance were more likely to be required in the MA group (49% vs 9%; p < 0.001). More participants in the MA group had tibiofemoral lift-off (43% vs 13%; p < 0.001). CONCLUSION: This study provides persuasive evidence that restoring the constitutional alignment with KA in TKA results in a statistically significant improvement in quantitative knee balance, and further supports this technique as a viable alternative to MA. Cite this article: Bone Joint J. 2020;102-B(1):117-124.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Osteoartritis de la Rodilla/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Femenino , Humanos , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Osteoartritis de la Rodilla/fisiopatología , Planificación de Atención al Paciente , Cuidados Preoperatorios , Implantación de Prótesis/métodos , Rango del Movimiento Articular/fisiología , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 99(2): e18702, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914075

RESUMEN

BACKGROUND/AIMS: Old age is a risk factor of suboptimal bowel preparation. This study aimed to evaluate the efficacy of mosapride citrate with a split dose of polyethylene glycol (PEG) plus ascorbic acid for bowel preparation in elderly patients (aged ≥65 years) before they underwent a colonoscopy. MATERIALS AND METHODS: This prospective investigator-blinded randomized study was conducted from November 2017 to October 2018. The patients were randomly divided into 2 groups, a mosapride group (mosapride citrate with a split-dose of PEG plus ascorbic acid) or a non-mosapride group (a split-dose of PEG plus ascorbic acid alone). Mosapride citrate 15 mg (Gastin CR) was administered once with each split-dose of the bowel preparation. The bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS). RESULTS: A total of 257 patients were finally included and analyzed in our study. The total BBPS score was significantly higher in the mosapride group than in the non-mosapride group (8.53 vs 8.24, P = .033). The BBPS scores of the right colon and mid-colon were 2.75 vs 2.61 (P = .044) and 2.89 vs 2.79 (P = .030), respectively. The rate of adequate bowel preparation (BBPS ≥ 6) was similar in both groups (98.4% vs 98.5%, P = .968), while the rate of excellent bowel preparation (BBPS = 9) was higher in the mosapride group than in the non-mosapride group (73.8% vs 61.1%, P = .029). The total incidence of adverse events during the administration of the bowel cleansing agent, particularly abdominal fullness, was lower in the mosapride group (11.9% vs 30.5%, P < .001). CONCLUSION: The administration of mosapride citrate with a split-dose of PEG plus ascorbic acid in elderly patients showed an increase in bowel preparation efficacy and reduced adverse events, particularly abdominal fullness, during the administration of a bowel cleansing agent.


Asunto(s)
Ácido Ascórbico/uso terapéutico , Benzamidas/uso terapéutico , Catárticos/uso terapéutico , Colonoscopía/métodos , Morfolinas/uso terapéutico , Polietilenglicoles/uso terapéutico , Anciano , Anciano de 80 o más Años , Ácido Ascórbico/administración & dosificación , Benzamidas/administración & dosificación , Benzamidas/efectos adversos , Catárticos/administración & dosificación , Catárticos/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Morfolinas/administración & dosificación , Morfolinas/efectos adversos , Cooperación del Paciente , Satisfacción del Paciente , Polietilenglicoles/administración & dosificación , Cuidados Preoperatorios , Estudios Prospectivos , Método Simple Ciego
16.
Medicine (Baltimore) ; 99(2): e18711, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914081

RESUMEN

Symptomatic epidural hematoma (SEH) after anterior cervical spine surgery is very rare, but it has disastrous consequences for the patients. Timely diagnosis and evaluation can effectively reduce the sequelae of neurological deficit in SEH. The purpose of this study was to retrospectively analyze a subset of clinical data of SEH after anterior cervical spine surgery, and to investigate the risk factors and treatment experience of this serious complication.Neurological deterioration after anterior cervical spine surgery was detected in six patients. Epidural hematoma was confirmed by emergency cervical magnetic resonance imaging (MRI). The patients included five males and one female, with an average age of 56.7 ±â€Š13.1 years (range 42-76 years). Three patients had a history of drinking and/or smoking. All of the patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively, but without anticoagulant drugs or pre-spinal surgery. The coagulation function was normal in all patients. Except for one patient, who had lower blood pressure (BP) during the operation and higher BP after the operation, the other patients had a normal level of BP during the pre-, intra-, and post-operation periods. The average time was 9.9 ±â€Š6.7 hours (range, 2-19 hours) from the postoperative period to the initial neurological deficit and 6.3 ±â€Š6.0 hours (range, 1.8-16.7 hours) from the initial deterioration to evacuation. Five patients underwent emergency evacuation, and one patient underwent conservative treatment. Four patients who underwent evacuation and one patient who received conservative treatment achieved neurological function recovery with an American Spinal Injury Association (ASIA) grade 2.4 ±â€Š0.9 (range, 2-4 score) score at the last follow-up. One patient with confirmed arterial epidural hemorrhage during the evaluation showed no neurological function recovery at the last follow-up.Wide exposure of the epidural space and BP level during the perioperative period play an important role in the formation of SEH after anterior cervical spine surgery. Arterial epidural hematoma has serious consequences; therefore, early diagnosis and evaluation play an important role in the recovery from paralysis.


Asunto(s)
Hematoma Espinal Epidural/etiología , Procedimientos Neuroquirúrgicos/efectos adversos , Adulto , Anciano , Vértebras Cervicales/cirugía , Femenino , Conductas Relacionadas con la Salud , Hematoma Espinal Epidural/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
17.
J Surg Oncol ; 121(4): 589-598, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31984517

RESUMEN

BACKGROUND: The use of preoperative magnetic resonance imaging (MRI) for newly diagnosed breast cancer remains controversial. We examined factors associated with detection of occult multicentric, multifocal, and contralateral malignant lesions only seen by MRI. METHODS: We performed a retrospective analysis of consecutive patients undergoing preoperative MRI for breast cancer. Clinicopathologic data were assessed regarding the findings of multifocality, multicentricity, and the presence of contralateral lesions. We analyzed the association of factors with these findings on MRI. RESULTS: Of 857 patients undergoing MRI, 770 patients met inclusion criteria. Mean age was 54.7 years. Biopsy-proven detection rates by MRI for multifocal, multicentric, and contralateral cancers were 6.2% (48 of 770), 1.9% (15 of 770) and 3.1% (24 of 770), respectively. African American race and heterogeneously or extremely dense mammographic density were associated with multifocal cancers on MRI. Larger lesion size and mammographic density were associated with multicentric cancers. Invasive lobular carcinoma (ILC) and progesterone receptor (PR)-positivity were associated with contralateral cancers. CONCLUSIONS: African American race, heterogeneously or extremely dense mammographic density, ILC, and PR-positivity were associated with additional biopsy-proven cancers based on MRI. These factors should be considered when assessing the clinical utility of preoperative breast MRI.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias Primarias Múltiples/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Retrospectivos
18.
Br J Anaesth ; 124(3): 243-250, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31902590

RESUMEN

BACKGROUND: Preoperative anaemia affects one third of patients undergoing cardiac surgery and is associated with increased mortality and morbidity. Although it is recommended that perioperative teams should identify and treat patients with preoperative anaemia before surgery, introducing new treatment protocols can be challenging in surgical pathways. The aim of this study was to assess the feasibility and effectiveness of introducing a preoperative intravenous iron service as a national initiative in cardiac surgery. METHODS: We performed a multicentre, stepped, observational study using the UK Association of Cardiothoracic Anaesthesia and Critical Care Research Network. The primary feasibility outcome was the ability to set up an anaemia and intravenous iron clinic at each site. The primary efficacy outcome was change in haemoglobin (Hb) concentration between intervention and operation. Secondary outcomes included blood transfusion and hospital stay. Patients with anaemia were compared with non-anaemic patients and with those who received intravenous iron as part of their routine treatment protocol. RESULTS: Seven out of 11 NHS hospitals successfully set up iron clinics over 2 yr, and 228 patients were recruited into this study. Patients with anaemia who received intravenous iron were at higher surgical risk, were more likely to have a known previous history of iron deficiency or anaemia, had a higher rate of chronic kidney disease, and were slightly more anaemic than the non-treated group. Intravenous iron was administered a median (inter-quartile range, IQR [range]) of 33 (15-53 [4-303]) days before surgery. Preoperative intravenous iron increased [Hb] from baseline to pre-surgery; mean (95% confidence interval) change was +8.4 (5.0-11.8) g L-1 (P<0.001). Overall, anaemic compared with non-anaemic patients were more likely to be transfused (49% [59/136] vs 27% (22/92), P=0.001) and stayed longer in hospital (median days [IQR], 9 [7-15] vs 8 [6-11]; P=0.014). The number of days alive and at home was lower in the anaemic group (median days [IQR], 20 [14-22] vs 21 [17-23]; P=0.033). CONCLUSION: The development of an intravenous iron pathway is feasible but appears limited to selected high-risk cardiac patients in routine NHS practise. Although intravenous iron increased [Hb], there is a need for an appropriately powered clinical trial to assess the clinical effect of intravenous iron on patient-centred outcomes.


Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Procedimientos Quirúrgicos Cardíacos , Hierro/administración & dosificación , Cuidados Preoperatorios/métodos , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Anemia Ferropénica/sangre , Anemia Ferropénica/complicaciones , Transfusión Sanguínea/estadística & datos numéricos , Vías Clínicas/organización & administración , Estudios de Factibilidad , Femenino , Hemoglobinas/metabolismo , Humanos , Hierro/uso terapéutico , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Medicina Estatal/organización & administración
19.
Rev Med Liege ; 75(1): 17-22, 2020 Jan.
Artículo en Francés | MEDLINE | ID: mdl-31920039

RESUMEN

Inhalation of gastric content is a significant risk factor for perioperative complications. Preoperative fasting reduces this risk. The preanesthesia fasting time is variable and is subject to recommendations from different scientific societies. The clinician can identify some risk factors for inhalation during the preoperative anesthetic consultation. On the day of the procedure, the gastric ultrasound allows quantitative or semi-quantitative assessment of the gastric content. In that way, the anesthesiologist can adapt the anesthesia, in particular by using a so-called rapid sequence induction and esophageal compression.


Asunto(s)
Anestesia , Ayuno , Cuidados Preoperatorios , Humanos , Derivación y Consulta , Factores de Riesgo , Ultrasonografía
20.
Plast Reconstr Surg ; 145(2): 365-374, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985623

RESUMEN

BACKGROUND: A practical application of three-dimensional printing technology has been considered a difficult area in rhinoplasty. However, the patient-specific three-dimensionally printed rhinoplasty guide based on the simulation program the authors developed could be a solution for minimizing the gap between simulation and actual surgical results. The aims of this study were to determine how a three-dimensional rhinoplasty guide based on three-dimensional simulation would link the patient to the surgeon to investigate its effectiveness. METHODS: Fifty patients who underwent rhinoplasty between January of 2017 and February of 2018 were included in this study. The patients were consulted about the desired shape of their nose based on preoperative three-dimensional photography. The confirmed three-dimensional simulation was sent to a manufacturing company for three-dimensionally printed rhinoplasty guides. In the guide group, rhinoplasty was performed based on the three-dimensionally printed rhinoplasty guide, and in the control group, procedures were performed based on the surgeon's intuition. RESULTS: The intraclass correlation coefficient test for comparing the simulated and postoperative measurements showed higher correlation in the three-dimensional printing guide group: higher correlation 11.3 percent in nasal tip projection, 21.6 percent in dorsum height, and 9.8 percent in nasolabial angle. The postoperative result of the nasal dorsum had a statistically significant difference between the two groups (p < 0.05). CONCLUSIONS: This study demonstrated the usefulness of the three-dimensionally-printed rhinoplasty guide, which delivers the preoperative simulated image in the actual clinical practice of rhinoplasty. This approach could cause a paradigm shift in simulation-based rhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Asunto(s)
Impresión Tridimensional , Rinoplastia/métodos , Adulto , Estudios de Casos y Controles , Simulación por Computador , Técnicas Cosméticas , Femenino , Humanos , Imagen Tridimensional , Masculino , Satisfacción del Paciente , Cuidados Preoperatorios/métodos , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento
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