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1.
Medicine (Baltimore) ; 99(19): e20058, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384471

RESUMEN

RATIONALE: A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years. PATIENT CONCERNS: A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago. DIAGNOSIS: A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE. INTERVENTIONS: The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded. OUTCOMES: After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications. LESSONS: TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.


Asunto(s)
Catéteres Cardíacos , Ecocardiografía Transesofágica , Cuerpos Extraños/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/cirugía , Anciano , Femenino , Humanos , Hallazgos Incidentales , Periodo Intraoperatorio
3.
Br J Anaesth ; 124(5): 553-561, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32139135

RESUMEN

BACKGROUND: Residual neuromuscular block has been associated with postoperative pulmonary complications. We hypothesised that sugammadex reduces postoperative pulmonary complications in patients aged ≥70 yr having surgery ≥3 h, compared with neostigmine. METHODS: Patients were enrolled in an open-label, assessor-blinded, randomised, controlled trial. At surgical closure, subjects were equally randomised to receive sugammadex 2 mg kg-1 or neostigmine 0.07 mg kg-1 (maximum 5 mg) for rocuronium reversal. The primary endpoint was incidence of postoperative pulmonary complications. Secondary endpoints included residual paralysis (train-of-four ratio <0.9 in the PACU) and Phase 1 recovery (time to attain pain control and stable respiratory, haemodynamic, and neurological status). The analysis was by intention-to-treat. RESULTS: Of the 200 subjects randomised, 98 received sugammadex and 99 received neostigmine. There was no significant difference in the primary endpoint of postoperative pulmonary complications despite a signal towards reduced incidence for sugammadex (33% vs 40%; odds ratio [OR]=0.74; 95% confidence interval [CI]=[0.40, 1.37]; P=0.30) compared with neostigmine. Sugammadex decreased residual neuromuscular block (10% vs 49%; OR=0.11, 95% CI=[0.04, 0.25]; P<0.001). Phase 1 recovery time was comparable between sugammadex (97.3 min [standard deviation, sd=54.3]) and neostigmine (110.0 min [sd=62.0]), difference -12.7 min (95% CI, [-29.2, 3.9], P=0.13). In an exploratory analysis, there were fewer 30 day hospital readmissions in the sugammadex group compared with the neostigmine group (5% vs 15%; OR=0.30, 95% CI=[0.08, 0.91]; P=0.03). CONCLUSIONS: In older adults undergoing prolonged surgery, sugammadex was associated with a 40% reduction in residual neuromuscular block, a 10% reduction in 30 day hospital readmission rate, but no difference in the occurrence of postoperative pulmonary complications. Based on this exploratory study, larger studies should determine whether sugammadex may reduce postoperative pulmonary complications and 30 day hospital readmissions. CLINICAL TRIAL REGISTRATION: NCT02861131.


Asunto(s)
Retraso en el Despertar Posanestésico/prevención & control , Enfermedades Pulmonares/prevención & control , Neostigmina/farmacología , Complicaciones Posoperatorias/prevención & control , Sugammadex/farmacología , Anciano , Anciano de 80 o más Años , Inhibidores de la Colinesterasa/farmacología , Método Doble Ciego , Femenino , Humanos , Periodo Intraoperatorio , Enfermedades Pulmonares/etiología , Masculino , Bloqueo Neuromuscular , Unión Neuromuscular/efectos de los fármacos , Fármacos Neuromusculares no Despolarizantes/antagonistas & inhibidores , Readmisión del Paciente/estadística & datos numéricos , Rocuronio/antagonistas & inhibidores
4.
J Laryngol Otol ; 134(3): 219-221, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32127054

RESUMEN

BACKGROUND: Endoscopes provide a magnified view of the middle ear and visualisation of hidden areas. Otoendoscopes facilitate excellent visualisation of the round window niche during cochlear implantation. OBJECTIVE: To compare microscopic and endoscopic visualisation of the round window membrane during cochlear implantation in 20 patients. METHODS: Twenty patients who underwent cochlear implantation were included in the study. After maximum exposure of the round window, the accessibility of the round window membrane was graded according to the St Thomas Hospital classification, first by microscope and then by endoscope. RESULTS: With the use of the endoscope, visualisation of the round window membrane improved in all the patients as compared to the microscope. The electrode array was inserted via a round window or extended round window approach in all but two cases; the latter cases required bony cochleostomy because of unfavourable anatomy. CONCLUSION: The main benefit of endoscope-assisted cochlear implantation is improved visibility of the round window region.


Asunto(s)
Implantación Coclear/métodos , Endoscopía/métodos , Microscopía/métodos , Otoscopía/métodos , Ventana Redonda/diagnóstico por imagen , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Ventana Redonda/cirugía , Adulto Joven
5.
Med Sci Monit ; 26: e919971, 2020 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-32198342

RESUMEN

BACKGROUND Intravenous lidocaine administered during surgery improves postoperative outcomes; however, few studies have evaluated the relationship between intravenous lidocaine and volatile anesthetics requirements. This study assessed the effects of lidocaine treatment on sevoflurane consumption and postoperative consciousness disorders in children undergoing major spine surgery. MATERIAL AND METHODS Patients were randomly divided into 2 treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 min, followed by a continuous infusion at 1 mg/kg/h to 6 h after surgery. The following data were assessed: end-tidal sevoflurane concentration required to maintain a bispectral index BIS between 40 and 60, intraoperative blood pressure, heart rate, demand for fentanyl, and consciousness level assessed after surgery using the Richmond Agitation-Sedation Scale. Any treatment-related adverse events were recorded. RESULTS Compared to the control group, lidocaine treatment reduced by 15% the end-tidal sevoflurane concentration required to maintain the intraoperative hemodynamic stability and appropriate level of anesthesia (P=0.0003). There were no intergroup differences in total dose of fentanyl used, average mean arterial pressure, or heart rate measured intraoperatively. The postoperative level of patient consciousness did not differ during the first 6 h between groups. After 9 h, more patients in the control group were still sleepy (P=0.032), and there were fewer perioperative complications in the lidocaine group. CONCLUSIONS Lidocaine treatment decreases sevoflurane consumption and improves recovery profiles in children undergoing major spine surgery.


Asunto(s)
Periodo de Recuperación de la Anestesia , Lidocaína/administración & dosificación , Sevoflurano/administración & dosificación , Columna Vertebral/cirugía , Adolescente , Anestesia General , Anestésicos Combinados/administración & dosificación , Niño , Relación Dosis-Respuesta a Droga , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Infusiones Intravenosas , Periodo Intraoperatorio , Lidocaína/efectos adversos , Lidocaína/sangre , Masculino , Monitoreo Intraoperatorio , Sevoflurano/sangre
6.
Rev. SOBECC ; 25(1): 50-57, 31-03-2020.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1096328

RESUMEN

Objetivo: Analisar os registros da sistematização da assistência de enfermagem perioperatória (SAEP) conforme recomendações da Associação Brasileira de Enfermeiros de Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização (SOBECC). Método: Estudo descritivo, documental e quantitativo desenvolvido em agosto de 2018 em um hospital do Rio Grande do Sul. A amostra foi composta por 50 prontuários de pacientes submetidos a procedimentos anestésico-cirúrgicos, selecionados aleatoriamente em uma unidade de internação cirúrgica. O instrumento de pesquisa coletou dados referentes a 10 atributos, subdivididos entre as fases do perioperatório, conforme as práticas recomendadas pela SOBECC. Os resultados estão apresentados por frequências absolutas e relativas. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição. Resultados: O maior percentual de registros foi totalmente atingido (61,40%). Porém verificou-se que 25,79% dos registros não foram realizados, principalmente aqueles relacionados aos cuidados da enfermagem. Conclusão: Conforme as recomendações da SOBECC, observou-se deficiência nos registros e na adesão à SAEP


Objective: To analyze records on the perioperative nursing care systematization (PNCS) according to recommendations of the Brazilian Society of Surgical, Anesthesia Recovery, Sterilization and Material Center Nurses (SOBECC). Method: Descriptive, documentary, and quantitative study developed in August 2018 on a hospital in the state of Rio Grande do Sul. The sample consisted of 50 medical records of patients who underwent anesthetic-surgical procedures, randomly selected from a surgical inpatient unit. Using the research instrument, we collected data on ten attributes, subdivided into perioperative phases, according to the practices recommended by SOBECC. The results are expressed as absolute and relative frequencies. The study was approved by the Research Ethics Committee of the institution. Results: The highest percentage of records was fully complied with (61.40%). However, 25.79% of records were not followed, especially those related to nursing care. Conclusion: According to SOBECC's recommendations, records and adherence to PNCS were inadequate.


Objetivo: Analizar los registros de la sistematización de la atención de enfermería perioperatoria (SAEP) según lo recomendado por la Asociación Brasileña de Enfermeras del Centro Quirúrgico, Centro de Recuperación Anestésica y Material y Esterilización (SOBECC). Método: Estudio descriptivo, documental y cuantitativo desarrollado en agosto de 2018 en un hospital de Rio Grande do Sul. La muestra consistió en 50 registros médicos de pacientes sometidos a procedimientos anestésico-quirúrgicos, seleccionados al azar en una unidad de pacientes internados quirúrgicos. El instrumento de investigación recolectó datos referentes a 10 atributos, subdivididos entre las fases perioperatorias, de acuerdo con las prácticas recomendadas por SOBECC. Los resultados se presentan por frecuencias absolutas y relativas. El estudio fue aprobado por el Comité de Ética en Investigación de la institución. Resultados: El porcentaje más alto de registros se logró completamente (61,40%). Sin embargo, se encontró que el 25,79% de los registros no se hicieron, especialmente aquellos relacionados con la atención de enfermería. Conclusión: De acuerdo con las recomendaciones de SOBECC, hubo una deficiencia en los registros y el cumplimiento de SAEP


Asunto(s)
Humanos , Calidad de la Atención de Salud , Atención Perioperativa , Atención de Enfermería , Cuidados Posoperatorios , Cuidados Preoperatorios , Periodo Intraoperatorio
7.
J Cardiothorac Surg ; 15(1): 3, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915030

RESUMEN

BACKGROUND: Widespread use of intraoperative epicardial ultrasonography (ECUS) for quality assessment of coronary artery bypass graft anastomoses during coronary artery bypass grafting (CABG) has not occurred - presumably due to technological and practical challenges including the need to maintain stable and optimal acoustic contact between the ultrasound probe and the target without the risk of distorting the anastomosis. We investigated the feasibility of using a stabilizing device during ultrasound imaging of distal coronary bypass graft anastomoses in patients undergoing on-pump CABG. Imaging was performed in both the longitudinal and transverse planes. METHODS: Single-centre, observational prospective feasibility study among 51 patients undergoing elective, isolated on-pump CABG. Ultrasonography of peripheral coronary bypass anastomoses was performed using a stabilizing device upon which the ultrasound transducer was connected. Transit-time flow measurement (TTFM) was also performed. Descriptive statistical tests were used. RESULTS: Longitudinal and transverse images from the heel, middle and toe were obtained from 134 of 155 coronary anastomoses (86.5%). After the learning curve (15 patients), all six projections were obtained from 100 of 108 anastomoses scanned (93%). Failure to obtain images were typical due to a sequential curved graft with anastomoses that could not be contained in the straight cavity of the stabilizing device, echo artefacts from a Titanium clip located in the roof of the anastomoses, and challenges in interpreting the images during the learning curve. No complications were associated with the ECUS procedure. The combined ECUS and TTFM resulted in immediate revision of five peripheral anastomoses. CONCLUSIONS: Peroperative use of a stabilizing device during ultrasonography of coronary artery bypass anastomoses in on-pump surgery facilitates imaging and provides surgeons with non-deformed longitudinal and transverse images of all parts of the anastomoses in all coronary territories. Peroperative ECUS in addition to flow measurements has the potential to increase the likelihood of detecting technical errors in constructed anastomoses. TRIAL REGISTRATION: The study was registered on September 29, 2016, ClinicalTrials.gov ID: NCT02919124.


Asunto(s)
Puente de Arteria Coronaria , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Ultrasonografía Intervencional/instrumentación , Anciano , Anastomosis Quirúrgica , Estudios de Factibilidad , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Estudios Prospectivos
8.
BMC Surg ; 20(1): 4, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31907042

RESUMEN

BACKGROUND: To evaluate the efficacy of a sensitive, real-time tool for identification and protection for parathyroid glands during thyroidectomy. METHODS: Near-infrared (NIR) auto-fluorescence was measured intraoperatively from 20 patients undergoing thyroidectomy. Spectra were measured from suspicious parathyroid glands and surrounding neck tissues during the operation with a NIR fluorescence system. Fast frozen sections were performed on the suspicious parathyroid glands. Accuracy was evaluated by comparison with histology and NIR identification. Data were attracted for Fisher's linear discriminant analysis. RESULTS: The auto-fluorescence intensity of parathyroid was significantly higher than that of thyroid, fat and lymph node. The peak intensity of auto-fluorescence from parathyroid was 5.55 times of that from thyroid at the corresponding wave number. Of the 20 patients, the parathyroid was accurately detected and identified in 19 patients by NIR system, compared with their histologic results. One suspicious parathyroid did not exhibit typical spectra, and was proved to be fat tissue by histology. The NIR auto-fluorescence method had a 100% sensitivity of parathyroid glands identification and a high accuracy of 95%. The positive predictive value was 95%. The parathyroid gland have specific auto-fluorescence spectrum and can be separated from the other three samples through the Fisher's linear discriminant analysis. CONCLUSIONS: NIR auto-fluorescence spectroscopy can accurately identify normal parathyroid gland during thyroidectomy. The Fisher's linear discriminant analysis demonstrated the specificity of the NIR auto-fluorescence of parathyroid tissue and its efficacy in parathyroid discrimination.


Asunto(s)
Glándulas Paratiroides/diagnóstico por imagen , Espectrometría de Fluorescencia/métodos , Espectroscopía Infrarroja Corta/métodos , Cirugía Asistida por Computador/métodos , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Anciano , Análisis Discriminante , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Curva ROC , Neoplasias de la Tiroides/diagnóstico
9.
PLoS One ; 15(1): e0227155, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31923183

RESUMEN

In intraoperative electron radiation therapy (IOERT) the energy of the electron beam is selected under the conventional assumption of water-equivalent tissues at the applicator end. However, the treatment field can deviate from the theoretic flat irradiation surface, thus altering dose profiles. This patient-based study explored the feasibility of acquiring intraoperative computed tomography (CT) studies for calculating three-dimensional dose distributions with two factors not included in the conventional assumption, namely the air gap from the applicator end to the irradiation surface and tissue heterogeneity. In addition, dose distributions under the conventional assumption and from preoperative CT studies (both also updated with intraoperative data) were calculated to explore whether there are other alternatives to intraoperative CT studies that can provide similar dose distributions. The IOERT protocol was modified to incorporate the acquisition of intraoperative CT studies before radiation delivery in six patients. Three studies were not valid to calculate dose distributions due to the presence of metal artefacts. For the remaining three cases, the average gamma pass rates between the doses calculated from intraoperative CT studies and those obtained assuming water-equivalent tissues or from preoperative CT studies were 73.4% and 74.0% respectively. The agreement increased when the air gap was included in the conventional assumption (98.1%) or in the preoperative CT images (98.4%). Therefore, this factor was the one mostly influencing the dose distributions of this study. Our experience has shown that intraoperative CT studies are not recommended when the procedure includes the use of shielding discs or surgical retractors unless metal artefacts are removed. IOERT dose distributions calculated under the conventional assumption or from preoperative CT studies may be inaccurate unless the air gap (which depends on the surface irregularities of the irradiated volume and on the applicator pose) is included in the calculations.


Asunto(s)
Neoplasias de la Mama/radioterapia , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia de Alta Energía/métodos , Neoplasias Retroperitoneales/radioterapia , Sarcoma/radioterapia , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Neoplasias de la Mama/diagnóstico por imagen , Estudios de Factibilidad , Femenino , Humanos , Periodo Intraoperatorio , Transferencia de Pacientes , Periodo Preoperatorio , Dosificación Radioterapéutica , Neoplasias Retroperitoneales/diagnóstico por imagen , Sarcoma/diagnóstico por imagen
10.
PLoS One ; 15(1): e0225939, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31967987

RESUMEN

BACKGROUND: The incidence, prediction and mortality outcomes of intraoperative and postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR) in surgical patients are under investigated and have not been studied concurrently in a single study. METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program data between 2008 and 2012. Firth's penalized logistic regression was used to study the incidence and identify risk factors for intra- and postoperative CPR and 30-day mortality. simplified prediction model was constructed and internally validated to predict the studied outcomes. RESULTS: Among about 1.86 million non-cardiac operations, the incidence rate of intraoperative CPR was 0.03%, and for postoperative CPR was 0.33%. The 30-day mortality incidence rate was 1.25%. The incidence rate of events decreased overtime between 2008-2012. Of the 29 potential predictors, 14 were significant for intraoperative CPR, 23 for postoperative CPR, and 25 for 30-day mortality. The five strongest predictors (highest odd ratios) of intraoperative CPR were the American Society of Anesthesiologists (ASA) physical status, Systemic Inflammatory Response Syndrome (SIRS)/sepsis, surgery type, urgent/emergency case and anesthesia technique. Intraoperative CPR, ASA, age, functional status and end stage renal disease were the most significant predictors for postoperative CPR. The most significant predictors of 30-day mortality were ASA, age, functional status, SIRS/sepsis, and disseminated cancer. The predictions with the simplified five-factor model performed well and was comparable to the full prediction model. Postoperative cardiac arrest requiring CPR, compared to intraoperative, was associated with much higher mortality. CONCLUSIONS: The incidence of cardiac arrest requiring CPR in surgical patients decreased overtime. Risk factors for intraoperative CPR, postoperative CPR and perioperative mortality are overlapped. We proposed a simplified approach compromised of five-factor model to identify patients at high risk. Postoperative, compare to intraoperative, cardiac arrest requiring CPR was associated with much higher mortality.


Asunto(s)
Reanimación Cardiopulmonar/estadística & datos numéricos , Paro Cardíaco/mortalidad , Paro Cardíaco/terapia , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Anciano , Análisis de Varianza , Femenino , Paro Cardíaco/diagnóstico , Humanos , Incidencia , Periodo Intraoperatorio , Funciones de Verosimilitud , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Complicaciones Posoperatorias/diagnóstico , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
11.
World Neurosurg ; 136: 326, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31996340

RESUMEN

A potential application of near-infrared (NIR) fluorescence imaging using second-window indocyanine green (SWIG) is demonstrated. We hypothesized that because the pituitary lacks a blood-brain barrier, we might visualize the pituitary stalk using SWIG. A 52-year-old, right-handed man presented to our clinic for evaluation of progressive loss of vision. Physical examination was significant for loss of right peripheral vision and near-complete loss of left field vision. Prolactin was high-normal at 16.2 mg/dL. Brain magnetic resonance imaging demonstrated a 36-mm sellar mass extending superiorly and laterally crossing the intracranial left internal carotid artery, consistent with a nonfunctional pituitary macroadenoma. We elected to pursue left pterional craniotomy for resection. The patient was eligible for our SWIG clinical trial and consented to the study. SWIG is a novel, investigational technique using Food and Drug Administration-approved indocyanine green to enhance visualization of neoplastic tissue intraoperatively.1-7 The patient received 2.5 mg/kg of indocyanine green intravenously approximately 24 hours preoperatively. Intraoperatively, under white-light microscopy, the tumor was easily identified and distinguished from the optic nerves and internal carotid artery. After debulking of the gross tumor, NIR visualization using a laser-equipped endoscope8 demonstrated strong NIR fluorescence in the pituitary stalk. Despite the distorted anatomy, this technique enabled us to confidently identify and preserve the pituitary stalk. Postoperatively, the patient had persistently high urine output that normalized in 24 hours without desmopressin (sodium 139-140 mmol/L); after uneventful recovery, he was discharged with mild improvement in visual function. This case demonstrated a potential use of our SWIG protocol. As the stalk demonstrates strong NIR fluorescence after high-dose indocyanine green administration, surgeons may be able to better localize and preserve the stalk even in complex skull base tumor cases where the anatomy may be significantly distorted.


Asunto(s)
Procedimientos Neuroquirúrgicos/métodos , Hipófisis/diagnóstico por imagen , Hipófisis/cirugía , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Neoplasias de la Base del Cráneo/cirugía , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/cirugía , Adenoma/cirugía , Fluorescencia , Colorantes Fluorescentes , Humanos , Verde de Indocianina , Periodo Intraoperatorio , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Imagen Óptica , Neoplasias Hipofisarias/cirugía , Neoplasias de la Base del Cráneo/complicaciones , Espectroscopía Infrarroja Corta , Resultado del Tratamiento , Trastornos de la Visión/etiología
12.
Ann Otol Rhinol Laryngol ; 129(3): 216-223, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31631685

RESUMEN

OBJECTIVES: To compare preoperative temporal bone high-resolution computed tomography (HRCT) readings to intraoperative findings during exploratory tympanotomy for suspected cases of isolated congenital middle ear malformations (CMEMs) and summarize the malformations that can and cannot be diagnosed with HRCT. METHODS: A retrospective study was conducted. All cases were confirmed as isolated CMEMs during surgery. Detailed clinical records were reviewed, with a focus on imaging and surgical findings. RESULTS: One hundred and thirty-two patients and 145 ears were reviewed. Ninety cases (62.1%) could be identified as isolated CMEMs and at least one as middle ear anomaly using preoperative HRCT. Fifty-five cases (37.9%) were reported to be completely normal and the patients underwent exploratory tympanotomy to determine the final diagnosis. Stapes fixation, either alone or associated with other ossicular chain anomalies, contributed to 53.1% of the cases. Most cases of aplasia or dysplasia of the ossicular chain, for example, aplasia/dysplasia of the long process of the incus, aplasia of the stapes' superstructure, and atresia of the oval window were easily identified in preoperative HRCT. However, fixation of the ossicular chain can be elusive in HRCT, and exploratory tympanotomy is needed for a definitive diagnosis. CONCLUSIONS: HRCT provides helpful preoperative clinical information in CMEM and may obviate the need for middle ear exploration in some cases. The negative findings (anomalies that are difficult to identify through preoperative HRCT) and the positive findings (anomalies that are relatively easy to identify through preoperative HRCT) were summarized.


Asunto(s)
Oído Medio/anomalías , Ventana Oval/anomalías , Adolescente , Adulto , Niño , Preescolar , Anomalías Congénitas/diagnóstico , Oído Medio/diagnóstico por imagen , Oído Medio/patología , Femenino , Pérdida Auditiva Conductiva/diagnóstico , Perdida Auditiva Conductiva-Sensorineural Mixta/diagnóstico , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Ventana Oval/diagnóstico por imagen , Ventana Oval/patología , Cuidados Preoperatorios , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven
13.
Am J Surg ; 219(1): 71-74, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31128840

RESUMEN

BACKGROUND: Following appendectomy, management is often guided by surgeon determination of whether the appendicitis is uncomplicated or complicated. Our objectives were to determine the incidence of discordance between intraoperative and pathological findings and determine effect on outcomes. METHODS: We performed a retrospective five-year cohort analysis of adults who underwent appendectomy for acute appendicitis. Outcomes examined were length of stay (LOS), return to ED, and 30-day readmission. We reported p-values from logistic regression. RESULTS: Of 1479 cases, 36.4% were labeled complicated appendicitis, among which, 58.2% were discordant. When intraoperative findings underestimated pathological findings, there was a decreased LOS (p < 0.001) compared to concordant diagnoses. There was no significant difference for readmission (p = 0.592) or ED (p = 0.857). CONCLUSION: Operative underestimation of appendicitis severity was associated with a shorter LOS. Discordance did not adversely affect hospital readmission or rate of return to ED. These findings suggest reliance on intraoperative findings is sufficient in guiding management. SUMMARY: We wanted determine the incidence of discordance between operative and pathological findings and determine effect on outcomes. Operative underestimation of appendicitis severity was associated with a shorter LOS. Discordance did not adversely affect hospital readmission or rate of return to ED. These findings suggest reliance on intraoperative findings is sufficient in guiding management.


Asunto(s)
Apendicitis/complicaciones , Apendicitis/diagnóstico , Adulto , Apendicectomía , Apendicitis/patología , Apendicitis/cirugía , Femenino , Humanos , Periodo Intraoperatorio , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
14.
Surgery ; 167(1): 241-249, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31653489

RESUMEN

BACKGROUND: Safe performance of laparoscopic transabdominal adrenalectomy requires the application of a complex body of knowledge and skills, which are difficult to define, teach, and measure. This qualitative study aims to characterize expert behaviors, decisions, and other cognitive processes required to perform laparoscopic transabdominal adrenalectomy. METHOD: Hierarchical and cognitive task analyses for right and left laparoscopic transabdominal adrenalectomy were performed using semi-structured interviews and field observations of experts. Verbal data was supplemented with published literature, coded and thematically analyzed using constructivist grounded-theory by 2 independent reviewers. RESULTS: A conceptual framework was synthesized. Sixty-eight tasks, 46 cognitive behaviors, and 52 potential errors were identified and categorized into 8 procedural steps and 8 fundamental principles: anticipation, exposure, teamwork or communication, physiology, dissection techniques, oncologic margins, tactical modification, and error recovery. Experts emphasized the importance of creating a 3-dimensional mental model of the anatomy or pathology (eg, aberrant vessels, tumor location) that is consistently fine-tuned throughout the operation, with conscious awareness of danger zones (eg, medial arc). Despite variations in dissection techniques, experts highlighted 2 themes: macrodissection and microdissection, with emphasis on nonlinear motions and effective transitions between the 2 when appropriate. CONCLUSION: This study defines behaviors and competencies that are essential to performing laparoscopic transabdominal adrenalectomy effectively and safely.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía/normas , Competencia Clínica/normas , Laparoscopía/normas , Cirujanos/psicología , Adulto , Actitud del Personal de Salud , Toma de Decisiones Clínicas , Cognición , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Mejoramiento de la Calidad , Cirujanos/normas
15.
Ann Otol Rhinol Laryngol ; 129(1): 70-77, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31510765

RESUMEN

OBJECTIVE: Prediction and early intervention for hypocalcemia following parathyroidectomy and total thyroidectomy can decrease hospital cost and prevent severe hypocalcemia-related complications. This study aims to predict the severity of hypocalcemia after parathyroidectomy or thyroidectomy and to stratify patients into groups with different levels of risk for developing severe hypocalcemia, so that higher risk patients may be monitored more closely and receive earlier interventions. METHODS: This was a retrospective cohort study of 100 patients with primary hyperparathyroidism who underwent parathyroidectomy as the primary treatment modality at a tertiary care hospital. Clinical information, including demographic information, perioperative PTH and calcium levels, vitamin D levels, weight of the pathologic glands removed, gland pathology, and re-admission rates, were retrieved. Statistical analysis was performed to analyze the association between collected variables and percentage of calcium drop following parathyroidectomy with statistical significant set at P-values <0.05. RESULTS: Age, sex, and vitamin D level provided very minimal information to quantify risks of postoperative hypocalcemia. The percentage of decrease from preoperative PTH level to the lowest PTH level after the removal of the abnormal gland(s) is the most significant predicting factor for the severity of postoperative hypocalcemia. There is a mathematic regressional correlation between them. A formula was generated to quantify this linear relationship between them, and the nadir calcium can be calculated as Canadir=Capreop*[1-0.35*(PTHpreop-PTHintraop)2PTHpreop2], where Canadir = the lowest postoperative calcium level, and PTHintraop = PTH level 15 minutes after removal of the abnormal gland, with the value of R2 > 0.7. The formula has been tested primarily in our patient population with good reliability. CONCLUSIONS: The highest preoperative, lowest postoperative, and change in PTH level can help us reliably calculate the trend of postoperative calcium level. Decision to pursue early interventions can be made based on the calculated result from the formula we obtained.


Asunto(s)
Hiperparatiroidismo Primario/cirugía , Hipocalcemia/epidemiología , Paratiroidectomía , Complicaciones Posoperatorias/epidemiología , Adenoma/sangre , Adenoma/patología , Adenoma/cirugía , Adulto , Factores de Edad , Femenino , Humanos , Hiperparatiroidismo Primario/sangre , Hipocalcemia/sangre , Hipocalcemia/terapia , Periodo Intraoperatorio , Magnesio/sangre , Masculino , Persona de Mediana Edad , Modelos Teóricos , Hormona Paratiroidea/sangre , Neoplasias de las Paratiroides/sangre , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/cirugía , Complicaciones Posoperatorias/sangre , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Tiroidectomía , Carga Tumoral , Vitamina D/sangre
16.
Anticancer Res ; 39(12): 6829-6834, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810949

RESUMEN

BACKGROUND/AIM: Circulating tumor cells (CTCs) are tumor cells shed from tumor sites and circulate in the peripheral blood. CTCs can be a surrogate biomarker of recurrence and prognosis. Because surgical manipulation could promote CTCs, it is important to reduce CTCs during surgery. This study aimed to evaluate the effectiveness of intraoperative wedge resection of the tumor site before lobectomy. PATIENTS AND METHODS: A total of 297 resected stage I lung adenocarcinoma patients were retrospectively reviewed. Patients were divided into two groups: Wedge and Non-Wedge. Recurrence-free survival (RFS) curves were plotted using the Kaplan-Meier method. Cox regression analyses were used to evaluate the hazard ratio (HR) with the endpoint RFS. RESULTS: The 5-year RFS rates were 92.9% and 85.5%, in Wedge and Non-Wedge groups, respectively (p=0.006). Wedge resection was an independent factor associated with RFS (HR=0.342, 95%CI=0.141-0.830, p=0.018). CONCLUSION: Wedge resection before lobectomy for lung adenocarcinoma patients can improve RFS rates.


Asunto(s)
Adenocarcinoma del Pulmón/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Venas Pulmonares/cirugía , Adenocarcinoma del Pulmón/irrigación sanguínea , Adenocarcinoma del Pulmón/patología , Femenino , Humanos , Periodo Intraoperatorio , Neoplasias Pulmonares/irrigación sanguínea , Neoplasias Pulmonares/patología , Masculino , Estadificación de Neoplasias , Células Neoplásicas Circulantes/patología , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Cirugía Torácica Asistida por Video , Resultado del Tratamiento
17.
Medicine (Baltimore) ; 98(50): e18047, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852066

RESUMEN

BACKGROUND: There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in pediatric patients. The purpose of our study was to perform a meta-analysis to compare rates of intra-abdominal abscess after appendectomy between irrigation and suction alone groups. METHODS: We identified studies by a systematic search in EMBASE, PubMed, Web of Science, and the Cochrane Library to recognize randomized controlled trials and case control studies from the 1950 to May 2019. We limited the English language studies. We checked the reference list of studies to recognize other potentially qualified trials. We analyzed the merged data with use of the Review Manager 5.3. RESULTS: We identified 6 eligible papers enrolling a total of 1633 participants. We found no significant difference in the incidence of postoperative intraabdominal abscess, wound infection, and the length of hospitalization between 2 group, but duration of surgery is longer in irrigation group (MD = 6.76, 95% CI = 4.64 to 8.87, P < .001; heterogeneity, I = 25%, P = .26). CONCLUSION: Our meta-analysis did not provide strong evidence allowing definite conclusions to be drawn, but suggested that peritoneal irrigation during appendectomy did not decrease the incidence of postoperative IAA. This meta-analysis also indicated the need for more high-quality trials to identify methods to decrease the incidence of postoperative IAA in pediatric perforated appendicitis patients.Trial registration number Standardization of endoscopic treatment of acute abdomen in children: 14RCGFSY00150.


Asunto(s)
Absceso Abdominal/prevención & control , Apendicectomía/métodos , Apendicitis/cirugía , Laparoscopía/métodos , Lavado Peritoneal/métodos , Complicaciones Posoperatorias/prevención & control , Absceso Abdominal/etiología , Apendicitis/complicaciones , Niño , Humanos , Periodo Intraoperatorio , Complicaciones Posoperatorias/etiología
18.
Medicine (Baltimore) ; 98(50): e18234, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852087

RESUMEN

The aim of this prospective observational single-centre pilot study was to evaluate the association between alterations in carotid artery blood flow velocities during cardiac surgery and postoperative delirium.Carotid artery blood flow velocity was determined perioperatively at 5 different timepoints by duplex sonography in 36 adult cardiac surgical patients. Delirium was assessed using the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. Additionally, blood flow velocities in the middle cerebral arteries, differences in regional cerebral tissue oxygenation and quantity and quality of microemboli were measured.Delirium was detected in 7 of 36 patients. After cardiopulmonary bypass carotid artery blood flow velocities increased by +23 cm/second (95% confidence interval (CI) 9-36 cm/second) in non-delirious patients compared to preoperative values (P = .002), but not in delirious patients (+3 cm/second [95% CI -25 to 32 cm/second], P = .5781). Middle cerebral artery blood flow velocities were higher at aortic de-cannulation in non-delirious patients (29 cm/second [inter-quartile range (IQR), 24-36 cm/second] vs 12 cm/second [IQR, 10-19 cm/second]; P = .017). Furthermore, brain tissue oxygenation was higher in non-delirious patients during surgery.Our results suggest that higher cerebral blood flow velocities after aortic de-clamping and probably also improved brain oxygenation might be beneficial to prevent postoperative delirium.


Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Arteria Carótida Común/fisiopatología , Delirio/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Ultrasonografía Doppler Dúplex/métodos , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Arteria Carótida Común/diagnóstico por imagen , Delirio/etiología , Delirio/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Proyectos Piloto , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos
19.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 403-407, Out.-Dez. 2019. tab
Artículo en Inglés | LILACS | ID: biblio-1024212

RESUMEN

Introduction: Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage. Objective: The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage. Methods: A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate. Results: A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases. Conclusion: The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Tonsilectomía/efectos adversos , Hemorragia Posoperatoria/etiología , Pulso Arterial , Estudios Retrospectivos , Factores de Riesgo , Pérdida de Sangre Quirúrgica , Hemorragia Posoperatoria/terapia , Tempo Operativo , Presión Arterial , Hospitales Universitarios , Periodo Intraoperatorio
20.
Anal Bioanal Chem ; 411(30): 7929-7933, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31754769

RESUMEN

Knowledge of the isocitrate dehydrogenase (IDH) mutation status of glioma patients could provide insights for decision-making during brain surgery. However, pathology is not able to provide such information intraoperatively. Here we describe the first application of a miniature mass spectrometer (MS) to the determination of IDH mutation status in gliomas intraoperatively. The instrumentation was modified to be compatible with use in the operating room. Tandem MS was performed on the oncometabolite, 2-hydroxyglutarate, and a reference metabolite, glutamate, which is not involved in the IDH mutation. Ratios of fragment ion intensities were measured to calculate an IDH mutation score, which was used to differentiate IDH mutant and wild-type tissues. The results of analyzing 25 biopsies from 13 patients indicate that reliable determination of IDH mutation status was achieved (p = 0.0001, using the Kruskal-Wallis non-parametric test). With its small footprint and low power consumption and noise level, this application of miniature mass spectrometers represents a simple and cost-effective platform for an important intraoperative measurement. Graphical abstract.


Asunto(s)
Neoplasias Encefálicas/enzimología , Glioma/enzimología , Isocitrato Deshidrogenasa/genética , Mutación , Espectrometría de Masa por Ionización de Electrospray/instrumentación , Espectrometría de Masas en Tándem/instrumentación , Biopsia , Neoplasias Encefálicas/patología , Estudios de Cohortes , Glioma/patología , Humanos , Periodo Intraoperatorio
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