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

RESUMEN

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


Asunto(s)
Isquemia Miocárdica , Procedimientos Quirúrgicos Operativos , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Factores de Riesgo , Procedimientos Quirúrgicos Operativos/efectos adversos , Troponina
2.
Medicine (Baltimore) ; 100(14): e25335, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832108

RESUMEN

ABSTRACT: The systemic immune-inflammation index (SII) is an independent prognostic predictor of hepatocellular carcinoma (HCC). The present investigation examined whether an association exists between preoperative SII value and postoperative acute kidney injury (pAKI) in HCC patients.The study included 479 hepatitis B virus (HBV)-associated HCC patients undergoing hepatectomy. The SII was calculated as P × N/L, where P, N, and L represent the counts of platelets, neutrophils, and lymphocytes in routine blood test, respectively. After propensity score matching, logistic regression analysis was used to explore independent predictors of pAKI in HCC patients.pAKI was confirmed in 51 patients (10.8%). The average SII value was higher in patients with pAKI than patients without pAKI. After multivariate logistic regression analysis, SII, history of hypertension, and tumor size, among others, were found to be predictors of pAKI. The optimal threshold value of SII for predicting pAKI was found to be 547.84 × 109/L. Multivariate analysis performed after propensity score matching confirmed that SII ≥ 547.84 × 109/L was an independent predictor of pAKI.The preoperative SII qualifies as a novel, independent predictor of pAKI in HCC patients with HBV infection who underwent hepatectomy.


Asunto(s)
Lesión Renal Aguda/etiología , Lesión Renal Aguda/inmunología , Carcinoma Hepatocelular/cirugía , Indicadores de Salud , Hepatectomía/efectos adversos , Neoplasias Hepáticas/cirugía , Lesión Renal Aguda/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/etiología , Carcinoma Hepatocelular/patología , Comorbilidad , Hepatitis B/complicaciones , Humanos , Recuento de Leucocitos , Pruebas de Función Hepática , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/patología , Modelos Logísticos , Persona de Mediana Edad , Periodo Posoperatorio , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Carga Tumoral , Adulto Joven
3.
Medicine (Baltimore) ; 100(15): e25416, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847639

RESUMEN

ABSTRACT: To study the efficacy of using amniotic membrane, balloon and intrauterine device (IUD) as barrier therapy to prevent re-adhesion after hysteroscopic adhesiolysis.A total of 45 patients diagnosed with intrauterine adhesions in Changzhou Maternal and Child Health Hospital from June 2014 to December 2017 were included in this retrospective case control study. According to different postoperative isolation barrier methods, the patients were divided into group A (Foley balloon + fresh amniotic membrane Day1 + IUD Day7) (22 cases) and group B (Foley balloon Day1 + IUD Day7) (23 cases). Three months after the surgery, the second hysteroscopy was performed to observe the condition of the uterine cavity and the improvement of menstruation, and to monitor the thickness of the endometrium.The efficacy of hysteroscopic procedure in group A was significantly higher than that of group B (P < .05). After 3 months of treatment, the improvement rate of menstruation was significantly higher in group A than in group B (P < .05). Endometrial thickness in both group A and B was significantly increased compared with that before the surgery (P < .05). The postoperative endometrium of group A was significantly thicker than that of group B (P < .05).Amniotic membrane-mediated sequential double-barrier method is clinically feasible for preventing recurrent intrauterine adhesions.


Asunto(s)
Amnios , Histeroscopía/métodos , Dispositivos Intrauterinos , Cateterismo Urinario/métodos , Enfermedades Uterinas/cirugía , Adulto , Estudios de Casos y Controles , Endometrio/fisiopatología , Femenino , Humanos , Histeroscopía/efectos adversos , Periodo Posoperatorio , Recurrencia , Estudios Retrospectivos , Adherencias Tisulares
4.
Medicine (Baltimore) ; 100(15): e25453, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847651

RESUMEN

ABSTRACT: This study aims to compare the nutritional outcomes and quality of life between patients who underwent esophagogastrostomy (EG) and those who underwent the double-tract reconstruction (DTR) after laparoscopic proximal gastrectomy for early gastric cancer.We retrospectively reviewed the prospectively established database of 45 patients who underwent EG with anti-reflux procedure and 58 patients who underwent the DTR after laparoscopic proximal gastrectomy between December 2013 and June 2017. Then, we compared the baseline characteristics, clinical outcomes, postoperative nutritional parameters, and quality of life (QOL) using European Organization for Research and Treatment of Cancer (EORTC) QLQ STO-22 between the EG and DTR groups.In the postoperative 1-year endoscopic findings, the incidence of esophageal reflux was higher in the EG group (17.8% vs 3.4%, P = .041) and there was no significant difference in anastomotic stricture. Nutritional status was evaluated via body mass index, serum albumin, protein, hemoglobin, and ferritin; we found no significant differences. The incidences of iron deficiency anemia and vitamin B12 deficiency also showed no significant difference between the 2 groups. With regards to the quality of life, the difference values between preoperative and postoperative 1-year were evaluated; there was no significant difference between the EG with anti-reflux procedure and DTR groups.EG had higher incidence of esophageal reflux and similar nutritional outcomes and QOL compared with the double-tract reconstruction after laparoscopic proximal gastrectomy. Additional large-scale research is needed to evaluate the long-term functional outcomes of EG and the double-tract reconstruction.


Asunto(s)
Esofagectomía/métodos , Gastrectomía/métodos , Estado Nutricional , Calidad de Vida , Procedimientos Quirúrgicos Reconstructivos/métodos , Neoplasias Gástricas/cirugía , Anciano , Esofagectomía/efectos adversos , Femenino , Gastrectomía/efectos adversos , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/etiología , Humanos , Incidencia , Laparoscopía/efectos adversos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Estudios Retrospectivos , Neoplasias Gástricas/fisiopatología , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 100(15): e25586, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847690

RESUMEN

RATIONALE: Although renal cell carcinoma (RCC) is one of the common origins of brain metastasis, few cases of extremely delayed brain metastasis from RCC, more than 10 years after nephrectomy, have been reported. We present a rare case of extremely delayed brain metastasis from RCC, also performed a literature review to increase knowledge of the characteristics for extremely delayed brain metastasis from RCC. PATIENT CONCERNS: A 72-year-old man presented with right-sided hemiplegia and dysarthria. The patient had a history of radical nephrectomy for RCC with stage T1N0M0 15 years earlier. DIAGNOSIS: Magnetic resonance imaging with contrast revealed a 2-cm sized non-homogenous enhanced mass in the left frontal lobe with peritumoral edema. The pathological examination after surgery reported metastatic clear cell RCC. INTERVENTIONS: A craniotomy for removal of the mass was performed at the time of diagnosis. Stereotactic radiosurgery was performed for the tumor bed 3 weeks after craniotomy, and then, chemotherapy was started 2 months after the SRS. OUTCOMES: Metastasis progressed to multiple organs 6 months after the craniotomy. The patient chose a hospice and no longer visited the hospital. LESSONS: In cases with a history of nephrectomy for RCC, long period follow-up is necessary for monitoring RCC brain metastasis and pathologic diagnosis should be confirmed.


Asunto(s)
Neoplasias Encefálicas/secundario , Carcinoma de Células Renales/secundario , Neoplasias Renales/patología , Nefrectomía/métodos , Anciano , Neoplasias Encefálicas/cirugía , Carcinoma de Células Renales/cirugía , Craneotomía , Resultado Fatal , Humanos , Neoplasias Renales/cirugía , Masculino , Periodo Posoperatorio , Radiocirugia , Factores de Tiempo
6.
Wiad Lek ; 74(3 cz 1): 395-398, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813439

RESUMEN

OBJECTIVE: The aim: The purpose of the present research was to study the results of coronary artery bypass graft (CABG) surgery depending on the degree of left ventricular ejection fraction (LVEF) reduction with the aim to identify additional echocardiographic predictors of the early postoperative period. PATIENTS AND METHODS: Materials and methods: Were fixed, the results of CABG in 97 patients operated on in the "Bikard" private clinic from March 2016 to December 2018 were the material of the research. All patients underwent CABG surgery under cardiopulmonary bypass and cardioplegia, and in the preoperative period underwent echocardiographic examination according to the standard technique on the Vivid 7 machine. Patients, in dependent of the LVEF, were divided into 3 groups: group 1 35 people (LVEF < 40%), group 2 32 people ( 40% < LVEF < 50%), group 3 30 people (LVEF > 50%). RESULTS: Results: Our studies showed that the most important echocardiographic predictors of a complicated development of the disease in the early postoperative period, in addition to LVEF of the heart, can be the size of the left ventricle and left atrial, the presence and severity of mitral regurgitation and diastolic dysfunction of the left ventricle of the heart. CONCLUSION: Conclusions: Comprehensive measurement of these echocardiographic parameters will allow more accurately predict the results of coronary artery bypass grafting in the early postoperative period.


Asunto(s)
Disfunción Ventricular Izquierda , Función Ventricular Izquierda , Puente de Arteria Coronaria , Ecocardiografía , Humanos , Periodo Posoperatorio , Volumen Sistólico , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico por imagen
7.
Anticancer Res ; 41(4): 2117-2122, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813422

RESUMEN

BACKGROUND/AIM: Stanniocalcin2 (STC2) is associated with proliferation, invasion, and metastasis in various cancers. We examined the clinical significance of STC2 mRNA expression in patients with colorectal cancer (CRC). PATIENTS AND METHODS: Relative expression levels of STC2 mRNA in CRC tissues and corresponding normal mucosa obtained from 202 patients were measured using quantitative real-time reverse transcriptase-polymerase chain reaction. RESULTS: Expression of STC2 mRNA was higher in the cancer tissue than in the adjacent normal mucosa. STC2 mRNA expression in cancer tissues was associated with tumour size, liver metastasis, venous invasion, and lymph node metastasis. High expression of STC2 mRNA was significantly associated with poorer postoperative survival (p=0.0003). Multivariate analysis showed that high expression of STC2 mRNA was an independent predictor of postoperative survival. CONCLUSION: High expression of STC2 mRNA in CRC tissue may be a useful prognostic marker in patients with CRC.


Asunto(s)
Adenocarcinoma/diagnóstico , Biomarcadores de Tumor/genética , Neoplasias Colorrectales/diagnóstico , Glicoproteínas/genética , Péptidos y Proteínas de Señalización Intercelular/genética , Adenocarcinoma/genética , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Anciano , Biomarcadores de Tumor/metabolismo , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/cirugía , Femenino , Regulación Neoplásica de la Expresión Génica , Glicoproteínas/metabolismo , Humanos , Péptidos y Proteínas de Señalización Intercelular/metabolismo , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Pronóstico , ARN Mensajero/genética , ARN Mensajero/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa , Análisis de Supervivencia , Resultado del Tratamiento
8.
Anticancer Res ; 41(4): 2123-2132, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813423

RESUMEN

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


Asunto(s)
Implantación de Mama , Implantes de Mama/efectos adversos , Linfopenia/etiología , Mamoplastia , Complicaciones Posoperatorias/inmunología , Linfocitos T Colaboradores-Inductores/patología , Adulto , Anciano , Implantación de Mama/efectos adversos , Implantación de Mama/instrumentación , Implantación de Mama/métodos , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Diseño de Equipo/efectos adversos , Femenino , Humanos , Linfopenia/diagnóstico , Linfopenia/inmunología , Mamoplastia/efectos adversos , Mamoplastia/instrumentación , Mamoplastia/métodos , Mastectomía/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/patología , Periodo Posoperatorio , Estudios Prospectivos , Factores de Tiempo
9.
Anticancer Res ; 41(4): 2147-2155, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813426

RESUMEN

BACKGROUND/AIM: Inflammation-based prognostic scores are proven prognostic biomarkers in various cancers. This study aimed to identify a useful prognostic score for patients with biliary tract cancer (BTC) after surgical resection. PATIENTS AND METHODS: This retrospective study recruited 115 patients with BTC during 2010-2020. The relationship between clinicopathological variables, including various prognostic scores and overall survival (OS), was investigated using univariate and multivariate analyses. RESULTS: BTC included 58 cholangiocarcinoma, 29 gallbladder carcinoma, 16 ampullary carcinoma, and 12 perihilar cholangiocarcinoma cases. A significant difference was detected in OS of patients with a Japanese modified Glasgow prognostic score (JmGPS) 0 (n=62) and JmGPS 1 or 2 (high JmGPS) (n=53). In the multivariate analysis, tumour differentiation (p=0.014) and a high JmGPS (p=0.047) were independent prognostic factors. CONCLUSION: The high JmGPS was an independent prognostic predictor after surgical resection and was superior to other prognostic scores.


Asunto(s)
Neoplasias del Sistema Biliar/diagnóstico , Neoplasias del Sistema Biliar/cirugía , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/cirugía , Inflamación/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/metabolismo , Ampolla Hepatopancreática/patología , Ampolla Hepatopancreática/cirugía , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/metabolismo , Neoplasias de los Conductos Biliares/mortalidad , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos/metabolismo , Conductos Biliares Intrahepáticos/patología , Conductos Biliares Intrahepáticos/cirugía , Neoplasias del Sistema Biliar/metabolismo , Neoplasias del Sistema Biliar/mortalidad , Biomarcadores de Tumor/metabolismo , Proteína C-Reactiva/metabolismo , Colangiocarcinoma/metabolismo , Colangiocarcinoma/mortalidad , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/metabolismo , Neoplasias del Conducto Colédoco/mortalidad , Neoplasias del Conducto Colédoco/cirugía , Femenino , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/metabolismo , Neoplasias de la Vesícula Biliar/mortalidad , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Inflamación/metabolismo , Japón/epidemiología , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/metabolismo , Tumor de Klatskin/mortalidad , Tumor de Klatskin/cirugía , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Pronóstico , Proyectos de Investigación , Estudios Retrospectivos , Sensibilidad y Especificidad , Análisis de Supervivencia , Resultado del Tratamiento
10.
Anticancer Res ; 41(4): 2165-2169, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813428

RESUMEN

BACKGROUND/AIM: In centrally-located lung cancer treatment, it is difficult to attain a sufficient resection margin. It is important to investigate recurrent styles in centrally-located lung cancer patients. PATIENTS AND METHODS: Primary lung cancer located at the hilar area that requires pneumonectomy or sleeve lobectomy is defined as centrally-located lung cancer. Early recurrence was defined as that within 1 year after surgery. RESULTS: This study included 43 centrally-located lung cancer patients. Ten patients underwent pneumonectomy and 33 underwent sleeve lobectomy. Eleven patients experienced early recurrence. Non-squamous cell carcinoma (p=0.012), tumor size>64 mm (p<0.001) and pathological N2 (p=0.012) were significant predictors for early recurrence by univariate analysis. Also, tumor size >64 mm (p=0.006) and pathological N2 (p=0.019) were independent predictors by multivariate analysis. CONCLUSION: Non-squamous cell carcinoma, tumor size and pathological N2 were significant predictors of early recurrence in centrally-located lung cancer. The type of surgical procedure did not affect recurrence development.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Ganglios Linfáticos/patología , Carga Tumoral/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neumonectomía/efectos adversos , Neumonectomía/métodos , Periodo Posoperatorio , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
11.
Medicine (Baltimore) ; 100(14): e25366, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832118

RESUMEN

ABSTRACT: To compare and analyze the postoperative 1-year outcomes of laser refractive surgery (LRS) alone vs LRS with laser asymmetric keratectomy (LAK), in patients with myopia, for preventing and resolving LRS complications.This retrospective study compared the preoperative and 1-year postoperative outcomes between the control and comparison groups using a sum of deviations in corneal thickness in 4 directions >80 µm. The control group included 41 patients with myopia (41 eyes) who underwent LRS. The comparison group included 33 patients (33 eyes) who received LAK-linked LRS. Age, spherical equivalent (SE), sphere, cylinder, uncorrected distance visual acuity (UDVA), pupil size, kappa angle, central corneal thickness, corneal irregularity in the 3.0 mm zone on Orbscan maps (SUM), distance between the maximum posterior elevation (best-fit-sphere) and the visual axis (DISTANCE), postoperative blurring scores, frequency of postoperative myopic regression, and efficiency index were compared.Preoperative age (P = .198), SE (P = .686), sphere (P = .562), cylinder (P = .883), UDVA (P = .139), pupil size (P = .162), kappa angle (P = .807), central corneal thickness (P = .738), corneal irregularity (P = .826), SUM (P = .774), and DISTANCE (P = .716) were similar between the 2 groups. The 1-year postoperative SE (P = .024), sphere (P = .022), corneal irregularity (P = .033), SUM (P = .000), DISTANCE (P = .04), blurring scores (P = .000), and frequency of postoperative myopic regression (P = .004) were significantly decreased in the comparison group compared to the control group. UDVA (P = .014) and the efficiency index (P = .035) were higher in the comparison group.LAK with LRS improved corneal symmetry by reducing the SUM and DISTANCE. UDVA and efficiency index were also improved and blurring and myopic regression were reduced postoperatively.


Asunto(s)
Córnea/cirugía , Cirugía Laser de Córnea/efectos adversos , Queratomileusis por Láser In Situ/efectos adversos , Miopía/cirugía , Adulto , Estudios de Casos y Controles , Terapia Combinada , Córnea/fisiopatología , Paquimetría Corneal/estadística & datos numéricos , Cirugía Laser de Córnea/métodos , Femenino , Humanos , Queratomileusis por Láser In Situ/métodos , Masculino , Miopía/diagnóstico , Miopía/fisiopatología , Periodo Posoperatorio , Refracción Ocular/fisiología , Estudios Retrospectivos , Resultado del Tratamiento , Trastornos de la Visión/epidemiología , Trastornos de la Visión/etiología , Agudeza Visual/fisiología
12.
Medicine (Baltimore) ; 100(14): e25400, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832135

RESUMEN

ABSTRACT: Ultrasound (US)-guided core needle biopsy (CNB) has been recognized as a crucial diagnostic tool for breast cancer. However, there is a lack of guidance for hospitals that are not equipped with adjunctive US. The aim of this study was to assess the sensitivity, specificity, and experience of freehanded CNB in the outpatient department, and to determine the minimum number of tissue strips required to obtain concordance for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), and tumor grade with the excised specimen.A prospective study was performed on 95 patients undergoing CNB and subsequent surgical procedures. The reliability of immunohistochemical assessments of the pathological type, tumor grade, ER, PR, and HER2 status in CNBs was compared with that of surgical specimens. Concordance between the CNBs and surgical samples was estimated as a percentage agreement, and analyzed using the chi-square test. A P < .05 was considered significant.The concordance rates of ER, PR, and HER2 status and tumor grade status between CNBs and surgically excised specimens were 97.9%, 91.6%, 82.1%, and 84.2%, respectively. The reliability of taking 2 tissue strips was similar to that of taking six tissue strips in distinguishing malignancy from benignancy, and determining the pathological type without the aid of US. Four tissue strips obtained by CNB showed good accuracy comparable to those obtained by surgical specimens in assessing ER, PR, and HER2 status and tumor grade.Two tissue strips obtained by CNB showed good accuracy in differentiating malignancy from benignancy, while at least 4 strips are recommended to obtain overall conformity of pathological biomarkers.


Asunto(s)
Biopsia con Aguja Gruesa/métodos , Neoplasias de la Mama/patología , Biopsia Guiada por Imagen/instrumentación , Cuidados Preoperatorios/estadística & datos numéricos , Manejo de Especímenes/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/cirugía , China/epidemiología , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Persona de Mediana Edad , Clasificación del Tumor/métodos , Periodo Posoperatorio , Estudios Prospectivos , Receptor ErbB-2/metabolismo , Receptores Estrogénicos/metabolismo , Receptores de Progesterona/metabolismo , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Manejo de Especímenes/tendencias , Ultrasonografía Intervencional/métodos
13.
Rev Port Cir Cardiotorac Vasc ; 28(1): 53-55, 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33834651

RESUMEN

Myxomas are the most common cardiac tumors; however right ventricular myxomas are very rare. We present the case of an asymptomatic 74 year old female with a right ventricular myxoma originating from the interventricular septum diagnosed during a routine echocardiographic examination. Initially the patient refused surgery due to being asymptomatic, but agreed to be operated two months later. Surgical removal was uneventful, as was the postoperative course. Histopathological analysis confirmed the suspected diagnosis of cardiac myxoma.


Asunto(s)
Neoplasias Cardíacas , Mixoma , Anciano , Ecocardiografía , Femenino , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Periodo Posoperatorio
15.
BMC Infect Dis ; 21(1): 370, 2021 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-33879083

RESUMEN

BACKGROUND: Native valves infective endocarditis due to Escherichia coli is still a rare disease and a particular virulence of some E.coli isolate may be suspected. CASE PRESENTATION: A 79-year-old woman presented during the post-operative period of an orthopedic surgery a urinary tract infection following obstructive ureteral lithiasis. E. coli was isolated from a pure culture of urine and blood sampled simultaneously. After evidence of sustained E.coli septicemia, further investigations revealed acute cholecystitis with the same micro-organism in biliary drainage and a native valve mitral endocarditis. E.coli was identified as O2:K7:H6, phylogenetic group B2, ST141, and presented several putative and proven virulence genes. The present isolate can be classified as both extra-intestinal pathogenic E.coli (ExPECJJ) and uropathogenic E. coli (UPECHM). CONCLUSIONS: The relationship between the virulent factors present in ExPEC strains and some serotypes of E. coli that could facilitate the adherence to cardiac valves warrants further investigation.


Asunto(s)
Endocarditis/diagnóstico , Escherichia coli Patógena Extraintestinal/aislamiento & purificación , Anciano , Animales , Endocarditis/microbiología , Escherichia coli Patógena Extraintestinal/clasificación , Escherichia coli Patógena Extraintestinal/patogenicidad , Femenino , Humanos , Procedimientos Ortopédicos/efectos adversos , Filogenia , Periodo Posoperatorio , Infecciones Urinarias/microbiología , Infecciones Urinarias/patología , Urolitiasis/cirugía , Virulencia/genética
16.
Klin Monbl Augenheilkd ; 238(4): 493-498, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33930924

RESUMEN

BACKGROUND: Surgical treatment of abducens nerve palsy depends on the remaining function of the lateral rectus muscle. Vertical rectus transposition surgery is indicated if the attempted maximal abduction effort does not rotate the eye beyond the midline. After the first description more than 100 years ago, a variety of muscle transposition modifications have been suggested. Nishida's minimally-invasive adaptation has attracted a great deal of attention in recent years. PATIENTS AND METHODS: Retrospective case series of four patients with abducens nerve palsy who were treated with Nishida muscle transposition surgery. Patients' characteristics with special emphasis on comparison between pre- and postoperative angle of deviation and ocular motility are reported. RESULTS: Four patients (2 females, 2 males) were included in this study. Unilateral transposition surgery was performed in a 7-year-old girl and a 37-year-old woman with a left abducens nerve palsy. In a 56-year-old male with a left sixth nerve palsy and in an 82-year-old male with a right sixth nerve palsy the transposition maneuver was combined with a recession of the medial rectus muscle in the same eye. In all patients, ocular motility was improved and the angle of deviation was reduced. CONCLUSIONS: Transposition of vertical rectus muscles is well established in the surgical treatment of abducens nerve palsy. Nishida's adaptation is a safe, effective and minimally-invasive treatment option. This vessel-sparing technique also allows for equilateral weakening of the medial rectus muscle.


Asunto(s)
Enfermedades del Nervio Abducens , Esotropía , Enfermedades del Nervio Abducens/cirugía , Adulto , Anciano de 80 o más Años , Niño , Esotropía/cirugía , Movimientos Oculares , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Periodo Posoperatorio , Estudios Retrospectivos
17.
Klin Monbl Augenheilkd ; 238(4): 499-503, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33930925

RESUMEN

PURPOSE: The rectus inferior myopexy is often used in vertical incomitant deviations without significant deviation in primary position. We analysed the long-term results in different pathologies. METHODS: Retrospective study of patients operated on rectus inferior myopexy between 1984 and 2018. Vertical and torsional deviations were measured in primary position (PP) and 25° downgaze and the field of binocular single vision (FBSV) was evaluated with the Harms tangent screen, establishing a functional score. Postoperative follow-ups took place at 1 month, 6 months and long term (1 - 24 years). RESULTS: 62 patients were included (mean age 41 years, 28 women and 34 men). 47 presented a fourth nerve palsy (group 1) and 15 a reduced depression of other origins (group 2). 31 patients had undergone previous operations and 34 contemporaneous operations with the myopexy. In group 1, preoperative mean vertical deviation was 6.4° in PP and 12.3° on downgaze, postoperative 4° and 7.2°. In group 2, the value decreased from 3.3° in PP and 11.5° on downgaze to 1.2° and 6.6°. Over the years, there has been a decrease in the effect, particularly in group 1. The torsion was hardly influenced in both groups. The median functional score of FBSV improved in group 1 from 10% preoperatively to 39% postoperatively and in group 2 from 25 to 69%. CONCLUSION: The inferior rectus myopexy shows an effective way to reduce the incomitance of vertical deviation without significant influence on torsion. Over the years, there has been a decrease in the effect, particularly in patients with superior oblique paresis. We do not consider inferior rectus myopexy as a classic surgical treatment of superior oblique paresis. We have only used it in special cases.


Asunto(s)
Estrabismo , Enfermedades del Nervio Troclear , Adulto , Femenino , Humanos , Masculino , Músculos Oculomotores/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Periodo Posoperatorio , Estudios Retrospectivos , Estrabismo/cirugía , Resultado del Tratamiento , Enfermedades del Nervio Troclear/cirugía , Visión Binocular
18.
Klin Monbl Augenheilkd ; 238(4): 510-520, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33930927

RESUMEN

BACKGROUND: To the best of our knowledge, there is no validated classification to assess intraoperative adverse events (iAEs) in ophthalmic surgery. ClassIntra is a newly developed classification for surgery- and anaesthesia-related iAEs that has been recently validated in various surgical disciplines, but not in ophthalmic surgery. We aim to assess the validity and practicability of ClassIntra in patients undergoing ophthalmic surgery. METHODS: A consecutive sample of in-hospital patients undergoing any type of ophthalmic surgery was included in this single-centre prospective cohort study. iAEs were classified using ClassIntra, consisting of 5 severity grades according to the symptoms of the patient and the required treatment. All patients were followed for two weeks to record all postoperative adverse events according to Clavien-Dindo. The primary endpoint was the risk-adjusted association between the most severe iAE and the weighted sum of all postoperative adverse events within the two-week follow-up using the Comprehensive Complication Index (CCI). In addition, ophthalmologists and anaesthesiologists were asked to complete an online survey assessing the severity of iAEs for 10 fictitious clinical case scenarios. Reliability was assessed by comparing the clinicians' ratings to the prespecified benchmark rating of the study team. RESULTS: In this study, 100 in-hospital patients with an average age of 64 years (SD 15) were included. The majority of all patients were ASA II (n = 53, 53%) or III (n = 42, 42%). Thirty-two iAEs were recorded in 22 patients (17 grade I, 12 grade II, 3 grade III). Ninety-four postoperative adverse events occurred in 50 patients (44 grade I, 36 grade II, 14 grade IIIa). We found a mean difference in CCI of 2,1 (95% confidence interval [CI] - 2,5 to 6,8) per one unit increase in severity grades of ClassIntra. Fifty ophthalmologists and anaesthesiologists completed the online survey (response rate 54%). The intraclass correlation coefficient was 0,79 (95% CI 0,64 to 0,94). CONCLUSIONS: The application of ClassIntra during daily routine in ophthalmic surgery showed the usefulness and practicability of this classification for the standardised assessment of intraoperative adverse events. Although construct validity could not be demonstrated, the good reliability in the survey's rating underlines the criterion validity of this newly developed classification in ophthalmic surgery.


Asunto(s)
Hospitales , Complicaciones Intraoperatorias , Humanos , Complicaciones Intraoperatorias/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados
19.
Medicine (Baltimore) ; 100(16): e25601, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33879725

RESUMEN

ABSTRACT: There is controversy in clinical application of antiplatelet drugs by monitoring platelet function. Therefore, we explored whether early and dynamic medication could bring better clinical outcomes for patients under the guidance of platelet function tests (PFT).In this retrospective cohort study, we analyzed the prognostic events of 1550 patients with acute coronary syndrome (ACS) at Tianjin People's Hospital in China. They received dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) from January 2017 to December 2018. The primary endpoint was based on the Bleeding Academic Research Consortium (BARC) 3 or 5 major bleeding. Secondary endpoints included MACCE (all-cause death, nonfatal myocardial infarction, stroke, stent thrombosis, and unplanned target vessel reconstruction) and BARC 1 to 2 minor bleeding. The endpoint events within 1 year after PCI were recorded. Patients were divided into a guided group and a control group according to the drug adjustment by PFT results. After the propensity scores matched, the end points of 2 groups were compared, and subgroup analysis was performed on major bleeding events.After propensity score matching, there were 511 cases in the guided group and the control group, respectively. The primary endpoint events occurred in 10 patients (1.96%) in the guided group and 23 patients (4.5%) in the control group (HR: 0.45; 95% CI, 0.21-0.95; P = .037). After the guided group adjusted drug doses, the risk of major bleeding was lower than standard DAPT of the control group. Although some patients in the guided group reduced doses earlier, the incidence of MACCE events did not increase in the guided group compared with the control group (4.89% vs 6.07%; P = .41). There was no statistical difference in BARC 1 to 2 minor bleeding (P = .22). Subgroup analysis showed that PFT was more effective in patients with diabetes and multivessel disease.Early observation of dynamic PFT in ACS patients after PCI can guide individualized antiplatelet therapy to reduce the risk of major bleeding without increasing the risk of ischemia.


Asunto(s)
Síndrome Coronario Agudo/terapia , Monitoreo de Drogas/métodos , Hemorragia/prevención & control , Inhibidores de Agregación Plaquetaria/uso terapéutico , Pruebas de Función Plaquetaria/estadística & datos numéricos , Síndrome Coronario Agudo/complicaciones , Anciano , China , Terapia Antiplaquetaria Doble , Femenino , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Periodo Posoperatorio , Pronóstico , Puntaje de Propensión , Estudios Retrospectivos , Resultado del Tratamiento
20.
BMC Surg ; 21(1): 177, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794852

RESUMEN

BACKGROUND: Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms. METHODS: This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV. RESULTS: Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03-5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17-4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively). CONCLUSIONS: PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients' outcomes.


Asunto(s)
Dimensión del Dolor , Dolor Postoperatorio , Náusea y Vómito Posoperatorios , Procedimientos Quirúrgicos Electivos/efectos adversos , Hospitales Públicos , Hospitales Universitarios , Humanos , Medio Oriente/epidemiología , Dolor Postoperatorio/epidemiología , Náusea y Vómito Posoperatorios/epidemiología , Periodo Posoperatorio , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo
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