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1.
Medicine (Baltimore) ; 99(19): e19624, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384425

RESUMEN

BACKGROUND: Patients suffering from degenerative scoliosis (DS) were commonly associated with coronal and sagittal imbalance which made deformity correction surgery necessary. The study aimed to explore the efficacy and feasibility of the limited correction of lumbar lordosis (LL) in the treatment of patients with DS. METHODS: This was a retrospective study including 58 DS patients who underwent spinal deformity correction surgery and were followed up at least 2 years between January 2013 and January 2017. According to the difference of postoperative LL, the patients were divided into 2 groups: the limited correction group: Pelvic incidence(PI)-18°≤ LL .05). In terms of surgery, the limited group had less intra-operative blood loss and operation time (P < .05). At the last follow-up, significant differences were found in terms of LL(-38.2 ±â€Š4.7° and -46.9 ±â€Š4.7°), PT (18.8 ±â€Š5.2° and 11.1 ±â€Š3.6°), sacrum slope (33.7 ±â€Š7.0° and 41.4 ±â€Š6.1°) (P < .05), while there were no significant differences in terms of lumbar Cobb angle (10.5 ±â€Š9.3°and 8.3 ±â€Š6.7°), Oswestry Disability Index scores (25.6 ±â€Š10.2 and 26.4 ±â€Š12.1), and JOA scores (23.6 ±â€Š5.2 and 22.3 ±â€Š5.7) (P > .05). CONCLUSION: Limited correction of LL in the treatment of DS patients can achieve favorable clinical outcomes including effective Cobb angle correction with less blood loss and operative time.


Asunto(s)
Lordosis/fisiopatología , Vértebras Lumbares/fisiopatología , Escoliosis/fisiopatología , Fusión Vertebral , Anciano , Evaluación de la Discapacidad , Femenino , Humanos , Lordosis/etiología , Lordosis/cirugía , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Huesos Pélvicos/fisiopatología , Periodo Posoperatorio , Estudios Retrospectivos , Sacro/fisiopatología , Escoliosis/complicaciones , Escoliosis/cirugía , Resultado del Tratamiento
2.
Medicine (Baltimore) ; 99(19): e19823, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384427

RESUMEN

BACKGROUND/AIM: Obesity is associated with increased incidence of gastroesophageal reflux disease (GERD), and it has been suggested that GERD symptoms may be improved by weight reduction. However, various patterns of bariatric surgery may affect symptoms of GERD due to the changed anatomy of stomach and esophagus. The aim of this systematic review and meta-analysis is to analyze the effect of bariatric surgery on GERD. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, EMBASE, and the Cochrane Library from January 2005 to January 2019, combining the words obesity, gastroesophageal reflux with different types of bariatric surgery and weight loss. The methodological quality of randomized controlled trials and non-randomized controlled trials published in English and have at least 1-year follow-up data were included and assessed by Cochrane Collaboration's tool for assessing risk bias and Newcastle-Ottawa scale. Only clinical trials were included, and case series or case reports were excluded. RESULTS: We anticipate that our review will provide the exact estimates of the burden and phenotype of GERD among patients that have undergone bariatric surgery. CONCLUSION: GERD may improve in obese patients who underwent laparoscopic sleeve gastrectomy (LSG); however, the most favorable effect is likely to be found after Roux-en-Y gastric bypass surgery. PROSPERO REGISTRATION NUMBER: CRD42018090074.


Asunto(s)
Cirugía Bariátrica , Reflujo Gastroesofágico/cirugía , Obesidad Mórbida/cirugía , Reflujo Gastroesofágico/etiología , Reflujo Gastroesofágico/fisiopatología , Humanos , Metaanálisis como Asunto , Obesidad Mórbida/complicaciones , Obesidad Mórbida/fisiopatología , Periodo Posoperatorio , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Pérdida de Peso/fisiología
3.
Medicine (Baltimore) ; 99(19): e19830, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384428

RESUMEN

BACKGROUND: Optimal treatments for ulnar coronoid fracture have yet to be determined. We aimed to systematically review treatment efficacy assessed by functional outcomes of patients with isolated ulnar coronoid fracture. METHODS: Medline, Cochrane Library, EMBASE, and Google Scholar were searched for studies reporting quantitative outcomes data after surgical treatment for isolated ulnar coronoid fractures up to July 16, 2019. Functional outcomes determined using disabilities of the arm, shoulder and hand score; Mayo elbow performance score (MEPS); and range of motion were systematically reviewed. RESULTS: Six studies with a total of 65 patients with isolated coronoid fracture who had received surgical treatment were included. All studies were of good quality according to a modified Delphi checklist. Most patients had Type II fractures based on Regan-Morrey or O'Driscoll classification. Disabilities of the arm, shoulder and hand scores were reported by 2 studies (mean range 5-17). Four studies reported MEPS (mean range 89-98). One study reported Broberg-Morrey scores, in which 93% patients achieved excellent or good outcomes. Five studies reported range of motion, with mean flexion ranging from 122 to 137 and mean extension ranging from 4.0 to 21 degrees. Quantitative analyses revealed that lateral, medial, or posterior approaches in treating Type II fractures are associated with higher postoperative MEPS and flexion scores than the anteromedial approach. CONCLUSIONS: Treatment efficacy assessed by functional outcomes for isolated ulnar coronoid fractures is overall satisfactory. Whether lateral, medial, or posterior approaches lead to more favorable outcomes than the anteromedial approach is inconclusive. Further prospective studies are warranted.


Asunto(s)
Artroscopía/métodos , Desbridamiento/métodos , Fijación Interna de Fracturas/métodos , Fracturas del Cúbito/fisiopatología , Fracturas del Cúbito/cirugía , Adolescente , Adulto , Femenino , Humanos , Masculino , Periodo Posoperatorio , Rango del Movimiento Articular , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Cúbito/fisiopatología , Cúbito/cirugía , Adulto Joven
4.
Ann R Coll Surg Engl ; 102(5): 363-368, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32233846

RESUMEN

INTRODUCTION: Hypercalcaemic crisis is a rare manifestation of hyperparathyroidism and occurs in 1.6-6% of patients with primary hyperparathyroidism (pHPT). Although such high serum calcium levels (>14mg/dl) are attributed to malignancy, it is also associated with benign disease of the parathyroid glands. The aim of this study was to evaluate the clinical features and treatment modalities of patients with severe hypercalcaemia who underwent surgery for pHPT. METHODS: The medical records of 537 patients who underwent parathyroidectomy in our department for pHPT between 2005 and 2019 were reviewed retrospectively. Twenty-four (4.4%) of the patients were described as having severe hypercalcaemia. RESULTS: Among 24 patients, 71% were female and the mean age was 55.7 years (range: 40-71 years). The mean serum calcium level at time of diagnosis was 15.9mg/dl (range: 14-22.7mg/dl). According to postoperative pathology reports, solitary adenoma, parathyroid cancer and parathyromatosis were diagnosed with the rates of 87.5%, 8.3% and 4.1% respectively. The mean weight of the solitary parathyroid lesions was 14.9g (standard deviation: 8.9g, range: 4-38g). The mean longest diameter was 2.87cm (standard deviation: 1.4cm, range: 1-5.5cm). Serum calcium levels were within the normal range on the first postoperative day in 75% of the cases. CONCLUSIONS: Severe hypercalcaemia is a rare but urgent condition of pHPT and requires prompt management. Accelerated surgery after adequate medical treatment should be performed. It is important to emphasise that giant adenoma, which is a benign disease, may be a more common cause of severe hypercalcaemia than carcinoma, unlike previously thought.


Asunto(s)
Adenoma/complicaciones , Carcinoma/complicaciones , Hipercalcemia/etiología , Hiperparatiroidismo Primario/etiología , Neoplasias de las Paratiroides/complicaciones , Adenoma/sangre , Adenoma/cirugía , Adulto , Anciano , Calcio/sangre , Carcinoma/sangre , Carcinoma/cirugía , Difosfonatos/administración & dosificación , Femenino , Furosemida/administración & dosificación , Humanos , Hipercalcemia/sangre , Hipercalcemia/diagnóstico , Hipercalcemia/terapia , Hiperparatiroidismo Primario/sangre , Hiperparatiroidismo Primario/cirugía , Masculino , Persona de Mediana Edad , Glándulas Paratiroides/patología , Glándulas Paratiroides/cirugía , Neoplasias de las Paratiroides/sangre , Paratiroidectomía , Periodo Posoperatorio , Diálisis Renal , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
5.
Zhonghua Yi Xue Za Zhi ; 100(12): 928-932, 2020 Mar 31.
Artículo en Chino | MEDLINE | ID: mdl-32234168

RESUMEN

Objective: To analyze the influencing factors of acute kidney injury (AKI) in patients after cardiac surgery using levosimendan or dobutamine, and explore the effect of positive inotropic drugs on AKI. Methods: The clinical data of 417 patients undergoing cardiac surgery from January to June 2018 in Beijing Anzhen Hospital and treated with levosimendan or dobutamine during perioperative period were retrospectively reviewed and collected. Patients were divided into AKI group and non-AKI group according to whether AKI occurred. Univariate logistic regression analysis was used to analyze the factors related to the occurrence of AKI. The statistically significant factors (P<0.05) were further included in the multivariate logistic regression analysis. Results: Totally, 417 patients were enrolled in the study, with a mean age of (58.2±10.4) years old and a male rate of 65.0% (n=271), and the AKI incidence rate was 25.2% (105/417). Univariate logistic regression analysis showed that male, chronic kidney disease, high serum creatinine level in preoperative period, aortic obstruction time ≥ 120 minutes and extracorporeal circulation time ≥ 120 minutes were risk factors for AKI (all P<0.05). Vasodilator and levosimendan treatment during perioperative period were protective factors (P<0.05). Multivariate logistic regression analysis showed that chronic kidney disease (OR=17.291, 95%CI: 4.335-68.960, P<0.001) and high serum creatinine level (OR=1.097, 95%CI: 1.074-1.121, P<0.001) in preoperative period were independent risk factors for AKI. Perioperative application of levosimendan (OR=0.533, 95%CI: 0.288-0.984, P=0.044) was an independent protective factor. Conclusions: Risk factors for AKI after cardiac surgery include chronic kidney disease and high serum creatinine level in preoperative period. The use of levosimendan during preoperative period has the potential effect to protect against AKI.


Asunto(s)
Lesión Renal Aguda , Procedimientos Quirúrgicos Cardíacos , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Riesgo
6.
Arq Bras Cir Dig ; 33(1): e1484, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32236290

RESUMEN

BACKGROUND: Hepatectomies promote considerable amount of blood loss and the need to administrate blood products, which are directly linked to higher morbimortality rates. The blood-conserving hepatectomy (BCH) is a modification of the selective vascular occlusion technique. It could be a surgical maneuver in order to avoid or to reduce the blood products utilization in the perioperative period. AIM: To evaluate in rats the BCH effects on the hematocrit (HT) variation, hemoglobin serum concentration (HB), and on liver regeneration. METHODS: Twelve Wistar rats were divided into two groups: control (n=6) and intervention (n=6). The ones in the control group had their livers partially removed according to the Higgins and Anderson technique, while the rats in the treatment group were submitted to BCH technique. HT and HB levels were measured at day D0, D1 and D7. The rate between the liver and rat weights was calculated in D0 and D7. Liver regeneration was quantitatively and qualitatively evaluated. RESULTS: The HT and HB levels were lower in the control group as of D1 onwards, reaching an 18% gap at D7 (p=0.01 and p=0.008, respectively); BCH resulted in the preservation of HT and HB levels to the intervention group rats. BCH did not alter liver regeneration in rats. CONCLUSION: The BCH led to beneficial effects over the postoperative HT and serum HB levels with no setbacks to liver regeneration. These data are the necessary proof of evidence for translational research into the surgical practice. A) Unresected liver; B) liver appearance after the partial hepatectomy (1=vena cava; 2=portal vein; 3=hepatic vein; 4=biliary drainage; 5=hepatic artery).


Asunto(s)
Hepatectomía/métodos , Regeneración Hepática , Hígado/irrigación sanguínea , Hígado/cirugía , Venas/fisiología , Animales , Volumen Sanguíneo/fisiología , Hematócrito , Hemoglobinas/análisis , Enfermedad Veno-Oclusiva Hepática/fisiopatología , Masculino , Vena Porta/cirugía , Periodo Posoperatorio , Ratas , Ratas Wistar
7.
Yonsei Med J ; 61(4): 341-348, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32233177

RESUMEN

PURPOSE: This study aimed to predict the surgical outcomes of diffuse idiopathic skeletal hyperostosis (DISH)-related dysphagia (DISH-phagia) and to evaluate the importance of prevertebral soft tissue thickness (PVST). MATERIALS AND METHODS: In total, 21 surgeries (anterior osteophytectomy or anterior cervical decompression and fixation) were included in this study for DISH-phagia from 2003 to 2019. Clinical outcomes were assessed using the Dysphagia Outcome and Severity Scale (DOSS) preoperatively, at 1 month postoperatively, and last follow up (mean 29.5 months). PVST was measured using lateral plain radiographs. Paired t-test and Spearman's correlation test was used to identify relationships between various PVST indices and DOSS. RESULTS: Comparisons were made from 17 patients out of 21, in which the record had all of three measurements. The narrowest PVST preoperatively was 2.55±0.90 mm, with a DOSS score of 4.47±1.61, and that at 1 month after surgery was 5.02±2.33 mm, with a DOSS score of 6.12±1.32. At last follow up, PVST and DOSS values were 3.78±0.92 mm and 5.82±1.34, and three patients experienced symptom relapse. Significant relationships were found between PVST and DOSS at all time points: before surgery (R=0.702, p<0.001), 1 month after surgery (R=0.539, p=0.012), and last follow up (R=0.566, p=0.020). CONCLUSION: Surgical removal of anterior osteophytes is an effective treatment option for DISH-phagia, and PVST is a useful parameter in DISH-phagia. The goal of DISH surgery should be to remove DISH as much as possible to ensure sufficient PVST postoperatively.


Asunto(s)
Vértebras Cervicales/cirugía , Trastornos de Deglución/cirugía , Hiperostosis Esquelética Difusa Idiopática/cirugía , Osteofito/complicaciones , Anciano , Vértebras Cervicales/diagnóstico por imagen , Estudios Transversales , Descompresión Quirúrgica , Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/etiología , Femenino , Humanos , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Cuello/cirugía , Procedimientos Neuroquirúrgicos , Osteofito/diagnóstico por imagen , Osteofito/cirugía , Periodo Posoperatorio , Radiografía , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 99(15): e19726, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282730

RESUMEN

This study aimed to discuss the risk factors of perioperative blood transfusion after the application of proximal femoral nail antirotation (PFNA) in the treatment of elderly patients with femoral intertrochanteric fracture (FIF). Moreover, this study also aimed to analyze the causes of perioperative blood transfusion and provide guidance for clinical treatment.Records of elderly patients with FIF who were treated with PFNA in our hospital from September 2014 to May 2017 were reviewed. They were divided into transfused and nontransfused groups. The Student t test, Chi-squared test, and Fisher exact test were used in univariate analysis of 11 variables. Multivariate logistic regression analysis was performed to analyze the possible risk factors associated with postoperative blood transfusion after the application of PFNA in elderly patients with FIF. Correlations were sought using the Spearman rank correlation analysis.The univariate analysis showed that age, sex, type of fracture, admission hemoglobin (Hb), admission albumin, and intraoperative blood loss were significantly associated with perioperative blood transfusion (P = .000, .019, .000, .000, .000, and .007, respectively). The multivariate logistic regression analysis demonstrated that age (P = .019, odds ratio [OR] = 1.062), type of fracture (P = .001, OR = 4.486), and admission Hb (P = .000, OR = 0.883) were independent risk factors of postoperative blood transfusion. We found a significant positive correlation between perioperative blood transfusion and age (r = 0.264, P = .000) and type of fracture (r = 0.409, P = .000), but a negative correlation between perioperative blood transfusion and admission Hb (r = -0.641, P = .000).The main factors affecting perioperative blood transfusion are age, fracture type, and admission Hb. These results indicate that, in high-risk patients who are older in age, more unstable fractures, and lower admission Hb, monitoring Hb concentrations during the perioperative period is important to correct severe anemia in a timely manner and avoid exacerbating existing underlying diseases and inducing severe complications.


Asunto(s)
Transfusión Sanguínea/métodos , Fijación Intramedular de Fracturas/instrumentación , Fracturas de Cadera/cirugía , Periodo Perioperatorio/efectos adversos , Anciano , Anciano de 80 o más Años , Albúminas/análisis , Anemia/epidemiología , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Clavos Ortopédicos/efectos adversos , Femenino , Fémur/patología , Fémur/cirugía , Hemoglobinas/análisis , Humanos , Masculino , Admisión del Paciente , Periodo Perioperatorio/estadística & datos numéricos , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Riesgo
9.
Medicine (Baltimore) ; 99(16): e19840, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32312007

RESUMEN

To determine the levels of parathyroid hormone (PTH) in the fluids of various tissues for identification of parathyroid glands during thyroidectomy.Our study comprised 31 patients with thyroid cancer who underwent lobectomy with central compartment dissection at our hospital from October 2014 to February 2015. A total of 186 tissue samples, including 28 from parathyroid glands and 158 from non-parathyroid tissues, were obtained during the operations. Tissue fluids were collected via fine-needle aspiration to measure PTH levels; the tissue was punctured 3 times with a 26-gauge syringe needle and washed with 0.5 mL normal saline. Tissues were also prepared for pathological examination.PTH concentrations were significantly higher in parathyroid tissues than non-parathyroid tissues. None of the patients had irremediable parathyroid dysfunction after surgical resection.Use of fine-needle aspiration for quantification of PTH levels in tissue fluids rapidly, safely, and effectively identifies the parathyroid glands during thyroidectomy.


Asunto(s)
Biopsia con Aguja Fina/métodos , Glándulas Paratiroides/cirugía , Hormona Paratiroidea/análisis , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Adulto , Anciano , Femenino , Humanos , Hipotiroidismo/epidemiología , Hipotiroidismo/prevención & control , Escisión del Ganglio Linfático/métodos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/normas , Enfermedades de las Paratiroides/diagnóstico , Enfermedades de las Paratiroides/fisiopatología , Glándulas Paratiroides/patología , Periodo Posoperatorio , Sensibilidad y Especificidad , Neoplasias de la Tiroides/patología , Tiroidectomía/efectos adversos
10.
Eur J Endocrinol ; 182(6): C17-C19, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32234974

RESUMEN

Transsphenoidal surgery (TSS) is the treatment of choice in Cushing's disease. However, recurrence rates are substantial and currently there are no robust predictors of late prognosis. As accumulating evidence challenge the accuracy of the traditionally used early postoperative cortisol values, alternative tests are required. The study of Cambos et al., published in a recent issue of the European Journal of Endocrinology, adds to the existing data that support a role of the desmopressin test as an early and reliable predictive marker in successfully TSS-treated patients. However, despite these promising data, the use of this test is hampered by the fact that it can be applied only in patients with a documented preoperative positive test. Moreover, the lack of robust criteria to define positive postoperative responses represents another major limitation.


Asunto(s)
Desamino Arginina Vasopresina/uso terapéutico , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/diagnóstico , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/cirugía , Hormona Adrenocorticotrópica/metabolismo , Biomarcadores/metabolismo , Humanos , Hidrocortisona/metabolismo , Periodo Posoperatorio , Recurrencia
11.
Acta Cir Bras ; 35(2): e202000201, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32320995

RESUMEN

PURPOSE: To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. METHODS: Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh - cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. RESULTS: The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). CONCLUSION: Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.


Asunto(s)
Reacción a Cuerpo Extraño/patología , Conducto Inguinal/cirugía , Mallas Quirúrgicas , Conducto Deferente/patología , Animales , Reacción a Cuerpo Extraño/sangre , Masculino , Modelos Animales , Tamaño de los Órganos , Polipropilenos , Periodo Posoperatorio , Ratas Wistar , Cordón Espermático/cirugía , Testículo/anatomía & histología , Testosterona/sangre , Conducto Deferente/cirugía
12.
Medicine (Baltimore) ; 99(16): e19771, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32311983

RESUMEN

BACKGROUND: For a long time, postoperative nutritional support for laryngeal cancer patients has depended on the gastric tube for enteral nutrition. Silica gel gastric tube is often used in clinical practice; however, the gastric tube placed in the conventional depth often leads to various complications in the stomach, thus damaging the nutritional status of patients and leading to the poor prognosis. METHODS/DESIGN: A total of 80 patients with laryngeal cancer in otolaryngology, head and neck surgery department of Deyang people's hospital from May 2020 to April 2022 will be selected and randomly divided into control group and experimental group according to the numerical table. Patients in the control group will receive conventional gastric tube placement, with a depth of 45 to 55 cm, which can extract gastric juice. B-ultrasound accurately positioned the gastric tube in the stomach instead of the cardia, and postoperative nasal feeding nutrition will be provided. In the experimental group, the gastric tube will be pulled out 10 cm after conventional placement and no gastric juice will be extracted. B-ultrasonography verified that the gastric tube will be located below the esophagus or above the cardia, and routine nasal feeding will be performed postoperatively. Analysis for comfort and prognosis were performed by general comfort questionnaire and various index including height, body mass index, albumin value, electrolyte, wound healing, pharyngeal fistula. DISCUSSION: In this study, visual simulation scale and general comfort questionnaire developed by Kolaba, an American comfort nursing specialist, were used to evaluate the comfort level of the 2 groups of patients, including pain, acid reflux, upper abdominal burning sensation, and hiccup. Objective indexes such as height, body mass index, albumin value, electrolyte, wound healing, and pharyngeal fistula were used to evaluate the prognosis of the 2 groups of patients. The visual simulation scale can preliminarily judge the subjective feelings of patients. TRIAL REGISTRATION: It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000030378), Registered February 29, 2020.


Asunto(s)
Nutrición Enteral/instrumentación , Neoplasias Laríngeas/cirugía , Humanos , Periodo Posoperatorio
13.
Bone Joint J ; 102-B(4): 434-441, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32228078

RESUMEN

AIMS: There are comparatively few randomized studies evaluating knee arthroplasty prostheses, and fewer still that report longer-term functional outcomes. The aim of this study was to evaluate mid-term outcomes of an existing implant trial cohort to document changing patient function over time following total knee arthroplasty using longitudinal analytical techniques and to determine whether implant design chosen at time of surgery influenced these outcomes. METHODS: A mid-term follow-up of the remaining 125 patients from a randomized cohort of total knee arthroplasty patients (initially comprising 212 recruited patients), comparing modern (Triathlon) and traditional (Kinemax) prostheses was undertaken. Functional outcomes were assessed with the Oxford Knee Score (OKS), knee range of movement, pain numerical rating scales, lower limb power output, timed functional assessment battery, and satisfaction survey. Data were linked to earlier assessment timepoints, and analyzed by repeated measures analysis of variance (ANOVA) mixed models, incorporating longitudinal change over all assessment timepoints. RESULTS: The mean follow-up of the 125 patients was 8.12 years (7.3 to 9.4). There was a reduction in all assessment parameters relative to earlier assessments. Longitudinal models highlight changes over time in all parameters and demonstrate large effect sizes. Significant between-group differences were seen in measures of knee flexion (medium-effect size), lower limb power output (large-effect size), and report of worst daily pain experienced (large-effect size) favouring the Triathlon group. No longitudinal between-group differences were observed in mean OKS, average daily pain report, or timed performance test. Satisfaction with outcome in surviving patients at eight years was 90.5% (57/63) in the Triathlon group and 82.8% (48/58) in the Kinemax group, with no statistical difference between groups (p = 0.321). CONCLUSION: At a mean 8.12 years, this mid-term follow-up of a randomized controlled trial cohort highlights a general reduction in measures of patient function with patient age and follow-up duration, and a comparative preservation of function based on implant received at time of surgery. Cite this article: Bone Joint J 2020;102-B(4):434-441.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Prótesis de la Rodilla , Osteoartritis de la Rodilla/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/instrumentación , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Extremidad Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Periodo Posoperatorio , Diseño de Prótesis , Falla de Prótesis/etiología , Rango del Movimiento Articular , Reoperación/estadística & datos numéricos , Índice de Severidad de la Enfermedad
14.
Medicine (Baltimore) ; 99(14): e19586, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32243378

RESUMEN

To investigate the effects of body weight support (BWS) and gait velocity on cardiovascular responses during walking on an antigravity treadmill early after unilateral and bilateral total knee arthroplasty (TKA).This study was a cross-sectional study design. Fifty patients (7 males and 43 females; average age, 72.0 ±â€Š5.1 years) at 4 weeks after unilateral (n = 25) and bilateral (n = 25) primary TKA were enrolled in the study. Subjects walked on an antigravity treadmill at speeds of 2.5 km/hour and 3.5 km/hour with 3 levels (50%, 25%, and 0%) of BWS. Cardiovascular responses were monitored by measuring oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure (SBP/DBP), the respiratory exchange ratio (RER), and rate pressure product (RPP). Borg rating of perceived exertion (RPE) and a visual analog scale (VAS) of knee pain were recorded immediately after each trial.There were no significant differences in cardiovascular responses between the unilateral and bilateral TKA groups. In the repeated measures Analysis of Variance, VO2 levels, HR, RPP, RPE, RER, and VAS were significantly increased in proportion to 3 levels (50%, 25%, and 0%) of BWS for unilateral and bilateral TKA groups, respectively. Meanwhile, SBP and DBP were unaffected by differences in BWS. At 3.5 km/hour, VO2, RPE, and RER values were statistically greater than those at 2.5 km/hour under the same BWS conditions.We found that the reduction in the metabolic demand of activity, coupled with positive pressure on the lower extremities, reduced VO2 and HR values as BWS increased.Cardiovascular responses vary according to BWS and gait velocity during antigravity treadmill walking. BWS rather than gait velocity had the greatest effect on cardiovascular responses and knee pain.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/rehabilitación , Peso Corporal , Sistema Cardiovascular/fisiopatología , Aparatos Ortopédicos , Osteoartritis de la Rodilla/fisiopatología , Velocidad al Caminar , Anciano , Presión Sanguínea , Estudios Transversales , Prueba de Esfuerzo , Femenino , Frecuencia Cardíaca , Humanos , Hipogravedad , Masculino , Osteoartritis de la Rodilla/cirugía , Periodo Posoperatorio
15.
Ann R Coll Surg Engl ; 102(5): 340-342, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32159383

RESUMEN

INTRODUCTION: Fine-needle aspiration cytology (FNAC) is an important diagnostic tool used preoperatively for the diagnosis of parotid lump. Mucoepidermoid carcinoma comprises 5-10% of all salivary gland tumours. It poses a diagnostic challenge on FNAC with high false negative rate. The objective of this study was to evaluate the discordance between cytology/FNAC and histopathology in patients with mucoepidermoid carcinoma. MATERIAL AND METHODS: A cross-sectional study was conducted from 1 January 2010 to 31 December 2014. Patients aged 18 years and above with FNAC or histopathology suggestive of mucoepidermoid carcinoma were identified. FNAC when compared with histology (gold standard) was classified into true positive (presence of mucoepidermoid carcinoma correctly diagnosed on FNAC), true negative (absence of mucoepidermoid carcinoma correctly diagnosed on FNAC), false positive (FNAC incorrectly diagnosed mucoepidermoid carcinoma), false negative (FNAC failed to diagnose mucoepidermoid carcinoma). RESULTS: A total of 16 patients fulfilled our eligibility criteria. Seven cytological samples were true positive (ie correctly diagnosed mucoepidermoid carcinoma by FNAC), eight cytological specimens were false negative (ie could not pick up mucoepidermoid carcinoma on FNAC). One case was false positive on cytology (ie diagnosed mucoepidermoid carcinoma on FNAC but was reported to be Warthin's tumour on histopathology) and none were true negative. CONCLUSION: FNAC is not reliable for diagnosis of mucoepidermoid carcinoma. More than 50% of our patients had discordant results between cytology and histology. We recommend a high index of suspicion for mucoepidermoid carcinoma given the poor yield of cytology.


Asunto(s)
Biopsia con Aguja Fina/normas , Carcinoma Mucoepidermoide/diagnóstico , Glándula Parótida/patología , Neoplasias de la Parótida/diagnóstico , Adolescente , Adulto , Anciano , Biopsia con Aguja Fina/estadística & datos numéricos , Carcinoma Mucoepidermoide/patología , Carcinoma Mucoepidermoide/cirugía , Estudios Transversales , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glándula Parótida/cirugía , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/cirugía , Periodo Posoperatorio , Periodo Preoperatorio , Reproducibilidad de los Resultados , Adulto Joven
16.
Einstein (Sao Paulo) ; 18: eAO4831, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32215467

RESUMEN

OBJECTIVE: To evaluate the impact of training in the Practical Life Room on patients experience during hospitalization. METHODS: Subjects submitted to orthopedic surgeries were randomized to two groups (Control and Intervention) in the postoperative period. The Control Group received only the printed guidelines regarding the postoperative period, and the Intervention Group received the printed guidelines and a demonstration and training session with a physical therapist, in an environment created to simulate a house and its rooms (living room, bedroom, kitchen, laundry and bathroom). The participants of both groups answered the questionnaire Hospital Consumer Assessment of Healthcare Providers and Systems on the day of discharge. RESULTS: Sixty-eight subjects were included in the study, 30 (44.1%) in the Control Group and 38 (55.9%) in the Intervention Group. The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire score showed no significant difference between the groups (p=0.496). CONCLUSION: There was no influence of the proposed intervention on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire, perhaps because of the limitation of the instrument or due to the fact it was employed when patients were still hospitalized. However, by reports from patients in the Intervention Group about felling better prepared and safer for performing daily activities, it is believed that patient education approaches through demonstration should be included as part of the process to prepare for discharge, whenever possible.


Asunto(s)
Actividades Cotidianas , Procedimientos Ortopédicos/rehabilitación , Educación del Paciente como Asunto/métodos , Entrenamiento Simulado/métodos , Artroplastia/rehabilitación , Femenino , Hospitalización , Humanos , Desplazamiento del Disco Intervertebral/rehabilitación , Desplazamiento del Disco Intervertebral/cirugía , Masculino , Alta del Paciente , Satisfacción del Paciente , Periodo Posoperatorio , Reproducibilidad de los Resultados , Escoliosis/rehabilitación , Escoliosis/cirugía , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Resultado del Tratamiento
18.
Br J Anaesth ; 124(5): 562-570, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32172954

RESUMEN

BACKGROUND: Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy. METHODS: This was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml-1 or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded. RESULTS: No complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [inter-quartile range 21-29] vs 29 [inter-quartile range 21-40] days; P=0.021). Other parameters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups. CONCLUSIONS: Intraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings. CLINICAL TRIAL REGISTRATION: NCT02256228.


Asunto(s)
Anestésicos Locales/administración & dosificación , Neoplasias Ováricas/cirugía , Ropivacaína/administración & dosificación , Adulto , Anciano , Analgésicos Opioides/administración & dosificación , Antineoplásicos/administración & dosificación , Quimioterapia Adyuvante/métodos , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Procedimientos Quirúrgicos de Citorreducción/métodos , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Inyecciones Intraperitoneales , Persona de Mediana Edad , Morfina/administración & dosificación , Neoplasias Ováricas/tratamiento farmacológico , Manejo del Dolor , Dolor Postoperatorio/prevención & control , Atención Perioperativa/métodos , Proyectos Piloto , Complicaciones Posoperatorias , Periodo Posoperatorio
19.
Bone Joint J ; 102-B(3): 388-393, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114818

RESUMEN

AIMS: To validate the Sydney Hamstring Origin Rupture Evaluation (SHORE), a hamstring-specific clinical assessment tool to evaluate patient outcomes following surgical treatment. METHODS: A prospective study of 70 unilateral hamstring surgical repairs, with a mean age of 47.3 years (15 to 73). Patients completed the SHORE preoperatively and at six months post-surgery, and then completed both the SHORE and Perth Hamstring Assessment Tool (PHAT) at three years post-surgery. The SHORE questionnaire was validated through the evaluation of its psychometric properties, including; internal consistency, reproducibility, reliability, sensitivity to change, and ceiling effect. Construct validity was assessed using Pearson's correlation analysis to examine the strength of association between the SHORE and the PHAT. RESULTS: The SHORE demonstrated an excellent completion rate (100%), high internal consistency (Cronbach's alpha 0.78), and good reproducibility (intraclass correlation coefficient (ICC) 0.82). The SHORE had a high correlation with the validated PHAT score. It was more sensitive in detecting clinical change compared to the PHAT. A ceiling effect was not present in the SHORE at six months; however, a ceiling effect was identified in both scores at three years post-surgery. CONCLUSION: This study has validated the SHORE patient reported outcome measure (PROM) as a short, practical, reliable, valid, and responsive tool that can be used to assess symptom and function following hamstring injury and surgical repair. Cite this article: Bone Joint J 2020;102-B(3):388-393.


Asunto(s)
Tendones Isquiotibiales/lesiones , Procedimientos Ortopédicos/métodos , Medición de Resultados Informados por el Paciente , Traumatismos de los Tendones/cirugía , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Tendones Isquiotibiales/diagnóstico por imagen , Tendones Isquiotibiales/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados , Rotura , Encuestas y Cuestionarios , Traumatismos de los Tendones/diagnóstico , Factores de Tiempo , Adulto Joven
20.
Br J Anaesth ; 124(5): 535-543, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32147104

RESUMEN

BACKGROUND: Elevated high-sensitivity troponin (hsTnT) after noncardiac surgery is associated with higher mortality, but the temporal relationship between early elevated troponin and the later development of noncardiac morbidity remains unclear. METHODS: Prospective observational study of patients aged ≥45 yr undergoing major noncardiac surgery at four UK hospitals (two masked to hsTnT). The exposure of interest was early elevated troponin, as defined by hsTnT >99th centile (≥15 ng L-1) within 24 h after surgery. The primary outcome was morbidity 72 h after surgery, defined by the Postoperative Morbidity Survey (POMS). Secondary outcomes were time to become morbidity-free and Clavien-Dindo ≥grade 3 complications. RESULTS: Early elevated troponin (median 21 ng L-1 [16-32]) occurred in 992 of 4335 (22.9%) patients undergoing elective noncardiac surgery (mean [standard deviation, sd] age, 65 [11] yr; 2385 [54.9%] male). Noncardiac morbidity was more frequent in 494/992 (49.8%) patients with early elevated troponin compared with 1127/3343 (33.7%) patients with hsTnT <99th centile (odds ratio [OR]=1.95; 95% confidence interval [CI], 1.69-2.25). Patients with early elevated troponin had a higher risk of proven/suspected infectious morbidity (OR=1.54; 95% CI, 1.24-1.91) and critical care utilisation (OR=2.05; 95% CI, 1.73-2.43). Clavien-Dindo ≥grade 3 complications occurred in 167/992 (16.8%) patients with early elevated troponin, compared with 319/3343 (9.5%) patients with hsTnT <99th centile (OR=1.78; 95% CI, 1.48-2.14). Absence of early elevated troponin was associated with morbidity-free recovery (OR=0.44; 95% CI, 0.39-0.51). CONCLUSIONS: Early elevated troponin within 24 h of elective noncardiac surgery precedes the subsequent development of noncardiac organ dysfunction and may help stratify levels of postoperative care in real time.


Asunto(s)
Complicaciones Posoperatorias/diagnóstico , Troponina T/sangre , Anciano , Biomarcadores/sangre , Análisis por Conglomerados , Estudios de Cohortes , Cuidados Críticos/estadística & datos numéricos , Femenino , Hospitalización , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Morbilidad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Cuidados Posoperatorios/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Periodo Posoperatorio , Estudios Prospectivos , Sensibilidad y Especificidad , Reino Unido/epidemiología
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