Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 32
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Ann Med ; 52(3-4): 120-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32204626

RESUMO

Background: This study aims to compare the effectiveness of inhaled prostacyclin or its analoguesversus nitric oxide (NO) in treating pulmonary hypertension (PH) after cardiac or pulmonary surgery remains unclear.Methods: PubMed, Cochrane, and Embase databases were searched for literature published prior to December 2019 using the following keywords: inhaled, nitric oxide, prostacyclin, iloprost, treprostinil, epoprostenol, Tyvaso, flolan, and pulmonary hypertension. Randomized controlled trials and multiple-armed prospective studies that evaluated inhaled NO versus prostacyclin (or analogues) in patients for perioperative and/or postoperative PH after either cardiac or pulmonary surgery were included. Retrospective studies, reviews, letters, comments, editorials, and case reports were excluded.Results: Seven studies with a total of 195 patients were included. No difference in the improvement of mean pulmonary arterial pressure (pooled difference in mean change= -0.10, 95% CI: -3.98 to 3.78, p = .959) or pulmonary vascular resistance (pooled standardized difference in mean change= -0.27, 95% CI: -0.60 to 0.05, p = .099) were found between the two treatments. Similarly, no difference was found in other outcomes between the two treatments or subgroup analysis.Conclusions: Inhaled prostacyclin (or analogues) was comparable to inhaled NO in treating PH after cardiac or pulmonary surgery.Key messagesThis study compared the efficacy of inhaled prostacyclin or its analogues versus inhaled NO to treat PH after surgery. The two types of agent exhibited similar efficacy in managing MPAP, PVR, heart rate, and cardiac output was observed.Inhaled prostacyclin may serve as an alternative treatment option for PH after cardiac or pulmonary surgery.

2.
Taiwan J Obstet Gynecol ; 58(4): 465-470, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307734

RESUMO

In most western countries, postoperative nausea and vomiting (PONV) is an important issue and prophylaxis guideline for PONV will be followed in clinical practice. We tried to conduct a review study and a local study to elucidate the incidence and severity of PONV to see if considering ethnicity factor, should we still need to follow those prophylaxis guidelines from western countries. The PubMed, and MEDLINE were consulted from January 2000 to 2018 and also Cochrane Central Register of Controlled Trials (CENTRAL 2010). The key word for searching is PONV (incidence, severity and prevention strategy), without language limitation and focus on Asian countries. The results showed that the overall incidence and severity of PONV in Asian countries was less significant than in western countries. PONV in western countries could be a serious issue and prophylaxis strategy adjusted by Apfel score could be adopted in routine practice. After this review consultation, the issue of PONV in different ethnic countries (including Taiwan) might be over emphasized and we may suggest not to follow west countries PONV prophylaxis guideline as our routine practice.


Assuntos
Medicina Baseada em Evidências/métodos , Náusea e Vômito Pós-Operatórios/etnologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Prevenção Primária/métodos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Prognóstico , Estudos Retrospectivos , Medição de Risco , Taiwan
3.
Taiwan J Obstet Gynecol ; 58(4): 552-556, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307750

RESUMO

OBJECTIVE: Patients with Long QT syndrome (LQTS) P may present with torsades de pointes, ventricular tachycardia (VT), or ventricular fibrillation (VF) and are at risk of sudden cardiac death. MATERIALS AND METHODS: A 38 y/o female patient with uterus myoma developed VF during laparoscopic assisted vaginal hysterectomy surgery. Defibrillation was delivered and the electrocardiogram (ECG) returned to sinus rhythm after CPR. RESULTS: Patient survived and implantable cardioverter-defibrillator was implanted and received beta-blocker therapy. ECG obtained in out-patient clinic still showed QT interval prolongation, but revealed no prolongation few months after persistent beta-blocker therapy. LQTS type 8 (CACNA1C E768del mutation) was identified by genetic DNA sequencing study. CONCLUSIONS: Patients with concealed LQTS may have normal QT interval unless exposing to stress or specific stimuli. Unexpected ventricular arrhythmia may happen during any medical management. We should avoid triggers of QT prolongation, and get familiar with management of the episode.


Assuntos
Morte Súbita Cardíaca , Cardioversão Elétrica/métodos , Histerectomia/métodos , Leiomioma/cirurgia , Síndrome do QT Longo/complicações , Neoplasias Uterinas/cirurgia , Adulto , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Reanimação Cardiopulmonar/métodos , Desfibriladores Implantáveis , Eletrocardiografia/métodos , Feminino , Humanos , Laparoscopia/métodos , Leiomioma/complicações , Leiomioma/diagnóstico , Síndrome do QT Longo/congênito , Síndrome do QT Longo/diagnóstico , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Resultado do Tratamento , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico
4.
Medicine (Baltimore) ; 98(19): e15375, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083166

RESUMO

In the study, we tried to evaluate the effects of morphine injected through the systemic or neuraxial route on immune cell function and cytokine production in healthy women.In total, 29 paired samples of fresh peripheral blood were collected from healthy women who had been administered morphine for anesthetic analgesia through intravenous (IV), epidural, or spinal route postpartum. Their isolated peripheral blood mononuclear cells were mitogen-activated and stained with fluorochrome-conjugated anti-CD4, anti-CD8, anti-interleukin (IL)-2, and anti-interferon (IFN)-γ antibodies for flow cytometry, and the plasma levels of cytokines, including IL-6, IFN-α2, IL-10, IL-8, GM-CSF, and monocyte chemoattractant protein (MCP)-1, were measured through enzyme-linked immunosorbent assay.The results demonstrated that regardless of the administration route, morphine delivery slightly reduced IL-2 expression in CD4 cells after activation, and the same effect was not noted for CD8 cells. Intravenous or epidural morphine tended to reduce IFN-γ expression in CD8 cells. Spinal and IV morphine substantially increased IL-6 production, whereas epidural morphine hindered IL-10 and GM-CSF production. IV morphine injection reduced MCP-1 production in plasma. Compared with spinal morphine, IV or epidural morphine may more effectively inhibit the expression of various cytokines and thus affect immune response.All 3 routes of morphine injection tended to decrease IL-2 production by CD4 cells, whereas IV or epidural morphine injection showed lower IFN-γ production by CD8 cells. However, additional large-scale studies with longer follow-up durations are warranted.


Assuntos
Analgésicos Opioides/administração & dosagem , Citocinas/sangue , Sistema Imunitário/efeitos dos fármacos , Sistema Imunitário/metabolismo , Morfina/administração & dosagem , Adulto , Biomarcadores/sangue , Feminino , Humanos , Período Pós-Parto , Linfócitos T/efeitos dos fármacos , Linfócitos T/imunologia
5.
Biopreserv Biobank ; 17(2): 189-197, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30715914

RESUMO

The emergence of biobanks has expanded the scope of biomedical research, ushering in an era of "precision medicine" to improve the treatment of disease. However, biobanks also face sustainability challenges comprising three dimensions-"financial," "operational," and "social." The Taiwan Biobank (TWB), as a large-scale national biobank that supplies valuable phenotypic and genetic information to biomedical researchers on an application basis to investigate the relationship among personal health, genes, lifestyle, environment and diseases of the Taiwanese population, has not been sufficiently explored by researchers. Although the TWB has successfully reached a few milestones since its inception, it faces many sustainability challenges. For the next chapter of the TWB, we propose three strategies to improve sustainability. First, the Ministry of Health and Welfare launched the TWB as an infrastructure project under the leadership of Academia Sinica in 2012. We now believe that it is time that the TWB is transformed into a legal entity as a nondepartmental public body. This would not only ensure efficient, effective, and flexible operation, but would also facilitate cooperation with commercial entities. Second, we suggest that the TWB integrates with other Taiwanese biobanks to reduce cost, improve low utilization, and expand specimen collection. Third, self-financing is important if funding is ceased. Besides implementing a cost-recovery model, the commodities developed by the TWB (e.g., TWB 2.0 microarray) will help increase income. After each of these strategies has been discussed in detail, this article will conclude by highlighting how these practices can help improve biobank sustainability.


Assuntos
Bancos de Espécimes Biológicos , Manejo de Espécimes/economia , Bancos de Espécimes Biológicos/economia , Bancos de Espécimes Biológicos/organização & administração , Pesquisa Biomédica/economia , Pesquisa Biomédica/métodos , Pesquisa Biomédica/organização & administração , Humanos , Taiwan
6.
Taiwan J Obstet Gynecol ; 57(1): 89-94, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29458911

RESUMO

OBJECTIVE: The mechanism through which neuroaxial morphine causes pruritus has not been elucidated clearly and thoroughly. MATERIALS AND METHODS: a study in 129 female parturients was conducted to investigate the effect of 14 single nucleotide polymorphisms (SNPs) on phenotype (pruritus) induced by neuroaxial (including intrathecal or epidural) morphine for cesarean section. Clinical phenotype, subjective complaints and objective observations were recorded. DNA from blood samples was used to record the SNPs. Eleven SNPs were then analyzed further. RESULTS: no significant association with the presence of phenotype (pruritus) versus genotype was observed (all p-values > 0.05). No significant association with severity of phenotype versus genotype of the 11 SNPs was observed except for unadjusted data for rs2737703. There was no significant difference between severity or incidence of IVPCA morphine-induced nausea and vomiting and genotype (11 SNPs). CONCLUSION: our results showed no association between SNPs of any of the genes studied with neuroaxial morphine inducing pruritus.


Assuntos
Analgésicos Opioides/efeitos adversos , Morfina/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Prurido/genética , Analgesia Epidural/efeitos adversos , Analgésicos Opioides/administração & dosagem , Cesárea/efeitos adversos , Feminino , Genótipo , Humanos , Morfina/administração & dosagem , Manejo da Dor , Testes Farmacogenômicos/métodos , Fenótipo , Polimorfismo de Nucleotídeo Único , Gravidez , Estudos Prospectivos , Prurido/induzido quimicamente , Taiwan
7.
Medicine (Baltimore) ; 96(30): e7624, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28746222

RESUMO

PURPOSE: Symptoms such as nausea, vomiting, tightness of the chest, bradycardia, and shoulder or abdominal discomfort, caused by vagotonia occurring during uterus manipulation, have concerned healthcare professionals for some time. Patients sometimes report these symptoms when undergoing spinal anesthesia for cesarean sections (CSs). We designed a prospective, double-blind study to investigate the effectiveness of tenoxicam in preventing these symptoms of discomfort. METHODS: A total of 105 American Society of Anesthesiologists (ASA) class I-II nulliparous pregnant women, who were scheduled for a CS, were enrolled into this prospective, double-blind study. Spinal anesthesia was conducted to reach a peak dermatome level of no more than T3. The 100 patients were randomly divided into 2 groups having completed study course: Group T (N = 50) received a 20 mg dose of tenoxicam in 5 mL of normal saline (NS) immediately after skin incision and Group N (N = 50) only received 5 mL NS. The incidence and severity of the symptoms experienced by the patients were recorded by a nurse anesthetist who was blinded to the injection regimen the patients were receiving. A chi-square test was used for statistical analysis t test and P < .05 was defined as significant. RESULTS: The incidence and degree of severity of nausea and vomiting were same in both the groups. The incidence and degree of severity of bradycardia, nausea, vomiting, tightness of the chest, shoulder discomfort, and abdominal discomfort were lower in Group T than in Group N. CONCLUSION: Tenoxicam might theoretically block the parasympathetic vagus pathway and decrease the visceral pain or visceral-specific symptoms, alleviating the symptoms caused by vagotonia. However, the prophylactic effect of tenoxicam in reducing the incidence and severity of nausea and vomiting was not statistically significant. This could be because nausea and vomiting are not solely caused by vagotonia, but also by other mechanisms.


Assuntos
Cesárea , Parassimpatolíticos/uso terapêutico , Piroxicam/análogos & derivados , Adulto , Raquianestesia/efeitos adversos , Bradicardia/epidemiologia , Bradicardia/etiologia , Bradicardia/prevenção & controle , Método Duplo-Cego , Feminino , Humanos , Incidência , Náusea/epidemiologia , Náusea/etiologia , Náusea/prevenção & controle , Enfermeiras Anestesistas , Dor/epidemiologia , Dor/etiologia , Dor/prevenção & controle , Piroxicam/uso terapêutico , Índice de Gravidade de Doença , Falha de Tratamento , Útero/fisiopatologia , Útero/cirurgia , Vômito/epidemiologia , Vômito/etiologia , Vômito/prevenção & controle
8.
Medicine (Baltimore) ; 96(25): e7009, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28640078

RESUMO

Nausea and vomiting are probably the most unpleasant side effects that occur when morphine used. A number of studies have investigated the effect on pain relief of single nucleotide polymorphisms (SNPs) in genes involved in morphine's metabolism, distribution, binding, and cellular action. The mechanism through which morphine causes nausea and vomiting has not been elucidated clearly. We examined all the reported SNPs which are associated with the complications of morphine, including SNPs in genes for phase I and phase II metabolic enzymes, ABC binding cassette drug transporters, κ and δ opioid receptors, and ion channels implicated in the postreceptor action of morphine.A prospective, observational study in 129 female patients was conducted to investigate the effect of 14 SNPs on nausea or vomiting induced by intravenous patient-controlled analgesia (IVPCA) with morphine after gynecology surgery. Clinical phenotype, subjective complaints, and objective observations were recorded. DNA from blood samples was used to record the SNPs. Eleven SNPs were then analyzed further.No significant association with the presence of phenotype (nausea or vomiting) versus genotype was observed (all P > .05). No significant association with severity of phenotype versus genotype of the 11 SNPs was observed except for unadjusted data for rs2737703.There was no significant difference between severity or incidence of IVPCA morphine-induced nausea and vomiting and genotype (11 SNPs). Further study should perhaps be focused on mRNA and proteinomics rather than SNPs.


Assuntos
Analgésicos Opioides/efeitos adversos , Morfina/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/genética , Administração Intravenosa/efeitos adversos , Adulto , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/administração & dosagem , Método Duplo-Cego , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Morfina/administração & dosagem , Medição da Dor , Dor Pós-Operatória/genética , Testes Farmacogenômicos , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos
10.
Biomed Res Int ; 2014: 965152, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24982917

RESUMO

PURPOSE: The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study. METHODS: We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion. RESULTS: There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups. CONCLUSION: Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.


Assuntos
Analgesia Epidural , Analgesia Controlada pelo Paciente , Bupivacaína/análogos & derivados , Cesárea , Fentanila/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Controlada pelo Paciente/efeitos adversos , Bupivacaína/efeitos adversos , Bupivacaína/uso terapêutico , Feminino , Fentanila/efeitos adversos , Humanos , Incidência , Levobupivacaína , Medição da Dor , Satisfação do Paciente , Gravidez
11.
Taiwan J Obstet Gynecol ; 53(1): 8-11, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24767638

RESUMO

OBJECTIVES: Patient-controlled epidural analgesia (PCEA) and continuous epidural infusion (CEI) are popular and effective methods for pain relief during labor; however, there are concerns about increasing rates of cesarean section (C/S) and instrumental delivery. This prospective study investigated the effect of PCEA and CEI with different formulas on labor and the mode of delivery in nulliparous women. MATERIALS AND METHODS: A total of 480 nulliparous women were randomized into four groups, with 120 in each. Group A received a loading dose of 10 mL of 1 mg/mL ropivacaine with 2 µg/mL fentanyl, then an intermittent bolus of 5 mL with a background infusion of 5 mL/hour by PCEA. Group B received the same PCEA formula as Group A with 0.8 mg/mL bupivacaine. Group C received the same formula as Group A by CEI with 1 mg/mL ropivacaine at a rate of 10 mL/hour. Group D received the same formula as Group C with 0.8 mg/mL bupivacaine. The rates of C/S and instrumental delivery and the incidence of side effects were recorded. RESULTS: The rates of C/S were significantly different between Groups A and C, Groups A and D, and Groups B and D. The rates of instrumental delivery for normal spontaneous delivery were significantly different between Groups A and B, A and D, B and C, and C and D. CONCLUSION: The C/S rate was higher in Groups C and D; however, the instrumental delivery rate was lower in Groups A and C. We conclude that PCEA with 1 mg/mL ropivacaine might provide the greatest benefit for labor analgesia.


Assuntos
Amidas/uso terapêutico , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/métodos , Fentanila/uso terapêutico , Dor do Parto/tratamento farmacológico , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Cesárea/métodos , Feminino , Humanos , Paridade , Gravidez , Estudos Prospectivos , Ropivacaina , Resultado do Tratamento
12.
Pain Res Treat ; 2013: 259306, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23431434

RESUMO

A cohort, double blind, and randomized study was conducted to investigate the effect of a single nucleotide polymorphism of the µ-opioid receptor at nucleotide position 118 (OPRM1:c.118A>G) on the association with the most common side effects (nausea or vomiting) induced by intravenous patient control analgesia (IVPCA) with morphine, including incidence and severity analysis. A total of 129 Taiwanese women undergoing gynecology surgery received IVPCA with pure morphine for postoperative pain relief. Blood samples were collected and sequenced with high resolution melting analysis to detect three different genotypes of OPRM1 (AA, AG, and GG). All candidates 24 h postoperatively will be interviewed to record the clinical phenotype with subjective complaints and objective observations. The genotyping after laboratory analysis showed that 56 women (43.4%) were AA, 57 (44.2%) were AG, and 16 (12.4%) were GG. The distribution of genotype did not violate Hardy-Weinberg equilibrium test. There was no significant difference neither between the severity and incidence of IVPCA morphine-induced side effects and genotype nor between the association between morphine consumption versus genotype. However, there was significant difference of the relation between morphine consumption and the severity and incidence of IVPCA morphine-induced nausea and vomiting. The genetic analysis for the severity and incidence of IVPCA morphine-induced nausea or vomiting showed no association between phenotype and genotype. It might imply that OPRM1:c.118A>G does not protect against IVPCA morphine-induced nausea or vomiting.

14.
Health Policy Plan ; 27(7): 590-9, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22258470

RESUMO

Facing escalating health care expenditures, the governments of countries with national health insurance programs are trying to control or even to reduce health care utilization. Little research has examined the effects of decreased health care utilization on health outcomes. Applying a natural experiment design to the Taiwan population between 2000 and 2004, which includes the 2003 SARS epidemic when an average 20% decline in health care utilization occurred, this study examines the association between a decline in health care utilization and health outcomes measured by cause-specific mortality rates. We analyse the monthly mortality rates caused by infectious diseases, cancer, diabetes mellitus, nervous system diseases, cerebrovascular diseases, heart and other vascular diseases, respiratory system diseases, digestive system diseases, genitourinary system diseases and accidents. Models control for age, sex, month and year effects. Results show the heterogeneous effect of reduced health care utilization on health outcomes. Patients with diabetes mellitus or cerebrovascular diseases are vulnerable to short-term reductions in health care; compared with the non-SARS period, mortality caused by diabetes mellitus and cerebrovascular diseases significantly increased during the SARS epidemic by 8.4% and 6.2%, respectively. No significant change in mortality rates caused by the other diseases or accidents is found. This study suggests that governments of countries where health care utilization and spending are similar to or inferior to those in Taiwan should carefully evaluate the impact of policies that attempt to reduce health care utilization. Furthermore, when an area encounters an epidemic, governments should be aware of the negative consequences of voluntary restraints on access to health care that accompany decreases in utilization.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Mortalidade/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/mortalidade , Criança , Pré-Escolar , Doenças Transmissíveis/mortalidade , Diabetes Mellitus/mortalidade , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Síndrome Respiratória Aguda Grave/mortalidade , Taiwan/epidemiologia , Doenças Vasculares/mortalidade , Adulto Jovem
15.
Urology ; 79(1): 128-32, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22055689

RESUMO

OBJECTIVE: To assess the risk factors for progressive deterioration of semen quality (PDSQ) in adult patients with varicocele. METHODS: A total of 32 men with left varicocele and impaired semen quality (group 1) and 30 age-matched patients with left varicocele and normal semen quality (group 2) were recruited for the present study. All the subjects received conservative treatment, and the parameters for evaluation every 12 months included semen quality, peak retrograde flow (PRF) and spontaneous venous reflux by color Doppler ultrasonography, body mass index, serum concentration of follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, testicular volume and discrepancy, grade of varicocele, and scrotal temperature. RESULTS: The mean follow-up time was 63.2 months (range 60-66). The patients in group 1 had a significantly greater PRF, lower testicular volume, greater testicular volume discrepancy, lower testosterone level, higher scrotal temperature, and greater follicle-stimulating hormone level than those in group 2 at first. The semen quality deteriorated in 28 subjects (87.5%) in group 1, but in only 6 patients (20%) in group 2 during follow-up. Furthermore, the 6 subjects with PDSQ in group 2 had greater PRF and scrotal temperature than those without. CONCLUSION: The rate of PDSQ was significantly greater in the varicocele patients with an initially abnormal semen quality than in those with initially normal semen quality (87.5% vs 20%). Furthermore, the varicocele patients with initially normal semen quality who had greater PRF and scrotal temperature might have a greater risk of PDSQ.


Assuntos
Progressão da Doença , Análise do Sêmen , Varicocele/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Humanos , Masculino , Monitorização Fisiológica/métodos , Prognóstico , Valores de Referência , Fatores de Risco , Contagem de Espermatozoides/métodos , Motilidade Espermática/fisiologia , Estatísticas não Paramétricas , Fatores de Tempo , Ultrassonografia Doppler , Varicocele/diagnóstico por imagem , Varicocele/cirurgia , Adulto Jovem
16.
Reg Anesth Pain Med ; 36(3): 249-55, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21519310

RESUMO

OBJECTIVE: Although complications of the epidural technique are known to affect the fetus adversely, there are no data indicating that regional analgesia directly causes harmful effects to the fetus. Our purpose was to determine the effect of epidural labor analgesia on the Doppler velocimetric indices of the uterine and fetal umbilical and middle cerebral arteries. METHODS: Doppler velocimetry indices, systolic/diastolic ratios, pulsatility index, and resistance index, of the fetal umbilical artery and uterine artery were recorded in 15 women receiving continuous epidural analgesia with 0.075% bupivacaine and 0.0002% fentanyl during labor; the same indices were recorded of the fetal umbilical and middle cerebral arteries in 10 women receiving the same analgesia. The cerebroplacental Doppler ratio was calculated. Maternal and neonatal outcome data were also recorded. RESULTS: Velocimetric indices of the fetal umbilical and middle cerebral artery after epidural infusion were not significantly different from the pre-epidural infusion levels. Indices of the maternal uterine artery were significantly increased after epidural infusion. The cerebroplacental ratio did not change after the beginning of epidural infusion. Neonatal outcome parameters (1- and 5-min Apgar scores) were all within normal limits. CONCLUSIONS: These data suggest that although velocimetric indices of the maternal uterine artery are affected by continuous epidural labor analgesia, fetal circulation, as measured by Doppler velocimetric indices, is not altered.


Assuntos
Analgesia Epidural/métodos , Feto/irrigação sanguínea , Artéria Cerebral Média/diagnóstico por imagem , Reologia/métodos , Ultrassonografia Doppler de Pulso/métodos , Artérias Umbilicais/diagnóstico por imagem , Adulto , Analgesia Epidural/efeitos adversos , Feminino , Feto/efeitos dos fármacos , Humanos , Recém-Nascido , Trabalho de Parto/efeitos dos fármacos , Trabalho de Parto/fisiologia , Artéria Cerebral Média/efeitos dos fármacos , Gravidez , Ultrassonografia Pré-Natal/métodos , Artérias Umbilicais/efeitos dos fármacos
17.
Urol Int ; 86(3): 320-4, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21212649

RESUMO

AIM: To examine the predictive factors of successful varicocelectomy in infertile patients. METHODS: Thirty-five infertile male patients with varicocele and requiring varicocelectomy were recruited in this study. The patients were divided into 2 groups based on their recovery outcome after subinguinal microsurgical varicocelectomy. Patients who showed significant improvement on their sperm density, motility and morphology 6 months after varicocelectomy were designated as group 1, whereas those who showed no improvement 6 months after surgery were designated as group 2. The predictive factors that were examined included: age; preoperative semen quality (i.e. sperm density, motility and morphology); testicular volume; seminal volume; varicocele grade; the number of ligated veins; body mass index (BMI), and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone, alkaline phosphatase (Alk-p), lactic dehydrogenase (LDH), cholesterol and triglyceride. RESULTS: Sperm density, motility and morphology improved significantly 6 months after varicocelectomy in group 1 patients (n = 35; 71.4%). Group 1 patients had significantly higher testicular volumes (mean ± SD: 29.6 ± 5.9 vs. 23.2 ± 6.1 ml), lower FSH (11.3 ± 2.9 vs. 16.1 ± 4.8 mIU/ml) and higher numbers of ligated veins (9.3 ± 0.8 vs. 7.9 ± 0.7) than group 2 patients. No significant association was observed between surgical outcome and age, preoperative sperm density, motility and morphology, seminal volume, varicocele grade, BMI and serum levels of LH, prolactin, testosterone, Alk-p, LDH, cholesterol and triglyceride. CONCLUSIONS: These findings suggest that the significant predictive factors of successful varicocelectomy in infertile patients were high testicular volume (>29.6 ml), low serum concentration of FSH (<11.3 mIU/ml) and high number of ligated veins (>9).


Assuntos
Testículo/fisiologia , Testículo/cirurgia , Varicocele/cirurgia , Adulto , Índice de Massa Corporal , Colesterol/metabolismo , Hormônio Foliculoestimulante/metabolismo , Humanos , Infertilidade Masculina/cirurgia , Masculino , Microcirurgia/métodos , Análise do Sêmen , Contagem de Espermatozoides , Motilidade Espermática , Resultado do Tratamento , Triglicerídeos/metabolismo
18.
Taiwan J Obstet Gynecol ; 50(4): 441-6, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22212315

RESUMO

OBJECTIVE: Conventional, intermittent, epidural morphine is widely applied as a post-Cesarean delivery analgesia. We compared the analgesic efficacy, motor weakness, and side effects of administering a patient-controlled epidural analgesia (PCEA) of pure ropivacaine versus the intermittent administration of epidural morphine after Cesarean delivery. MATERIALS AND METHODS: This randomized, double-blind study included 120 full-term parturients who underwent elective Cesarean delivery and received either PCEA with pure ropivacaine or an intermittent bolus epidural of 2 mg/10 mL morphine in normal saline twice per day. The efficacy of pain relief, post-Cesarean side effects, motor blockades, time to first ambulation, and global satisfaction scores were evaluated. RESULTS: Pain scores were recorded at the four evaluation times (2, 12, 24, and 48 hours post-Cesarean delivery), and the time to first ambulation did not statistically differ between the two groups. Patients in the ropivacaine group experienced more motor weakness at 2 and 12 hours, fewer side effects, and higher global satisfaction scores than those in the morphine group (p < 0.05). CONCLUSION: The analgesic efficacy after cesarean delivery was almost equivalent between two groups. PCEA with pure ropivacaine induced significant motor blockade during the first 12 hours, but without delaying the time to first ambulation. Patients in the ropivacaine group reported higher patient satisfaction scores due to the significant reduction of annoying side effects, such as pruritus, nausea, vomiting, and urinary retention.


Assuntos
Amidas/uso terapêutico , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Cesárea , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Adulto , Amidas/efeitos adversos , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/efeitos adversos , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Injeções Epidurais , Morfina/efeitos adversos , Medição da Dor , Satisfação do Paciente , Gravidez , Estudos Prospectivos , Recuperação de Função Fisiológica , Ropivacaina , Resultado do Tratamento
19.
Taiwan J Obstet Gynecol ; 50(4): 515-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22212328

RESUMO

OBJECTIVE: Placenta accreta is associated with significant maternal morbidity and is the leading indication for peripartum hysterectomy. In our institution, occlusion balloon catheters are commonly placed in bilateral common iliac arteries in order to reduce blood loss and facilitate surgery in patients with this obstetric complication. Few studies, however, have evaluated the effect of different anesthetic methods for cesarean hysterectomy on neonatal outcome. In this study, we compared Apgar scores among neonates born to mothers under general anesthesia with those who received regional anesthesia. CASE REPORTS: A retrospective analysis of 19 women with placenta accreta/percreta who underwent cesarean hysterectomy in our hospital, revealed that the 1-minute Apgar score was <7 in 4/12 neonates born to women who underwent general anesthesia and in 1/7 neonates born to mothers who received regional anesthesia. The 5-minute Apgar score was >7 after immediate resuscitation in all neonates. There were no significant differences in demographic data, induction-to-delivery period, or Apgar scores between the general and the regional anesthesia groups. CONCLUSION: We acknowledge that the retrospective nature of this study makes it difficult to conclude whether the different anesthesia management strategies had an impact on Apgar score; however, according to our clinical observation, regional anesthesia may be a better alternative in the induction-to-delivery period, especially for women with accreta/percreta and in situations in which poor neonatal outcome is expected.


Assuntos
Anestesia Obstétrica/métodos , Índice de Apgar , Oclusão com Balão , Cesárea , Placenta Acreta/terapia , Adulto , Anestesia Endotraqueal/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Feminino , Humanos , Histerectomia , Artéria Ilíaca , Recém-Nascido , Gravidez , Estudos Retrospectivos
20.
Urol Int ; 83(4): 410-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19996647

RESUMO

AIM: To compare cost-effectiveness, success rates and sat isfaction score of ureteroscopic lithotripsy with lithoclast (URSL) and extracorporeal shock wave lithotripsy (ESWL) for ureteral stones in a Taipei City Hospital. METHODS: This is a retrospective study. From July 1998 to June 2000, 448 patients who underwent treatment for ureteral stones were included. The patients were divided into two treatment groups according to the initial method adopted for the management of their stone. Medical records and hospital financial records were collected for costs of implementing each treatment program. The satisfaction scores of patients (rating from 0 to 10) were collected by telephone interviews. Success was defined as complete clearance of the stone or fragmentation of stones smaller than 2 mm by plain abdominal film and complete relief of symptoms after initial treatment. RESULTS: A total of 360 patients were in the ESWL group (including 144 upper, 48 middle and 168 lower third stones) and 88 in the URSL group (including 28 upper, 24 middle and 36 lower third stones). The range of stone size was from 0.6 to 1.9 cm. The overall treatment cost was comparable in both groups with a trend for it to be higher in the ESWL group without reaching statistical significance (TWD 20,901.5 +/- 8,911.3 vs. 19,876.1 +/- 4,782.2). Stratified by the location of stone, the overall treatment cost was significantly higher in the ESWL group than in the URSL group for patients with upper third ureteral stones irrespective of stone size. The efficiency quotient for ESWL and URSL was 0.62 and 0.65, respectively. The success rate was significantly higher in the URSL group than in the ESWL group (89.8 vs. 71.7%). Satisfaction scores were similar for both groups with a trend to be higher in the ESWL group without reaching statistical significance (7.97 +/- 1.01 vs. 7.53 +/- 1.37). CONCLUSIONS: The overall treatment cost of patients with upper third ureteral stone was significantly higher in the ESWL group than in the URSL group, but the success rate was significantly higher in the URSL group than in the ESWL group.


Assuntos
Litotripsia/economia , Cálculos Ureterais/economia , Cálculos Ureterais/terapia , Ureteroscopia/economia , Análise Custo-Benefício , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA