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1.
Transfus Apher Sci ; : 102631, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31585831

RESUMO

BACKGROUND: Massive transfusion protocol (MTP) has been used to provide plasma and packed red blood cells (pRBCs) rapidly. MTP also has been adapted for non-traumatic patients. The effects of hospital-wide MTP implementation on clinical outcomes were reviewed. METHODS: This was a retrospective study of patients who received massive transfusion before and after MTP implementation, between August 2010 and May 2018. Massive transfusion was defined as 10 or more units of pRBCs within 24 h. Recipients of massive transfusion were divided into periods before and after MTP implementation. The 24 -h death rate, thirty-day death rate and several laboratory findings were investigated. RESULTS: Eighty patients whose massive transfusion occurred before MTP implementation and 63 patients whose massive transfusion occurred after MTP implementation were compared. No statistically significant difference was found in 24 -h death rate (15.0% vs. 23.8%, p = 0.181), or 30-day death rate (43.8% vs. 36.5%, p = 0.381). Use of an anti-fibrinolytic agent was more frequent in patients after the MTP implementation (31.3% vs. 55.6%, p = 0.003). A statistically significant difference was found in the lowest body temperature of the two groups during the 24 -h period (34.7 °C vs. 35.6 °C, p < 0.001). Transfusion ratio of plasma to pRBC was numerically improved after the MTP implementation (1:1.91 vs. 1:1.58, p = 0.173). Earlier initiation of pRBC transfusion was achieved after implementation (51 min vs. 40 min, p = 0.042). CONCLUSIONS: MTP implementation showed improved coagulation profiles, but did not show a statistically significant death-rate reduction in non-traumatic patients.

2.
PLoS One ; 14(5): e0217641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150465

RESUMO

We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. The secondary endpoint was initial success of central line placement. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation (p = 0.001) and with hemodynamic instability (p <0.001) compared to the fluoroscopy-guided PICC placement. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside (p = 0.004). However, all re-inserted central lines were successful. There was no significant difference in procedure time between the three groups. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups (p = 0.038). Ultrasound-guided PICC placement by a neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients.


Assuntos
Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Procedimentos Neurocirúrgicos/métodos , Trombose/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Unidades de Terapia Intensiva , Veias Jugulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Radiologistas , Trombose/fisiopatologia , Resultado do Tratamento , Ultrassonografia/métodos , Ultrassonografia de Intervenção/efeitos adversos
3.
Transplantation ; 102(12): 2025-2032, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30153223

RESUMO

BACKGROUND: The feasibility of liver transplantation (LT) in elderly recipients remains a topic of debate. METHODS: This cohort study evaluated the impact of recipient's age on LT outcome between January 2007 and May 2016 covered by the Korean National Health Insurance system (n = 9415). Multilevel regression models were used to determine the impact of recipient's age on in-hospital and long-term mortality after LT. RESULTS: All patients had a first LT, with 2473 transplanted with liver from deceased donors (DD) and 6942 from living donors. The mean age was 52.2 ± 9.0 years. Most LT were performed on patients in their 50s (n = 4290, 45.6%) and 0.9% (n = 84) of the LT was performed on patients older 70 years. The overall in-hospital mortality was 6.3%, and the 3-year mortality was 11.3%. The in-hospital mortality included, 13.5% associated with DDLT and 3.7% involved living donor LT. When compared with that for patients aged 51 to 55 years, the risk of death among recipients older than 70 years was about fourfold higher after adjusting for baseline liver disease (odds ratio, 4.1; 95% confidence interval, 2.21-7.58), and was nearly threefold higher after adjusting for baseline liver disease and perioperative complications (odds ratio, 2.92; 95% confidence interval, 1.37-6.24). Also, the cost of LT increased significantly with age. CONCLUSIONS: The data show that age remains an important risk factor for LT, suggesting that LT should be considered with caution in elderly recipients.


Assuntos
Transplante de Fígado/mortalidade , Transplantados , Demandas Administrativas em Assistência à Saúde , Adulto , Fatores Etários , Idoso , Causas de Morte , Tomada de Decisão Clínica , Bases de Dados Factuais , Estudos de Viabilidade , Feminino , Mortalidade Hospitalar , Humanos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
PLoS One ; 12(4): e0176143, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28423065

RESUMO

BACKGROUND: Obesity might be associated with disturbance of cannulation in situation of extracorporeal cardiopulmonary resuscitation (ECPR). However, limited data are available on obesity in the setting of ECPR. Therefore, we investigated the association between body mass index (BMI) and clinical outcome in patients underwent ECPR. METHODS: From January 2004 to December 2013, in-hospital cardiac arrest patients who had ECPR were enrolled from a single-center registry. We divided patients into four group according to BMI defined with the WHO classification (underweight, BMI < 18.5, n = 14; normal weight, BMI = 18.5-24.9, n = 118; overweight, BMI = 25.0-29.9, n = 53; obese, BMI ≥ 30, n = 15). The primary outcome was survival to hospital discharge. RESULTS: Analysis was carried out for a total of 200 adult patients (39.5% females). Their median BMI was 23.20 (interquartile range, 20.93-25.80). The rate of survival to hospital discharge was 31.0%. There was no significant difference in survival to hospital discharge among the four groups (underweight, 35.7%; normal, 31.4%; overweight, 30.2%; obese, 26.7%, p = 0.958). Neurologic outcomes (p = 0.85) and procedural complications (p = 0.40) were not significantly different among the four groups either. SOFA score, initial arrest rhythm, and CPR to extracorporeal membrane oxygenation (ECMO) pump on time were significant predictors for survival to discharge, but not BMI. CONCLUSION: BMI was not associated with in-hospital mortality who underwent ECPR. Neurologic outcomes at discharge or procedural complications following ECPR were not related with BMI either.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/diagnóstico , Obesidade/diagnóstico , Sistema de Registros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/mortalidade , Parada Cardíaca/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/mortalidade , Obesidade/cirurgia , Alta do Paciente/estatística & dados numéricos , República da Coreia , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
5.
J Laparoendosc Adv Surg Tech A ; 27(8): 799-803, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28080205

RESUMO

INTRODUCTION: Although laparoscopic liver resection (LLR) has developed rapidly, its usefulness for the treatment of large tumors is less clear, due to concerns about compromising oncological principles and patient safety. The purpose of this study was to explore the feasibility and safety of LLR for the treatment of hepatocellular carcinoma (HCC) with a tumor size larger than 5 cm. PATIENTS AND METHODS: From January 2007 to December 2014, we performed LLR in 45 patients with HCC with a tumor size ≥5 cm. Perioperative outcome, tumor recurrence, and overall patient survival were analyzed. RESULTS: Median age was 60 years (interquartile range [IQR] 52-68) and 64.4% (29/45) were male. Seven patients (15.6%) had larger than 10 cm of HCC. No operative deaths occurred and six of the laparoscopic procedures were converted to open resection (conversion rate 13.3%). Median operation time was 365 minutes (IQR 277-443) and median estimated blood loss (EBL) was 400.0 mL (IQR 275-600). There was no R1 or R2 resection and median resection margin was 19.0 mm (IQR 8.0-33.0). Complications above Clavien-Dindo classification grade III occurred in four patients (8.9%). The median overall follow-up time was 10.7 month (range 1.1-62.1). One-year recurrence free survival (RFS) and overall survival (OS) were 86.0% and 95.5%, and 3-year RFS and OS were 70.7% and 86.0%. CONCLUSION: LLR appears safe and feasible in patients with HCC with a tumor size larger than 5 cm. Expansion of indication for LLR in patients with HCC may be considered.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Duração da Cirurgia , Análise de Sobrevida , Carga Tumoral
6.
World J Surg Oncol ; 13: 227, 2015 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-26216347

RESUMO

BACKGROUND: The majority of patients with intrahepatic cholangiocarcinoma (IHCC) who undergo complete tumor resection subsequently develop tumor recurrence. The objectives of this study were to determine the risk factors for IHCC recurrence after curative (R0) liver resection and to identify the feasibility about postoperative adjuvant radiation therapy (RT). METHODS: We retrospectively reviewed patients who underwent liver resection for IHCC between April 1995 and December 2012 at Samsung Medical Center. Cox regression analysis was performed to determine risk factors of recurrence. Patients with a recurrence in remnant liver within 2 cm from the resection margin, with or without locoregional lymph node (LN) metastases, were considered as potential RT candidates. Center-of-mass (COM) distances between the recurrent cancers and the cut surface were measured with MATLAB. RESULTS: We included 153 out of 198 patients who underwent partial liver resection for IHCC. About two thirds (n=93, 60.8%) of patients developed recurrent disease. The median recurrence-free survival (RFS) was 14 months (range, 0-204). Tumor size≥4.0 cm, LN metastasis and multiple tumors were significant predictors of IHCC recurrence on multivariate analysis. Tumor size≥5.0 cm was the only factor associated with recurrence beyond the RT field in patients with recurrence. Among 93 patients with recurrence, 16 (17.2%) patients were recurred in the RT field. CONCLUSION: After curative resection in IHCC, more than 60% of patients recurred, and among recurred patients, 17.2% were recurred within the RT field. Consequently, for control of locoregional recurrence, adjuvant RT could be carefully considered in patients with recurrence factors. Especially, patients with a tumor size larger than 5 cm should be judiciously selected for adjuvant RT.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Hepatectomia/mortalidade , Recidiva Local de Neoplasia/patologia , Planejamento da Radioterapia Assistida por Computador , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/mortalidade , Colangiocarcinoma/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
7.
ANZ J Surg ; 83(12): 985-90, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23072713

RESUMO

BACKGROUNDS: Mucinous cystic neoplasms (MCNs) of the pancreas are rare, but have recently been increasing in incidence. The aim of this retrospective clinical study was to elucidate the clinicopathological features and prognosis of MCNs with ovarian stroma at a single centre. METHODS: Using the presence of ovarian stroma as a requisite criterion for diagnosis of MCNs, the medical records of 47 surgically treated patients with MCNs from January 2004 to April 2011 were reviewed and classified according to the new 2010 World Health Organization classification. RESULTS: Included were 37 cases of low-grade (78.7%), 4 intermediate-grade (8.5%) and 1 high-grade dysplasia (8.5%), and 5 cases of invasive carcinomas (10.6%). Patients were exclusively women (91.5%) with a mean age of 48.5 years. Most tumours were in the pancreatic body/tail (89.4%) with a mean size of 5.24 cm. More than half were asymptomatic. Findings associated with malignancy were presence of mural nodules (P < 0.001) and cyst wall calcifications (P = 0.017). All invasive MCNs were ≥5.0 cm or had mural nodules. No lymph node metastasis was seen in 20 cases of lymph nodes dissected. None of the 42 patients with non-invasive MCNs recurred after a mean follow-up of 25 months. However, two of five patients with invasive MCNs recurred, and one died within 2 years. CONCLUSIONS: The prognosis of the resected non-invasive MCNs was excellent. Although resection should be considered for all cases, in low-risk MCNs (<5 cm and without nodules), nonradical resections (i.e. enucleations) are appropriate.


Assuntos
Cistadenocarcinoma Mucinoso/patologia , Ovário/citologia , Neoplasias Pancreáticas/patologia , Adulto , Idoso , Cistadenocarcinoma Mucinoso/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Células Estromais
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