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1.
Am J Surg ; 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32312476

RESUMO

BACKGROUND: We compared the Emergency General Surgery Specific Frailty Index (EGSFI), Risk Analysis Index (RAI-C) and the Katz Index (KI) at assessing frailty in acute care surgery (ACS). METHODS: A prospective cohort of ACS patients was stratified into frail or non-frail by the EGSFI, RAI-C and KI. The agreement between scales were compared. RESULTS: Of 272 eligible patients, 72, 75, and 56 were categorized as frail by the EGSFI, RAI-C, and KI respectively. There was weak to no agreement between instruments and consensus among all three scales was 59.4%. CONCLUSION: Between 21 and 28% of patients seen in this ACS cohort were categorized as frail using the EGSFI, RAI-C and KI. These frailty tools have different measures of what constitutes frailty and there was poor agreement between them. Only the KI definition of frailty was associated with a longer LOS. The KI may be more useful for assessing ACS patients in a tertiary care facility.

2.
Am J Surg ; 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32115176

RESUMO

BACKGROUND: This study analyzed independent factors associated with post-thyroidectomy Emergency Room (ER) visits and Hospital Readmissions (HR). METHODS: This is a retrospective review from the CESQIP registry of 8381 thyroidectomy patients by 173 surgeons at 46 institutions. A total of 7142 ER visits and 7265 HR were analyzed. Multivariable logistic regression analysis was performed to determine the risk factors for an ER visit or HR. RESULTS: Within 30-days of surgery, rates of all ER visits were 3.4% (n = 250) and all HR were 2.3% (n = 170). Hypocalcemia was the reason for 21.9% of ER encounters and 36.4% of HR. BMI >40 kg/m2 was a risk factor for both ER visit (OR1.86) and HR (OR1.94). Surgical duration >3 h (OR2.63), and transection of recurrent laryngeal nerve (OR4.58) were risk factors for HR. CONCLUSIONS: Strategies to decrease hypocalcemia and improve perioperative care of patients with BMI >40 kg/m2 may improve post-thyroidectomy outcome.

4.
Am Surg ; 85(9): 939-943, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638503

RESUMO

Reoperative parathyroid surgery (REOPS) is often associated with lower cure rates and greater risk of nerve injury and hypoparathyroidism. The aim of this study was to evaluate cure rates, pathology, complications, and the efficacy of preoperative localization in patients requiring REOPS. Between 1992 and 2017, 2491 consecutive patients underwent parathyroidectomy for primary hyperparathyroidism. With Institutional Review Board approval, our prospectively collected parathyroidectomy outcomes database was queried for operative findings, outcomes, pathology, and localization methodology. Three hundred forty-six patients had REOPS (111 men/32% and 235 women/68%), with an overall cure rate of 91 per cent and a mean follow-up of 1.9 ± 0.7 years. The average preoperative serum calcium and parathyroid hormone were 11 ± 1 mg/dL and 373 ± 796 pg/mL, respectively. Normalization of intraoperative parathyroid hormone occurred in 248 patients and it was predictive of cure in 98.8 per cent of patients. A single adenoma was resected in 253 patients (75%), and the superior gland location was most common at 57 per cent. Ectopic glands were identified in only 33 patients. When preoperative imaging localized a lesion, a tumor was identified in that location in 75.4 per cent of sestamibi or SPECT/CT scans, 57.8 per cent of CT, 61.2 per cent of MRI, and 46.2 per cent of US. When at least two imaging modalities were concordant, sensitivity improved to 91.6 per cent (P < 0.001). Complication rates of permanent hypoparathyroidism and recurrent nerve palsy occurred in 0.03 per cent of patients. REOP for recurrent or persistent primary hyperparathyroidism has a cure rate of 91 per cent. Most missed parathyroid tumors are in the neck, and multimodal imaging improves preoperative localization and success.


Assuntos
Adenoma/cirurgia , Hiperparatireoidismo Primário/cirurgia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Reoperação , Adenoma/sangue , Adenoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/sangue , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico por imagem , Hipoparatireoidismo , Masculino , Pessoa de Meia-Idade , Paralisia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/diagnóstico por imagem , Paratireoidectomia/efeitos adversos , Complicações Pós-Operatórias , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Adulto Jovem
6.
Am Surg ; 85(7): 742-746, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405420

RESUMO

Insulinomas are rare endocrine malignancies of the pancreas that require surgical resection but can be difficult to localize preoperatively. We sought to review and improve the accuracy of preoperative localization techniques at our institution. We retrospectively reviewed all insulinomas that underwent resection at our institution between 1998 and 2016. Localization techniques include selective arterial calcium stimulation (CaStim), CT, MRI, angiography, and somatostatin receptor scintigraphy. Thirty-eight patients had pathologically proven insulinomas on surgical resection. Localization accuracies of CaStim, CT, and MRI were 89 per cent (31/35), 67 per cent (22/33), and 46 per cent (11/24), respectively. When compared with CT alone and CaStim alone, the combination of these two modalities resulted in 100 per cent preoperative localization (30/30), whereas the use of CaStim alone resulted in 80 per cent (4/5) localization and the use of CT alone resulted in 66 per cent (2/3) localization. Four of our patients had both negative CT and MRI. Among these patients, CaStim was 100 per cent localizing and the only positive modality for these patients. These data confirm that CaStim is accurate in preoperatively identifying single and multiple insulinomas; and when combined with CT, this accuracy is increased to 100 per cent. Based on these data, we propose that a dual imaging approach is a superior means of preoperative localization.


Assuntos
Insulinoma/diagnóstico por imagem , Imagem Multimodal/métodos , Neoplasias Pancreáticas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Insulinoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Cuidados Pré-Operatórios/métodos , Cintilografia/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
J Am Coll Surg ; 227(4): 455-466.e6, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30138702

RESUMO

BACKGROUND: Academic global surgery value to low- and middle-income countries (LMICs) is increasingly understood, yet value to academic health centers (AHCs) remains unclear. STUDY DESIGN: A task force from the Association for Academic Surgery Global Affairs Committee and the Society for University Surgeons Committee on Global Academic Surgery designed and disseminated a survey to active US academic global surgeons. Questions included participant characteristics, global surgeon qualifications, trainee interactions, academic output, productivity challenges, and career models. The task force used the survey results to create a position paper outlining the value of academic global surgeons to AHCs. RESULTS: The survey had a 58% (n = 36) response rate. An academic global surgeon has a US medical school appointment, spends dedicated time in an LMIC, spends vacation time doing mission work, or works primarily in an LMIC. Most spend 1 to 3 months abroad annually, dedicating <25% effort to global surgery, including systems building, teaching, research, and clinical care. Most are university-employed and 65% report compensation is equivalent or greater than colleagues. Academic support includes administrative, protected time, funding. Most institutions do not use specific global surgery metrics to measure productivity. Barriers include funding, clinical responsibilities, and salary support. CONCLUSIONS: Academic global surgeons spend a modest amount of time abroad, require minimal financial support, and represent a low-cost investment in an under-recognized scholarship area. This position paper suggests measures of global surgery that could provide opportunities for AHCs and surgical departments to expand missions of service, education, and research and enhance institutional reputation while achieving societal impact.


Assuntos
Centros Médicos Acadêmicos , Saúde Global , Missões Médicas , Procedimentos Cirúrgicos Operatórios , Humanos , Cooperação Internacional , Inquéritos e Questionários , Estados Unidos
9.
Semin Dial ; 30(4): 369-372, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28558417

RESUMO

Secondary hyperparathyroidism from chronic renal failure often requires a parathyroidectomy for correction. A successful parathyroidectomy often relies upon localization of all parathyroid tumors. Although most of the tumors are localized during a neck exploration, preoperative localization studies can help identify ectopic and supernumerary tumors. Three of the most common localization studies are radionuclide imaging, ultrasound, and CT scanning. Utility of these studies is strongly dependent on local institutional practice.


Assuntos
Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/etiologia , Falência Renal Crônica/complicações , Glândulas Paratireoides/diagnóstico por imagem , Humanos , Hiperparatireoidismo Secundário/cirurgia , Falência Renal Crônica/diagnóstico por imagem , Paratireoidectomia , Cintilografia , Tomografia Computadorizada por Raios X , Ultrassonografia
10.
Appl Immunohistochem Mol Morphol ; 25(10): 731-735, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27490759

RESUMO

BACKGROUND: Differentiation of parathyroid carcinoma (PC) from parathyroid adenoma (PA) relies solely on the pathologic determination of invasion of surrounding structures and/or distant metastasis. Parathyroid lesions with atypical histologic features with no demonstration of invasion or metastasis present a diagnostic dilemma. Different authors report a parafibromin and adenomatous polyposis coli (APC) loss or reduction in PC cases. High proliferative activity of MIB-1 and increased galectin 3 expression are reported in PC. There is no clear cutoff for the sensitivity, specificity, or predictive value for all these markers. METHODS: The immunohistochemical expression of parafibromin, APC, MIB-1, and galectin 3 was studied in 73 adenomas, 21 PCs, and 3 atypical adenomas. The presence or absence of each marker was identified through the use of a comprehensive scoring system based on multiplying the percentage of tumor cells stained (0 to 100) and the staining intensity (0 to 3) on each biopsy. The highest score that any slide could reach was 300. A cutoff of >100 was used to consider the specimen positive for parafibromin, APC, or galectin 3 staining. MIB-1 proliferation indices were calculated using image cytometry; proliferation indices >5% were considered positive. RESULTS: We identified parafibromin loss in 7/21 (33%) carcinomas and 1/73 (1%) adenomas. Loss of APC was seen in 20/21 (95%) carcinomas and 38/73 (52%) adenomas. MIB-1 indices were elevated in 18/21 (86%) carcinomas. MIB-1 indices were <5% in all (100%) adenomas. MIB-1 indices were elevated in 2/3 (67%) atypical adenomas. CONCLUSIONS: Our study presents a clear cutoff to determine the practicality of using parafibromin, APC, and MIB-1 as immunohistochemical markers to differentiate between PCs and PAs. Loss of parafibromin and a high MIB-1 index are both independently sensitive and specific markers for the diagnosis of PC. Loss of APC was only specific for PC. This panel of markers provides a novel, useful approach in the diagnosis and differentiation of PCs from PAs.


Assuntos
Adenoma/diagnóstico , Polipose Adenomatosa do Colo/metabolismo , Biomarcadores Tumorais/metabolismo , Antígeno Ki-67/metabolismo , Neoplasias das Paratireoides/diagnóstico , Proteínas Supressoras de Tumor/metabolismo , Adenoma/patologia , Estudos Transversais , Galectina 3/metabolismo , Humanos , Imuno-Histoquímica
11.
Am Surg ; 82(9): 839-45, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27670574

RESUMO

Neuropsychiatric symptoms (NPSs) of sporadic primary hyperparathyroidism (PHPT) are often subtle and effects of parathyroidectomy (PTX) on symptoms remains poorly characterized. Our aim was to evaluate effects of PTX on NPS in patients with PHPT. A prospective questionnaire was distributed to all patients undergoing PTX and to a thyroidectomy (TX) control group. The questionnaire included the validated scales Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to assess for depression and anxiety respectively, as well as questions modified from Pasieka's Parathyroid Assessment of Symptoms (M-PAS). Point values were assigned to questionnaire answers to create a score, with a maximum of 63. Fifty-eight patients underwent PTX (58.6%) and 41 TX (41.4%). Mean preoperative scores were greater in PTX versus TX patients in total score, PHQ-9, GAD-7, and M-PAS (all P < 0.05). Post-PTX scores were lower than pre-PTX in total score, PHQ-9, GAD-7, and M-PAS (all P < 0.05), but not in pre- and post-TX. Post-PTX 69.0 and 82.8 per cent of patients showed no symptoms of depression and anxiety, respectively, compared with 37.9 and 56.9 per cent pre-PTX. A total of 16.2 and 10.3 per cent of patients had moderately severe to severe depression and anxiety, which fell to 0 per cent post-PTX. NPSs are more common in patients with PHPT when compared with TX. Patients undergoing PTX have improvements in NPS. NPS scoring should occur in all patients with PHPT and severity of NPS should be considered a relative indication for PTX.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Hiperparatireoidismo Primário/psicologia , Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Estudos de Casos e Controles , Depressão/diagnóstico , Feminino , Seguimentos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Resultado do Tratamento
12.
Infect Control Hosp Epidemiol ; 37(10): 1179-85, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27430647

RESUMO

OBJECTIVE We compared risk for surgical site infection (SSI) following surgical breast procedures among 2 patient groups: those whose procedures were performed in ambulatory surgery centers (ASCs) and those whose procedures were performed in hospital-based outpatient facilities. DESIGN Cohort study using National Healthcare Safety Network (NHSN) SSI data for breast procedures performed from 2010 to 2014. METHODS Unconditional multivariate logistic regression was used to examine the association between facility type and breast SSI, adjusting for American Society of Anesthesiologists (ASA) Physical Status Classification, patient age, and duration of procedure. Other potential adjustment factors examined were wound classification, anesthesia use, and gender. RESULTS Among 124,021 total outpatient breast procedures performed between 2010 and 2014, 110,987 procedure reports submitted to the NHSN provided complete covariate data and were included in the analysis. Breast procedures performed in ASCs carried a lower risk of SSI compared with those performed in hospital-based outpatient settings. For patients aged ≤51 years, the adjusted risk ratio was 0.36 (95% CI, 0.25-0.50) and for patients >51 years old, the adjusted risk ratio was 0.32 (95% CI, 0.21-0.49). CONCLUSIONS SSI risk following breast procedures was significantly lower among ASC patients than among hospital-based outpatients. These findings should be placed in the context of study limitations, including the possibility of incomplete ascertainment of SSIs and shortcomings in the data available to control for differences in patient case mix. Additional studies are needed to better understand the role of procedural settings in SSI risk following breast procedures and to identify prevention opportunities. Infect Control Hosp Epidemiol 2016;1-7.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Mama/cirurgia , Risco Ajustado/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Pacientes Ambulatoriais , Qualidade da Assistência à Saúde/estatística & dados numéricos , Fatores de Risco , Estados Unidos/epidemiologia
13.
J Surg Res ; 201(1): 126-33, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26850193

RESUMO

BACKGROUND: Trauma systems in high-income countries have been shown to reduce trauma-related morbidity and mortality; however, these systems are infrequently implemented in low- and middle-income countries. Haiti currently lacks a well-resourced and structured trauma system and in turn loses an estimated 800,000 y of healthy life to injuries annually. In the present study, we perform a nationwide trauma capacity assessment, and using the World Health Organization's Guidelines for Essential Trauma Care as a framework, we attempt to identify achievable steps that can be taken toward improving trauma care in Haiti. MATERIALS AND METHODS: This cross-sectional study was performed at 12 facilities nationally using a survey tool assessing the areas of infrastructure, supplies and equipment, personnel and training, and procedural capabilities. Additionally, the total number of trauma cases presenting to each facility was tabulated from emergency room logbooks. RESULTS: A total of six secondary and six tertiary facilities were surveyed. Secondary facilities received an average of 35 trauma cases per week, whereas tertiary facilities received an average of 65 cases per week. Survey results demonstrated a shortage of airway, breathing, and circulation equipment and supplies in both facility levels, particularly in emergency rooms. All facilities lacked access to essential surgical personnel and trauma training. CONCLUSIONS: This study makes recommendations for improvements in trauma care in Haiti in the areas of infrastructure and administration, physical resources, and training and human resources. These recommendations represent feasible steps that can be taken toward the construction of a national trauma system in Haiti.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Estudos Transversais , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Haiti , Número de Leitos em Hospital , Recursos Humanos
14.
Am Surg ; 82(12): 1244-1249, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28234192

RESUMO

Postoperative acute renal failure is a major cause of morbidity and mortality in colon and rectal surgery. Our objective was to identify preoperative risk factors that predispose patients to postoperative renal failure and renal insufficiency, and subsequently develop a risk calculator. Using the National Surgical Quality Improvement Program Participant Use Files database, all patients who underwent colorectal surgery in 2009 were selected (n = 21,720). We identified renal complications during the 30-day period after surgery. Using multivariate logistic regression analysis, a predictive model was developed. The overall incidence of renal complications among colorectal surgery patients was 1.6 per cent. Significant predictors include male gender (adjusted odds ratio [OR]: 1.8), dependent functional status (OR: 1.5), preoperative dyspnea (OR: 1.5), hypertension (OR: 1.6), preoperative acute renal failure (OR: 2.0), American Society of Anesthesiologists class ≥3 (OR: 2.2), preoperative creatinine >1.2 mg/dL (OR: 2.8), albumin <3.5 g/dL (OR: 1.8), and emergency operation (OR: 1.5). This final model has an area under the curve (AUC) of 0.79 and was validated with similar excellent discrimination (area under the curve: 0.76). Using this model, a risk calculator was developed with excellent predictive ability for postoperative renal complications in colorectal patients and can be used to aid clinical decision-making, patient counseling, and further research on measures to improve patient care.


Assuntos
Cirurgia Colorretal/efeitos adversos , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/etiologia , Medição de Risco , Doença Aguda , Adulto , Idoso , Anestesiologia , Área Sob a Curva , Creatinina/sangue , Bases de Dados Factuais/estatística & dados numéricos , Dispneia/complicações , Emergências , Feminino , Humanos , Hipertensão/complicações , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Melhoria de Qualidade , Insuficiência Renal/epidemiologia , Fatores de Risco , Albumina Sérica/análise , Fatores Sexuais
17.
Surgery ; 156(6): 1631-6; discussion 1636-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25456966

RESUMO

BACKGROUND: Tertiary hyperparathyroidism (3°HPT) is hyperparathyroidism with hypercalcemia after renal transplantation. With unclear guidelines for parathyroidectomy (PTX), this study aims to determine which renal transplant patients develop 3°HPT and would benefit from PTX. METHODS: We performed a retrospective review of patients who received a renal transplant between 1994 and 2013; 105 patients who underwent near total PTX (NTPTX) were compared with 180 renal transplant control patients who did not undergo NTPTX. RESULTS: Calcium and PTH varied significantly between groups (P < .001). One year before transplant, the mean serum calcium was 9.7 ± 1.1 mg/dL in the NTPTX group versus 9.1 ± 0.9 mg/dL in the control group (P < .01). One month after transplant, the mean calcium in the NTPTX group was 10.4 ± 1.1 versus 9.4 ± 0.6 mg/dL in the control group (P < .001). One year before renal transplant, the median serum PTH level was 723 pg/mL (range, 557-919) in the NTPTX group versus 212 pg/mL (range, 160-439) in the control group (P < .01). One-month post renal transplant, the NTPTX group had a median PTH of 351 pg/mL (range, 199-497) versus 112 pg/mL (range, 73-178) pg/mL in the control group (P < .01). CONCLUSION: Before and after renal transplantation, PTH and calcium levels can serve as predictors of 3°HPT.


Assuntos
Hipercalcemia/complicações , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo Secundário/cirurgia , Transplante de Rim/métodos , Paratireoidectomia/métodos , Adulto , Idoso , Cálcio/sangue , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Hipercalcemia/diagnóstico , Hiperparatireoidismo Secundário/diagnóstico , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Seleção de Pacientes , Cuidados Pós-Operatórios , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Am Surg ; 80(7): 646-51, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24987894

RESUMO

Tertiary hyperparathyroidism (3°HPT) is defined as persistent hyperparathyroidism with hypercalcemia after renal transplantation. Near total parathyroidectomy (NTPTX) is the current standard for surgical intervention. The purpose of this study was to identify outcomes of NTPTX. A retrospective review was conducted of surgeries performed between 1994 and 2013. NTPTX resulted in resolution of 96.9 per cent of patients' hypercalcemia at a median follow-up of three years (interquartile range [IQR], 1 to 8). However, 3.1 per cent of patients remained hypercalcemic with a mean calcium of 10.5 ± 0.2 mg/dL. A total of 78.4 per cent of patients had parathyroid hormone (PTH) levels below 250 pg/mL at a median follow-up of two years (IQR, 2 to 8). The remaining 21.6 per cent had a median PTH of 535 (IQR, 345 to 857). PTH levels dropped from a median of 745 (IQR, 285.75 to 1594.25) pg/mL to 97 (IQR, 60 to 285) pg/mL one month post-NTPTX (P < 0.01). The most frequent complication was transient hypocalcemia in 27.1 per cent of patients, but no patients became permanently hypocalcemic. In the 1-month postoperative period, only one patient had a cardiac complication, and there was 0 per cent all-cause mortality. Glomerular filtration rate fell from 57.9 ± 28.3 mL/min pre-NTPTX to 53.2 ± 27.5 mL/min at 1-year post-NTPTX (P < 0.01). NTPTX effectively treats hypercalcemia in 3°HPT. However, PTH remains elevated (greater than 250) in 21.6 per cent of patients.


Assuntos
Hipercalcemia/cirurgia , Hiperparatireoidismo/cirurgia , Falência Renal Crônica/cirurgia , Transplante de Rim , Paratireoidectomia/métodos , Complicações Pós-Operatórias/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo/etiologia , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
J Surg Res ; 192(1): 34-40, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25015749

RESUMO

BACKGROUND: Surgical burden is a large and neglected global health problem in low- and middle-income countries. With the increasing trauma burden, the goal of this study was to evaluate the trauma capacity of hospitals in the central plateau of Haiti. MATERIALS AND METHODS: The World Health Organization Emergency and Essential Surgical Care survey was adapted with a focus on trauma capacity. Interviewers along with translators administered the survey to key hospital staff. RESULTS: Seven hospitals in the region were surveyed. Of the hospitals surveyed, 3/7 had functioning surgical facilities. None of the hospitals had trauma registries. 71% of the hospitals had no formal trauma guidelines. 2/7 hospitals had a general surgeon available 100% of the time. All surgical facilities had oxygen cylinders available 100% of the time, but three of the primary level hospitals only had it available 51%-90% of the time. Intubation equipment was available at 57% of the facilities. Ventilators were only available in the operating room. Only the largest hospital had a computed tomography scanner. Other hospitals (66%) had a functioning x-ray machine 76%-90% of the time. Hospitals (57%) had an ultrasound machine. The most common reasons for referral were lack of appropriate facilities and supplies at the primary level care centers or lack of trained personnel at higher-level facilities. CONCLUSIONS: Trauma capacity in the central plateau of Haiti is limited. There is a great need for more personnel, trauma training at all staff levels, emergency care guidelines, trauma registries, and imaging equipment and training, specifically in ultrasonography. To accomplish this, coordination is needed between the Haitian government and local and international nongovernmental organizations.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Estudos Transversais , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Haiti/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Oxigenoterapia/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Centro Cirúrgico Hospitalar/organização & administração , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Ultrassonografia/estatística & dados numéricos
20.
World J Surg ; 38(6): 1268-73, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24744114

RESUMO

INTRODUCTION: Primary hyperparathyroidism (PHPT) results in increased bone turnover, resulting in bone mineral density (BMD) reduction and a predisposition towards fractures. Parathyroidectomy (PTX) is the only definitive cure. OBJECTIVE: The primary goals of this study were to investigate the impact of PTX on BMD in patients with PHPT and to identify factors associated with post-operative BMD improvement using a multivariate model. METHODS: Between 1999 and 2010, a total of 757 patients underwent PTX for treatment of PHPT; 123 patients had both a pre- and a post-operative dual-energy X-ray absorptiometry (DEXA) scan. A prospective database was queried to obtain information about patient demographics, medications, comorbidities, and pre- and post-operative laboratory values. A Cox regression model was used to stratify patients and to identify factors that independently predict BMD response following PTX in this patient population. RESULTS: Overall, mean percent change in BMD was +12.31 % at the spine, +8.9 % at the femoral neck (FN), and +8.5 % at the hip, with a mean follow-up of 2.3 ± 1.5 years. A total of 101 (82.1 %) patients had BMD improvement at their worst pre-operative site. In patients who improved, 69.9 % (n = 86) had >5 % increase. Factors associated with BMD improvement at the worst pre-operative site were as follows: male gender (hazard ratio [HR] 2.29; 95 % confidence interval [CI] 1.54-4.21); pre-operative BMD with T-score less than -2.0 (HR 1.89; 95 % CI 1.11-2.39); age <55 years (HR 1.74; 95 % CI 1.14-2.25); BMD DEXA scan at >2.5 years post-operatively (HR 1.71; 95 % CI 1.09-2.17); history of previous fracture (HR 1.24; 95 % CI 1.05-1.92); and private insurance (HR 1.18; 95 % CI 1.06-2.1). The use of bisphosphonates, estrogens, vitamin D supplementation, or tobacco; obesity; history of previous PTX, serum calcium or parathyroid hormone levels were not independently associated with post-operative BMD improvement. CONCLUSION: Osteoporosis is one of the established National Institutes of Health criteria for PTX in asymptomatic patients with PHPT, but BMD improvement is not consistently seen during the post-operative period. Gender, age, more severe pre-operative bone disease, and insurance status were all predictors for greater BMD improvement following PTX. Further studies with a rigorous post-operative BMD regimen are needed in order to validate these results.


Assuntos
Densidade Óssea/fisiologia , Hiperparatireoidismo Primário/cirurgia , Osteoporose/diagnóstico , Hormônio Paratireóideo/sangue , Paratireoidectomia/métodos , Absorciometria de Fóton , Adulto , Idoso , Estudos de Coortes , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/diagnóstico , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Paratireoidectomia/efeitos adversos , Cuidados Pós-Operatórios/métodos , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
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