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1.
Cancer Radiother ; 24(6-7): 645-648, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32883627

RESUMO

Immediate breast reconstruction versus delayed breast reconstruction improves quality of life of breast cancer patients undergoing total mastectomy without impacting oncologic outcomes. Two types of immediate reconstruction are possible, implant-based reconstruction or autologous reconstruction. These reconstructions interpose a tissue in the operating bed, which modifies target volume definition compared to a wall without reconstruction Post mastectomy radiotherapy increases the rate of postoperative complications for both surgical procedures. Recent guidelines were published about target volume definition in the post mastectomy setting after implant-based reconstruction. Guidelines about target volume definition after autologous reconstruction are still awaited. The aim of our work is to present the different surgical procedures for immediate breast reconstruction, their complications, and the definition of the postmastectomy target volume.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mamoplastia , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Radioterapia Adjuvante/efeitos adversos , Fatores de Tempo
2.
Medicine (Baltimore) ; 99(36): e21835, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899012

RESUMO

RATIONALE: Macular hole (MH) formation after vitrectomy is rare and it may be due to several mechanisms associated with change of foveolar anatomy by vitrectomy. If a MH develops after vitrectomy, surgical treatments including internal limiting membrane peeling and intravitreal gas injection are usually needed for repair of hole. Spontaneous closure of MH is much rarer. PATIENT CONCERNS: A 66-year-old patient had a vitrectomy for rhegmatogenous retinal detachment not involving the macula of the right eye. Eight months after the vitrectomy, the visual acuity decreased and full-thickness defect of macula, epiretinal membrane progression, intraretinal cysts, and flame shape hemorrhage along with superior temporal vascular arcade were observed on fundus examination and optical coherence tomography. DIAGNOSES: MH and branch retinal vein occlusion (BRVO) accompanying cystoid macular edema (CME) were both present on her right eye. Thus, we planned a surgery for MH repair. INTERVENTIONS: The status of MH was observed while waiting the surgery schedule. At 2 weeks after detection of the MH, optical coherence tomography showed that intraretinal cysts had decreased in extent and the inner wall of the MH had contracted; 4 weeks later, the MH was closed with a subtle subretinal space. OUTCOMES: The fovea was well-maintained with a complete closure for 9 months. LESSONS: MH formation and spontaneous closure occurred in association with BRVO accompanying CME in a patient who had a vitrectomy. In vitrectomized eyes, physicians should consider the possibility of MH development in association with BRVO, and possible spontaneous closure of the MH in accordance with CME resolution.


Assuntos
Perfurações Retinianas/etiologia , Vitrectomia/efeitos adversos , Idoso , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Remissão Espontânea
3.
J Wound Ostomy Continence Nurs ; 47(5): 456-457, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925588

RESUMO

BACKGROUND: Surgical creation of a urostomy with or without radical cystectomy is a common urologic procedure. Despite advances in techniques, ostomy and surgical-related postoperative complications are prevalent and may impair physical recovery and health quality of life. Restrictions in face-to-face clinic visits created by the coronavirus disease-2019 (COVID-19) pandemic have dramatically altered care for patients with a new urostomy. CASE: This case report describes our management approaches using telemedicine and complementary communication strategies during the recent COVID-19 pandemic for a patient with multiple complex chronic conditions and multiple stoma and related postoperative complications. CONCLUSIONS: Despite challenges imposed during the COVID-19 pandemic, we were able to manage multiple surgical- and ostomy-related complications using a combination of telecommunication techniques that mitigated the need for routine and urgent postoperative clinic visits, hospital readmission, or unplanned visits to an emergency department. The new onset use of telemedicine approaches (telephone, televideo, and direct telemedicine) and various Health Insurance and Portability and Accountability Act-secure platforms due to pandemic conditions can improve access to care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estomia/efeitos adversos , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Telemedicina/organização & administração , Idoso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
4.
Eur J Endocrinol ; 183(5): R119-R132, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32869608

RESUMO

Despite well recognized improvements in obesity-related comorbidities, increasing evidence implicates bariatric surgery in the onset of adverse skeletal health outcomes. The purpose of this review is to provide a focused update in three critical areas: (i) emergent data on sleeve gastrectomy and bone loss, (ii) evidence linking bariatric surgery to incident fracture, and (iii) intervention strategies designed to mitigate surgical bone loss. Better understanding of these issues will inform our treatment of skeletal health for patients planning bariatric surgery.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Fraturas Ósseas/etiologia , Gastrectomia/efeitos adversos , Obesidade Mórbida/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
5.
J Med Vasc ; 45(5): 254-259, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862982

RESUMO

INTRODUCTION: Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture. METHODS: This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture. RESULTS: Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported. CONCLUSION: TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.


Assuntos
Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Lesões do Sistema Vascular/cirurgia , Adolescente , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aorta Torácica/fisiopatologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Hemodinâmica , Humanos , Escala de Gravidade do Ferimento , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Adulto Jovem
6.
BMC Surg ; 20(1): 194, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867744

RESUMO

BACKGROUND: Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy. METHODS: We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070. RESULTS: Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55-4.48; I2 = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54-2.32; I2 = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58-5.47; I2 = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05-3.71; I2 = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02-14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13-3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16-2.34; I2 = 19.5%). CONCLUSIONS: This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.


Assuntos
Adrenalectomia/métodos , Laparoscopia/métodos , Obesidade/epidemiologia , Adulto , Humanos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório
7.
Rozhl Chir ; 99(7): 316-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972150

RESUMO

INTRODUCTION: Decompressive craniectomy is an important method for managing refractory intracranial hypertension. Although decompressive craniectomy is a relatively simple procedure, various complications may arise. The aim of our paper was to determine the incidence of complications of decompressive craniectomy in patients with head injury and to analyse their risk factors. METHODS: We retrospectively analysed a group of 94 patients after decompressive craniectomy for head injury between 01 Jan 2014 and 31 Dec 2018. Postoperative complications were evaluated based on clinical examination and postoperative CT scan. The impact of potential risk factors on the occurrence of complications was assessed (age, worse initial clinical condition, any haemocoagulation disorder). RESULTS: Twenty patients died within the first month after surgery. Control CT scan showed one complication in 78 patients (83%), while 46 patients (49%) had more than one complication. We had to reoperate 22 patients (23.4%) due to a complication. The following complications were found: postoperative acute subgaleal/subdural haematoma (30× - 32%), subgaleal/subdural cerebrospinal fluid effusion (29× - 31%), soft tissues oedema (29× - 31%), haemorrhagic progression of brain contusion (17× - 18%), malignant brain oedema (8× - 8.5%), hydrocephalus (8× - 8.5%), temporal muscle atrophy (7× - 7.5%), peroperative massive bleeding ( 6× - 6.4%), epilepsy (4× - 4.3%), syndrome of the trephined (2× - 2.1%), skin necrosis (2× - 2.1%). Patients with a haemocoagulation disorder had a significantly higher incidence of complications (p=0.01). CONCLUSION: Complications of decompressive craniectomy after head injury are frequent. The potential benefit of decompressive craniectomy can be adversely affected by the occurrence of many complications.


Assuntos
Lesões Encefálicas , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Craniectomia Descompressiva/efeitos adversos , Derrame Subdural/cirurgia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(38): e22296, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957388

RESUMO

RATIONALE: The increasing incidence of cardiac comorbidities in the elderly population has led to an increasing demand for vigilance of cardiac dysfunction induced by surgery. Favorable outcomes can be ensured in such cases by an increased awareness of cardiogenic complications, early identification of the problem, and appropriate treatment. PATIENT CONCERNS: This study presents 2 cases of acute pulmonary edema (PE) that were likely caused by ischemic heart disease and diastolic dysfunction in postoperative patients, following vitrectomy, in the post-anesthetic care unit. DIAGNOSES: Chest x-ray and computed tomography indicated PE. INTERVENTIONS: Following the diagnosis of PE, patients were intubated and transferred to the intensive care unit where 20 mg furosemide was injected and 10 µg/kg/min dobutamine was infused intravenously. OUTCOMES: On postoperative day 2, the patients' vital signs were stable and there were no signs of respiratory disturbance. LESSONS: Physicians should be alert to the potential development of PE as a postoperative complication in patients with left ventricular (LV) diastolic dysfunction and ischemic heart disease, even if the patient has undergone a procedure with mild hemodynamic change and minimal surgical stimulation such as vitrectomy. We propose that physicians treating elderly patients with LV diastolic dysfunction and ischemic heart disease undergoing vitrectomy should consider the use of intraoperative transthoracic echocardiogram or transesophageal echocardiogram with continuous monitoring of blood pressure, using devices such as arterial catheter devices.


Assuntos
Complicações Pós-Operatórias/etiologia , Edema Pulmonar/etiologia , Vitrectomia/efeitos adversos , Idoso , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem
9.
JAMA ; 324(9): 871-878, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32870297

RESUMO

Importance: Outcomes of postoperative atrial fibrillation (AF) after noncardiac surgery are not well defined. Objective: To determine the association of new-onset postoperative AF vs no AF after noncardiac surgery with risk of nonfatal and fatal outcomes. Design, Setting, and Participants: Retrospective cohort study in Olmsted County, Minnesota, involving 550 patients who had their first-ever documented AF within 30 days after undergoing a noncardiac surgery (postoperative AF) between 2000 and 2013. Of these patients, 452 were matched 1:1 on age, sex, year of surgery, and type of surgery to patients with noncardiac surgery who were not diagnosed with AF within 30 days following the surgery (no AF). The last date of follow-up was December 31, 2018. Exposures: Postoperative AF vs no AF after noncardiac surgery. Main Outcomes and Measures: The primary outcome was ischemic stroke or transient ischemic attack (TIA). Secondary outcomes included subsequent documented AF, all-cause mortality, and cardiovascular mortality. Results: The median age of the 452 matched patients was 75 years (IQR, 67-82 years) and 51.8% of patients were men. Patients with postoperative AF had significantly higher CHA2DS2-VASc scores than those in the no AF group (median, 4 [IQR, 2-5] vs 3 [IQR, 2-5]; P < .001). Over a median follow-up of 5.4 years (IQR, 1.4-9.2 years), there were 71 ischemic strokes or TIAs, 266 subsequent documented AF episodes, and 571 deaths, of which 172 were cardiovascular related. Patients with postoperative AF exhibited a statistically significantly higher risk of ischemic stroke or TIA (incidence rate, 18.9 vs 10.0 per 1000 person-years; absolute risk difference [RD] at 5 years, 4.7%; 95% CI, 1.0%-8.4%; HR, 2.69; 95% CI, 1.35-5.37) compared with those with no AF. Patients with postoperative AF had statistically significantly higher risks of subsequent documented AF (incidence rate 136.4 vs 21.6 per 1000 person-years; absolute RD at 5 years, 39.3%; 95% CI, 33.6%-45.0%; HR, 7.94; 95% CI, 4.85-12.98), and all-cause death (incidence rate, 133.2 vs 86.8 per 1000 person-years; absolute RD at 5 years, 9.4%; 95% CI, 4.9%-13.7%; HR, 1.66; 95% CI, 1.32-2.09). No significant difference in the risk of cardiovascular death was observed for patients with and without postoperative AF (incidence rate, 42.5 vs 25.0 per 1000 person-years; absolute RD at 5 years, 6.2%; 95% CI, 2.2%-10.4%; HR, 1.51; 95% CI, 0.97-2.34). Conclusions and Relevance: Among patients undergoing noncardiac surgery, new-onset postoperative AF compared with no AF was associated with a significant increased risk of stroke or TIA. However, the implications of these findings for the management of postoperative AF, such as the need for anticoagulation therapy, require investigation in randomized trials.


Assuntos
Fibrilação Atrial/complicações , Ataque Isquêmico Transitório/etiologia , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/etiologia , Procedimentos Cirúrgicos Operatórios , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Ataque Isquêmico Transitório/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
10.
Medicine (Baltimore) ; 99(37): e20798, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925709

RESUMO

BACKGROUND AND OBJECTIVE: Intravascular ultrasound (IVUS) could take on a vital position when angiographic images are not clear enough to be precisely visualized or measured by computer-aided technology. This meta-analysis was designed to compare the benefits of IVUS-guided and angiography-guided percutaneous coronary intervention(PCI) strategies for improving clinical outcomes. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched for articles published from inception to 13th October, 2019. A comparative study of IVUS-guided and angiography-guided PCI strategies for patients with coronary bifurcation lesions was retrieved. The early endpoint events (≤1 year) and the late endpoint events (>1 years) were determined according to the follow-up time. The former included cardiac death, target lesion or vessel revascularization, stent thrombus, and major adverse cardiac events, while the latter included cardiac death. Statistical software Review Manager Version 5.3 was performed for meta-analysis. RESULTS: Five studies involving7,830 patients with coronary bifurcation lesions were included in this meta-analysis, the incidence of major adverse cardiac events for IVUS-guided strategy in patients with coronary bifurcation lesions were lower than those of patients with angiography-guided strategy at the early follow-up(OR = 0.55, 95% CI 0.42 - 0.70, P < .0001).Meanwhile, cardiac death, target vessel or target lesion revascularization, stent thrombosis were not statistically significant(OR = 0.68, 95% CI 0.34 - 1.35, P = .27; OR = 0.78, 95% CI 0.59 - 1.05, P = .10; OR = 0.36, 95% CI 0.12-1.04, P = .06).However, significant differences in cardiac death between IVUS-guided and angiographic-guided strategies were observed in the late follow - up (OR = 0.36, 95% CI 0.23 - 0.57, P < .00001). CONCLUSION: The IVUS-guided PCI strategy was associated with more clinical benefits compared with angiography-guided PCI strategy in patients with coronary bifurcation lesions. These findings suggest that the IVUS-guided PCI strategy can be recommended as an optimization in this kind of patients.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Ultrassonografia de Intervenção/métodos , Idoso , Angiografia Coronária/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Stents/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos
11.
Medicine (Baltimore) ; 99(37): e21833, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925720

RESUMO

Massive blood transfusion (MBT) is a relatively common complication of cardiac surgery, which is independently associated with severe postoperative adverse events. However, the value of using rapid thrombotomography (r-TEG) to predict MBT in perioperative period of cardiac surgery has not been explored. This study aimed to identify the effect of r-TEG in predicting MBT for patients undergoing coronary artery bypass grafting (CABG).This retrospective study included consecutive patients first time undergoing CABG at the Zhongnan Hospital of Wuhan University between March 2015 and November 2017. All the patients had done r-TEG tests before surgery. The MBT was defined as receiving at least 4 units of red blood cells intra-operatively and 5 units postoperatively (1 unit red blood cells from 200 mL whole blood).Lower preoperative hemoglobin level (P = .001) and longer cardiopulmonary bypass time (P = .001) were the independent risk factors for MBT during surgery, and no components of the r-TEG predicted MBT during surgery. Meanwhile, longer activated clotting time (P < .001), less autologous blood transfusion (P = .001), and older age (P = .008) were the independent risk factors for MBT within 24 hours of surgery.Preoperative r-TEG activated clotting time can predict the increase of postoperative MBT in patients undergoing CABG. We recommend the careful monitoring of coagulation system with r-TEG, which allows rapid diagnosis of coagulation abnormalities even before the start of surgery.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico por imagem , Testes de Coagulação Sanguínea/métodos , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Tromboelastografia/métodos , Idoso , Transtornos da Coagulação Sanguínea/etiologia , Transfusão de Sangue/estatística & dados numéricos , Doença da Artéria Coronariana/cirurgia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
12.
Medicine (Baltimore) ; 99(37): e21862, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925723

RESUMO

This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more.This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared.There are no statistically significant differences when compared general data in patients from group A and B (P > .05). Operation time in Group A is less than Group B (103.33, 40-230 min vs 122.64, 75-180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50-100 mL vs 194.44, 100-500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7-100 days vs 6.67, 4-14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0-91 points vs 64.41, 0-90 points, P > .05).Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more.


Assuntos
Fixação Intramedular de Fraturas/mortalidade , Hemiartroplastia/mortalidade , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/mortalidade , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Fixação Intramedular de Fraturas/métodos , Avaliação Geriátrica , Hemiartroplastia/métodos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
13.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933905

RESUMO

A 25-year-old woman brought to the hospital with symptoms of acute confusion, disorientation, diplopia, hearing loss and unsteady gait which started 4 days prior to her presentation with rapid worsening in its course until the day of admission. She had a surgical history of laparoscopic sleeve gastrectomy 2 months earlier which was complicated by persistent vomiting around one to three times per day. She lost 30 kg of her weight over 2 months and was not compliant to vitamin supplementation. CT of the brain was unremarkable. Brain MRI was done which showed high signal intensity lesions involving the bilateral thalamic regions symmetrically with restricted diffusion on fluid-attenuated inversion recovery imaging. Other radiological investigations, such as magnetic resonance venography and magnetic resonance angiography of the brain were unremarkable. An official audiogram confirmed the sensorineural hearing loss. A diagnosis of Wernicke's encephalopathy due to thiamin deficiency post-sleeve gastrectomy was made based on the constellation of her medical background, clinical presentation and further supported by the distinct MRI findings. Consequently, serum thiamin level was requested and intravenous thiamin 500 mg three times per day for six doses was started empirically, then thiamin 250 mg intravenously once daily given for 5 more days. Marked improvement in cognition, eye movements, strength and ambulation were noticed soon after therapy. She was maintained on a high caloric diet with calcium, magnesium oxide, vitamin D supplements and oral thiamin with successful recovery of the majority of her neurological function with normal cognition, strength, reflexes, ocular movements, but had minimal resolution of her hearing deficit. Serum thiamin level later was 36 nmol/L (67-200).


Assuntos
Gastrectomia/efeitos adversos , Perda Auditiva/etiologia , Complicações Pós-Operatórias/etiologia , Encefalopatia de Wernicke/complicações , Adulto , Feminino , Gastrectomia/métodos , Humanos , Encefalopatia de Wernicke/diagnóstico
14.
Anticancer Res ; 40(9): 5301-5307, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878821

RESUMO

BACKGROUND/AIM: The aim of this single center, non-randomized, open-label, uncontrolled, interventional trial was to determine the feasibility of continuous administration of low-dose human atrial natriuretic peptide (hANP) perioperatively during curative operation for colorectal cancer patients without history of acute heart failure. PATIENTS AND METHODS: The study included three males and two females ranging from 27 to 70 years old. Continuous intravenous injection of hANP solution was started before surgery. The primary endpoint was safety of hANP administration, and the secondary endpoints were perioperative changes in ANP, b-type natriuretic peptide, electrocardiogram (ECG), and lung function. RESULTS: The American Society of Anaesthesiologists physical status was 1, 2, and 3 in three, one, and one patient, respectively. Grade 2 hypotension was observed in one case. No marked changes were observed between pre- and post-operation in all cases. CONCLUSION: Perioperative low-dose hANP administration is feasible and safe in patients with curative colorectal cancer.


Assuntos
Fator Natriurético Atrial/administração & dosagem , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Insuficiência Cardíaca/prevenção & controle , Assistência Perioperatória , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Biomarcadores , Neoplasias Colorretais/cirurgia , Eletrocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Avaliação de Sintomas , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(33): e21714, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872051

RESUMO

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, yet it is inconsistently defined, preventing accurate estimation of its incidence and identification of risk factors. Here we began to explore a unified definition of PPH that may be valid for vaginal delivery and cesarean section.Medical records of women who underwent vaginal delivery or cesarean section at our tertiary medical center between January and December 2018 were retrospectively analyzed. Patients who delivered by each route were compared in terms of PPH incidence and risk factors depending on different blood loss cut-off values.A total of 560 vaginal deliveries and 393 cesarean sections were analyzed. Vaginal deliveries were associated with significantly greater blood loss based on change of hemoglobin level, but significantly lower blood loss based on clinical estimation. When PPH was defined as blood loss ≥500 ml based on change of hemoglobin level, its incidence was 57.7% for vaginal deliveries and 28.2% for cesarean sections. The corresponding incidences were 15.4% and 3.3% when PPH was defined as blood loss ≥1000 ml based on change of hemoglobin levels. Independent risk factors for PPH in vaginal deliveries were lateral perineotomy (OR 2.835, 95%CI 1.694-4.743), suturing by a junior physician (OR 3.456, 95%CI 2.005-5.956), and long time from delivery of placenta to return to the recovery room (OR 1.013, 95%CI 1.003-1.022). A risk factor for PPH in cesarean sections was a long time from delivery of the fetus until the end of the operation.PPH is a significantly underestimated obstetric problem, especially in vaginal deliveries. Regardless of delivery route, hemoglobin-based blood loss of 500 ml and 1000 ml may be useful, respectively, as early warning and diagnostic cut-off values.


Assuntos
Cesárea/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Adulto , Cesárea/efeitos adversos , China/epidemiologia , Feminino , Humanos , Incidência , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Terminologia como Assunto
16.
Medicine (Baltimore) ; 99(33): e21727, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872054

RESUMO

INTRODUCTION: Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection. PATIENT CONCERNS: We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery. DIAGNOSIS: The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods. INTERVENTION: We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect. OUTCOMES: Post-operative period was uneventful and the patient showed good recovery. CONCLUSION: Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.


Assuntos
Discotomia/efeitos adversos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Ureter/lesões , Angiografia por Tomografia Computadorizada , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Necrose , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Ureter/diagnóstico por imagem , Ureter/patologia , Ureter/cirurgia , Urografia
17.
Orthop Clin North Am ; 51(4): 527-532, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950222

RESUMO

Pulmonary comorbidities and ASA physical status class III and IV can significantly increase the rate of major complications after ISC placement. Patients with an underlying pulmonary comorbidity or lung disease (chronic obstructive pulmonary disease, asthma, or obstructive sleep apnea) have a 2.2-fold increased risk of having any complication and a 2.4-fold increased risk of having a major pulmonary complication compared to those without pulmonary comorbidities. Patients with pulmonary comorbidities may benefit from alternative pain management strategies to avoid complications in the early postoperative period.


Assuntos
Artroplastia do Ombro/efeitos adversos , Pneumopatias Obstrutivas/complicações , Bloqueio Nervoso/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cateteres de Demora/efeitos adversos , Humanos , Bloqueio Nervoso/instrumentação , Nervo Frênico , Complicações Pós-Operatórias/prevenção & controle
18.
BMC Pulm Med ; 20(1): 243, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917185

RESUMO

BACKGROUND: Factors affecting the safety of bronchoscopy in patients with malignant hematologic disorders have not been well described. We evaluated the safety of bronchoscopy and describe factors affecting its complication rate in such patients. METHODS: Between January 2009 and December 2018, 316 bronchoscopies in 282 patients with malignant hematologic disorders and pulmonary infiltrates were performed at our institution. The bronchoscopic procedure used and its complications were evaluated. RESULTS: The most common underlying disease was acute myeloid leukemia (134/282 patients, 47.5%). Platelet transfusion was performed the day before or the day of bronchoscopy in 42.4%, supplemental oxygen was administered before the procedure in 23.1%, and midazolam was used in 74.4%. Thirty-five bronchoscopies (11.1%) were complicated by hemoptysis and 7 patients developed pneumothorax, 4 of whom required thoracic drainage. Two patients (0.6%) were intubated within 48 h of the procedure and prolonged oxygen desaturation (> 48 h) occurred in 3.8%. Multivariate analysis showed that only use of midazolam significantly reduced the risk of prolonged oxygen desaturation (hazard ratio 0.28, 95% confidence interval 0.09-0.85, p = 0.03). Transbronchial lung biopsy significantly increased the risk of hemoptysis (hazard ratio 10.40, 95% confidence interval 4.18-25.90, p = 0.00), while use of midazolam significantly reduced the risk (hazard ratio 0.31, 95% confidence interval 0.14-0.73, p = 0.01). CONCLUSIONS: Bronchoscopy is relatively safe in patients with malignant hematologic disorders. Caution and judicious use of sedatives may improve the patient's procedural tolerance and lower complications.


Assuntos
Broncoscopia/efeitos adversos , Neoplasias Hematológicas/complicações , Complicações Pós-Operatórias/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 99(39): e22471, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991485

RESUMO

RATIONALE: Patients with long term bed rest in intensive care unit after neurosurgery could experience splanchnic hypoperfusion. These patients have several other medical conditions that exacerbate splanchnic hypoperfusion during treatment and the splanchnic hypoperfusion could result in "stress-induced intestinal necrosis", which could cause massive hematochezia. We report here the experience of life-threatening hematochezia in 3 patients who underwent brain surgery in our institution. PATIENTS CONCERNS: One female patient (72-year-old) and 2 male patients (58- and 35-year-old) were admitted to our institution because of traumatic intracerebral hemorrhage, subarachnoid hemorrhage due to a ruptured anterior communicating artery, and subarachnoid hemorrhage with unknown cause respectively. All patients underwent emergency brain surgery for diagnosis and treatment. After surgery, they all experienced long-term bed rest in intensive care unit. Hematochezia occurred on postoperative day 15, 17, and 49, respectively. DIAGNOSES: All of the patients were assessed by abdomen/pelvis computed tomography and underwent a colonoscopy. INTERVENTIONS: The female patient underwent embolization through pelvic arteriography and epinephrine injection through colonoscopy, but a total colectomy and ileostomy was performed due to refractory hematochezia. 58-year-old male patient had a laparoscopic ileostomy for the bowel rest. The other patient underwent nil per os and conservative treatment for 2 weeks. OUTCOMES: The female patient was discharged without further treatment plan, 58-year-old male patient survived after laparoscopic ileostomy, while the other patient survived after 2 weeks of nil per os. LESSON: Abdominal symptoms, such as hematochezia, should be actively managed in neurosurgical patients who are undergoing long-term bed rest in an intensive care unit under physiologically stressful medical conditions.


Assuntos
Repouso em Cama/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
20.
Bone Joint J ; 102-B(9): 1113-1121, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862675

RESUMO

AIMS: We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately. METHODS: PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures. RESULTS: A total of 18 studies corresponding to 16 non-overlapping RCTs with a total of 2,819 intracapsular hip fractures were included. Comparing contemporary cemented versus uncemented hemiarthroplasty, RRs (95% CIs) for mortality were 1.32 (0.44 to 3.99) perioperatively, 1.01 (0.48 to 2.10) at 30 days, and 0.90 (0.71 to 1.15) at one year. The use of contemporary cemented hemiarthroplasty reduced the risk of intra- and postoperative periprosthetic fracture. There were no significant differences in the risk of other complications, function, pain, and quality of life. There were no significant differences in perioperative outcomes except for increases in operating time and overall anaesthesia for contemporary cemented hemiarthroplasty with mean differences (95% CIs) of 6.67 (2.65 to 10.68) and 4.90 (2.02 to 7.78) minutes, respectively. The morbidity and mortality outcomes were not significantly different between non-contemporary cemented and uncemented hemiarthroplasty. CONCLUSION: There are no differences in the risk of mortality when comparing the use of contemporary cemented with uncemented hemiarthroplasty in the management of intracapsular hip fractures. Contemporary cemented hemiarthroplasty is associated with a substantially lower risk of intraoperative and periprosthetic fractures. Cite this article: Bone Joint J 2020;102-B(9):1113-1121.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos , Hemiartroplastia/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Humanos , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Resultado do Tratamento
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