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1.
Trials ; 22(1): 610, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503565

RESUMO

BACKGROUND: Postoperative ileus (POI) occurs in almost all patients after abdominal laparoscopic surgery, resulting in complications and increasing the length of hospitalization. Electroacupuncture has been used as an alternative therapy for gastrointestinal dysfunction, but its efficacy for POI is inconclusive. The study is designed to determine whether electroacupuncture can accelerate recovery from POI. METHODS/DESIGN: This study is a three-arm, randomized controlled trial. A total of 105 patients will be randomized into a group receiving electroacupuncture at Tianshu (ST25), a group receiving electroacupuncture at Zusanli (ST36), or a control group in a 1:1:1 ratio. Patients in the electroacupuncture groups will receive electroacupuncture treatment for 4 days from the first day after surgery. The primary outcome consists of the time to first flatus and the time to first defecation. Secondary outcomes include the time to first tolerance of liquid and semiliquid food; the length of the hospital stay; postoperative pain, nausea, and vomiting; abdominal distension; the time to first get out of bed; and postoperative complications. The outcomes will be assessed by the patients themselves every day during hospitalization. Surgeons, nurses, assessors, and statisticians will be blinded to the group assignments. Patients in the two electroacupuncture groups, but not in the control group, will be blinded to the group assignments. The acupuncturists will not be blinded. DISCUSSION: The aim of this trial is to provide a nonpharmacological therapy for POI and may provide evidence of the effect of electroacupuncture at ST25 or ST36 on POI. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900027466 . Registered on 14 November 2019.


Assuntos
Neoplasias Colorretais , Eletroacupuntura , Íleus , Laparoscopia , Eletroacupuntura/efeitos adversos , Humanos , Íleus/diagnóstico , Íleus/etiologia , Íleus/terapia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Int J Mol Sci ; 22(15)2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34360975

RESUMO

Liver transplantation has been identified as the most effective treatment for patients with end-stage liver diseases. However, hepatic ischemia reperfusion injury (IRI) is associated with poor graft function and poses a risk of adverse clinical outcomes post transplantation. Cell death, including apoptosis, necrosis, ferroptosis and pyroptosis, is induced during the acute phase of liver IRI. The release of danger-associated molecular patterns (DAPMs) and mitochondrial dysfunction resulting from the disturbance of metabolic homeostasis initiates graft inflammation. The inflammation in the short term exacerbates hepatic damage, leading to graft dysfunction and a higher incidence of acute rejection. The subsequent changes in the graft immune environment due to hepatic IRI may result in chronic rejection, cancer recurrence and fibrogenesis in the long term. In this review, we mainly focus on new mechanisms of inflammation initiated by immune activation related to metabolic alteration in the short term during liver IRI. The latest mechanisms of cancer recurrence and fibrogenesis due to the long-term impact of inflammation in hepatic IRI is also discussed. Furthermore, the development of therapeutic strategies, including ischemia preconditioning, pharmacological inhibitors and machine perfusion, for both attenuating acute inflammatory injury and preventing late-phase disease recurrence, will be summarized in the context of clinical, translational and basic research.


Assuntos
Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/metabolismo , Disfunção Primária do Enxerto/metabolismo , Animais , Humanos , Precondicionamento Isquêmico/métodos , Fígado/irrigação sanguínea , Fígado/metabolismo , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/terapia , Disfunção Primária do Enxerto/tratamento farmacológico , Disfunção Primária do Enxerto/terapia , Prostaglandinas/uso terapêutico
3.
Medicine (Baltimore) ; 100(27): e26572, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232202

RESUMO

CONTEXT: There are no scientific reports unambiguously describing the efficacy of alternating magnetic field therapy in patients after anterior cruciate ligament (ACL) reconstruction in the early postoperative period. OBJECTIVE: This study aims to evaluate the efficacy of using an alternating magnetic field in the resorption of postoperative joint effusion in patients after ACL reconstruction. STUDY DESIGN: A randomized, double-blind placebo-controlled study. SETTING: Inpatients. PARTICIPANTS: Forty patients were enrolled in the trial. However, the final study group consisted of 38 patients (28 men and 10 women) after ACL reconstruction who were randomly divided into an experimental group (19 patients) and a control group (19 patients). INTERVENTION: Each group received magnetic field therapy in the postoperative period, but only 1 apparatus emitted a magnetic field (the experimental group). Patients used the apparatus every day for 30 minutes for the next 11 days. The parameters in both devices were the same-3 mT and 10 Hz. MAIN OUTCOME MEASURES: The measurement of the knee circumference and range of motion were made. The knee circumference measurement was performed before magnetic field therapy began and for 11 days after magnetic field treatment. The active knee range of motion was evaluated before and after magnetic field therapy was completed. RESULTS: There were no statistically significant differences between the groups in the reduction of post-operative joint effusion or knee joint function. CONCLUSION: In patients after ACL reconstruction, in whom an alternating magnetic field was used to treat postoperative joint effusion, there were no beneficial effects on the analyzed variables compared to the control group.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Articulação do Joelho/cirurgia , Campos Magnéticos , Complicações Pós-Operatórias/terapia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Adulto Jovem
4.
J Clin Neurosci ; 90: 256-261, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275559

RESUMO

OBJECTIVE: Severe intracranial atherosclerotic stenosis has become one of the main causes resulting transient ischemic attack and stroke. This study aimed to evaluate the efficacy and safety of low profile visualized intraluminal support (LVIS) stent in treating symptomatic intracranial atherosclerotic stenosis. METHODS: Data of 31 patients with at least 70% stenosis treated with LVIS stent in our center were retrospectively collected between July 2017 and November 2020. Further evaluation of lesion characteristics, technical success rate, preoperative complication, clinical and angiographic follow-up outcome, delayed in-stent stenosis were conducted. RESULTS: Stent delivery and deployment were successfully achieved in all 31 patients (100%). 22 cases (71%) were located in anterior circulation and 9 cases (29%) were located in posterior circulation. The mean degree of stenosis lesion before stent deployment was 85.6 ±â€¯9.4%, while after stenting was 11.2 ±â€¯11.8%. One patient suffered from ischemic complication in stenting procedure, and timely delivery of rt-PA successfully recanalized the artery. Clinical follow-up was available in all 31patients (100%) with mean follow-up time 15.0 ±â€¯12.1(3-45) months. No patients experienced the recurrence of stroke or TIA or death after discharge. Angiographic follow-up was available in 21patients (67.7%) with mean follow-up time 11.43 ±â€¯6.8 (6-36) months. 19 patients (90.5%) were stable while 2 patients (9.5%) developed ISR in their last angiographic follow-up. The 2 patients received balloon angioplasty and reached satisfactory results after retreatment. CONCLUSION: This preliminary study suggests that LVIS stent deployment was a feasible approach in treating intracranial atherosclerotic stenosis with satisfactory procedure success rate, low complication rate and favorable long-term outcome.


Assuntos
Procedimentos Endovasculares/métodos , Arteriosclerose Intracraniana/cirurgia , Stents , Adulto , Idoso , Angioplastia com Balão , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Angiografia Cerebral , Circulação Cerebrovascular , Constrição Patológica , Feminino , Seguimentos , Oclusão de Enxerto Vascular , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do Tratamento
5.
Mayo Clin Proc ; 96(7): 1845-1860, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34218859

RESUMO

OBJECTIVE: To evaluate the effects of female sex on in-hospital outcomes and to provide estimates for sex-specific prediction models of adverse outcomes following left atrial appendage closure (LAAC). PATIENTS AND METHODS: Cohort-based observational study querying the National Inpatient Sample database between October 1, 2015, and December 31, 2017. Demographics, baseline characteristics, and comorbidities were assessed with the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index score (ECS), and CHA2DS2-VASc score. The primary outcome was in-hospital major adverse events (MAEs) defined as the composite of bleeding, vascular, cardiac complications, post-procedural stroke, and acute kidney injury. The associations of the CCI, ECS, and CHA2DS2-VASc score with in-hospital MAE were examined using logistic regression models for women and men, respectively. RESULTS: A total of 3294 hospitalizations were identified, of which 1313 (40%) involved women and 1981 (60%) involved men. Women were older (76.3±7.7 vs 75.2±8.4 years, P<.001), had a higher CHA2DS2-VASc score (4.9±1.4 vs 3.9±1.4, P<.001) but showed lower CCI and ECS compared with men (2.1±1.9 vs 2.3±1.9, P=.01; and 9.3±5.9 vs 9.9±5.7, P=.002, respectively). The primary composite outcome occurred in 4.6% of patients and was higher in women compared with men (women 5.6% vs men 4.0%, P=.04), and this was mainly driven by the occurrence of cardiac complications (2.4% vs 1.2%, P=.01). In women, older age, higher median income, and higher CCI (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.21 to 1.44; P<.001), ECS (aOR, 1.04; 95% CI, 1.02 to 1.07; P=.002), and CHA2DS2-VASc score (aOR, 1.24; 95% CI, 1.10 to 1.39; P<.001) were associated with increased risk of in-hospital MAE. In men, non-White race/ethnicity, lower median income, and higher ECS (aOR, 1.06; 95% CI, 1.04 to 1.09; P<.001) were associated with increased risk of in-hospital MAE. CONCLUSION: Women had higher rates of in-hospital adverse events following LAAC than men did. Women with older age and higher median income, CCI, ECS, and CHA2DS2-VASc scores were associated with in-hospital adverse events, whereas men with non-White race/ethnicity, lower median income, and higher ECS were more likely to experience adverse events. Further research is warranted to identify sex-specific, racial/ethnic, and socioeconomic pathways during the patient selection process to minimize complications in patients undergoing LAAC.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial , Procedimentos Cirúrgicos Cardíacos , Hospitalização/estatística & dados numéricos , Complicações Pós-Operatórias , Implantação de Prótese/instrumentação , Acidente Vascular Cerebral , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Regras de Decisão Clínica , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Risco Ajustado/métodos , Medição de Risco/métodos , Dispositivo para Oclusão Septal , Fatores Sexuais , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
6.
Am J Cardiol ; 154: 41-47, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34256942

RESUMO

Saphenous vein grafts are imperfect yet indispensable conduits commonly used for coronary artery bypass grafting. Their degeneration ultimately leading to occlusion results from the pathological response of the vein to altered blood rheology and several types of vascular injury. Surgical techniques minimizing vessel damage, and prolonged antiplatelet and lipid-lowering treatment are established methods of mitigating the degeneration process hence preventing graft occlusions. Percutaneous interventions in degenerated vein grafts carry high risk of embolization, periprocedural myocardial infarction and restenosis. Thus, native vessel should be the preferred treatment target in case of graft failure whenever technically feasible.


Assuntos
Aterosclerose/prevenção & controle , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Veia Safena/transplante , Trombose/prevenção & controle , Aterosclerose/fisiopatologia , Aterosclerose/terapia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/terapia , Humanos , Hipolipemiantes/uso terapêutico , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Recidiva , Trombose/fisiopatologia , Trombose/terapia
8.
Ann Emerg Med ; 78(3): 409-415, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34148664

RESUMO

Patients who undergo gender-affirming genital surgeries may present to the emergency department for their postsurgical complications. In this paper, we briefly describe the transfeminine and transmasculine genital procedures, review the diagnosis and management of both common and potentially life-threatening complications, and discuss the criteria for hospitalization and time frame for surgical consultation and referral.


Assuntos
Genitália/cirurgia , Complicações Pós-Operatórias/terapia , Cirurgia de Readequação Sexual/efeitos adversos , Medicina de Emergência/educação , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Cirurgia de Readequação Sexual/métodos
9.
J Surg Oncol ; 124(4): 492-509, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34091906

RESUMO

BACKGROUND AND OBJECTIVES: The transverse musculocutaneous gracilis (TMG) flap has gained popularity for breast reconstruction. However, the literature regarding its donor site morbidity is heterogeneous. This systematic review sought to clarify the evidence on donor site morbidity. METHODS: A systematic literature search was conducted. We included all articles reporting on donor-site morbidity of the TMG flap for breast reconstruction. The results were analyzed in R and its extension meta. A generalized linear mixed model was used to combine proportions and their 95% confidence intervals (CIs) in a random-effects meta-analysis. RESULTS: Nineteen articles provided an overall sample of 843 TMG flaps. The total flap loss was low at 2% (95% CI, 1%-3%). All patients were normal weight (pooled body mass index 22.75, 95% CI, 21.88-23.63). The incidence of wound dehiscence (8%, 95% CI, 4%-16%), seroma (4%, 95% CI, 2%-7%), hematoma (2%, 95% CI, 1%-4%) and infection (0%-5%) on the TMG donor site was low. Functional impairments included sensory disturbance (0%-74%), motoric deficits (0%-50%), and changes in the genital region (0%-24%), all of which were modest. CONCLUSIONS: This review confirms the safety and low donor site morbidity of the TMG flap in normal-weight patients, which is comparable to that of other popular free flaps in breast reconstruction.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Retalho Miocutâneo/transplante , Complicações Pós-Operatórias/terapia , Retalhos Cirúrgicos/irrigação sanguínea , Doadores de Tecidos/estatística & dados numéricos , Sítio Doador de Transplante/fisiopatologia , Neoplasias da Mama/patologia , Feminino , Humanos , Mamoplastia/efeitos adversos , Retalho Miocutâneo/cirurgia , Complicações Pós-Operatórias/etiologia , Prognóstico , Sítio Doador de Transplante/cirurgia , Transplante Autólogo
10.
AJR Am J Roentgenol ; 217(2): 433-438, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34106766

RESUMO

OBJECTIVE. The purpose of this study is to evaluate the safety and efficacy of intranodal lymphangiography (INL) with high-dose ethiodized oil in patients with postoperative refractory chylothorax. MATERIALS AND METHODS. A retrospective review of a cohort of 18 patients with refractory postoperative chylothorax seen between May 2015 and March 2019 was conducted. All patients underwent intranodal lymphangiography with high doses of ethiodized oil (mean, 75 mL; range, 40-140 mL). The following information was gathered from the institutional database: patient demographics, type of surgery, output volumes, interval between surgery and lymphangiography, imaging results, amount of ethiodized oil injected, clinical success, and time to resolution. RESULTS. Of the 18 patients, 11 (61%) had previously undergone thoracic duct ligation, and seven (39%) had not. A lymphatic leak was confirmed by lymphangiography in 12 of 18 patients (67%). A total of five patients underwent a second session of INL, which was successful in three of the patients (60%). Removal of all chest tubes was possible in 15 of 18 patients (83%) after a mean of 12 days (range, 1-25 days). Two patients had an anastomotic leak develop after esophagectomy and died with their chest tubes in situ. One patient underwent thoracic duct ligation after two failed INL procedures. No complications were recorded. CONCLUSION. INL with a high dose of injected ethiodized oil is a safe and effective procedure for the management of postsurgical refractory chylothorax, with chest tube removal in 83% of patients.


Assuntos
Quilotórax/diagnóstico por imagem , Quilotórax/terapia , Óleo Etiodado/uso terapêutico , Linfografia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(23): e26074, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114991

RESUMO

ABSTRACT: To compare the clinical effect of Bulldog clamps with traditional Pringle for vascular occlusion during laparoscopic hepatectomy.One hundred ten patients were retrospectively investigated in this research from December 2014 to January 2019 in the second hospital of Anhui Medical University, who underwent laparoscopic liver resection using Bulldog (modified group, n = 54) and cotton tourniquet (traditional group, n = 56) for blocking the liver inflow-blood. Intraoperative blood loss, duration of the operation time, clamping time, postoperative outcomes were analyzed.All the operations were accomplished successfully without conversion to laparotomy, perioperative period clinical date was calculated. Intraoperative operative time, blood loss and resection sections had no statistical significance, but the clamping time (36.2 ±â€Š5.6 vs 277.3 ±â€Š88.4 s, P < .001) was significantly shorter in the bulldog group. Albumin, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin had no statistical differences in postoperative day (POD) 1and 3, but POD 5 alanine aminotransferase (71.0 ±â€Š46.8vs 105.8 ±â€Š61.7IU/L P = .018) and aspartate aminotransferase (72.8 ±â€Š39.7 vs 100.2 ±â€Š16.7 IU/L P = .028). The postoperative hospital stays (7.02 ±â€Š1.56 vs 8.50 ±â€Š2.35 days P = .026) in bulldog group were lower than cotton group and differences had statistical significance. The C-reactive protein levels were significantly higher in the traditional group than in the modified group on POD 3 (46.3 ±â€Š19.2 vs 57.7 ±â€Š23.9 mg/L P = .019), and POD5 (13.3 ±â€Š4.2 vs 17.5 ±â€Š7.3 mg/L P = .001). There were 8 postoperative complications occurred in cotton group, while there was 5 in Bulldog group, all patients with complications were discharged after adequate drainage and symptomatic treatment.Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle maneuver.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Carcinoma Hepatocelular , Hepatectomia , Laparoscopia , Neoplasias Hepáticas , Complicações Pós-Operatórias , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , China/epidemiologia , Constrição , Drenagem/métodos , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/instrumentação , Hepatectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Testes de Função Hepática/métodos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Torniquetes
12.
Medicine (Baltimore) ; 100(23): e26322, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115046

RESUMO

RATIONALE: Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery. PATIENT CONCERNS: A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16. DIAGNOSIS: Emergency brain computed tomography revealed massive pneumocephalus. INTERVENTIONS: Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol. OUTCOMES: Repeated computed tomography showed complete resolution of the pneumocephalus after five days. LESSONS: Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.


Assuntos
Neoplasias Ósseas , Descompressão Cirúrgica/efeitos adversos , Drenagem/efeitos adversos , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Vértebras Torácicas , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Descompressão Cirúrgica/métodos , Diuréticos Osmóticos/administração & dosagem , Drenagem/métodos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Manitol/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neuroimagem/métodos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Pneumocefalia/diagnóstico , Pneumocefalia/etiologia , Pneumocefalia/fisiopatologia , Pneumocefalia/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Reoperação/efeitos adversos , Reoperação/métodos , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
13.
Ann R Coll Surg Engl ; 103(7): 504-507, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192497

RESUMO

INTRODUCTION: Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia are conflicting, with some suggesting a high rate and other large cohorts in which no tracheomalacia is reported. The aim of our study was to assess the incidence and factors associated with tracheomalacia after thyroidectomy in patients with retrosternal goitres requiring sternotomy at a high-volume tertiary care referral centre. METHODS: A longitudinal cohort study was conducted from January 2011 to December 2019. All adult patients who underwent thyroidectomy with sternotomy were included. Tracheomalacia was considered when tracheal rings were soft compared with other parts (proximal or distal) of the trachea and required either tracheostomy or resection with anastomosis. The decision to perform a tracheostomy or to administer continuous or bilevel positive airway pressure postoperatively was made depending on the degree of tracheomalacia. Logistic regression analysis was used to assess factors associated with tracheomalacia. RESULTS: We evaluated 40 patients who underwent thyroidectomy with sternotomy. The mean age of our cohort was 48.7 ± 11.3 years and the population was predominantly female (67.5%). One patient required tracheal resection with anastomosis, and two patients required tracheostomy. Multivariable logistic regression analysis did not reveal any patient- or thyroid-related factor significantly associated with the development of tracheomalacia in our cohort. CONCLUSIONS: The incidence of tracheomalacia after thyroidectomy with sternotomy appears to be very low. However, the occurrence of tracheomalacia after thyroidectomy in cases of large goitre is possible and hence worrisome.


Assuntos
Bócio/cirurgia , Complicações Pós-Operatórias/epidemiologia , Esternotomia/efeitos adversos , Tireoidectomia/efeitos adversos , Traqueomalácia/epidemiologia , Adulto , Estudos Transversais , Feminino , Bócio/patologia , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Respiração com Pressão Positiva/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Esternotomia/métodos , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Traqueia/patologia , Traqueia/cirurgia , Traqueomalácia/diagnóstico , Traqueomalácia/etiologia , Traqueomalácia/terapia , Traqueostomia/estatística & dados numéricos
14.
Medicine (Baltimore) ; 100(24): e26332, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128877

RESUMO

BACKGROUND: Patients after breast cancer surgery have a high sense of stigma due to the formation of surgical scars, loss of breast shape or other reasons, leading to anxiety, depression, and other adverse mental health problems, thus reducing their quality of life. Remote peer support intervention based on telephone, internet or email is low-cost and easy to spread, and protects patients' privacy, solves the barriers to access that many patients face when attending face-to-face programs. Therefore, remote peer support may be an effective way to reduce stigma and improve mental health in patients after breast cancer surgery during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Eight databases (PubMed, Embase, Cochrane Library, CNKI, PsycNET, MEDLINE, Psychology & Behavioral Sciences Collection and Web of Science) will be used to select eligible studies that were published from inception to May, 2021. The eligible studies will be screened, extracted and then the methodological quality will be evaluated independently by 2 reviewers. Review manager software version 5.3 software and Stata version 14.0 software will be used for meta-analysis. RESULTS: The results of this study will show the effect of remote peer support on stigma, depression and anxiety in patients after breast cancer surgery during the COVID-19 pandemic and will be submitted to a peer-reviewed journal for publication. CONCLUSION: The results of this study will provide evidence for the effectiveness of remote peer support in patients after breast cancer surgery during the COVID-19 pandemic. PROSPERO REGISTRATION NUMBER: CRD42021255971.


Assuntos
Neoplasias da Mama/psicologia , Mastectomia/psicologia , Complicações Pós-Operatórias/terapia , Estigma Social , Apoio Social , Ansiedade/etiologia , Ansiedade/terapia , Neoplasias da Mama/cirurgia , COVID-19 , Depressão/etiologia , Depressão/terapia , Feminino , Humanos , Metanálise como Assunto , Grupo Associado , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Projetos de Pesquisa , SARS-CoV-2 , Revisões Sistemáticas como Assunto , Resultado do Tratamento
15.
Medicine (Baltimore) ; 100(25): e26372, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160410

RESUMO

RATIONALE: Idiopathic ventricular tachycardia (VT) occurs in individuals without structural abnormalities in the heart, accounts for approximately 10% of total VTs. Furthermore, approximately 70% of idiopathic VTs originate from Right ventricular outflow tract (RVOT). However, among perioperative arrhythmias, incidence of VT after surgery is extremely rare and most arrhythmias are atrial origin. PATIENT CONCERNS: A 69-year-old man with permanent pacemaker underwent colon surgery. DIAGNOSES: Patient suffered from low blood pressure and dizziness, sweating at post anesthetic care unit (PACU) and heart rate (HR) increased suddenly to 200 beats/min with monomorphic VT after bolus ephedrine administration and continuous dopamine infusion. INTERVENTIONS: Pacemaker interrogation followed by DC cardioversion was done. OUTCOMES: Patient's vital signs became normal and symptoms are subsided. LESSONS: RVOT VT can be caused by triggering activities, such as ephedrine, dopamine, and inadequate fluid management. These triggering activities are initiated by acceleration of HR from ventricles with infusion of catecholamine which lead monomorphic VT originating from RVOT.RVOT origin PVCs can be precipitated into monomorphic VT by administrating catecholamines such as ephedrine and dopamine even in patient with pacemaker. The mechanism of these VTs includes catecholamine induced acceleration of HR. Since RVOT PVCs can be recognize by 12 EKGs, we should be pay more attentions to the pre-operation EKG and be cautious using catecholamines.


Assuntos
Colectomia/efeitos adversos , Ventrículos do Coração/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Taquicardia Ventricular/diagnóstico , Idoso , Neoplasias do Colo/cirurgia , Ecocardiografia , Cardioversão Elétrica , Eletrocardiografia , Bloqueio Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Marca-Passo Artificial , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(25): e26426, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160431

RESUMO

INTRODUCTION: Esophagectomy is a major surgery with a high degree of catabolic and post-surgical inflammatory response accompanied by high morbidity and significant mortality. Post-surgical nutritional support via enteral administration of ω-3 fatty acids has been seen to be effective although its bad tolerance. There are few clinical trials with parenteral ω-3 fatty acids in these patients. We propose to investigate the effect of combining a parenteral fish oil lipid emulsion with the standard enteral nutrition (EN) support. MATERIALS AND METHODS: Prospective, single-center, randomized, double-blind study in esophagectomized patients, and treated after surgery with parenteral lipid emulsions of ω-3 fatty acids or a mixture of ω-6 long-chain triglycerides/short-chain triglycerides 50%. These emulsions will be added to the standard nutritional support in continuous infusion until 5 days of treatment have been completed. Patients will be randomized 1:1:1 in Group A receiving 0.4 g/kg/d of fish-oil lipid emulsion and 0.4 g/kg/d of a lipid emulsion mixture of ω-6 long-chain fatty acids (LCT) plus medium-chain fatty acids (MCT) (total dose of 0.8 g/kg/d of lipid emulsion); Group B receiving 0.8 g/kg/d of fish oil lipid emulsion and Group C receiving 0.8 g/kg/d of LCT/MCT emulsion.The main objective is to determine whether 5 days administration of intravenous ω-3 fatty acid lipid emulsion is effective in normalizing interleukin-6 levels compared with LCT/MCT emulsions, and whether a 0.8 g/kg/d dose is more effective than 0.4 g/kg/d. Secondary outcomes include other inflammatory markers such as C-reactive protein, tumor necrosis factor alpha and interleukin-10, and parameters of morbidity, safety, nutrition and mortality.Samples will be collected at the time when surgery is indicated and on days 0, 1, 3, 5 and 21 to determine inflammatory, nutritional, hepatic and safety parameters. In addition, clinical follow-up will be continued throughout the hospital admision and up to 1 year after surgery. DISCUSSION: Studies of ω-3 fatty acids administered parenterally in esophagectomized patients are scarce. This study proposes to investigate the effect of combining fish-oil lipid emulsions administered parenterally with EN support. Potential benefits include fast incorporation of lipids to the cellular membranes and to the inflammatory cascade, and the use of only 1 pharmaconutrient. TRIAL REGISTRATION: FAR-NP-2017-01 EudraCT number: 2016-004978-17.https://reec.aemps.es/reec/public/detail.html searching the EudraCT number. VERSION IDENTIFIER: Version 2, 08/06/2017.


Assuntos
Esofagectomia/reabilitação , Emulsões Gordurosas Intravenosas/administração & dosagem , Óleos de Peixe/administração & dosagem , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/terapia , Adulto , Terapia Combinada/métodos , Método Duplo-Cego , Nutrição Enteral , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Feminino , Humanos , Interleucina-6/sangue , Interleucina-6/imunologia , Masculino , Nutrição Parenteral/métodos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/imunologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
17.
Nutrients ; 13(5)2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-34063091

RESUMO

The prevalence of obesity is increasing globally, and along with it, there is a growing number of patients opting to undergo bariatric surgery to treat this condition. Whilst it has many advantages, bariatric surgery is known to induce micronutrient deficiency, with possible deleterious effects on overall health. This topic becomes even more relevant during pregnancy, where deficiencies can also affect the developing fetus, possibly being the cause of an increase in congenital anomalies. Most notably amongst these micronutrients is folate, or vitamin B9, which plays an essential role in development, gene expression and genomic stability. As insufficient levels of folate are associated with neural tube defects in the fetus, preventing and treating folate deficiencies during pregnancies after bariatric surgery is a relevant issue. Unfortunately, folate supplementation recommendations for bariatric patients who wish to become pregnant are not clear. In this narrative review, we discuss whether the recommendations for the general population are still valid for bariatric patients. Furthermore, we discuss the role of folate in the human body, folate status in both non-bariatric and bariatric patients, the various types of folate that are available for substitution and the risk associated with over-supplementation.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Micronutrientes/deficiência , Complicações Pós-Operatórias/terapia , Cuidado Pré-Concepcional/métodos , Feminino , Humanos , Defeitos do Tubo Neural/prevenção & controle , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Gravidez
19.
Medicine (Baltimore) ; 100(19): e25849, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106628

RESUMO

BACKGROUND: : Lumbar disc herniation (LDH) is a common disease in orthopedics. Surgery is shown to provide significant faster relief of pain compared to conservative therapy. However, due to the influence of surgical trauma, anesthesia and other perioperative stress factors, patients may have complications. Among them, postoperative fatigue syndrome (POFS) is a common complication. Traditional Chinese medicine or integrated traditional Chinese and Western medicine have been proved to be effective in improving postoperative fatigue. METHODS: : This study is a randomized controlled trial. One hundred eighty Chinese patients with POFS of LDH will be randomly divided into control group, experimental group 1, experimental group 2 and experimental group 3 according to the ratio of 1:1:1:1. The patients in the control group will be treated with conventional treatment after operation, the patients in the experimental group 1 will be treated with acupoint massage, the patients in the experimental group 2 will be treated with relaxation therapy, and the patients in the experimental group 3 will be treated with acupoint massage combined with relaxation therapy. The whole treatment will last for 5 days. The main outcome measures will be fatigue visual analogue scale and identity-consequence fatigue scale, and the secondary outcome measures will be hospital anxiety and depression scale. DISCUSSION: : This study is to observe the effects of acupoint massage comblined with relaxation therapy on reducing postoperative fatigue of lumbar disc herniation surgical patients. TRIAL REGISTRATION: : Chinese Clinical Trial Registry (http://www.chictr.org.cn/edit.aspx?pid=123978&htm=4), No. ChiCTR2100044788. Registered on March 27, 2021.


Assuntos
Fadiga/terapia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Massagem/métodos , Complicações Pós-Operatórias/terapia , Terapia de Relaxamento/métodos , Pontos de Acupuntura , Humanos
20.
Am J Cardiol ; 151: 45-50, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34030883

RESUMO

The prognosis of left circumflex (LC) versus non-LC in-stent restenosis (ISR) ostial lesions following treatment has not been assessed. We aimed to assess this prognosis. Anecdotally, treatment of ostial LC ISR has been associated with high recurrence rates. We performed a retrospective analysis of patients from our institution who underwent coronary intervention of an ostial ISR lesion between 2003 and 2018. The primary endpoint was target lesion revascularization (TLR) and major adverse cardiovascular events (MACE). Overall, 563 patients underwent ostial ISR lesion intervention, 144 for an ostial LC ISR lesion. Compared to patients with ostial ISR in non-LC lesions, patients with ostial LC ISR were older, had higher rates of diabetes mellitus and previous coronary bypass surgery. At 1-year follow-up, TLR-MACE rates were 26.6% in the LC group versus 18.4% in the non-LC group (p = 0.036). The TLR rate was also higher in the LC group compared to the non-LC group (p = 0.0498). Univariate and multivariate analyses demonstrated a higher TLR-MACE rate for LC versus non-LC ostial ISR lesions. In conclusion, our study shows increased event rates after treatment of LC versus non-LC ISR lesions. Further studies should be done to assess the optimal treatment approach for ostial LC ISR.


Assuntos
Angioplastia Coronária com Balão , Braquiterapia , Doença da Artéria Coronariana/cirurgia , Reestenose Coronária/terapia , Stents Farmacológicos , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/terapia , Idoso , Aterectomia Coronária , Feminino , Hemorragia/epidemiologia , Mortalidade Hospitalar , Humanos , Masculino , Metais , Infarto do Miocárdio/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Modelos de Riscos Proporcionais , Recidiva , Stents , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Ultrassonografia de Intervenção
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