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1.
Bone Joint J ; 102-B(1): 5-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888369

RESUMO

AIMS: Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery. METHODS: A total of 20 consecutive patients with AIS were treated with ION corrective spinal surgery. Both qualitative and quantitative analysis was performed with real-time modifications. Operating time, scan time, dose length product (measure of CT radiation exposure), use of fluoroscopy, the influence of the reference frame, blood loss, and neuromonitoring were assessed. RESULTS: The greatest gains in productivity were in avoiding repeat intraoperative scans (a mean of 248 minutes for patients who had two scans, and a mean 180 minutes for those who had a single scan). Optimizing accuracy was the biggest factor influencing this, which was reliant on incremental changes to the operating setup and technique. CONCLUSION: The application of lean principles to the introduction of ION for AIS surgery helps assimilate this method into the environment of the operating theatre. Data and stakeholder analysis identified a reproducible technique for using ION for AIS surgery, reducing operating time, and radiation exposure. Cite this article: Bone Joint J. 2020;102-B(1):5-10.


Assuntos
Neuronavegação/métodos , Escoliose/cirurgia , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parafusos Ósseos/estatística & dados numéricos , Desenho de Equipamento , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Bloqueadores Neuromusculares/administração & dosagem , Neuronavegação/instrumentação , Duração da Cirurgia , Posicionamento do Paciente , Doses de Radiação , Resultado do Tratamento
2.
BJOG ; 127(1): 99-105, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31502397

RESUMO

OBJECTIVE: To evaluate if the intraoperative human papillomavirus (IOP-HPV) test has the same prognostic value as the HPV test performed at 6 months after treatment of high-grade squamous intraepithelial lesion (HSIL) to predict treatment failure. DESIGN: Prospective cohort study. SETTING: Barcelona, Spain. POPULATION: A cohort of 216 women diagnosed with HSIL and treated with loop electrosurgical excision procedure (LEEP). METHODS: After LEEP, an HPV test was performed using the Hybrid Capture 2 system. If this was positive, genotyping was performed with the CLART HPV2 technique. The IOP-HPV test was compared with HPV test at 6 months and with surgical margins. MAIN OUTCOME MEASURE: Treatment failure. RESULTS: Recurrence rate of HSIL was 6%. There was a strong association between a positive IOP-HPV test, a positive 6-month HPV test, positive HPV 16 genotype, positive surgical margins and HSIL recurrence. Sensitivity, specificity, and positive and negative predictive values of the IOP-HPV test were 85.7, 80.8,24.0 and 98.8% and of the HPV test at 6 months were 76.9, 75.8, 17.2 and 98.0%. CONCLUSION: Intraoperative HPV test accurately predicts treatment failure in women with cervical intraepithelial neoplasia grade 2/3. This new approach may allow early identification of patients with recurrent disease, which will not delay the treatment. Genotyping could be useful in detecting high-risk patients. TWEETABLE ABSTRACT: IOP-HPV test accurately predicts treatment failure in women with CIN 2/3.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Detecção Precoce de Câncer/métodos , Eletrocirurgia , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/cirurgia , Adulto , Alphapapillomavirus , Biomarcadores Tumorais/metabolismo , Neoplasia Intraepitelial Cervical/virologia , Colposcopia/estatística & dados numéricos , Feminino , Genótipo , Testes de DNA para Papilomavírus Humano/métodos , Humanos , Biópsia Guiada por Imagem , Cuidados Intraoperatórios/métodos , Recidiva Local de Neoplasia/virologia , Estudos Prospectivos , Sensibilidade e Especificidade , Falha de Tratamento , Neoplasias do Colo do Útero/virologia
3.
Medicine (Baltimore) ; 98(44): e17767, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689838

RESUMO

The aim of this study was to evaluate the efficacy and safety of prophylactic intraoperative bilateral uterine or internal iliac artery embolization in planned cesarean for pernicious placenta previa in the third trimester of pregnancy.The patients with pernicious placenta previa were retrospectively included from January 2011 to May 2018, being divided into embolization group and control group. Intraoperative uterine artery embolization (UAE) or internal iliac artery embolization (IIAE) was undertaken to stop intrapartum and postpartum hemorrhage in embolization group.There were no significant differences on age, pregnancy times, gestational age, neonatal weight, neonatal asphyxia, prenatal bleeding, placental implantation, and mortality between embolization group and control group (P > .05). The amount of intraoperative and postoperative bleeding in embolization group was significantly greater than that in control group (P < .05). However, the hysterectomy rate in the embolization group was significantly lower than that in the control group (P < .05). Two (6.25%, 2/32) cases had undergone the second time embolotherapy after 8 hours of cesarean surgery because of severe vaginal bleeding. One case (3.13%, 1/32) died of diffuse intravascular coagulation because of hemorrhagic shock in embolization group. Transient and self-remitted lumbosacral pain was present in 28 (95%, 28/32) patients and no other severe interventional complications were reported in embolization group. All babies in 2 groups were healthy at half to 5 years' follow-up.The prophylactic intraoperative embolization of bilateral UAE or IIAE may be an effective strategy to treat intractable peripartum hemorrhage and preserve the fertility in patients with pernicious placenta previa.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/efeitos adversos , Cuidados Intraoperatórios/métodos , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Embolização da Artéria Uterina/métodos , Adulto , Feminino , Humanos , Artéria Ilíaca/cirurgia , Gravidez , Terceiro Trimestre da Gravidez , Procedimentos Cirúrgicos Profiláticos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Artéria Uterina/cirurgia
4.
Anticancer Res ; 39(10): 5761-5765, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570479

RESUMO

BACKGROUND/AIM: To clarify the usefulness of intraoperative colonoscopy (CS) for preventing postoperative anastomotic leakage and bleeding in rectal cancer surgery. PATIENTS AND METHODS: The data of rectal cancer patients who underwent circular-stapled anastomosis from January 2008 to December 2016 were compared between 162 patients who received intraoperative CS (the CS group) and 23 patients who did not receive intraoperative CS (the non-CS group). RESULTS: Anastomotic leakage rate in the CS group (8.6%) was similar to that in the non-CS group (4.3%) (p=0.70). Postoperative anastomotic bleeding rate was also similar between the CS and non-CS groups (2.4% vs. 0%, p=0.50). Although a positive air leak test was observed in two patients in the CS group, no postoperative leakage developed by adding intraoperative treatment. CONCLUSION: Although intraoperative CS did not significantly reduce the incidence of postoperative anastomotic leakage or bleeding, it can be useful for certain cases.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Colonoscopia/métodos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos
5.
Br J Anaesth ; 123(6): 898-913, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31587835

RESUMO

Postoperative pulmonary complications (PPCs) occur frequently and are associated with substantial morbidity and mortality. Evidence suggests that reduction of PPCs can be accomplished by using lung-protective ventilation strategies intraoperatively, but a consensus on perioperative management has not been established. We sought to determine recommendations for lung protection for the surgical patient at an international consensus development conference. Seven experts produced 24 questions concerning preoperative assessment and intraoperative mechanical ventilation for patients at risk of developing PPCs. Six researchers assessed the literature using questions as a framework for their review. The modified Delphi method was utilised by a team of experts to produce recommendations and statements from study questions. An expert consensus was reached for 22 recommendations and four statements. The following are the highlights: (i) a dedicated score should be used for preoperative pulmonary risk evaluation; and (ii) an individualised mechanical ventilation may improve the mechanics of breathing and respiratory function, and prevent PPCs. The ventilator should initially be set to a tidal volume of 6-8 ml kg-1 predicted body weight and positive end-expiratory pressure (PEEP) 5 cm H2O. PEEP should be individualised thereafter. When recruitment manoeuvres are performed, the lowest effective pressure and shortest effective time or fewest number of breaths should be used.


Assuntos
Cooperação Internacional , Pneumopatias/prevenção & controle , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Respiração Artificial/métodos , Humanos , Cuidados Intraoperatórios/métodos
6.
Medicine (Baltimore) ; 98(39): e17316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574861

RESUMO

The purpose of this study was to investigate the effect of intraoperative positions in single-level (L4-5) transforaminal lumbar interbody fusion (TLIF) on segmental and overall lumbar lordosis (LL) in patients with lumbar degenerative disease. Thirty-eight consecutive patients who had undergone single-segment (L4-5) TLIF with 0° polyetheretherketone (PEEK) cage and pedicle screw fixation were evaluated. Twenty patients underwent surgery on the four-poster type frame with hip flexion at 30° (Group I) and 18 patients were operated on a Jackson spinal table to adjust their hip flexion to 0° (Group II). Preoperative standing, intraoperative prone, and postoperative standing lateral radiographs were obtained in each patient. The overall and segmental LL were analyzed according to the position in which the patients were placed for their operation and results compared between Groups I and II. Intraoperative intervertebral segmental LL at L4-5 and L5-S1 was increased in Group II than in Group I, whereas postoperative intervertebral segmental LL at L4-5 (fused level) was increased LL. In Group I intraoperative intervertebral segmental LL at L4-5 did not achieve sufficient lordosis, whereas postoperative intervertebral segmental LL at L3-4 was increased. The overall spinal alignment was unaffected by the decreased segmental LL in the fused level owing to the compensation of the upper adjacent segments. The more the hip was extended intraoperatively, the more the segmental lordosis increased in the lower lumbar spine. Thus, selecting the appropriate surgical table and hip position are very important. Underachievement of segmental lordosis leads to the acceleration of upper adjacent segment load.


Assuntos
Cuidados Intraoperatórios/métodos , Lordose , Vértebras Lombares , Mesas Cirúrgicas , Posicionamento do Paciente/métodos , Fusão Vertebral , Idoso , Feminino , Humanos , Lordose/diagnóstico , Lordose/fisiopatologia , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Amplitude de Movimento Articular , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Espondilolistese/cirurgia
7.
Jpn J Radiol ; 37(8): 605-611, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31256316

RESUMO

PURPOSE: A transomental hernia (TOH) is a rare type of internal hernia and is associated with a high strangulation rate and high mortality rate. Displacement of the transverse colon on computed tomography (CT) may be specific to a TOH and may facilitate an early diagnosis. The aim of this study was to verify the effectiveness of a novel approach assessing displacement of the transverse colon for the preoperative diagnosis of a TOH. MATERIALS AND METHODS: We retrospectively reviewed the CT and operative data of 113 patients who underwent surgery for small bowel obstruction (SBO) between 2011 and 2018. The proportion of transverse colon loops posterior to dilated intestinal loops (PTPI) was calculated. RESULTS: The patients were divided into a TOH group (n = 7) and other SBO group (n = 106). The median PTPI was significantly higher in the TOH group than in the other SBO group (67% [0-97%] vs. 0% [0-100%], Wilcoxon's test, p = 0.03). A receiver operating characteristic curve showed that when the PTPI was ≥ 57%, its sensitivity and specificity for a TOH were 71% and 94%, respectively. CONCLUSION: The PTPI is a reliable quantitative measure to distinguish a TOH from other types of SBOs.


Assuntos
Colo Transverso/diagnóstico por imagem , Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Cuidados Intraoperatórios/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Arch Orthop Trauma Surg ; 139(9): 1287-1292, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31209613

RESUMO

INTRODUCTION: The Kellgren-Lawrence score helps the orthopedic surgeon to classify the severity of knee osteoarthritis (OA) before total knee arthroplasty (TKA). There might be a discrepancy between subjective complaints of the patients and radiologically visible changes of the knee joint in many cases. In this context, we performed a prospective clinical study to compare the preoperative degree of knee OA using the Kellgren-Lawrence score with the intraoperative extent of cartilage damage during primary TKA. MATERIALS AND METHODS: A total of 251 primary TKA surgeries due to a primary knee OA were prospectively included. Preoperative Kellgren-Lawrence score was determined using standardized preoperative plain radiographs of three views; anteroposterior, lateral and skyline of the patella by a senior radiologist. Intraoperatively, in all cases, photographs of the medial, lateral, and patellofemoral joint compartments were taken. Using the International Cartilage Repair Society (ICRS) score, the degree of chondromalacia was assessed. Subsequently, correlation analysis was performed using the Pearson-Clopper 95% confidence interval (CI). RESULTS: There were higher intraoperative scores compared to the preoperative scores in 160 of all cases (63.7% of 251, 95% CI 57.5-69.7%). A mismatch of two score grade points was found in 8.4% (95% CI 5.3-12.5%). The most common mismatch was noted in patients with preoperative Kellgren-Lawrence score of 3 and an intraoperative score of 4 in 48.2% (95% CI 41.9-54.6%). CONCLUSIONS: The preoperative radiographs using Kellgren-Lawrence underestimate the severity of knee osteoarthritis. The true extent of articular cartilage damage can be better appreciated intraoperatively. In patients undergoing primary TKA, the correlation of clinical symptoms with radiological findings is crucial in deciding when to perform the surgery. Besides, other imaging modalities may be used as an adjunct when the clinical findings and plain radiographs do not correlate.


Assuntos
Artroplastia do Joelho , Cartilagem Articular/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Humanos , Interpretação de Imagem Assistida por Computador , Cuidados Intraoperatórios/métodos , Osteoartrite do Joelho/classificação , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Fotografação , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Radiografia
9.
Acta Cytol ; 63(5): 424-430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31234167

RESUMO

BACKGROUND: Squash cytology is of significant importance in intraoperative consultation of central nervous system (CNS) pathology. There are several studies on squash cytology of CNS lesions, and only a few of them deal with spinal lesions alone. AIMS: (1) To evaluate intraoperative squash cytology of spinal lesions. (2) To correlate cytological diagnosis with histopathological diagnosis and assess the diagnostic accuracy. (3) To study Ki67 expression on squash smears and determine whether it can assist in grading spinal tumours on cytology. MATERIALS AND METHODS: A prospective study was conducted on 68 patients with clinico-radiologically diagnosed lesions of the spine. Intraoperative squash smears were stained with haematoxylin-eosin (H&E) stain, Papanicolaou (Pap) stain, and May-Grünwald-Giemsa (MGG) stain. Subsequently, histological diagnosis was made. Ki67 immunostaining was performed on squash smears and histology sections. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of squash cytology in spinal lesions were 84.6, 100, 100, 23.1, and 80.88%, respectively. On immunocytochemistry, the mean Ki67 labelling indices for grade I, II, and III tumours were 0, 0.33 and 9%, respectively. CONCLUSION: Squash smear cytology is a rapid intraoperative technique for diagnosing spinal lesions, with high specificity and high positive predictive value. It is more effective in diagnosing neoplasms than non-neoplastic lesions. Ki67 immunostaining can be done on cytology smears to effectively differentiate between WHO grade I and grade II spinal tumours.


Assuntos
Citodiagnóstico/métodos , Imuno-Histoquímica , Cuidados Intraoperatórios/métodos , Antígeno Ki-67/análise , Manejo de Espécimes/métodos , Neoplasias da Coluna Vertebral/química , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Adulto Jovem
10.
Eur Arch Otorhinolaryngol ; 276(7): 1995-1999, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161361

RESUMO

BACKGROUND: Bleeding during functional endoscopic sinus surgery always been a challenge for the quality of surgical field for surgeons. This study aimed to evaluate the effect of local nasal desmopressin premedication on blood loss and the quality of surgical field in functional endoscopic sinus surgery. METHODS: This study was conducted on 90 patients with chronic rhinosinusitis who were candidate for endoscopic sinus surgery. They were randomly assigned to two study groups. One group received a single puff of local desmopressin (10 µg) in each side of nasal cavity 30 min before the surgery and the other received normal saline instead. Blood loss and the quality surgical field were determined in 15, 30, 60 and 90 min during the surgery (scoring by BOEZAART grading system). All data were analyzed. RESULTS: Blood loss was significantly lesser in the desmopressin group (mean ± SD, 16.289 ± 5.605 ml) than in the control group (24.289 ± 5.2722 ml, P < 0.001).Surgeons were more satisfied with the surgical field in the desmopressin group than control group in all cutoff points (15, 30, 60, and 90 min during the surgery, P < 0.001). No side effects were observed using local desmopressin. CONCLUSIONS: Premedication with local desmopressin can reduce bleeding effectively and clear the surgical field during functional endoscopic sinus surgery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Desamino Arginina Vasopressina/administração & dosagem , Endoscopia , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Doença Crônica , Monitoramento de Medicamentos/métodos , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Hemostáticos/administração & dosagem , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Pré-Medicação/métodos , Resultado do Tratamento
11.
J Laryngol Otol ; 133(6): 477-481, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31172896

RESUMO

OBJECTIVE: Pre-operative imaging is often used to predict the extent of a cholesteatoma and anatomical variation to plan for surgery. This study aimed to measure the predictive accuracy of computed tomography findings. METHODS: A retrospective cohort study was conducted of all patients in a district general hospital undergoing mastoid surgery within a consecutive 12-month period, in whom computed tomography had been performed prior to operative intervention. The study measured the key findings of pre-operative computed tomography imaging and compared them to the intra-operative findings. RESULTS: A total of 106 patients were included. The sensitivity and specificity for predicting cholesteatoma were 79 per cent and 81 per cent respectively. The positive predictive value was 90 per cent and the negative predictive value was 65 per cent. In predicting complications of cholesteatomas, the sensitivity was 70 per cent, whereas the specificity was 91 per cent. The positive predictive value was 88 per cent and the negative predictive value was 76 per cent. CONCLUSION: Pre-operative computed tomography conducted prior to mastoid surgery has high positive predictive values for both predicting cholesteatomas and complications (90 per cent and 88 per cent respectively).


Assuntos
Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/cirurgia , Mastoidectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Hospitais Gerais , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Resultado do Tratamento
12.
J Craniofac Surg ; 30(4): e333-e335, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166278

RESUMO

In microsurgical head and neck reconstruction, a watertight closure following flap inset is essential to prevent saliva leakage and subsequent complications, such as wound dehiscence and fistulas. However, no standard method has been established to detect and localize the leakage following flap inset. The authors introduce a simple, easy, mobile, and inexpensive method to intraoperatively detect the leakage using topical fluorescein sodium mixed saline and Wood lamp. This simple procedure will allow surgeons to be confident of watertight closure.


Assuntos
Fluoresceína/administração & dosagem , Corantes Fluorescentes/administração & dosagem , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Administração Tópica , Humanos , Cuidados Intraoperatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos
13.
Braz J Med Biol Res ; 52(6): e8523, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31166383

RESUMO

This study aimed to observe the effects of lung-protective ventilation (LPV) on oxygenation index (OI) and postoperative pulmonary complications (PPCs) after laparoscopic radical gastrectomy in middle-aged and elderly patients. A total of 120 patients who were scheduled to undergo laparoscopic radical gastrectomy with an expected time of >3 h were randomly divided into conventional ventilation (CV group) with tidal volume (TV) of 10 mL/kg without positive end-expiratory pressure (PEEP), and lung-protective ventilation (PV group) with 7 mL/kg TV and personal level of PEEP with regular recruitment maneuver every 30 min. Measurements of OI, modified clinical pulmonary infection score (mCPIS), and PPCs were assessed during the perioperative period. Fifty-seven patients in the CV group and 58 in the PV group participated in the data analysis. Patients in the PV group showed better pulmonary dynamic compliance, OI, and peripheral capillary oxygen saturation during and after surgery. The mCPIS was significantly lower in the PV group than in the CV group after surgery. The incidence rate of PPCs was lower in the PV group than in the CV group and the difference was significant in patients whose ventilation time was longer than 6 h in both groups. LPV during laparoscopic radical gastrectomy significantly improved pulmonary oxygenation function and reduced postoperative mCPIS and the incidence of PPCs during the early period after surgery of middle-aged and elderly patients, especially patients whose mechanical ventilation time was longer than 6 h.


Assuntos
Gastrectomia/métodos , Cuidados Intraoperatórios/métodos , Laparoscopia/métodos , Pneumopatias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Troca Gasosa Pulmonar/fisiologia , Respiração Artificial/métodos , Idoso , Método Duplo-Cego , Feminino , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
J Laryngol Otol ; 133(6): 462-465, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159909

RESUMO

OBJECTIVE: This study was undertaken to determine the accuracy of the surgeon's assessment in detecting epithelial remnants over the malleus after de-epithelisation in tympanoplasty. METHODS: Intra-operatively, the umbo was assessed for epithelial remnants with the microscope. The umbo was then resected and sent for histopathological examination to detect epithelial remnants. RESULTS: Out of 42 cases, microscopic examination findings for epithelium were positive in 16 cases and negative in 26 cases. Histopathology findings were positive in 13 cases. The surgeons' assessment was accurate only in two cases. CONCLUSION: Residents, with their limited experience, are more likely to leave residual epithelium. When the chance of residual epithelium over the umbo is significant, the surgeon has two choices: to place the graft medial to the umbo or to resect the umbo. It is our opinion that the malleus exteriorisation should be incorporated into tympanoplasty training, with the aim of preventing epithelial entrapment in the middle ear.


Assuntos
Colesteatoma da Orelha Média/cirurgia , Cuidados Intraoperatórios/métodos , Martelo/patologia , Martelo/cirurgia , Perfuração da Membrana Timpânica/cirurgia , Timpanoplastia/métodos , Adolescente , Adulto , Biópsia por Agulha , Colesteatoma da Orelha Média/diagnóstico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Perfuração da Membrana Timpânica/diagnóstico , Timpanoplastia/efeitos adversos , Adulto Jovem
15.
J Urol ; 202(4): 763-769, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31059666

RESUMO

PURPOSE: Current guidelines recommend confirming a negative urethral margin prior to orthotopic neobladder reconstruction. We investigated our rate of urethral positive margins and recurrence in the absence of intraoperative frozen section. MATERIALS AND METHODS: We retrospectively reviewed clinical and pathological data on 357 patients who underwent radical cystectomy and orthotopic urinary diversion without intraoperative frozen section. At a median followup of 27 months the rates of positive urethral margins and urethral recurrence were tabulated. Differences in overall and recurrence-free survival in patients with a positive urethral margin were analyzed by Cox regression to generate the HR with the 95% CI. RESULTS: We identified 6 urethral recurrences (1.6%) during followup. The urethral recurrence rate was not higher in patients with a positive urethral margin (p=0.22). In the 15 patients with positive urethral margins overall survival was unchanged (HR 0.98, 95% CI 0.24-4.04). When accounting for lymph node staging, recurrence-free survival was not significantly worse in patients with positive urethral margins (HR 2.33, 95% CI 0.95-5.73). CONCLUSIONS: Omitting intraoperative frozen section prior to orthotopic neobladder reconstruction appears safe with a rate of urethral recurrence similar to that in historical series. It may allow for increased performance of orthotopic urinary diversions.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia , Secções Congeladas , Cuidados Intraoperatórios/métodos , Uretra/patologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adulto , Idoso , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Uretra/cirurgia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Coletores de Urina
16.
Surg Clin North Am ; 99(3): 419-437, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047033

RESUMO

Multimodality therapy is the standard of care for locoregional esophageal cancers (greater than clinical T3 or Nþ), including Siewert type 1 and 2 gastroesophageal junction tumors. Induction regimen, chemotherapy only or chemoradiation, is an area of controversy and often institution-specific, as neither has shown to be superior. Response to induction therapy is an important prognostic marker. For esophageal squamous cell carcinoma, it may be acceptable to observe clinical complete responders after chemoradiotherapy and perform salvage esophagectomy for recurrent disease. Clinical T2N0 esophageal cancer presents a unique challenge given its inaccuracy in clinical staging; management of this particular subset is controversial.


Assuntos
Adenocarcinoma/terapia , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/terapia , Junção Esofagogástrica , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia Adjuvante/métodos , Quimioterapia Adjuvante , Ensaios Clínicos como Assunto , Terapia Combinada/métodos , Humanos , Cuidados Intraoperatórios/métodos
17.
BMC Cancer ; 19(1): 430, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072314

RESUMO

BACKGROUND: The spine is the most frequent location of bone metastases. Local treatment aims at palliation of pain and, given the increased likelihood of long-term cancer survival, at local control. Kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provided instantaneous pain relief in 70% of patients at the first day after the intervention and resulted in local control rates of > 93% at 1 year in a recently conducted phase I/II trial. To assess its clinical value, we designed a phase III trial which tests Kypho-IORT against the most widespread standard-of-care, external beam radiotherapy (EBRT), in patients with painful vertebral metastases. METHODS: This phase III study includes patients ≥50 years of age with up to 4 vertebral metastases and a pain score of at least 3/10 points on the visual/numeric analogy scale (VAS). Patients randomized into the experimental arm (A) will undergo Kypho-IORT (Kyphoplasty plus IORT with 8 Gy prescribed to 13 mm depth). Patients randomized into the control arm (B) will receive EBRT with either 30 Gy in 10 fractions or 8 Gy as a single dose. The primary end point is pain reduction defined as at least - 3 points on the VAS compared to baseline at day 1. Assuming that 40% of patients in the Kypho-IORT arm and 5% of patients in the control arm will achieve this reduction and 20% will drop out, a total of 54 patients will have to be included to reach a power of 0.817 with a two-sided alpha of 0.05. Secondary endpoints are evaluation of the percentage of patients with a pain reduction of at least 3 points at 2 and 6 weeks, local tumor control, frequency of re-intervention, secondary fractures/sintering, complication rates, skin toxicity/wound healing, progression-free survival (PFS), overall survival (OS) and quality of life. DISCUSSION: This trial will generate level 1 evidence on the clinical value of a one-stop procedure which may provide instantaneous pain relief, long-term control and shortened intervals to further adjuvant (systemic) therapies in patients with spinal metastases. TRIAL REGISTRATION: Registered with ClinicalTrials.gov, number: NCT02773966 (Registration date: 05/16/2016).


Assuntos
Dor do Câncer/terapia , Cuidados Intraoperatórios/métodos , Cifoplastia/métodos , Manejo da Dor/métodos , Neoplasias da Coluna Vertebral/terapia , Dor do Câncer/diagnóstico , Dor do Câncer/etiologia , Ensaios Clínicos Fase III como Assunto , Terapia Combinada/métodos , Fracionamento da Dose de Radiação , Humanos , Pessoa de Meia-Idade , Medição da Dor , Intervalo Livre de Progressão , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral/efeitos da radiação , Coluna Vertebral/cirurgia
18.
Anaesthesia ; 74(6): 793-800, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30950522

RESUMO

Intra-operative remifentanil is associated with increased postoperative analgesic requirements and opioid consumption. Dexmedetomidine has characteristics suggesting it may substitute for intra-operative remifentanil during general anaesthesia, but existing literature has reported conflicting results. We undertook this meta-analysis to investigate whether general anaesthesia including dexmedetomidine would result in less postoperative pain than general anaesthesia including remifentanil. The MEDLINE and PubMed electronic databases were searched up to October 2018. Only randomised trials including patients receiving general anaesthesia and comparing dexmedetomidine with remifentanil administration were included. Meta-analyses were performed mostly employing a random effects model. The primary outcome was pain score at rest (visual analogue scale, 0-10) at two postoperative hours. The secondary outcomes included: pain score at rest at 24 postoperative hours; opioid consumption at 2 and 24 postoperative hours; and rates of hypotension, bradycardia, shivering and postoperative nausea and vomiting. Twenty-one randomised trials, including 1309 patients, were identified. Pain scores at rest at two postoperative hours were lower in the dexmedetomidine group, with a mean difference (95%CI) of -0.7 (-1.2 to -0.2), I2  = 85%, p = 0.004, and a moderate quality of evidence. Secondary pain outcomes were also significantly better in the dexmedetomidine group. Rates of hypotension, shivering and postoperative nausea and vomiting were at least twice as frequent in patients who received remifentanil. Time to analgesia request was longer, and use of postoperative morphine and rescue analgesia were less, with dexmedetomidine, whereas episodes of bradycardia were similar between groups. There is moderate evidence that intra-operative dexmedetomidine during general anaesthesia improves pain outcomes during the first 24 postoperative hours, when compared with remifentanil, with fewer side effects.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Dexmedetomidina/uso terapêutico , Cuidados Intraoperatórios/métodos , Dor Pós-Operatória/tratamento farmacológico , Remifentanil/uso terapêutico , Analgesia/métodos , Anestesia Geral/métodos , Humanos
19.
J BUON ; 24(1): 391-396, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30941996

RESUMO

PURPOSE: Peritoneal mesothelioma is a rare disease that remains confined to the peritoneal surfaces for long. Cytoreductive surgery (CRS) combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) is the most effective treatment and complete cytoreduction is the most significant prognostic indicator of long-term survival. This study attempted to present the results of CRS in combination with hyperthermic intraperitoneal chemotherapy in patients with peritoneal mesothelioma and identify the prognostic indicators of survival. METHODS: The files of patients with peritoneal mesothelioma were retrospectively reviewed. Morbidity, hospital mortality, recurrences, and the sites of recurrence were recorded. Survival and recurrence were correlated to performance status, age, extent of peritoneal dissemination, tumor grade, tumor volume, and completeness of cytoreduction. RESULTS: From 2005-2017, 29 patients underwent 33 cytoreductions for peritoneal mesothelioma. Hospital mortality and morbidity were 3% and 27.3% respectively. The median and 8-year survival were 66 and 62% months, respectively. The completeness of cytoreduction was the single prognostic indicator of survival, and the tumor grade the single prognostic indicator of recurrence. CONCLUSION: CRS combined with HIPEC is the therapeutic strategy that may provide long-term survival.


Assuntos
Mesotelioma/terapia , Neoplasias Peritoneais/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Hipertermia Induzida/métodos , Cuidados Intraoperatórios/métodos , Masculino , Mesotelioma/mortalidade , Mesotelioma/patologia , Pessoa de Meia-Idade , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/patologia , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
20.
Int J Clin Pract ; 73(6): e13338, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30829429

RESUMO

BACKGROUND: Moderate to severe pain is common despite the use of potent opioids during craniotomies. Non-opioid agents such as dexmedetomidine reduce undesirable opioid effects and are successfully used as primary analgesic during bariatric surgeries. This study assessed the feasibility of conducting a large randomised controlled trial comparing fentanyl with dexmedetomidine for perioperative analgesia during craniotomy. METHODS: This was a prospective single-centre randomised controlled feasibility trial. Twenty-four consenting adult patients undergoing supratentorial craniotomy at NIMHANS, Bangalore, India, were recruited after ethical approval in March and April 2018. They received either fentanyl 1 µg kg-1  h-1 (n = 12) or dexmedetomidine 0.5  µg kg-1  h-1 (n = 12) as primary intraoperative analgesic drug. Patient, anaesthesiologist, outcome assessor and data analyst were blinded to the study intervention. Our feasibility outcomes (primary) were recruitment and adherence rates. We also explored the potential efficacy of intervention and adverse events. RESULTS: We recruited 24 out of 30 eligible patients and had 100% protocol adherence, thereby demonstrating the feasibility of a larger randomised controlled trial. All 24 patients completed the study. The demographic and clinical parameters were similar between the groups. Compared between fentanyl and dexmedetomidine, there was no difference in the intraoperative fentanyl (top-up) consumption (µg), expressed as median and interquartile range: 25 (0-50) and 0 (0-50); P = 0.844; and no difference in postoperative pain at 15 and 60 minutes. Adverse events were few and similar with fentanyl and dexmedetomidine. CONCLUSIONS: A large-scale randomised controlled trial of perioperative dexmedetomidine versus fentanyl is feasible. Dexmedetomidine has the potential to be non-inferior to fentanyl for perioperative analgesia during craniotomies.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Craniotomia , Dexmedetomidina/uso terapêutico , Fentanila/uso terapêutico , Cuidados Intraoperatórios/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Método Duplo-Cego , Esquema de Medicação , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento
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