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1.
Medicine (Baltimore) ; 99(2): e18710, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914080

RESUMO

The present study aimed to assess the effect of removing an indwelling urinary catheter at different times on urinary retention and urinary infection in patients undergoing gynecologic surgery.Electronic databases including PubMed, EMbase, the Cochrane Central Register of Controlled Trials, and Ovid from inception to June 2018 were searched. Relevant randomized controlled trials (RCTs) of removal the indwelling urinary catheter in different time were included.Eight RCTs were included. Data were analyzed by RevMan 5.3 version. There was significant difference in urinary retention (relative risk [RR] 2.46, 95% confidence intervals [CIs] 1.10-5.53), P = .03) between the ≤6 hours and >6 hours indwelling urinary catheter removal groups, while no significant differences were found in the gynecologic surgery excluded the vaginal surgery group and vaginal surgery group. When compared with >6 hours indwelling urinary catheter removal group, the incidence of urinary infection was significantly reduced at the ≤6 hours removal group (RR = 0.66, 95% CI 0.48-0.89, P = .007). The urinary catheter removal time at ≤6 hours also significantly reduced the incidence of urinary retention (RR = 5.06, 95%CI 1.74-14.69, P = .003), and did not statistically increase the incidence of urinary infection (RR = 0.30, 95%CI 0.08 to 1.20, P = .09), compared with immediate urinary catheter removal after surgery.Removal time of the urinary catheter at ≤6 hours postoperatively seems to be more beneficial than immediate or >6 hours for patients undergoing gynecologic surgery which excluded the vaginal surgery.


Assuntos
Remoção de Dispositivo/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Cuidados Pós-Operatórios/métodos , Cateteres Urinários , Remoção de Dispositivo/efeitos adversos , Humanos , Cuidados Pós-Operatórios/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Retenção Urinária/etiologia , Infecções Urinárias/etiologia
2.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 252-256, jan.-dez. 2020. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047924

RESUMO

Objetivo: avaliar a influência das orientações em saúde nas complicações no pós-operatório de cirurgias torácicas e abdominais altas. Método: estudo quantitativo transversal realizado com 266 indivíduos. Os dados foram coletados por um questionário sociodemográfico, clínico e assistencial. Foram incluídos sujeitos de ambos os sexos, com faixa etária de 18 a 80 anos, que estivessem na enfermaria em pós-operatório de cirurgias torácicas e ou abdominais altas. Resultados: 82 (30%) dos indivíduos receberam orientações no período de pós-operatório e 184 (70%) não receberam nenhum tipo de orientação. Quatro dos sujeitos que receberam orientações desenvolveram algum tipo de complicação e 16 dos que não receberam tiveram complicações; não apresentando resultados estatisticamente significativos quanto aos pesquisados que tiveram orientação e os que não tiveram orientações (p=0,4). Conclusão: em relação ao número de complicações, ao comparar os indivíduos que receberam orientações com os que não receberam não houve resultado estatisticamente significativo


Objective: to evaluate correlation between health guidelines and complications in the postoperative period after thoracic and upper abdominal surgeries. Method: a cross-sectional quantitative study with 266 individuals. Data were collected by a sociodemographic, clinical and care questionnaire. We included subjects of both sexes, with ages ranging from 18 to 80 years, who were in the postoperative ward after thoracic and/ or upper abdominal surgeries. Results: 82 (30%) of the subjects received guidance in the postoperative period and 184 (70%) received no guidance. Four of the subjects who received guidelines developed some type of complication while 16 of those who did not receive guidance developed complications; therefore, the results were not statistically significant (p=0,4). Conclusion: in relation to the number of complications, when comparing individuals who received guidelines with those who did not receive, there was no statistically significant result


Objetivo: evaluar la influencia de las orientaciones en salud en las complicaciones en el postoperatorio de cirugías torácicas y abdominales altas. Metodo: estudio cuantitativo transversal realizado con 266 individuos. Los datos fueron recolectados por un cuestionario sociodemográfico, clínico y asistencial. Se incluyeron sujetos de ambos sexos, con rango de edad de 18 a 80 años, que estuvieran en la enfermería en postoperatorio de cirugías torácicas y / o abdominales alta. Resultados: 82 (30%) de los individuos recibieron orientaciones en el período de postoperatorio y 184 (70%) no recibieron ningún tipo de orientación. Cuatro de los sujetos que recibieron orientaciones, desarrollaron algún tipo de complicación y 16 de los que no recibieron tuvieron complicaciones; no presentando resultados estadísticamente significativos en cuanto a los encuestados que tuvieron orientación y los que no tuvieron orientaciones (p=0,4). Conclusión: en relación al número de complicaciones, al comparar a los individuos que recibieron orientaciones con los que no recibieron no hubo resultado estadísticamente significativo


Assuntos
Humanos , Animais , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cuidados Pós-Operatórios/educação , Cuidados Pós-Operatórios/estatística & dados numéricos , Cirurgia Torácica/estatística & dados numéricos , Abdome/cirurgia , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/enfermagem , Enfermagem Perioperatória , Estudos Transversais
3.
J Matern Fetal Neonatal Med ; 33(1): 68-72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886771

RESUMO

Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time.Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time.Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time.Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.


Assuntos
Cateteres de Demora , Cesárea , Remoção de Dispositivo/métodos , Cateterismo Urinário , Cateteres Urinários/efeitos adversos , Adulto , Infecções Relacionadas a Cateter/epidemiologia , Cateteres de Demora/efeitos adversos , Cateteres de Demora/estatística & dados numéricos , Cesárea/efeitos adversos , Cesárea/instrumentação , Cesárea/métodos , Cesárea/estatística & dados numéricos , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/instrumentação , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Paridade/fisiologia , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Cateteres Urinários/estatística & dados numéricos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
4.
J Cardiothorac Surg ; 14(1): 190, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699118

RESUMO

BACKGROUND: Intermediate bronchial fistula formation caused by mediastinal drainage tube compression and fungal infection is rare. CASE PRESENTATION: A 50-year-old male patient with type 2 diabetes was observed air filling in mediastinal drainage tube, 12 days after esophagectomy for esophageal squamous carcinoma. Based on the results of computed tomography, bronchoscopy and pathology, the diagnosis of intermediate bronchial fistula caused by mediastinal drainage tube compression and fungal infection was made. Anti-fungal drug and temporary covered metallic stent was used. After stent removed, the fistula was healed with some granulation hyperplasia. He was free from respiratory symptom during 1 year follow-up. CONCLUSION: Intermediate bronchial fistula caused by the combination of mediastinal drainage tube compression and fungal infection is rare. Timely stenting could boost the healing of fistula via granulation tissue proliferation.


Assuntos
Fístula Brônquica/etiologia , Drenagem/instrumentação , Micoses/etiologia , Cuidados Pós-Operatórios/instrumentação , Complicações Pós-Operatórias/etiologia , Doenças da Traqueia/etiologia , Fístula Brônquica/diagnóstico , Fístula Brônquica/terapia , Drenagem/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/terapia , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Stents Metálicos Autoexpansíveis , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/terapia
5.
Trials ; 20(1): 432, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307501

RESUMO

BACKGROUND: Skin fibrosis is a significant global health problem that affects over 100 million people annually and has a profoundly negative impact on quality of life. Characterized by excessive fibroblast proliferation and collagen deposition, skin fibrosis underlies a wide spectrum of dermatologic conditions ranging from pathologic scars secondary to injury (e.g., burns, surgery, trauma) to immune-mediated diseases. Effective anti-scarring therapeutics remain an unmet need, underscoring the importance of developing novel approaches to treat and prevent skin fibrosis. Our in vitro data show that light emitting diode-red light (LED-RL) can modulate key cellular and molecular processes involved in skin fibrosis. In two phase I clinical trials (STARS 1 and STARS 2), we demonstrated the safety and tolerability of LED-RL at fluences of 160 J/cm2 up to 480 J/cm2 on normal human skin. METHODS/DESIGN: CURES (Cutaneous Understanding of Red-light Efficacy on Scarring) is a dose-ranging, randomized, parallel group, split-face, single-blind, mock-controlled phase II study to evaluate the efficacy of LED-RL to limit post-surgical skin fibrosis in subjects undergoing elective mini-facelift surgery. Thirty subjects will be randomly allocated to three treatment groups to receive LED-RL phototherapy or temperature-matched mock irradiation (control) to either periauricular incision site at fluences of 160 J/cm2, 320 J/cm2, or 480 J/cm2. Starting one week post-surgery (postoperative days 4-8), treatments will be administered three times weekly for three consecutive weeks, followed by efficacy assessments at 30 days, 3 months, and 6 months. The primary endpoint is the difference in scar pliability between LED-RL-treated and control sites as determined by skin elasticity and induration measurements. Secondary outcomes include clinical and photographic evaluations of scars, 3D skin imaging analysis, histological and molecular analyses, and adverse events. DISCUSSION: LED-RL is a therapeutic modality of increasing importance in dermatology, and has the potential to limit skin fibrosis clinically by decreasing dermal fibroblast activity and collagen production. The administration of LED-RL phototherapy in the early postoperative period may optimize wound healing and prevent excessive scarring. The results from this study may change the current treatment paradigm for fibrotic skin diseases and help to pioneer LED-RL as a safe, non-invasive, cost-effective, portable, at-home therapy for scars. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03795116 . Registered on 20 December 2018.


Assuntos
Cicatriz/prevenção & controle , Fototerapia/métodos , Cuidados Pós-Operatórios/métodos , Doses de Radiação , Pele/efeitos da radiação , Cicatriz/etiologia , Cicatriz/patologia , Ensaios Clínicos Fase II como Assunto , Fibrose , Humanos , New York , Fototerapia/efeitos adversos , Cuidados Pós-Operatórios/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Pele/patologia , Fatores de Tempo , Resultado do Tratamento
6.
World J Surg ; 43(9): 2164-2174, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31073685

RESUMO

BACKGROUND: There are a number of studies in the literature that describe the prevalence, causes, and factors associated with chronic postoperative opioid use, but there is a lack of synthesis of the literature to guide clinicians in optimally managing postoperative pain while avoiding opioid dependence. Thus, the goal of this study was to perform a systematic review of the literature to investigate the prevalence of chronic postoperative opioid use and the associated risk factors. MATERIALS AND METHODS: A systematic search was performed using Ovid Medline and Embase according to PRISMA guidelines. Data were collected on the following outcomes of interest: prevalence of opioid use at 3, 6, and 12 months postoperatively, and risk factors associated with chronic postoperative opioid use. RESULTS: Forty-three articles were included in the final analysis. The mean prevalence of chronic postoperative opioid use in all populations at 3, 6, and 12 months postoperatively was 30.5%, 25.6%, and 25.2%, respectively. The prevalence of patients who developed chronic opioid use at 3, 6, and 12 months postoperatively was 10.4%, 8.5%, and 9.8%, respectively. Forty of the articles analyzed risk factors associated with chronic postoperative opioid use. The most common associated risk factor identified was preoperative opioid use with 27 articles demonstrating a significant association with chronic postoperative opioid use. DISCUSSION: The current opioid crisis is in part secondary to the prevalence of chronic opioid use following surgery. This study identified associated risk factors with chronic postoperative opioid use, which may help identify patients at risk for developing chronic postoperative opioid use.


Assuntos
Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Esquema de Medicação , Humanos , Transtornos Relacionados ao Uso de Opioides/etiologia , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Cuidados Pós-Operatórios/efeitos adversos , Prevalência , Fatores de Risco
7.
Arch Orthop Trauma Surg ; 139(9): 1253-1259, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31053870

RESUMO

BACKGROUND AND PURPOSE: Reduced mobility is a severe threat to the clinical outcomes and survival of elderly hip fracture patients. These patients generally struggle to comply with partial weight bearing, yet postoperative weight-bearing restrictions are still recommended by nearly 25% of surgeons. Therefore, we hypothesized that weight-bearing restrictions in elderly hip fracture patients merely leads to reduced mobility, while transposing full weight to the fractured extremity remains unaffected disregarding the prescribed aftercare. PATIENTS AND METHODS: 41 equally treated patients with pertrochanteric fractures were enrolled consecutively in a maximum care hospital in a pre-post study design (level of evidence 2). A study group of 19 patients was instructed to maintain partial weight bearing (PWB), whereas the control group of 22 patients was instructed to mobilize at full weight bearing (FWB). All patients were asked to participate in a gait analysis using an insole force sensor (loadsol®, Novel, Munich, Germany) on the fifth postoperative day. RESULTS: The postoperative Parker Mobility Score in the PWB group compared to the FWB group was significantly reduced (3.21 vs. 4.73, p < 0.001). Accordingly, a significantly lower gait speed in the PWB group of 0.16 m/s vs. 0.28 m/s was seen (p = 0.003). No difference in weight bearing was observed in between the groups (average peak force 350.25 N vs. 353.08 N, p = 0.918), nor any differences in the demographic characteristics, ASA Score, Barthel Index or EQ5D. INTERPRETATION: Weight-bearing restrictions in elderly hip fracture patients contributed to a loss of mobility, while no significant differences in loading of the affected extremity were observed. Therefore, postoperative weight-bearing restrictions in elderly hip fracture patients should be avoided, to achieve early mobilization at full weight bearing.


Assuntos
Fraturas do Quadril , Cuidados Pós-Operatórios , Amplitude de Movimento Articular/fisiologia , Suporte de Carga/fisiologia , Estudos de Casos e Controles , Análise da Marcha , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos
8.
Urol Clin North Am ; 46(2): 265-272, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961859

RESUMO

Patients with nephrolithiasis are exposed to significant quantities of ionizing radiation with the potential to cause secondary malignancy. This risk is magnified by the high recurrence rate of nephrolithiasis. In this article, we identify the risks of ionizing radiation as they pertain to patients with nephrolithiasis. We then identify evidence-based techniques for mitigating patient radiation exposure in the preoperative, intraoperative, and postoperative settings. Key factors include limiting the use of computed tomographic imaging, appropriate modulation of fluoroscopy settings, and minimizing rates of stone recurrence.


Assuntos
Cálculos Renais/diagnóstico por imagem , Doses de Radiação , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Fluoroscopia/efeitos adversos , Humanos , Cuidados Intraoperatórios/efeitos adversos , Cálculos Renais/cirurgia , Nefrolitíase/diagnóstico por imagem , Nefrolitíase/cirurgia , Cuidados Pós-Operatórios/efeitos adversos , Lesões por Radiação/etiologia , Fatores de Risco , Tomografia Computadorizada por Raios X/efeitos adversos
9.
J Vasc Interv Radiol ; 30(5): 761-764, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30948324

RESUMO

Surgical lysis of intra-abdominal adhesions is associated with a high rate of complications. This brief report presents 24 patients with dense intra-abdominal adhesions who underwent preoperative progressive pneumoperitoneum (PPP) prior to surgical lysis of adhesions. PPP was successfully performed in 23 patients, with few adverse events, resulting in subjectively improved ease of intraoperative tissue dissection. One patient withdrew due to intractable pain during insufflation. The results suggest that PPP is a low-risk technique with the potential to improve access to intra-abdominal structures in patients for whom conventional surgical therapy is predicted to carry a high rate of complications.


Assuntos
Abdome/cirurgia , Pneumoperitônio Artificial , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumoperitônio Artificial/efeitos adversos , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Fatores de Risco , Aderências Teciduais , Resultado do Tratamento
10.
J Pediatr Surg ; 54(5): 945-948, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30814037

RESUMO

PURPOSE: This study examines the impact of postoperative noninvasive ventilation strategies on outcomes in esophageal atresia-tracheoesophageal fistula (EA-TEF) patients. METHODS: A single center retrospective chart review was conducted on all neonates followed at the EA-TEF Clinic from 2005 to 2017. Primary outcomes were: survival, anastomotic leak, stricture, pneumothorax, and mediastinitis. Statistical significance was determined using Chi-square and logistic regression (p ≤ .05). RESULTS: We reviewed 91 charts. Twenty-five infants (27.5%) were bridged with postextubation noninvasive ventilation (15 on Continuous Positive Airway Pressure (CPAP), 5 on Noninvasive Positive Pressure Ventilation (NIPPV), and 14 on High-Flow Nasal Cannula (HFNC)). Overall, 88 (96.7%) patients survived, 25 (35.7%) had a stricture, 14 (20%) had anastomotic leak, 9 (12.9%) had a pneumothorax, and 4 (5.7%) had mediastinitis. Use of NIPPV was associated with increased risk of mediastinitis (P = .005). Use of HFNC was associated with anastomotic leak (P = .009) and mediastinitis (P = .036). CONCLUSIONS: These data suggest that postoperative noninvasive ventilation techniques are associated with a significantly higher risk of anastomotic leak and mediastinitis. Further prospective research is needed to guide postoperative ventilation strategies in this population. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: IV.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Atresia Esofágica/cirurgia , Ventilação não Invasiva , Respiração com Pressão Positiva , Fístula Traqueoesofágica/cirurgia , Fístula Anastomótica/etiologia , Cânula , Constrição Patológica/etiologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Feminino , Humanos , Recém-Nascido , Masculino , Mediastinite/etiologia , Ventilação não Invasiva/efeitos adversos , Nariz , Pneumotórax/etiologia , Respiração com Pressão Positiva/efeitos adversos , Cuidados Pós-Operatórios/efeitos adversos , Estudos Retrospectivos , Taxa de Sobrevida
11.
Pediatr Transplant ; 23(2): e13354, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30714274

RESUMO

The influenza vaccine is critical for preventing influenza-related complications in transplant patients. Previous studies demonstrated de novo donor-specific antibody formation and rejection following the influenza vaccination. This risk has not been adequately assessed in the pediatric population. We performed a single-center retrospective analysis of 187 unique pediatric kidney transplant recipients, transplanted from January 1, 2006, to December 31, 2015, assessing for an association of the influenza vaccination with various transplant outcomes. The influenza vaccine was received by 125 of 187 patients within the first year post-transplant. Using log-rank tests and Kaplan-Meier curves, vaccinated patients had a significantly lower risk of mortality (P = 0.048). There were no differences in death-censored graft survival (P = 0.253), graft survival (P = 0.098), or rejection (P = 0.195) between vaccinated and unvaccinated groups. To address the problem of multiple exposures for a yearly vaccine, Cox proportional hazards regression was utilized with post-transplant vaccination status considered as a time-dependent covariate; analyses were performed using both a 360- and 180-day vaccination period following any post-transplant influenza vaccination. In this model, being vaccinated did not result in a significant difference in mortality (HR 0.90 [0.16, 5.15], P = 0.91), death-censored graft survival (HR 0.70 [0.31, 1.58], P = 0.39), graft survival (HR 0.69 [0.32, 1.49], P = 0.34), or rejection (HR 0.67 [0.37, 1.19], P = 0.17). Eight patients developed de novo donor-specific antibodies following the first post-transplant influenza vaccination; three then developed biopsy-proven rejection. These results suggest influenza vaccination is safe in pediatric kidney transplant recipients, and larger prospective studies are required to conclusively confirm our findings.


Assuntos
Rejeição de Enxerto/prevenção & controle , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Transplante de Rim , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Lactente , Recém-Nascido , Vacinas contra Influenza/efeitos adversos , Influenza Humana/epidemiologia , Influenza Humana/etiologia , Transplante de Rim/mortalidade , Masculino , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
12.
Exp Clin Transplant ; 17(Suppl 1): 50-56, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30777523

RESUMO

OBJECTIVES: Kidney transplantation is not readily available in low-resource settings because of poor health structure, dearth of experts, and pervading poverty. Although many centers now offer kidney transplant, patients still travel outside Nigeria for this service for many reasons and many return home without a detailed medical report. MATERIALS AND METHODS: Medical records of individuals who underwent kidney transplant in Nigeria and elsewhere and who were presently receiving posttransplant care or had received such care from 2002 to 2018 at 4 Nigerian hospitals were retrospectively reviewed and analyzed. RESULTS: Of 35 patients (30 males; 85.7%) analyzed (mean ages of 42 ± 16 and 47 ± 8 years for men and women, respectively; P = .54), common primary kidney diseases included hypertension (27.2%), glomerulonephritis (24.2%), and diabetes mellitus/hypertension (18.3%). Most patients received transplants in India (48.6%), with others in Nigeria (23.0%) and Pakistan (8.6%). Relationships to recipient were unrelated (28.5%), living related (22.9%), and unknown (48.6%). Less than 30% of recipients had care details in their hospital records. Almost all transplant patients were treated with prednisolone (81.8%); cyclosporine (40.0%), mycophenolate mofetil (31.4%), tacrolimus (20.0%), and azathioprine (9.1%) were also used. Complications were documented in 88.9%, with 57.0% due to bacterial infections/sepsis. Many (88.9%) had more than 2 complications. In follow-up, median first transplant duration was 24 months (interquartile range, 6-44). Of total patients, 25.7% were still alive, 17.1% had died, and 54.2% were lost to follow-up. Follow-up data for only 2 donors were available. CONCLUSIONS: Lapses in follow-up care of kidney transplant recipients and donors continue in lowresource settings where transplant tourism is still rife, resulting in poor graft/patient survival. Adherence to transplant guidelines is advocated. We propose a transplant stratification model according to level of development and resources of countries or regions. This model will encourage customizing strategies for improving patient outcomes.


Assuntos
Continuidade da Assistência ao Paciente , Transplante de Rim/métodos , Doadores Vivos , Turismo Médico , Nefrectomia , Cuidados Pós-Operatórios/métodos , Transplantados , Adulto , Feminino , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/mortalidade , Nigéria , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Ann Vasc Surg ; 56: 280-286, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30496900

RESUMO

BACKGROUND: Postoperative subtherapeutic low-dose heparin infusion (LDHI) is sometimes administered in patients undergoing extremity arterial revascularization to maintain graft patency and decrease the risk of thrombosis. However, the safety of this management strategy is unknown. METHODS: From 2013 to 2015, we retrospectively reviewed all patients undergoing upper and lower extremity arterial revascularization at a single university-affiliated medical center. Patients were grouped by receipt of LDHI within the first 24-hour postoperative period. Preoperative demographics, comorbidities, intraoperative measures, 30-day postoperative complications, arterial patency rates, and amputation rates were analyzed for each group. RESULTS: We identified 379 patients who received extremity revascularization, and 56 (14.8%) of them had received LDHI. Patients who received LDHI were less likely to have an elective admission on presentation (26.8% vs. 56%, P < 0.001) or an admission from home (69.6% vs. 81.7%, P = 0.04). They were more likely to have preoperative bleeding (44.6% vs. 22%, P < 0.01) and need for emergent operation (23.2% vs. 11.8%, P = 0.04). Postoperatively, although patients who received LDHI demonstrated a trend toward increased bleeding (48.2% vs. 33.7%, P = 0.053), they did not demonstrate an increase in 30-day mortality (1.79% vs. 1.24%, P = 0.55) or reoperation (19.7% vs. 12.4%, P = 0.21). Multivariable analysis demonstrated that LDHI did not have a significant association with immediate postoperative bleeding (P = 0.99), survival (P = 0.13), primary patency (P = 0.872), and amputation-free survival (P = 0.387). CONCLUSIONS: Although LDHI was more likely to be administered in patients who received emergent operations, risk-adjusted analysis demonstrated that it was not associated with increased postoperative bleeding, mortality, short-term need for reintervention, or amputation after extremity arterial revascularization.


Assuntos
Anticoagulantes/administração & dosagem , Heparina/administração & dosagem , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Cuidados Pós-Operatórios/métodos , Trombose/prevenção & controle , Extremidade Superior/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Anticoagulantes/efeitos adversos , Bases de Dados Factuais , Esquema de Medicação , Feminino , Heparina/efeitos adversos , Humanos , Infusões Intravenosas , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/mortalidade , Hemorragia Pós-Operatória/induzido quimicamente , Estudos Retrospectivos , Fatores de Risco , Trombose/etiologia , Trombose/mortalidade , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
14.
BJOG ; 126(6): 804-813, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30548529

RESUMO

OBJECTIVE: To evaluate if immediate catheter removal (ICR) after laparoscopic hysterectomy is associated with similar retention outcomes compared with delayed removal (DCR). STUDY DESIGN: Non-inferiority randomised controlled trial. POPULATION: Women undergoing laparoscopic hysterectomy in six hospitals in the Netherlands. METHODS: Women were randomised to ICR or DCR (between 18 and 24 hours after surgery). PRIMARY OUTCOME: The inability to void within 6 hours after catheter removal. RESULTS: One hundred and fifty-five women were randomised to ICR (n = 74) and DCR (n = 81). The intention-to-treat and per-protocol analysis could not demonstrate the non-inferiority of ICR: ten women with ICR could not urinate spontaneously within 6 hours compared with none in the delayed group (risk difference 13.5%, 5.6-24.8, P = 0.88). However, seven of these women could void spontaneously within 9 hours without additional intervention. Regarding the secondary outcomes, eight women from the delayed group requested earlier catheter removal because of complaints (9.9%). Three women with ICR (4.1%) had a urinary tract infection postoperatively versus eight with DCR (9.9%, risk difference -5.8%, -15.1 to 3.5, P = 0.215). Women with ICR mobilised significantly earlier (5.7 hours, 0.8-23.3 versus 21.0 hours, 1.4-29.9; P ≤ 0.001). CONCLUSION: The non-inferiority of ICR could not be demonstrated in terms of urinary retention 6 hours after procedure. However, 70% of the women with voiding difficulties could void spontaneously within 9 hours after laparoscopic hysterectomy. It is therefore questionable if all observed urinary retention cases were clinically relevant. As a result, the clinical advantages of ICR may still outweigh the risk of bladder retention and it should therefore be considered after uncomplicated laparoscopic hysterectomy. TWEETABLE ABSTRACT: The advantages of immediate catheter removal after laparoscopic hysterectomy seem to outweigh the risk of bladder retention.


Assuntos
Remoção de Dispositivo/métodos , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Cuidados Pós-Operatórios , Cateterismo Urinário/métodos , Retenção Urinária , Adulto , Feminino , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Fatores de Tempo , Cateteres Urinários , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia , Retenção Urinária/terapia , Micção/fisiologia
15.
Digestion ; 100(3): 160-169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30554216

RESUMO

BACKGROUND/AIMS: Feeding recommendations after endoscopic submucosal dissection (ESD) for gastric neoplasms are not established and based on clinical experience. METHODS: This was a prospective pilot randomized controlled trial. Patients undergoing ESD for gastric neoplasms were randomly assigned to solid (n = 50) or liquid diet (n = 50) groups. Beginning the day after hemostasis confirmation until discharge, the solid diet group started on a diet of rice porridge, whereas the liquid diet group started on a liquid diet, with gradual transition to solid food. The primary endpoint was delayed bleeding rate. The secondary endpoints were quality of life (QOL), ulcer-stage, hospital fees, and post-ESD symptoms. RESULTS: Delayed bleeding occurred in the solid diet group (2%) but not in the liquid diet group. The QOL evaluation using European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-STO22 showed better score in the solid diet group. The patients who felt dietary restriction at discharge was of a larger number in the liquid diet group (p = 0.019). More patients experienced appetite loss (p = 0.038), constipation (p = 0.022), and dietary restriction (p = 0.037) in the liquid diet group during hospitalization. The other endpoints were equivalent between the groups. CONCLUSION: Early initiation of solid foods after ESD is feasible and associated with higher QOL, potentially rendering conventional liquid diets unnecessary, although additional studies are needed (Trial registration number: UMIN000013297).


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Gastroscopia/efeitos adversos , Terapia Nutricional/métodos , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Ressecção Endoscópica de Mucosa/métodos , Ressecção Endoscópica de Mucosa/reabilitação , Estudos de Viabilidade , Feminino , Gastroscopia/métodos , Gastroscopia/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Nutricional/efeitos adversos , Projetos Piloto , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Neoplasias Gástricas/cirurgia , Fatores de Tempo , Resultado do Tratamento
16.
PLoS One ; 14(12): e0227027, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31891621

RESUMO

BACKGROUND: There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. AIM: To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3-19 years. DESIGN: A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. RESULTS: 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. CONCLUSIONS: There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.


Assuntos
Analgésicos/administração & dosagem , Análise Custo-Benefício , Procedimentos Cirúrgicos Bucais/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Cuidados Pós-Operatórios/métodos , Administração Oral , Adolescente , Analgésicos/efeitos adversos , Analgésicos/economia , Criança , Pré-Escolar , Humanos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/economia , Resultado do Tratamento , Adulto Jovem
17.
Trials ; 19(1): 586, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30367680

RESUMO

BACKGROUND: Perioperative complications occur in 30-40% of non-cardiac surgical patients and are the leading cause of early postoperative morbidity and mortality. Regular visits by trained health professionals may decrease the incidence of complications and mortality through earlier detection and adequate treatment of complications. Until now, no studies have been performed on the impact of routine postsurgical anesthesia visits on the incidence of postoperative complications and mortality. METHODS: TRACE is a prospective, multicenter, stepped-wedge cluster randomized interventional study in academic and peripheral hospitals in the Netherlands. All hospitals start simultaneously with a control phase in which standard care is provided. Sequentially, in a randomized order, hospitals cross over to the intervention phase in which patients at risk are routinely followed up by an anesthesia professional at postoperative days 1 and 3, aiming to detect and prevent or treat postoperative complications. We aim to include 5600 adult patients who are at high risk of developing complications. The primary outcome variable is 30-day postoperative mortality. Secondary outcomes include incidence of postoperative complications and postoperative quality of life up to one year following surgery. Statistical analyses will be performed to compare the control and intervention cohorts with multilevel linear and logistic regression models, adjusted for temporal trends and for clusters (hospitals). The time horizon of the economic (cost-effectiveness) evaluation will be 30 days and one year following surgery. DISCUSSION: TRACE is the first to study the effects of a routine postoperative visit by an anesthesia healthcare professional on mortality and cost-effectiveness of surgical patients. If the intervention proves to be beneficial for the patient and cost-effective, the stepped-wedge design ensures direct implementation in the participating hospitals. TRIAL REGISTRATION: Nederlands Trial Register/Netherlands Trial Registration, NTR5506 . Registered on 02 December 2015.


Assuntos
Anestesia/efeitos adversos , Anestesiologia/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias , Encaminhamento e Consulta , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adolescente , Adulto , Anestesia/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Países Baixos , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/mortalidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/mortalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
J Surg Oncol ; 118(6): 861-866, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30293243

RESUMO

BACKGROUND: Early postmastectomy discharge with a drain in place is standard practice in most developed countries. Its feasibility has not been evaluated in low resource settings like Nigeria. METHODS: Consenting patients undergoing mastectomy were discharged on the third postoperative day and assessed as outpatients for wound complications as well as their experience at home. Wound outcomes were compared with patients who had traditional long stay. RESULTS: Forty-five of the 58 patients who had a mastectomy during the study period participated in the early discharge program (77.6%). Of these, four patients (8.9%) had drain malfunction, seroma occurred in eight patients (17.8%), eight patients (17.8%) had wound infection, and six patients (13.3%) had flap necrosis. There was no readmission. Compared with long stay patients, postoperative stay was significantly shorter (3 vs 11 days; P < 0.01) with significant cost savings, while complication rates were not statistically different. All the patients in the early discharge group were confident operating their drains and preferred early discharge. Being around relatives, reduced cost, and fear of the hospital environment were common reasons cited for their preference. CONCLUSION: Our results support the implementation of an early postmastectomy discharge program in a low resource setting.


Assuntos
Neoplasias da Mama/cirurgia , Drenagem/métodos , Mastectomia/métodos , Alta do Paciente , Ferida Cirúrgica/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Drenagem/efeitos adversos , Feminino , Humanos , Tempo de Internação , Mastectomia/efeitos adversos , Mastectomia/economia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nigéria , Satisfação do Paciente , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Fatores Socioeconômicos
19.
Medicine (Baltimore) ; 97(40): e12742, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30290687

RESUMO

RATIONALE: According to previously published studies, major complications arising from a percutaneous liver biopsy are rare and occur in less than 0.1% of cases. This report describes an approach to percutaneous liver biopsy that can help avoid damage to the liver in a living donor liver transplantation (LDLT) setting. PATIENT CONCERNS: Case 1: In the first case a donor percutaneous liver biopsy (PLB) of both lobes of the liver was performed for pre-LDLT evaluation. The ultrasonography (US)-guided epigastric right-angle approach and an automatic one-handed cocking disposable 18G biopsy gun was used to puncture the left liver lobe to determine the presence of fatty liver. A penetrating liver injury occurred, accompanied by massive bloody ascites (about 700 cc) and subcapsular hematoma at the left lateral segment. The bleeding was managed by bi-polar coagulation during the transplant and the following liver donation procedure proceeded smoothly without any subsequent complications. Case 2: In the second case, selective right lobe PLB for clinical assessment after LDLT was performed in the recipient. Hemorrhagic shock occurred following a puncture of the right posterior branch of the right hepatic artery when using the biopsy-gun via the right lateral intercostal approach. DIAGNOSES: Extravasation was documented by angiography and emergent transhepatic arterial embolization was performed. INTERVENTION: Extravasation was documented by angiography and emergent transhepatic arterial embolization with glue:lipiodol (1:4) was performed to stop bleeding. OUTCOMES: The recipient survived after medical management. LESSONS: To prevent complications, the right-angle approach of PLB may be changed to an oblique angle using a one-fire biopsy-gun. Use of a manual Menghini's needle should be considered for left lobe liver biopsies. Since US-guided manual Menghini's needle for PLB can be observed with the needle tip inserted in the liver, needle-mediated compromising of the major vessels or biliary tree can be prevented, and it does not penetrate the liver again. A superficial puncture less than 0.5 cm away from the liver surface should be made during right lobe liver biopsy. This approach can help to avoid damage to the hepatic artery.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/efeitos adversos , Adulto , Hemorragia Gastrointestinal/etiologia , Hematoma/etiologia , Artéria Hepática/cirurgia , Humanos , Fígado/lesões , Transplante de Fígado , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Choque Hemorrágico/etiologia , Coleta de Tecidos e Órgãos , Ultrassonografia de Intervenção/métodos
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