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2.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205461

RESUMO

Malnourishment is prevalent in patients suffering from head and neck cancer. The postoperative period is crucial in terms of nutritional support, especially after composite resection and reconstruction surgery. These patients present with a number of risk factors that aggravate feeding intolerance, including postoperative status, prolonged immobility, decreased head elevation, mechanical ventilation, and applied sedative agents. Routine management protocols for feeding intolerance include prokinetic drug use and post-pyloric tube insertion, which could be both limited and accompanied by detrimental adverse events. This single-blind clinical trial aimed to investigate the effects of acupuncture in postoperative feeding intolerance in critically ill oral and hypopharyngeal cancer patients. Twenty-eight patients were randomized into two groups: Intervention group and Control group. Interventions were administered daily over three consecutive postoperative days. The primary outcome revealed that the intervention group reached 70% and 80% of target energy expenditure (EE) significantly earlier than the control group (4.00 ± 1.22 versus 6.69 ± 3.50 days, p = 0.012), accompanied by higher total calorie intake within the first postoperative week (10263.62 ± 1086.11 kcals versus 8384.69 ± 2120.05 kcals, p = 0.004). Furthermore, the intervention group also needed less of the prokinetic drug (Metoclopramide, 20.77 ± 48.73 mg versus 68.46 ± 66.56 mg, p = 0.010). In conclusion, digestion-specific acupuncture facilitated reduced postoperative feeding intolerance in oral and hypopharyngeal cancer patients.


Assuntos
Terapia por Acupuntura , Estado Terminal/terapia , Digestão , Neoplasias Hipofaríngeas/terapia , Neoplasias Bucais/terapia , Cuidados Pós-Operatórios/métodos , Idoso , China , Ingestão de Energia , Metabolismo Energético , Humanos , Masculino , Desnutrição/etiologia , Desnutrição/terapia , Metoclopramida/uso terapêutico , Pessoa de Meia-Idade , Apoio Nutricional/métodos , Método Simples-Cego , Resultado do Tratamento
3.
J Laryngol Otol ; 135(7): E3, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34137368

RESUMO

I wish to thank the Semon Committee for inviting me to deliver the 2020 Semon lecture. This is a very special honour, as is evidenced by the list of distinguished lecturers dating back to the inaugural lecture delivered at University College London in 1913. I am not the first South African to deliver the Semon lecture, having been preceded by my previous chairman Sean Sellars in 1993, and by Jack Gluckman in 2001, who was South African raised and educated and who subsequently became the chairman of otolaryngology in Cincinnati, USA.


Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Traqueostomia/métodos , Pesquisa Biomédica , Fístula Cutânea/prevenção & controle , Nutrição Enteral/métodos , Recursos em Saúde , Humanos , Laringe Artificial , Recidiva Local de Neoplasia/epidemiologia , Tratamentos com Preservação do Órgão , Otolaringologia , Doenças Faríngeas/prevenção & controle , Cuidados Pós-Operatórios/métodos , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Radioterapia , Classe Social , África do Sul , Voz Esofágica , Estomas Cirúrgicos , Tireoidectomia
4.
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
5.
Medicine (Baltimore) ; 100(26): e26581, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190202

RESUMO

BACKGROUND: To investigate the clinical application and effect of laparoscopic partial nephrectomy with renal artery branch occlusion in the treatment of early renal tumors. METHODS: A retrospective analysis was conducted on the clinical data of 15 cases of renal tumor patients who underwent partial nephrectomy by laparoscopic selective renal artery branch occlusion in our department from January 2017 to January 2018. Nine male patients and 6 female patients were aged 46 to 65 years, with an average age of 54.3 ±â€Š7.2 years. The diameters of tumors were 2.2 to 4.0 cm, with an average of 3.3 ±â€Š0.7 cm. There are 10 tumors locating on the left side and 5 on the right side. Preoperative renal glomerular filtration rate (GFR) were 77.3 to 61.9 mL/min with an average of 47.6 ±â€Š7.5 mL/min. All patients' diseased kidneys underwent renal computer tomography angiography examination before surgery. And the diseased kidney underwent reexamination of renal GFR. The operation time, renal artery branch occlusion time, intraoperative blood loss, postoperative hospital stay, changes of renal function, and complications were evaluated. RESULTS: All surgery were completed successfully, the surgery time was 136.7 ±â€Š15.2 min, intraoperative renal artery branch occlusion time was 21.3 ±â€Š4.5 min, the intraoperative blood loss was 223.3 ±â€Š69.5 mL, the postoperative hospital stay was 6.5 ±â€Š1.7 days, and the postoperative 1-month GFR was 49.5 ±â€Š6.6 mL/min. There was no significant difference between the renal GFR before and after surgery (P > .05). There was no blood transfusion and transfer open surgery cases. The patients were followed up for 3 to 15 months without complications. CONCLUSIONS: Partial nephrectomy with selective renal artery branch occlusion by laparoscopy is a safe, feasible, and effective method for the treatment of early renal cancer. It makes good use of the technical advantages of clear operation field and fine operation of laparoscopic surgery, avoids the heat ischemia process of the whole kidney, and can better protect the renal function.


Assuntos
Embolização Terapêutica/métodos , Neoplasias Renais , Laparoscopia , Nefrectomia , Artéria Renal , China/epidemiologia , Angiografia por Tomografia Computadorizada/métodos , Intervenção Médica Precoce/métodos , Feminino , Humanos , Testes de Função Renal/métodos , Neoplasias Renais/irrigação sanguínea , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios/métodos , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Carga Tumoral
6.
Artigo em Inglês | MEDLINE | ID: mdl-34040680

RESUMO

Background and aim: The current COVID-19 pandemic scenario has driven surgical departments to a transformation.The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. Material and method: Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. Results: A total of 5031 telephone calls were made, differentiating between medical referrals, specialised primary care visits, and outpatient consultation.They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved.53% of all telematic visits were successful. Conclusions: Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.


Assuntos
Assistência ao Convalescente/métodos , COVID-19/prevenção & controle , Controle de Infecções/métodos , Ortopedia/métodos , Cuidados Pós-Operatórios/métodos , Consulta Remota/métodos , Telefone , Assistência ao Convalescente/estatística & dados numéricos , COVID-19/epidemiologia , Estudos de Viabilidade , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Ortopedia/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias , Distanciamento Físico , Cuidados Pós-Operatórios/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Espanha/epidemiologia
7.
Surg Clin North Am ; 101(3): 427-441, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34048763

RESUMO

Esophageal cancer is the eighth most common cancer worldwide, and its incidence has been increasing over the past several decades. Esophagectomy currently is the standard of care for more advanced early esophageal cancer and should be performed at centers of excellence with high volumes, appropriate supportive staff, and multidisciplinary expertise.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Assistência ao Convalescente/métodos , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Humanos , Estadiamento de Neoplasias , Cuidados Pós-Operatórios/métodos , Resultado do Tratamento
8.
Am J Gastroenterol ; 116(4): 821-824, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33982954

RESUMO

INTRODUCTION: Gastrointestinal bleeding is a morbid complication of dual antiplatelet therapy (DAPT). We evaluated the extent to which contemporary trials of DAPT included steps to ensure appropriate use of proton pump inhibitor (PPI) gastroprotection and reported rates of PPI use. METHODS: A methodological review of randomized trials comparing varying durations of DAPT after percutaneous coronary intervention. RESULTS: Among 21 trials, none incorporated protocol procedures or guidance for prescribing PPIs. Five reported rates of PPI use (range 25.6-69.1%). DISCUSSION: PPI gastroprotection is overlooked in major trials of DAPT. Appropriate use of PPI gastroprotection represents an important opportunity to improve patient safety.


Assuntos
Ensaios Clínicos como Assunto , Terapia Antiplaquetária Dupla/normas , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Cuidados Pós-Operatórios/métodos , Guias de Prática Clínica como Assunto , Gastropatias/prevenção & controle , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Estômago/efeitos dos fármacos
9.
J Surg Oncol ; 124(3): 400-410, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33866554

RESUMO

BACKGROUND AND OBJECTIVES: Radiotherapy (RT) enables conservative surgery for soft tissue sarcoma (STS). RT can be delivered either pre-operatively (PreRT) or postoperatively (PORT), yet in some patients, neither approach is fully satisfactory (e.g., urgent surgery or wound healing risk prevents PreRT, yet PORT alone cannot cover the entire surgical field). We hypothesized that, in such situations, low-dose PreRT (LD-PreRT) would decrease the risk of intraoperative tumor seeding and thus permit PORT to a reduced volume (covering the high-risk tumor bed but not all surgically manipulated tissues). METHODS: We identified a single-institution retrospective cohort of 78 patients treated with LD-PreRT (10-30 Gy), resection, and PORT between 1980 and 2018. RESULTS: At a median follow-up of 8.2 years, 8-year overall survival (OS) was 65.9%, disease-free survival (DFS) 50.5%, and local control (LC) 76.7%; in 45 patients with extremity/superficial trunk (E/ST) STS, 8-year LC was 80.9%. Both before and after propensity score adjustment, there were no differences in OS, DFS, or LC between this cohort and a separate cohort of 394 STS (221 E/ST-STS) patients treated with surgery and PORT alone. CONCLUSIONS: In patients for whom neither PreRT nor PORT alone is optimal, LD-PreRT may prevent intraoperative tumor seeding and enable PORT to a reduced volume while preserving oncologic outcomes.


Assuntos
Sarcoma/radioterapia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/radioterapia , Neoplasias de Tecidos Moles/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Dosagem Radioterapêutica , Estudos Retrospectivos , Adulto Jovem
10.
Br J Anaesth ; 127(1): 143-152, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33892948

RESUMO

BACKGROUND: Bilateral lung transplantation results in pulmonary vagal denervation, which potentially alters respiratory drive, volume-feedback, and ventilatory pattern. We hypothesised that Neurally Adjusted Ventilatory Assist (NAVA) ventilation, which is driven by diaphragm electrical activity (EAdi), would reveal whether vagally mediated pulmonary-volume feedback is preserved in the early phases after bilateral lung transplantation. METHODS: We prospectively studied bilateral lung transplant recipients within 48 h of surgery. Subjects were ventilated with NAVA and randomised to receive 3 ventilatory modes (baseline NAVA, 50%, and 150% of baseline NAVA values) and 2 PEEP levels (6 and 12 cm H2O). We recorded airway pressure, flow, and EAdi. RESULTS: We studied 30 subjects (37% female; age: 37 (27-56) yr), of whom 19 (63%) had stable EAdi. The baseline NAVA level was 0.6 (0.2-1.0) cm H2O µV-1. Tripling NAVA level increased the ventilatory peak pressure over PEEP by 6.3 (1.8), 7.6 (2.4), and 8.7 (3.2) cm H2O, at 50%, 100%, and 150% of baseline NAVA level, respectively (P<0.001). EAdi peak decreased by 10.1 (9.0), 9.5 (9.4) and 8.8 µV (8.7) (P<0.001), accompanied by small increases in tidal volume, 8.3 (3.0), 8.7 (3.6), and 8.9 (3.3) ml kg-1 donor's predicted body weight at 50%, 100%, and 150% of baseline NAVA levels, respectively (P<0.001). Doubling PEEP did not affect tidal volume. CONCLUSIONS: NAVA ventilation was feasible in the majority of patients during the early postoperative period after bilateral lung transplantation. Despite surgical vagotomy distal to the bronchial anastomoses, bilateral lung transplant recipients maintained an unmodified respiratory pattern in response to variations in ventilatory assistance and PEEP. CLINICAL TRIAL REGISTRATION: NCT03367221.


Assuntos
Retroalimentação , Suporte Ventilatório Interativo/métodos , Transplante de Pulmão/métodos , Respiração com Pressão Positiva/métodos , Cuidados Pós-Operatórios/métodos , Volume de Ventilação Pulmonar/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ventilação Pulmonar/fisiologia , Desmame do Respirador/métodos
12.
Radiol Clin North Am ; 59(3): 335-347, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33926681

RESUMO

Diffusion MR imaging exploits the diffusion properties of water to generate contrast between normal tissue and pathology. Diffusion is an essential component of nearly all brain tumor MR imaging examinations. This review covers the important clinical applications of diffusion weighted imaging in the pretreatment diagnosis and grading of brain tumors and assessment of treatment response. Diffusion imaging improves the accuracy of identifying treatment-related effects that may mimic tumor improvement or worsening. Fiber tractography models of eloquent white matter pathways are generated using diffusion tensor imaging. A practical and concise tractography guide is provided for anyone new to preoperative surgical mapping.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Encéfalo/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Imagem de Tensor de Difusão/métodos , Humanos
13.
Pan Afr Med J ; 38: 80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889246

RESUMO

Introduction: chronic subdural hematoma (cSDH) is not uncommon in sub-Saharan Africa and has a striking morbidity and mortality if not managed adequately. With the limited number of neurosurgeons in resource poor countries, general surgeons should be trained in the skills of craniotomy and burr-hole craniostomy. Methods: we conducted a retrospective review of all medical records of patients with cSDH, who underwent flap craniotomy at the Choithrams Memorial Hospital, Sierra Leone, between January 2016 and March 2018. The case notes, operative records and computerized axial tomography (CT) scans were reviewed and all pertinent data extracted. All patients were jointly managed post operatively by medical (neurological) and surgical teams in an intensive care unit. Results: a total of 23 patients had surgical drainage of the chronic subdural hematoma. The mean age of the patients was 65.8 years (ranging from 54-78) with a male: female ratio of 3: 2: 1. The main predisposing risk factors were head trauma (60.9%) and antiplatelet medications (21.7%). Hypertension was the most common comorbidity, followed by diabetes mellitus. Ten (62.5%) out of sixteen patients referred for Head CT-scan by the primary physicians, had an initial missed clinical diagnosis until computerized tomography (CT) scan confirmation report of chronic subdural hematoma (cSDH) was obtained. Flap craniotomy under general anesthesia with a subdural drainage left in situ (100%) was done for all patients. Mean duration of Intensive Care Unit (ICU) admission was 10.6 days (range 6-16 days). Twenty-one (91.3%) patients made a full recovery. There was no mortality. Conclusion: flap craniotomy for cSDH was safely performed by a traumatologist/general surgeon in a developing country where there is no neuro-surgical service. The outcome of the patients was favorable as there was co-management with the surgical and medical team.


Assuntos
Craniotomia/métodos , Drenagem/métodos , Hematoma Subdural Crônico/cirurgia , Retalhos Cirúrgicos , Idoso , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Serra Leoa , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
J Surg Oncol ; 123(6): 1414-1422, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33831256

RESUMO

Systemic chemotherapy improves the survival of patients who undergo pancreatectomy, but whether chemotherapy should be delivered before or after surgery remains debated. At The University of Texas MD Anderson Cancer Center, localized pancreatic ductal adenocarcinoma (PDAC) has been preferentially treated with preoperative therapy-a practice supported by a robust history of institutional and national trials. In the following review, we discuss the historical use of perioperative therapy, our experience with it at MD Anderson Cancer Center and internationally, and the future of treatment and trials for PDAC.


Assuntos
Carcinoma Ductal Pancreático/tratamento farmacológico , Carcinoma Ductal Pancreático/cirurgia , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/cirurgia , Quimioterapia Adjuvante , Ensaios Clínicos Fase III como Assunto , Humanos , Terapia Neoadjuvante , Pancreatectomia/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Phys Med Rehabil Clin N Am ; 32(2): 319-353, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33814061

RESUMO

Telehealth visits result in high-quality care, with high patient and provider satisfaction. Strong evidence suggests that virtual physical therapy is noninferior to conventional face-to-face physical therapy for a variety of musculoskeletal disorders. Postoperative telerehabilitation has a strong positive effect on clinical outcomes, and the increased intensity telerehabilitation programs offer is a promising option for patients. Studies demonstrate effective virtual postoperative management. The novel coronavirus disease 2019 pandemic has led to improved reimbursement for telehealth visits and accelerated widespread implementation of telemedicine. This article establishes experience and evidence-based practice guidelines for conducting telemedicine visits, with emphasis on the virtual physical examination.


Assuntos
Doenças Musculoesqueléticas/terapia , Dor Musculoesquelética/terapia , Exame Físico/métodos , Cuidados Pós-Operatórios/métodos , Telemedicina/métodos , COVID-19/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Doenças Musculoesqueléticas/fisiopatologia , Dor Musculoesquelética/fisiopatologia , Terapia Ocupacional , Pandemias , Satisfação do Paciente , Modalidades de Fisioterapia , SARS-CoV-2
16.
Medicine (Baltimore) ; 100(17): e25670, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907134

RESUMO

BACKGROUND: Baduanjin, as an ancient Chinese exercise, is beneficial to both physical and mental health. Moreover, researchers discovered that Baduanjin has effects on the recovery of postoperative breast cancer patients. Yet, nobody focused on the systematic review, which can provide convincing evidence to verify the effect of Baduanjin in breast cancer patients. Therefore, our study will conduct a systematic review to fill in the blank, besides we will offer new evidence for clinical workers. METHODS: PubMed, Embase.com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be used for literature search, retrieve time is up to June 1, 2021. We will include randomized controlled trials that evaluate the effects of Baduanjin on postoperative rehabilitation for breast cancer patients. Two independent researchers will perform study selection and data extraction. The risk of bias will be assessed by the Cochrane bias assessment tool. We will use funnel plot and Egger test to evaluate publication bias. Stata 13.0, as a necessary software, will be used to perform statistical analysis. Also, we will utilize subgroup analyses and sensitivity analyses to explore the sources of heterogeneity. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: Evidence that adequately assesses the effect of Baduanjin in the recovery of breast cancer patients will be confirmed through this systematic review. Our study will offer a guideline for clinical workers, besides we will supply a new way for the rehabilitation of breast cancer patients.


Assuntos
Neoplasias da Mama/reabilitação , Mastectomia/reabilitação , Cuidados Pós-Operatórios/métodos , Qigong/métodos , Adulto , Neoplasias da Mama/cirurgia , Feminino , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
17.
J Cardiovasc Surg (Torino) ; 62(4): 347-353, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33829744

RESUMO

INTRODUCTION: A postoperative neck hematoma can be a life-threatening complication after carotid endarterectomy necessitating urgent surgical decompression to avoid airway compromise. The practice of routine incisional drain placement is variable with few published studies evaluating the "to drain versus not to drain" approach. We conducted a systematic review and meta-analysis of the safety and efficacy of neck drain placement for prevention of neck hematoma requiring re-exploration for decompression. EVIDENCE ACQUISITION: This study is a systematic review and meta-analysis performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled odds ratios with 95% confidence intervals were calculated for the outcome of surgical re-exploration for neck decompression among patients receiving or not receiving wound drainage. EVIDENCE SYNTHESIS: We identified 5 studies for inclusion, comprising 48,297 patients with 19,832 (41.1%) patients receiving a drain after carotid endarterectomy. Patients in the drain group had a significantly higher re-exploration rate after carotid endarterectomy compared to those who did not receive a drainage (OR=1.24, 95% CI: 1.03-1.49; P=0.02) with no heterogeneity (I2=0%). CONCLUSIONS: Routine drain placement does not offer complete protection against neck hematoma development and may give the surgeon a false sense of security in wound drainage. Thus, we conclude that drain placement following carotid endarterectomy should be selective, not routine.


Assuntos
Estenose das Carótidas/cirurgia , Tomada de Decisões , Drenagem/métodos , Endarterectomia das Carótidas , Hematoma/cirurgia , Cuidados Pós-Operatórios/métodos , Hemorragia Pós-Operatória/cirurgia , Humanos , Pescoço/irrigação sanguínea
18.
Med Sci Monit ; 27: e929814, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33883543

RESUMO

BACKGROUND Treating advanced finger joint contractures from Dupuytren disease remains a challenge. We evaluated the effectiveness of a skeletal distraction device versus alternative treatment options. MATERIAL AND METHODS We analyzed the surgical treatment of contracted finger joints in stage III and stage IV Dupuytren's disease over a 10-year period. Data were obtained from inpatient and outpatient medical records, including postoperative clinical examinations and extended Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores. Complications of infection, postoperative pain, and wound healing disorders were recorded. RESULTS A total of 79 patients (83 hands) were assigned to 2 treatment groups. Patients in group 1 underwent an initial open transection of the main fibrous cord, Z-plasty, distraction with the Erlangen external distraction device, and fasciectomy. The distraction period was 13 to 81 days (mean 31 days). Group 2 underwent a conventional single-stage fasciectomy and arthrolysis. DASH scores and subjective patient satisfaction were lower in group 1 (20.7/33%) than in group 2 (10.3/50%). However, the staged approach of group 1 to treat proximal interphalangeal joint contractures in the long term (improvement >40%) was more effective than the approach of group 2 (>33%). Distraction device pin infections occurred in 20% of hands. Postoperative pain and complex regional pain syndrome type I occurred in 25% of hands in group 1 and 3% in group 2. CONCLUSIONS A screw thread driven external fixation device is useful in end-stage Dupuytren's finger joint contractures. It is indicated when joint contractures are advanced and simple arthrolysis is insufficient.


Assuntos
Contratura de Dupuytren/cirurgia , Equipamentos e Provisões , Articulações dos Dedos/fisiologia , Procedimentos Ortopédicos/métodos , Cuidados Pós-Operatórios/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Progressão da Doença , Fixadores Externos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Resultado do Tratamento
19.
Clin Nutr ; 40(4): 1604-1612, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33744604

RESUMO

BACKGROUND: Early oral or enteral nutrition (EEN) has been proven safe, tolerable, and beneficial in elective surgery. In emergency abdominal surgery no consensus exists regarding postoperative nutrition standard regimens. This review aimed to assess the safety and clinical outcomes of EEN compared to standard care after emergency abdominal surgery. METHODS: The review protocol was performed according to the Cochrane Handbook and reported according to PRISMA. Clinical outcomes included mortality, specific complication rates, length of stay, and serious adverse events. Risk of bias was assessed by Cochrane risk of bias tool and Downs and Black. GRADE assessment of each outcome was performed, and Trial Sequential Analysis was completed to obtain the Required Information Size (RIS) of each outcome. RESULTS: From a total of 4741 records screened, a total of five randomized controlled trials and two non-randomized controlled trials were included covering 1309 patients. The included studies reported no safety issues regarding the use of EEN. A significant reduction in the mortality rate of EEN compared with standard care was seen (OR 0.59 (CI 95% 0.34-1.00), I2 = 0%). Meta-analyses on sepsis and postoperative pulmonary complications showed non-significant tendencies in favor of EEN compared with standard care. GRADE assessment of all outcomes was evaluated 'low' or 'very low'. Trial Sequential Analysis revealed that all outcomes had insufficient RIS to confirm the effects of EEN. CONCLUSION: EEN after major emergency surgery is correlated with reduced mortality, however, more high-quality data regarding the optimal timing and composition of nutrition are needed before final conclusions regarding the effects of EEN can be made.


Assuntos
Abdome/cirurgia , Tratamento de Emergência/mortalidade , Nutrição Enteral/mortalidade , Cuidados Pós-Operatórios/mortalidade , Complicações Pós-Operatórias/reabilitação , Ensaios Clínicos como Assunto , Serviço Hospitalar de Emergência , Tratamento de Emergência/métodos , Nutrição Enteral/métodos , Humanos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/mortalidade , Período Pós-Operatório , Fatores de Tempo , Resultado do Tratamento
20.
Mayo Clin Proc ; 96(7): 1727-1745, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33743997

RESUMO

OBJECTIVE: To determine whether radioiodine remnant ablation (RRA) reduces cause-specific mortality (CSM) or tumor recurrence (TR) rate after bilateral lobar resection (BLR). PATIENTS AND METHODS: There were 2952 low-risk adult papillary thyroid cancer (LRAPTC) patients (with MACIS scores <6) who underwent potentially curative BLR during 1955-2014. During 1955-1974, 1975-1994, and 1995-2014, RRA was administered in 3%, 49%, and 28%. Statistical analyses were performed using SAS software. RESULTS: During 1955-1974, the 20-year CSM and TR rates after BLR alone were 1.0% and 6.8%; rates after BLR+RRA were 0% (P=.63) and 5.9% (P=.82). During 1975-1994, post-BLR 20-year rates for CSM and TR were 0.3% and 7.5%; after BLR+RRA, rates were higher at 0.9% (P=.31) and 12.8% (P=.01). When TR rates were examined separately for 448 node-negative and 317 node-positive patients, differences were nonsignificant. In 1995-2014, post-BLR 20-year CSM and TR rates were 0% and 9.2%; rates after BLR+RRA were higher at 1.4% (P=.19) and 21.0% (P<.001). In 890 pN0 cases, 15-year locoregional recurrence rates were 3.4% after BLR and 3.7% after BLR+RRA (P=.99). In 740 pN1 patients, 15-year locoregional recurrence rates were 10% higher after BLR+RRA compared with BLR alone (P=.01). However, this difference became nonsignificant when stratified by numbers of metastatic nodes. CONCLUSION: RRA administered to LRAPTC patients during 1955-2014 did not reduce either the CSM or TR rate. We would therefore not recommend RRA in LRAPTC patients undergoing BLR with curative intent.


Assuntos
Radioisótopos do Iodo/uso terapêutico , Recidiva Local de Neoplasia , Cuidados Pós-Operatórios , Radioterapia Adjuvante , Câncer Papilífero da Tireoide , Tireoidectomia , Técnicas de Ablação/métodos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Compostos Radiofarmacêuticos/uso terapêutico , Radioterapia Adjuvante/métodos , Radioterapia Adjuvante/estatística & dados numéricos , Risco Ajustado/métodos , Fatores de Risco , Câncer Papilífero da Tireoide/mortalidade , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/radioterapia , Câncer Papilífero da Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Estados Unidos/epidemiologia
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