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1.
Curr Oncol ; 28(3): 2248-2259, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34204531

RESUMO

Patients awaiting cancer treatment were classified as "vulnerable" and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention.


Assuntos
COVID-19/epidemiologia , Neoplasias/terapia , Telemedicina/métodos , Idoso , Inglaterra , Exercício Físico , Estudos de Viabilidade , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Medicina de Precisão/métodos , Cuidados Pré-Operatórios , Exercício Pré-Operatório , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
3.
Clin Ter ; 172(4): 315-321, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34247214

RESUMO

Background: This study aimed to determine the diagnostic per-formance of fractional anisotropy (FA) and mean diffusivity (MD) values for glioma grading. Conclusion: The tMD, rMDt/w, and rFAp/w values represent useful indices for the differentiation between LGG and HGG. The combination of these indices can improve diagnostic specificity. Methods: A total of 42 patients who underwent biopsy or surge-ry and were histologically diagnosed with glioma from September 2019 to December 2020 were enrolled in this retrospective study. Diffusion tensor imaging (DTI) and conventional magnetic resonance imaging (MRI) were performed preoperatively using 3 Tesla MRI in all cases. The FA and MD values were measured in the solid portion of the tumor, the peritumoral area, and the normal white matter. The diagnostic performances of the absolute and relative FA and MD values for glioma grading were analyzed using the receiver operating characteristic (ROC) curve. Results: The MD value in the solid portion of the tumor (tMD), the MD value of the solid portion of the tumor relative to that in the normal white matter (rMDt/w), and the FA value for the peritumoral region relative to that of the normal white matter (rFAp/w) showed significant differences between the low-grade (LGG) and high-grade glioma (HGG) groups. The combination of these three parameters provided the largest area under the curve value of 89% with sensitivity, specificity, accuracy, negative predictive, and positive predictive values of 72%, 100%, 81%, 62%, and 100%, respectively, for distinguishing between the LGG and HGG groups.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/fisiopatologia , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Glioma/diagnóstico , Glioma/fisiopatologia , Gradação de Tumores/métodos , Adolescente , Adulto , Anisotropia , Neoplasias Encefálicas/cirurgia , Criança , Feminino , Glioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
4.
Clin Ter ; 172(4): 322-328, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34247215

RESUMO

Background: Dupuytren's contracture (DC) is a fibrosing disor-der that produces pathological subcutaneous nodules and cords in the normal fascia. The isolated occurrence of Dupuytren's disease of the fifth digit is uncommon. This study is aimed to describe the imaging features of an isolated digital cord of the small finger and its relationship with the neurovascular bundle. Methods: A total of 13 hands in 13 patients who were clinically diagnosed with an isolated occurrence of Dupuytren's disease of the small finger were included between October 2008 and October 2013. Two independent radiologists used ultrasound and magnetic reso-nance imaging (MRI) to record size, signal or echogenicity, contrast enhancement or hyperemia, calcification, and anatomical features of the cord and its relationship with the neurovascular bundle. Results: We found that ultrasound and MRI were accurate for the detection of the cords and neurovascular bundles in the small finger. The intermodality agreement between MRI and ultrasound was 100% for the detection of 6 spiraling bundles containing 13 isolated cords (46.2%). Among the subjects examined, 100% of the hands had ab-ductor digiti minimi (ADM) area involvement, and the distal insertion of the cord was on the ulnar side of the base of the middle phalanx. On MRI, all of the cords showed predominantly low signal intensity on both T1- and T2-weighted images. On ultrasound, the ulnar cord showed a hyperechoic or isoechoic appearance in 69.3% of hands and a hypoechoic appearance in 30.7% of hands. Conclusions: The spiraling of the bundle in the isolated occurrence of Dupuytren's disease at the small finger is a frequent occurrence. MRI and ultrasound are good imaging modalities for the evaluation of the relationship between the neurovascular bundle and the isolated cord.


Assuntos
Contratura de Dupuytren/diagnóstico por imagem , Dedos/diagnóstico por imagem , Dedos/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Cuidados Pré-Operatórios/métodos , Ultrassonografia/métodos , Adulto , Idoso , Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/fisiopatologia , Contratura de Dupuytren/cirurgia , Feminino , Dedos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Zhonghua Yi Xue Za Zhi ; 101(26): 2066-2070, 2021 Jul 13.
Artigo em Chinês | MEDLINE | ID: mdl-34275240

RESUMO

Objective: To explore the effect of video distraction on preoperative separation anxiety and induction compliance of preschool children receiving strabismus surgery under general anesthesia. Methods: In this prospective trial, 80 children aged 3 to 6 years scheduled for strabismus surgery under inhalation anesthesia were randomly allocated to one of two groups, a control group and a video distraction group, with 40 cases in each group. Children in the video distraction group continuously watched videos from waiting in the holding area, separating with parents, entering the operating room and induction of anesthesia, while children in the control group didn't watch videos during the same process. The modified Yale Preoperative Anxiety Scale (mYPAS) of children were recorded upon arriving at the holding area(T1)and separating with parents(T2). Induction Compliance Checklist (ICC) score was recorded when the anesthesia induction was performed. The emergence time, the occurrence rate of adverse events in post-anesthesia care unit (PACU) including nausea and vomiting, laryngospasm, severe cough, hypoxemia and sinus bradycardia, incidence of postoperative adverse reactions such as pain, dizziness, nausea and vomiting and lethargy, the parents' satisfaction of anesthesia were also assessed. Results: There were no significant difference in mYPAS score and the proportion of mYPAS score>30 between 2 groups at T1 (all P>0.05). At T2, the mYPAS score and the proportion of mYPAS score>30 in video distraction group were (34.41±13.23) and 52.50%, which were lower than those in control group (50.64±20.96, 87.50%) with statistically significant difference (all P<0.05). The ICC score of video distraction group was lower than that of the control group, which was (1.83±2.26) vs (4.03±2.99), and the difference was statistically significant (P<0.05). The proportion of children with ICC score=0 in video distraction group was 37.50%, which was higher than that in the control group (12.50%), while the proportion of children with ICC score=4-10 was lower than that of the control group, which was 17.50% vs 45.00%, and the difference was statistically significant (P<0.05). No significant intergroup differences were observed in emergence time, incidence of adverse events in PACU, and incidence of postoperative adverse reactions (P>0.05). The parents' satisfaction of anesthesia in the video distraction group was (9.23±0.89), which was higher than that in the control group (8.63±1.23), with statistically significant (P<0.05). Conclusion: Preoperative video distraction alleviates separation anxiety, improves induction compliance of preschool children receiving strabismus surgery under general anesthesia, and increases the parents' satisfaction of anesthesia.


Assuntos
Ansiedade de Separação , Cuidados Pré-Operatórios , Ansiedade , Transtornos de Ansiedade , Pré-Escolar , Humanos , Estudos Prospectivos
6.
Rev Med Suisse ; 17(743): 1150-1154, 2021 Jun 16.
Artigo em Francês | MEDLINE | ID: mdl-34133091

RESUMO

Some hepato-biliary cancers require major liver resections. Post hepatectomy liver failure is a complication that occurs when the remnant liver cannot maintain its synthetic and excretory functions. To overcome this issue, portal vein embolization has been developed to induce future remnant liver hypertrophy preoperatively. However, up to 20% of patients cannot proceed to the hepatectomy due to insufficient hypertrophy or tumor progression in the interval between the embolization and the planned surgery. Liver venous deprivation (LVD) is a technique that combine ipsilateral portal and hepatic vein embolization. With this technique, the hypertrophy seems to be faster and more important, with low complications rate and no mortality associated with the procedure.


Assuntos
Embolização Terapêutica , Neoplasias Hepáticas , Hepatectomia , Veias Hepáticas , Humanos , Fígado , Neoplasias Hepáticas/cirurgia , Veia Porta , Cuidados Pré-Operatórios , Resultado do Tratamento
8.
Artigo em Inglês | MEDLINE | ID: mdl-34147408

RESUMO

INTRODUCTION: Due to its high transmissibility, measures aimed at reducing the spread of SARS CoV2 have become mandatory. Different organizations have recommended performing polymerase chain reaction tests (PCR) as part of the preoperative screening of surgical patients. We aimed to determine the performance of PCR testing to detect asymptomatic carriers. METHODS: Observational study carried out at a tertiary care center. We compared the results of preoperative real-time reverse-transcription-PCR test (RT-PCR) performed on a cohort of patients pending surgery with the results we would have expected assuming the epidemiological data released by government offices. RESULTS: We registered no positives in the 2,722 preoperative RT-PCR tests performed in our health care area between epidemiological Weeks 18 to 21, meaning a cumulative incidence trending to zero. Assuming public epidemiological data, the probabilistic projection of potential asymptomatic individuals ranged from 0.27 × 10e-4 (according to official data of new cases diagnosed by PCR) to 4.69 × 10e-4 if we assumed cases confirmed by IgG test in our province. Assuming a RT-PCR sensitivity of 95%, to obtain a positive result we should perform 38,461 and 2,028 tests respectively. CONCLUSIONS: In scenarios of very low prevalence and despite high sensitivity scores, indiscriminate preoperative RT-PCR screening is of a questionable effectiveness for detecting asymptomatic carriers. Our findings evidence the difficulty of establishing reliable predictive models for the episodic and rapidly evolving incidence of infections such as has characterized the SARS CoV2 pandemic.


Assuntos
Teste de Ácido Nucleico para COVID-19 , COVID-19/diagnóstico , Portador Sadio/diagnóstico , Pandemias , Cuidados Pré-Operatórios , SARS-CoV-2 , COVID-19/epidemiologia , Teste de Ácido Nucleico para COVID-19/estatística & dados numéricos , Portador Sadio/epidemiologia , Humanos , Incidência , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia
9.
Medicine (Baltimore) ; 100(26): e26531, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190189

RESUMO

ABSTRACT: The aim of this study was to compare the sensitivity of mammography (MG), ultrasound (US), magnetic resonance imaging (MRI), and combinations of these imaging modalities for the detection of small (≤2 cm) breast cancer and to evaluate the benefit of preoperative breast MRI after performing conventional imaging techniques for small breast cancer.This was an observational retrospective review of 475 patients with pathologically confirmed breast cancer. We reviewed the medical records; assessed the preoperative reports of MG, US, and MRI; and categorized them as benign features (BI-RADS 1-3) or malignant features (BI-RADS 4 or 5). The criterion standard for detection was the pathologic assessment of the surgical specimen. The sensitivities of the different techniques were compared using the McNemar test.Among the 475 women, the sensitivity of MG was significantly greater in patients with low breast density than in those with high breast density (84.5% vs 65.8%, P < .001). US had higher sensitivity than MG (P < .001), and the combination of MG + US showed better sensitivity than MG or US alone (P < .001). Further addition of MRI to the combination of MG and US statistically contributed to the sensitivity yield (from 93.3% to 98.2%; P < .001) but did not significantly increase the mastectomy rate (from 48.2% to 49.3%; P = .177).MG has limited diagnostic sensitivity in patients with small breast cancer, especially in those with dense breast tissue. US is better than MG at detecting small breast cancer, regardless of breast density. The addition of MRI to MG and US could increase sensitivity without increasing the mastectomy rate. This study suggests performing MRI routinely on the basis of MG and US for small (≤2 cm) breast cancer.


Assuntos
Neoplasias da Mama , Imageamento por Ressonância Magnética/métodos , Mamografia/métodos , Mastectomia , Ultrassonografia Mamária/métodos , Densidade da Mama , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , China/epidemiologia , Feminino , Humanos , Mastectomia/métodos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Carga Tumoral
10.
Biomed Res Int ; 2021: 5554500, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34124245

RESUMO

Objective: We aimed to evaluate the advantages of preoperative digital design of skin flaps to repair fingertip defects during the COVID-19 pandemic. We combined digital design with a 3D-printed model of the affected finger for preoperative communication with fingertip defect patients under observation in a buffer ward. Methods: From December 2019 to January 2021, we obtained data from 25 cases of 30 fingertip defects in 15 males and 10 females, aged 20-65 years old (mean 35 ± 5 years). All cases were treated by digitally designing preoperative fingertip defect flaps combined with a 3D-printed model. Preoperative 3D Systems Sense scanning was routinely performed, 3-matic 12.0 was used to measure the fingertip defect area ranging from 1.5 cm × 3.5 cm to 2.0 cm × 5.0 cm, and the skin flap was designed. The flap area was 1.6 cm × 3.6 cm to 2.1 cm × 5.1 cm. CURA 15.02.1 was used to set parameters, and the 3D model of the affected finger was printed prior to the operation. Full-thickness skin grafts were taken from donor areas for repair. Results: No vascular crises occurred in any of the 25 cases, and all flaps survived. The postoperative follow-up occurred over 3-12 months. All patients were evaluated 3 months after operation according to the trial standard of hand function evaluation of the Chinese Hand Surgery Society. The results showed that 20 cases had excellent outcomes (80%), four cases had good outcomes (16%), and one case had a fair outcome (4%). The excellent and good rate was 96%. Conclusions: During the COVID-19 epidemic, fingertip defects were treated with preoperative digital design of fingertip defect flaps combined with 3D printing. Precision design saves surgery time and improves the success rate of surgery and the survival rates of skin flaps. In addition, 3D model simulations improve preoperative communication efficiency, and the personalized design improves patient satisfaction.


Assuntos
COVID-19/epidemiologia , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Pandemias , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Adulto , Idoso , COVID-19/psicologia , China/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Impressão Tridimensional/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/psicologia , SARS-CoV-2/patogenicidade , Transplante de Pele/psicologia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Resultado do Tratamento , Cicatrização/fisiologia
11.
Acta Oncol ; 60(8): 1025-1031, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34102947

RESUMO

BACKGROUND: Prehabilitation is the process of increasing functional capacity (FC) before surgery. Poor glycemic control is associated with worse outcomes in patients undergoing surgery. Therefore, prediabetic patients could particularly benefit from prehabilitation. METHODS: This is a pooled analysis of individual patient data from three multimodal prehabilitation trials in colorectal cancer surgery. Following a baseline assessment using the 6-minute walking test (6MWT), subjects were randomized to multimodal prehabilitation or to a control group. Participants were reassessed 24 h before surgery and 4 weeks after surgery. Prediabetes (PreDM) was defined as HbA1c 5.7%-6.4%. Multivariable logistic regression was used to adjust for potentially confounding variables. RESULTS: Participation in a prehabilitation program was the most important predictive factor of clinical improvement in FC prior to surgery (Adjusted OR 2.42, 95% CI 1.18, 4.94); prediabetes was not a statistically significant predictor of improvement in FC after adjustments for covariates. Prehabilitation attenuated the loss of FC in unadjusted analyses after surgery in prediabetic patients (PreDM Control: median change -6 m [IQR -50-20] vs PreDM Prehab: median change +25 m [IQR -20-53], p = 0.045). Adjusted analyses also suggested the protective effect against loss of FC after surgery was stronger in prediabetic patients (PreDM Prehab vs PreDM Control: OR 5.5, 95% CI: 1.2-25.8; Normo Prehab vs Normo Control: OR 1.5, 95% CI: 0.53-4.52). CONCLUSIONS: Multimodal prehabilitation favored clinical recovery of FC after surgery in CRC patients, especially prediabetic patients.


Assuntos
Neoplasias Colorretais , Estado Pré-Diabético , Neoplasias Colorretais/cirurgia , Humanos , Cuidados Pré-Operatórios , Exercício Pré-Operatório , Recuperação de Função Fisiológica
12.
Biomed Res Int ; 2021: 5554500, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1263956

RESUMO

Objective: We aimed to evaluate the advantages of preoperative digital design of skin flaps to repair fingertip defects during the COVID-19 pandemic. We combined digital design with a 3D-printed model of the affected finger for preoperative communication with fingertip defect patients under observation in a buffer ward. Methods: From December 2019 to January 2021, we obtained data from 25 cases of 30 fingertip defects in 15 males and 10 females, aged 20-65 years old (mean 35 ± 5 years). All cases were treated by digitally designing preoperative fingertip defect flaps combined with a 3D-printed model. Preoperative 3D Systems Sense scanning was routinely performed, 3-matic 12.0 was used to measure the fingertip defect area ranging from 1.5 cm × 3.5 cm to 2.0 cm × 5.0 cm, and the skin flap was designed. The flap area was 1.6 cm × 3.6 cm to 2.1 cm × 5.1 cm. CURA 15.02.1 was used to set parameters, and the 3D model of the affected finger was printed prior to the operation. Full-thickness skin grafts were taken from donor areas for repair. Results: No vascular crises occurred in any of the 25 cases, and all flaps survived. The postoperative follow-up occurred over 3-12 months. All patients were evaluated 3 months after operation according to the trial standard of hand function evaluation of the Chinese Hand Surgery Society. The results showed that 20 cases had excellent outcomes (80%), four cases had good outcomes (16%), and one case had a fair outcome (4%). The excellent and good rate was 96%. Conclusions: During the COVID-19 epidemic, fingertip defects were treated with preoperative digital design of fingertip defect flaps combined with 3D printing. Precision design saves surgery time and improves the success rate of surgery and the survival rates of skin flaps. In addition, 3D model simulations improve preoperative communication efficiency, and the personalized design improves patient satisfaction.


Assuntos
COVID-19/epidemiologia , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Pandemias , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Adulto , Idoso , COVID-19/psicologia , China/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Impressão Tridimensional/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/psicologia , SARS-CoV-2/patogenicidade , Transplante de Pele/psicologia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Resultado do Tratamento , Cicatrização/fisiologia
13.
Artigo em Inglês | MEDLINE | ID: covidwho-1263366

RESUMO

INTRODUCTION: Due to its high transmissibility, measures aimed at reducing the spread of SARS CoV2 have become mandatory. Different organizations have recommended performing polymerase chain reaction tests (PCR) as part of the preoperative screening of surgical patients. We aimed to determine the performance of PCR testing to detect asymptomatic carriers. METHODS: Observational study carried out at a tertiary care center. We compared the results of preoperative real-time reverse-transcription-PCR test (RT-PCR) performed on a cohort of patients pending surgery with the results we would have expected assuming the epidemiological data released by government offices. RESULTS: We registered no positives in the 2,722 preoperative RT-PCR tests performed in our health care area between epidemiological Weeks 18 to 21, meaning a cumulative incidence trending to zero. Assuming public epidemiological data, the probabilistic projection of potential asymptomatic individuals ranged from 0.27 × 10e-4 (according to official data of new cases diagnosed by PCR) to 4.69 × 10e-4 if we assumed cases confirmed by IgG test in our province. Assuming a RT-PCR sensitivity of 95%, to obtain a positive result we should perform 38,461 and 2,028 tests respectively. CONCLUSIONS: In scenarios of very low prevalence and despite high sensitivity scores, indiscriminate preoperative RT-PCR screening is of a questionable effectiveness for detecting asymptomatic carriers. Our findings evidence the difficulty of establishing reliable predictive models for the episodic and rapidly evolving incidence of infections such as has characterized the SARS CoV2 pandemic.


Assuntos
Teste de Ácido Nucleico para COVID-19 , COVID-19/diagnóstico , Portador Sadio/diagnóstico , Pandemias , Cuidados Pré-Operatórios , SARS-CoV-2 , COVID-19/epidemiologia , Teste de Ácido Nucleico para COVID-19/estatística & dados numéricos , Portador Sadio/epidemiologia , Humanos , Incidência , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia
14.
J Laryngol Otol ; 135(7): 568-573, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34120662

RESUMO

OBJECTIVE: This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy. METHOD: This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy. RESULTS: Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13-59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11-40 per cent) following pre-operative supplementation. CONCLUSION: Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.


Assuntos
Hormônios e Agentes Reguladores de Cálcio/uso terapêutico , Cálcio/uso terapêutico , Hipocalcemia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Tireoidectomia/métodos , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Calcitriol/uso terapêutico , Carbonato de Cálcio/uso terapêutico , Colecalciferol/uso terapêutico , Humanos , Hidroxicolecalciferóis/uso terapêutico , Hipocalcemia/fisiopatologia , Cuidados Pré-Operatórios/métodos
15.
Br J Radiol ; 94(1123): 20210193, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34111980

RESUMO

OBJECTIVES: To compare the efficacy and safety of pre-operative localization of ground glass nodule (GGN) using embolization microcoils and the locating needles designed for pulmonary nodules. METHODS: From June 2019 to December 2020, 429 patients who received CT-guided localization of single GGN before video-assisted thoracoscopic surgery (VATS) were enrolled. The diameter and depth of GGNs were 0.84 ± 0.39 cm and 1.66 ± 1.37 cm. Among 429 cases, the first 221 GGNs were marked with microcoils (the microcoil group), and the remaining 208 GGNs were marked with the locating needles designed for pulmonary nodules (the locating needle group). SPSS 17.0 statistical software was used to compare the marking success rate, marking time, marking-related complications between two groups. p values < 0.05 were considered statistically significant. RESULTS: The marking time in the microcoil group was longer than that in the locating needle group (11.1 ± 3.9 vs 8.2 ± 2.0 min, t = -7.87, p = 0.000). The marking success rate in the microcoil group was lower than that in the locating needle group (91.4% vs 98.6%, χ2 = 11.27, p = 0.001). In the microcoil group, marking failures included 16 cases of microcoil dislocation and 3 cases of unsatisfactory microcoil position, while all 3 cases of marking failure in the locating needle group were due to unsatisfactory anchor position. No significant differences in the incidence of total complications (23.1% vs 22.1%), pneumothorax (18.1% vs 19.2%), hemorrhage (9.5% vs 9.1%), and hemoptysis (1.8% vs 1.4%) were observed between the two groups. All the complications were minor and did not need special treatment. Except for one case in the microcoil group, which was converted to thoracotomy, the remaining 428 GGNs were successfully resected by VATS. CONCLUSIONS: It is safe and effective to perform pre-operative localization of GGN using either embolization microcoil or the locating needle designed for pulmonary nodules. The locating needle is superior to microcoil for marking GGN in terms of procedure time and the success rate. The complication rate of both methods is similar. ADVANCES IN KNOWLEDGE: The locating needle designed for pulmonary nodules has recently been used to mark pulmonary nodule. Its structure can effectively avoid dislocation after localization, and the marking process is simple and quick. Compared with localization using microcoil, it takes less time and has higher success rate to mark GGNs using the locating needle. The complication rate of both methods is similar.


Assuntos
Embolização Terapêutica/instrumentação , Agulhas , Radiografia Intervencionista , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Nódulo Pulmonar Solitário/patologia , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida
16.
J Clin Neurosci ; 89: 8-14, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119299

RESUMO

It remains controversial whether preoperative low muscle mass affects clinical outcomes after lumbar surgery. Previous studies evaluated outcomes such as pain, quality of life, and disability, but none investigated preoperative low muscle mass and psychological factors. The purpose of this study was to clarify the association between preoperative low muscle mass and postoperative psychological factors in lumbar spinal stenosis (LSS). A longitudinal analysis was performed in 85 consecutive preoperative patients with LSS. Demographic data, leg pain, low back pain, Japanese Orthopaedic Association score, Pain Catastrophizing Scale (PCS) score, Fear-Avoidance Beliefs Questionnaire on Physical Activity (FABQ-PA) score, Hospital Anxiety and Depression Scale (HADS) score, walking velocity, grip strength, and appendicular lean mass were assessed. Muscle mass was measured using bioelectrical impedance analysis. Patients were divided into two groups based on skeletal muscle mass index. These clinical outcomes were evaluated preoperatively and 1 year after surgery. In the 73 patients who were analyzed 1 year after surgery, the prevalence of preoperative low muscle mass was 21.9%. The normal muscle mass group showed significantly improved PCS, FABQ-PA, HADS-anxiety, and HADS-depression scores 1 year after surgery. The low muscle mass group did not demonstrate significantly improved PCS, FABQ-PA, or HADS-depression scores, and had a significantly smaller increase in the FABQ-PA score than the normal muscle mass group. Multivariate analysis showed that low muscle mass was significantly related to change in FABQ-PA score. Our results suggest that preoperative low muscle mass hinders improvement in fear-avoidance beliefs 1 year after surgery.


Assuntos
Medo/psicologia , Vértebras Lombares/cirurgia , Força Muscular/fisiologia , Cuidados Pré-Operatórios/psicologia , Estenose Espinal/psicologia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Catastrofização/diagnóstico , Catastrofização/psicologia , Pessoas com Deficiência/psicologia , Impedância Elétrica , Feminino , Humanos , Estudos Longitudinais , Dor Lombar/diagnóstico , Dor Lombar/psicologia , Dor Lombar/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/tendências , Qualidade de Vida/psicologia , Estenose Espinal/diagnóstico
17.
J Orthop Traumatol ; 22(1): 26, 2021 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-34180020

RESUMO

BACKGROUND: Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use. MATERIALS AND METHODS: We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN. RESULTS: Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2. CONCLUSIONS: In our study population, despite not having a control group, preliminary traction-when effective-seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home. LEVEL OF EVIDENCE: 3.


Assuntos
Luxação Congênita de Quadril/terapia , Tração , Fatores Etários , Pré-Escolar , Feminino , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/prevenção & controle , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Humanos , Lactente , Masculino , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Tração/efeitos adversos , Tração/métodos , Índices de Gravidade do Trauma , Resultado do Tratamento
20.
In Vivo ; 35(4): 1913-1920, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34182463

RESUMO

BACKGROUND/AIM: Abdominal wall hernias represent a common problem in surgical practice. A significant proportion of them entails large defects, often difficult to primarily close without advanced techniques. Injection of botulinum toxin preoperatively at specific points targeting lateral abdominal wall musculature has been recently introduced as an adjunct in achieving primary fascia closure rates. MATERIALS AND METHODS: A literature search was conducted investigating the role of botulinum toxin in abdominal wall reconstruction focusing on anatomic repair of hernia defects. RESULTS: Injecting botulinum toxin preoperatively achieved chemical short-term paralysis of the lateral abdominal wall muscles, enabling a tension-free closure of the midline, which according to anatomic and clinical studies should be the goal of hernia repair. No significant complications from botulinum injections for complex hernias were reported. CONCLUSION: Botulinum is a significant adjunct to complex abdominal wall reconstruction. Further studies are needed to standardize protocols and create more evidence.


Assuntos
Parede Abdominal , Toxinas Botulínicas Tipo A , Hérnia Ventral , Fármacos Neuromusculares , Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Cuidados Pré-Operatórios , Estudos Prospectivos , Telas Cirúrgicas
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