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1.
Langenbecks Arch Surg ; 408(1): 44, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36662311

RESUMO

PURPOSE: To investigate if body composition parameters measured by bioelectrical impedance analysis (BIA) and are reportedly correlated with clinical outcomes of patients undergoing digestive tract surgery could be useful for reliably evaluating the perioperative risk in patients undergoing hepatectomy. METHODS: Consecutive 200 patients who underwent BIA before hepatectomy were retrospectively reviewed. A risk prediction model for postoperative morbidity was created using the initial 100 patients, and its performance was validated using the remaining 100 patients. RESULTS: Based on the correlation with postoperative morbidity, a novel risk prediction model, the protein-edema score, was created using net protein weight and extracellular water/total body water ratio measured through BIA. The protein-edema score (score 0 vs. ≥ 1) showed a reproducible correlation with Clavien-Dindo 2 or greater postoperative morbidity in the validation set (17.7% vs. 46.4%, P = 0.002) as observed in the training set (18.8% vs. 49.0%, P = 0.002) after statistical adjustment. Similar tendency was also confirmed in Clavien-Dindo 3a or greater postoperative morbidity (5.9% vs. 18.2%, P = 0.037) and postoperative refractory ascites (5.5% vs. 17.4%, P = 0.037) in the validation set. CONCLUSIONS: The protein-edema score created based on BIA is significantly correlated with postoperative morbidity in patients undergoing liver resection.


Assuntos
Edema , Hepatectomia , Humanos , Hepatectomia/efeitos adversos , Impedância Elétrica , Estudos Retrospectivos , Fatores de Risco , Edema/etiologia , Fígado
4.
Sci Rep ; 13(1): 661, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36635339

RESUMO

Soft-tissue conditioning due to posttraumatic oedema after complicated joint fractures is a central therapeutic aspect both pre- and postoperatively. On average, 6-10 days pass until the patient is suitable for surgery. This study compares the decongestant effect of vascular impulse technology (VIT) with that of conventional elevation. In this monocentric RCT, 68 patients with joint fractures of the upper (n = 36) and lower (n = 32) extremity were included and randomized after consent in a 1:1 ratio. Variables were evaluated for all fractures together and additionally subdivided into upper or lower extremity for better clinical comparability. Primary endpoint was the time in days from hospital admission to operability. Secondary endpoints were total length of stay, oedema reduction, pain intensity, complications, and revisions. The time from admission until operability was reduced by 1.4 (95% CI - 0.4; 3.1) days in the mITT analysis (p = 0.120) and was statistically significant with 1.7 (95% CI 0.1; 3.3) days in the as-treated sensitivity analysis (pAT = 0.038). Significantly less pain and a faster oedema reduction were found in the intervention group. Due to rare occurrences, nothing can be concluded regarding complications and revisions. Administration of VIT therapy did not lead to a significant reduction in time until operability in the whole population but was superior to elevation for soft-tissue conditioning and pain reduction. However, there was a significant reduction by 2.5 days (95% CI 0.7; 4.3) in the subgroup of lower extremity fractures. VIT therapy therefore seems to be a helpful tool in the treatment of posttraumatic oedema after complex joint fractures of the lower and upper extremity, especially in tibial head and lower leg fractures.


Assuntos
Fraturas Ósseas , Humanos , Edema/etiologia , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Articulações , Extremidade Inferior , Fatores de Tempo , Resultado do Tratamento
6.
Evid Based Dent ; 23(4): 142-143, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36526836

RESUMO

Design This study is a double-blind, single-centre, split-mouth, prospective randomised control trial. In total, 48 patients had bilateral third molars removed during two separate operations at least 21 days apart by the same maxillofacial surgeon. During the control operation, the tooth was irrigated with saline at 25°C. During the test operation, patients were randomised to tooth irrigation with saline at either 10°C (n = 24) or 4°C (n = 24). Local anaesthetic, flap design, burr design and sutures remained consistent throughout. Patients were prescribed amoxicillin, chlorhexidine and were advised to take paracetamol as needed. The patients remained blinded to which test group they were randomised to and to the order of the control or test operations performed. Participants self-recorded analgesia use and post-operative pain daily for seven days using a visual analogue scale (VAS). A second maxillofacial surgeon examined patients on days one, three and seven. Facial swelling was assessed by measuring the distance between various soft tissue points compared to pre-operative levels. Trismus was determined by measuring maximum inter-incisal opening compared to pre-operative levels.Case selection In total, 28 female and 20 male medically fit adult patients with a mean age of 24.6 ± 3.8 with bilateral mandibular asymptomatic third molar teeth were selected. Second molars with periodontal probing depths >4 mm or impacted third molars associated with cysts or tumours were excluded. Patients had no antibiotic prescription in the preceding month nor analgesic consumption in the 12 hours before surgery.Data analysis The Shapiro-Wilk test was used to evaluate if the sample fit a normal distribution. Relationships between the categorical variables of the groups was tested using chi-square statistics. Data comparisons were examined with the Duncan, Kriskal-Wallis, Dunn and Friedman test (p <0.05).Results The median duration of the control and test group operations were similar (p = 0.051). Test group patients reported lower pain VAS values and consumed less analgesics compared to the control groups (p = 0.001), with the lowest values seen in the 4°C group (p <0.001). A greater decrease in trismus levels was also seen on day three and seven in the test groups (p <0.001) compared to the control group (p = 0.07). Swelling was greatest in the control group (p <0.001) and reduced on day seven (p <0.001) in all groups. While trismus and swelling values were lower in the 10°C test group compared to the control (p <0.001), the lowest values of these parameters at all time points was in the 4°C group (p <0.001).Conclusions Early complications following third molar removal include facial swelling, trismus and pain. In this study, intraoperative cooled saline irrigation to 4°C and 10°C was more effective than saline irrigation at 25°C in reducing the intensity of these conditions.


Assuntos
Dente Serotino , Trismo , Adulto , Humanos , Masculino , Feminino , Adulto Jovem , Dente Serotino/cirurgia , Trismo/prevenção & controle , Trismo/complicações , Estudos Prospectivos , Mandíbula/cirurgia , Extração Dentária/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/complicações , Edema/etiologia , Solução Salina/uso terapêutico , Analgésicos , Morbidade , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Am Fam Physician ; 106(5): 557-564, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36379502

RESUMO

Edema is a common clinical sign that may indicate numerous pathologies. As a sequela of imbalanced capillary hemodynamics, edema is an accumulation of fluid in the interstitial compartment. The chronicity and laterality of the edema guide evaluation. Medications (e.g., antihypertensives, anti-inflammatory drugs, hormones) can contribute to edema. Evaluation should begin with obtaining a basic metabolic panel, liver function tests, thyroid function testing, brain natriuretic peptide levels, and a urine protein/creatinine ratio. Validated decision rules, such as the Wells and STOP-Bang (snoring, tired, observed, pressure, body mass index, age, neck size, gender) criteria, can guide decision-making regarding the possibility of venous thromboembolic disease and obstructive sleep apnea, respectively. Acute unilateral lower-extremity edema warrants immediate evaluation for deep venous thrombosis with a d-dimer test or compression ultrasonography. For patients with chronic bilateral lower-extremity edema, duplex ultrasonography with reflux can help diagnose chronic venous insufficiency. Patients with pulmonary edema or elevated brain natriuretic peptide levels should undergo echocardiography to assess for heart failure. Lymphedema is often a clinical diagnosis; lymphoscintigraphy can be performed if the diagnosis is unclear. Treatment of edema is specific to the etiology. Diuretics are effective but should be used only for systemic causes of edema. Ruscus extract and horse chestnut seed demonstrate moderate-quality evidence to improve edema from chronic venous insufficiency. Compression therapy is effective for most causes of edema.


Assuntos
Linfedema , Insuficiência Venosa , Humanos , Peptídeo Natriurético Encefálico , Edema/diagnóstico , Edema/etiologia , Edema/terapia , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico , Linfedema/etiologia , Atenção Primária à Saúde
10.
Praxis (Bern 1994) ; 111(15): 847-853, 2022 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-36415990

RESUMO

CME Rheumatology 26: Bone Marrow Edema of the Sacro-Iliac Joint = Spondyloarthritis? What the General Practicioner Should Know Abstract. Axial spondyloarthritis is a chronic inflammatory joint disease mainly involving the sacroiliac joints (ISG) and the spine. The diagnosis can be made early due to acute inflammatory changes in the ISG on magnetic resonance imaging (MRI). Radiographs of the ISG do not help in early diagnosis because structural damage is not apparent on radiographs until an advanced stage. In recent years, however, several studies have shown that bone marrow edema - hyperintense signals (= bright spots) as a possible MRI correlate for inflammation - does not specifically occur in axial spondyloarthritis, but can also be seen in healthy people, athletes, people with high mechanical stress (e.g. military recruits) and postpartum women. The diagnosis of axial spondyloarthritis should therefore never be based solely on an MRI finding, but must always include the overall clinical context.


Assuntos
Reumatologia , Espondilartrite , Feminino , Humanos , Articulação Sacroilíaca/diagnóstico por imagem , Medula Óssea , Espondilartrite/diagnóstico , Edema/etiologia
12.
Pediatrics ; 150(6)2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36353857

RESUMO

A 13-year-old male presented with a 10-day history of left eye swelling and pain. These symptoms prompted presentation to the emergency department. He had no significant past medical history and no preceding fevers or chills. He was found on examination of the eyes and the orbit to have left supraorbital erythema, edema, and pain with upward and medial gaze. Examination of the globe, fundus, and visual fields were normal. His white blood cell count was 6.2 (x1000/mm3) with an erythrocyte sedimentation rate of 4 (mm/hr). Diagnostic endoscopic biopsy was performed. Here we present this case alongside clinical reasoning and diagnostic evaluation with relevant input from respective experts. This case discussion reviews the final diagnosis, as well as the corresponding evaluation and management. Diagnostic algorithms based on literature review and clinical experience are also included.


Assuntos
Edema , Olho , Masculino , Humanos , Adolescente , Edema/etiologia , Dor
13.
Ugeskr Laeger ; 184(44)2022 10 31.
Artigo em Dinamarquês | MEDLINE | ID: mdl-36331318

RESUMO

Multiple inflammatory syndrome in children (MIS-C) has casuistically been reported in conjunction with retropharyngeal oedema. This case report details the diagnosis and treatment of MIS-C in a 13-year-old girl where the initial treatment was targeted against the retropharyngeal oedema. The aim is to highlight the atypical presentation of MIS-C.


Assuntos
Edema , Síndrome de Linfonodos Mucocutâneos , Criança , Feminino , Humanos , Adolescente , Edema/diagnóstico , Edema/etiologia , Edema/terapia , Síndrome de Linfonodos Mucocutâneos/complicações
14.
Neurosurg Focus ; 53(5): E7, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36321292

RESUMO

OBJECTIVE: Peritumoral edema (PTE) is recognized as a complication following stereotactic radiosurgery (SRS). The aim of this paper was to evaluate the risk of post-SRS PTE for intracranial benign meningiomas and determine the predictive factors. METHODS: Between 2006 and 2021, 227 patients with 237 WHO grade I meningiomas were treated with Novalis linear accelerator SRS. All patients were treated with a single-fraction dose of 11-20 Gy (median 14 Gy). The median tumor volume was 3.32 cm3 (range 0.24-51.7 cm3). RESULTS: The median follow-up was 52 months (range 12-178 months). The actuarial local tumor control rates at 2, 5, and 10 years after SRS were 99.0%, 96.7%, and 86.3%, respectively. Twenty-seven (11.9%) patients developed new or worsened post-SRS PTE, with a median onset time of 5.2 months (range 1.2-50 months). Only 2 patients developed post-SRS PTE after 24 months. The authors evaluated factors related to new-onset or worsened PTE after SRS. In univariate analysis, initial tumor volume > 10 cm3 (p = 0.03), total marginal dose > 14 Gy (p < 0.001), preexisting edema (p < 0.0001), tumor location (p < 0.001), parasagittal location (p < 0.0001), superior sagittal sinus (SSS) involvement (p < 0.0001), and SSS invasion (p < 0.015) were found to be significant risk factors. In multivariate analysis, total marginal dose > 14 Gy (HR 3.38, 95% CI 1.37-8.33, p = 0.008), preexisting SRS edema (HR 12.86, 95% CI 1.09-4.15, p < 0.0001), tumor location (HR 2.13, 95% CI 1.04-3.72, p = 0.027), parasagittal location (HR 8.84, 95% CI 1.48-52.76, p = 0.017), and SSS invasion (HR 0.34, 95% CI 0.13-0.89, p = 0.027) were significant risk factors. Twelve (5.3%) patients were symptomatic. Ten of 27 patients had complete resolution of neurological symptoms and edema improvement with steroid treatment. Steroid treatment failed in 2 patients, who subsequently required resection for PTE. CONCLUSIONS: Radiosurgery is a safe and effective method of treating benign intracranial meningiomas according to long-term follow-up. We also identified total marginal dose > 14 Gy, preexisting PTE, parasagittal location, and SSS invasion as predictors of post-SRS PTE. Risk factors for post-SRS PTE should be considered in meningioma treatment.


Assuntos
Neoplasias Meníngeas , Meningioma , Radiocirurgia , Humanos , Meningioma/cirurgia , Radiocirurgia/métodos , Seguimentos , Edema/etiologia , Fatores de Risco , Neoplasias Meníngeas/cirurgia , Esteroides , Estudos Retrospectivos , Resultado do Tratamento
15.
J Contemp Dent Pract ; 23(7): 733-738, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36440521

RESUMO

AIM: This study was conducted to compare the efficacy of using 0.5 mg/mL povidone-iodine solution as an irrigant and coolant in reducing postoperative sequelae like swelling, trismus, and pain with the conventional normal saline irrigation during the surgical removal of the impacted lower third molar. MATERIALS AND METHODS: The research was conducted out toward the MES Dental College in Perinthalmanna, Kerala, in the Department of Oral and Maxillofacial Surgery. After mandibular third-molar surgical removal, researchers studied 60 individuals, 30 of whom had normal saline irrigation (group I), and 30 of whom received 0.05% povidone-iodine irrigation (group II). The postoperative discomforts were measured on the second and seventh days after surgery, respectively. After that, the data were analyzed using SPSS. The data analysis considered p-values less than 0.05 to be significant. RESULTS: At the second postoperative visit, patients in the povidone-iodine group reported much less pain, swelling, and reduced mouth opening than those in the normal saline group. But on the seventh postoperative day, there was not much difference between either group. CONCLUSION: Following the surgical removal of teeth, it was revealed that povidone-iodine solution (0.5 mg/mL) was more effective as irrigation and cooling aid than regular saline solution. CLINICAL SIGNIFICANCE: Low-concentrated povidone-iodine is a better option in dentistry as irrigant.


Assuntos
Dente Serotino , Dente Impactado , Humanos , Dente Serotino/cirurgia , Povidona-Iodo/uso terapêutico , Solução Salina , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Edema/etiologia , Edema/prevenção & controle , Dor
16.
Vnitr Lek ; 68(3): 181-184, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36208949

RESUMO

Lower extremity edema is a common complaint of patients across all medical specialties. This is a wide group of conditions, ranging from relatively minor conditions such as false swelling in lipedema to life-threatening conditions such as heart failure and nephrotic syndrome. The most common cause of chronic edema is chronic venous disease. High-quality differential diagnosis aims to determine the etiology of edema and initiate targeted treatment.


Assuntos
Edema , Insuficiência Cardíaca , Diagnóstico Diferencial , Edema/diagnóstico , Edema/etiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Humanos , Extremidade Inferior
19.
Am J Dent ; 35(5): 233-237, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36261402

RESUMO

PURPOSE: A retrospective clinical study was performed to compare the post-operative sequelae of the submucosal administration of two different low dosages of dexamethasone, after the surgical extraction of lower third molars. METHODS: Data regarding edema, trismus, pain and analgesic consumption were collected from 150 subjects, selecting three equal groups (n= 50): a control group with no administered dexamethasone (G1); submucosal injection of dexamethasone 2 mg/0.5 ml (G2) and submucosal injection of dexamethasone 4 mg/1 ml (G3). Collected data were evaluated at three different time points: T0 before surgery, T1 on the third day after surgery and T2 on the 7th day after surgery. Patients' gender and age were also considered for statistical purposes. RESULTS: The effects on facial swelling reduction were statistically significant in G2 at T1 in the male subgroup. With trismus, the differences between the time points considered were statistically significant in G2 in the subgroup of subjects younger than 25 years old. Differences in analgesics taken were statistically significant when G1 and G2 were compared at T1. CLINICAL SIGNIFICANCE: The submucosal injection of 2 mg/0.5 ml of dexamethasone to subjects younger than 25 years old is enough to reduce trismus. For females and subjects older than 25 years old, it is preferable to administer at least 4 mg of dexamethasone to reduce edema.


Assuntos
Dente Serotino , Trismo , Feminino , Humanos , Masculino , Adulto , Dente Serotino/cirurgia , Trismo/etiologia , Trismo/prevenção & controle , Estudos Retrospectivos , Dexametasona/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Medição da Dor , Estudos Prospectivos , Edema/etiologia , Edema/prevenção & controle
20.
Anticancer Res ; 42(11): 5507-5519, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36288873

RESUMO

BACKGROUND/AIM: The latest developments in oncological therapies for malignant melanoma, and the discovery that complete lymph node dissection offers no survival benefit, are changing the landscape of melanoma surgery. There is a need for more information on health-related quality of life (HRQoL) consequences of melanoma surgery. PATIENTS AND METHODS: This longitudinal cohort study was carried out from 2004 to 2009 in the Helsinki and Uusimaa Hospital District and patients were followed-up at 6, 12 and 24 months. The patients were asked to fill in the generic 15D questionnaire and the cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). In addition, they were asked selected questions from the EORTC Item Library regarding upper and lower limb edema. RESULTS: A total of 169 (64.5%) patients with local or locally advanced melanoma referred for surgical treatment responded, of whom 161 were included in the final analysis. For the whole patient group, distress, depression and emotional function improved over time. Worse HRQoL in some of the dimensions were associated with female sex, skin transplant versus direct wound closure and complications 30 days or more after surgery, but none was associated with worse overall HRQoL. Postoperative complications, type of wound closure or lymph node surgery had no effect on overall HRQoL. Patient-reported limb edema was associated with worse overall HRQoL at baseline and during follow-up by both instruments. Patients reporting limb edema reported worse mobility and more pain throughout the study. CONCLUSION: Patient-reported limb edema, regardless of the cause, seems to be an important predictor of worse HRQoL among patients with melanoma.


Assuntos
Melanoma , Qualidade de Vida , Humanos , Feminino , Seguimentos , Estudos Longitudinais , Estudos Prospectivos , Melanoma/complicações , Melanoma/cirurgia , Melanoma/patologia , Inquéritos e Questionários , Edema/etiologia
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