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1.
J Cardiothorac Surg ; 15(1): 291, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008467

RESUMO

BACKGROUND: Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). METHODS: This was a retrospective study of patients aged ≥70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. RESULTS: A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan-Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray's test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray's test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. CONCLUSIONS: The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.


Assuntos
Ablação por Cateter , Doenças das Valvas Cardíacas/cirurgia , Idoso , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Ablação por Cateter/métodos , Cateteres , Feminino , Humanos , Incidência , Masculino , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
2.
J Cardiothorac Surg ; 15(1): 294, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008486

RESUMO

BACKGROUND: Ever since the coronavirus disease 2019 (COVID-19) has become a pandemic, worldwide efforts are being made to "flatten the curve". Israel was amongst the first countries to impose significant restrictions. As a result, cardiac surgeons have been required to scale down their routine practice, resulting in a significant reduction in the number of cardiac surgeries. The aim of this study is to characterize the impact of COVID-19 on cardiac surgery in Israel. METHODS: This is a retrospective observational study performed in two cardiac surgery departments in Israel and includes all patients who underwent cardiac surgery in March and April during the years 2019 and 2020. The patient cohort was divided into two groups based on the year of operation. Analysis of the patients' baseline characteristics, operative data, and postoperative outcome, was performed. RESULTS: The 2019 group (n = 173), and the 2020 group (n = 108) were similar regarding their baseline characteristics, previous medical history, and rates of previous revascularization interventions. However, compared to the 2019 group, patients in the 2020 group were found to be more symptomatic (NYHA class IV; 2.4% vs. 6.2%, p = 0.007). While all patients underwent similar procedures, patients in the 2020 group had significantly longer procedural time (p < 0.001). In-hospital mortality rate was found to be significantly higher in group 2020 (13% vs. 5.2%, p = 0.037). CONCLUSIONS: While the number of patients undergoing cardiac surgery declined during the outbreak period, the rate of surgical mortality increased. One explanation for this might be delayed hospital arrival.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos
3.
Rev Assoc Med Bras (1992) ; 66(9): 1301-1306, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027462

RESUMO

INTRODUCTION: Radiation therapy is widely used as adjuvant treatment in breast cancer patients. In the last decades, several studies have been designed to evaluate the safety and efficacy of hypofractionated breast radiation therapy. More recently, even shorter regimens with doses above 4 Gy (hyper-hypofractionation) have also been proposed. This study aims to present a narrative review of the various hypofractionation protocols used to treat breast cancer patients with a focus on clinical application. RESULTS: Long-term results from several phase III randomized controlled trials demonstrated the safety and efficacy of hypofractionated breast radiation therapy using 15 or 16 fractions for early and locally advanced disease. The results of the initial clinical trials of hyper-hypofractionation are also encouraging and it is believed that these regimens may become routine in the indication of adjuvant radiation therapy treatment after the ongoing studies on this subject have matured. CONCLUSIONS: The idea that normal tissues could present high toxicity at doses above 2 Gy was opposed by clinical trials that demonstrated that moderate hypofractionation had similar results regarding oncological and cosmetic outcomes compared to conventional fractionation. Cosmetic and toxicity results from hyper-fractionation studies are in principle favorable. However, the long-term oncological results of studies that used hyper-hypofractionation for the treatment of breast cancer patients are still awaited.


Assuntos
Neoplasias da Mama , Hipofracionamento da Dose de Radiação , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Fracionamento da Dose de Radiação , Humanos , Período Pós-Operatório , Radioterapia Adjuvante
5.
Niger J Clin Pract ; 23(9): 1243-1247, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913163

RESUMO

Aim: This study aimed to determine the effects of strabismus surgery on choroidal thickness in paediatric patients with Spectral Domain-Optical Coherence Tomography (SD-OCT). Material and Methods: Sixty eyes of 60 children with esotropia were included. The mean age was 9.5 ± 3.1 years. The choroidal thickness was measured using SD-OCT, which was performed before the surgery and 1 week, 1 month and 3 months postoperatively. At the same time, the patients' visual acuity was evaluated. Results: There were no statistically significant differences between the preoperative and postoperative values in terms of the visual acuity (P > 0.05). When compared to the preoperative values, decreases were found in the choroidal thicknesses in all of the areas measured during the first week evaluation (P < 0.05). In the postoperative first month, significant decreases were also found in the choroidal thicknesses in all the areas measured (P < 0.05); however, in the postoperative third month, there were no changes in any of the areas (P > 0.05). Conclusions: We observed that there was a significant decrease in the choroidal thickness during the early postoperative period and no significant change in the late postoperative period in paediatric patients of double horizontal muscle surgery. Moreover, these early changes in the choroid in paediatric patients show that it does not cause a functional loss.


Assuntos
Corioide/diagnóstico por imagem , Corioide/patologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Estrabismo/cirurgia , Tomografia de Coerência Óptica/instrumentação , Adolescente , Criança , Corioide/anatomia & histologia , Feminino , Humanos , Masculino , Tamanho do Órgão , Período Pós-Operatório , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Acuidade Visual/fisiologia
6.
Ann Ital Chir ; 91: 235-238, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877383

RESUMO

The present pandemic caused by the SARS COV-2 coronavirus is still ongoing, although it is registered a slowdown in the spread for new cases. The main environmental route of transmission of SARS-CoV-2 is through droplets and fomites or surfaces, but there is a potential risk of virus spread also in smaller aerosols during various medical procedures causing airborne transmission. To date, no information is available on the risk of contagion from the peritoneal fluid with which surgeons can come into contact during the abdominal surgery on COVID-19 patients. We have investigated the presence of SARS-CoV-2 RNA in the peritoneal cavity of patients affected by COVID-19, intraoperatively and postoperatively. KEY WORDS: Covid-19, Laparotomy, Surgery.


Assuntos
Líquido Ascítico/virologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Perfuração Intestinal/cirurgia , Laparotomia , Pandemias , Pneumonia Viral/transmissão , Doenças do Colo Sigmoide/cirurgia , Viremia/transmissão , Aerossóis , Idoso de 80 Anos ou mais , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Divertículo/complicações , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/sangue , Perfuração Intestinal/complicações , Perfuração Intestinal/virologia , Período Intraoperatório , Nasofaringe/virologia , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , RNA Viral/isolamento & purificação , Risco , Soro/virologia , Doenças do Colo Sigmoide/sangue , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/virologia , Viremia/virologia
7.
BMC Surg ; 20(1): 194, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867744

RESUMO

BACKGROUND: Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy. METHODS: We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070. RESULTS: Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55-4.48; I2 = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54-2.32; I2 = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58-5.47; I2 = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05-3.71; I2 = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02-14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13-3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16-2.34; I2 = 19.5%). CONCLUSIONS: This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.


Assuntos
Adrenalectomia/métodos , Laparoscopia/métodos , Obesidade/epidemiologia , Adulto , Humanos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório
8.
Zhonghua Yi Xue Za Zhi ; 100(37): 2897-2902, 2020 Oct 13.
Artigo em Chinês | MEDLINE | ID: mdl-32993247

RESUMO

Objective: To develop a fast track transfer to intensive care unit (ICU) for the perioperative high-risk elderly patients after hip fracture surgery and analyze the preliminary clinical effect of the application. Methods: From January 2014 to December 2017, before the application of postoperative fast track transfer to ICU, the clinical data of 195 elderly patients with hip fracture were included in a retrospective analysis. Among 195 hip fracture patients, 18 were transferred to ICU post operation (non-fast track group). Multivariate logistic regression analysis was applied to investigate relevant risk factors for transferring to ICU after hip fracture surgery. Based on risk factors acquired from the analysis and clinical experience, the fast track transfer to ICU for the perioperative high-risk elderly patients after hip fracture surgery was constructed according to the preliminary and experiential criteria. From January 2018 to December 2019, the clinical data of 70 patients (fast track group) who were transferred to ICU after hip fracture surgery through the fast track were collected and compared with non-fast track group. Results: Multivariate regression analysis revealed that American Society of Anesthesiologists classification(≥Ⅲ) (OR=4.260, 95%CI:1.157-15.683, P=0.029), pre-hospital stage (≥48 h) (OR=4.301, 95%CI:1.212-15.266, P=0.024), hemoglobin concentration at admission(<90 g/L) (OR=7.979, 95%CI:1.936-32.889, P=0.004), coronary heart disease as one comorbidity(OR=6.063, 95%CI:1.695-21.693, P=0.006) were independent risk factors for transferring to ICU after hip fracture surgery. There were no significant difference in gender, age, fracture type, hemoglobin concentration at admission and time of pre-hospital stage between the non-fast track group and fast track group(all P>0.05). However, the number of comorbidities in the fast track group was significantly higher than that in the non-fast track group (Z=-1.995, P=0.046). The time to surgery, postoperative hospital stay, and length of hospital stay in fast track group were all significantly less than those in non-fast track group (Z=-2.121, -2.726, -3.130, all P<0.05). Also, there were fewer medical consultations needed and fewer patients who stayed in ICU more than or equal to 2 nights in fast track group than that in non-fast track group(all P<0.05). There were no significant difference in the rate of patients who transferred from the general ward to ICU after transferring from ICU to the general ward, the proportion of patients who received more than or equal to 4 departments, operation time, hospitalization expense, mortality during hospitalization, 30-day mortality and 90-day mortality after operation between the two groups(all P>0.05). Conclusions: The fast track constructed in this study can reduce time to surgery, postoperative hospitalization stay and length of hospitalization stay for the perioperative high-risk elderly patients with hip fractures and is a specific clinical application of eras concept based on multidisciplinary team.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Fraturas do Quadril/cirurgia , Idoso , Humanos , Unidades de Terapia Intensiva , Período Pós-Operatório , Estudos Retrospectivos
9.
Khirurgiia (Mosk) ; (8): 23-28, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869611

RESUMO

OBJECTIVE: To identify the criteria of smooth postoperative period after cholecystectomy and risk factors of local surgical infection. MATERIAL AND METHODS: A prospective analysis included 680 patients after laparoscopic cholecystectomy. We assessed incidence and risk factors of infectious complications. Major markers of acute inflammation, ultrasonic features of surgical site in early postoperative period were analyzed. RESULTS: Postoperative infectious complications developed in 35 patients (5.1%). All studied risk factors except an age (obesity, cardiorespiratory diseases, surgery time over 150 min, violation of the principles of antibiotic therapy, intraoperative blood loss over 50 ml, drainage time over 5 days) significantly affected the development of infectious complications. Surgery time over 150 min and violation of the principles of antibiotic therapy were the most significant factors. Serum procalcitonin, erythrocyte sedimentation rate and C-reactive protein were characterized by the highest prognostic value on the 3rd postoperative day. Threshold values were defined. CONCLUSION: Surgery time and violation of the rules of antibiotic prophylaxis were the most significant risk factors of postoperative infectious complications. We determined the criteria of smooth postoperative period: procalcitonin <1.5 mg/l, C-reactive protein <50 mg/l, erythrocyte sedimentation rate <39 mm/h, ultrasonic pattern of hypoechoic accumulation within the bed of the bladder (dimension <10 mm) without signs of intestinal insufficiency, abdominal or subhepatic effusion on the 3rd day after surgery.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Doenças da Vesícula Biliar/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Antibioticoprofilaxia/normas , Sedimentação Sanguínea , Proteína C-Reativa/análise , Humanos , Duração da Cirurgia , Período Pós-Operatório , Pró-Calcitonina/sangue , Prognóstico , Estudos Prospectivos , Fatores de Risco , Ultrassonografia
10.
Medicine (Baltimore) ; 99(35): e21683, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871883

RESUMO

Several studies have reported short-term results for post-cholecystectomy symptoms and quality of life (QoL). However, reports on long-term results are still limited. This study aimed to identify risk factors affecting short- and long-term patient-reported outcome (PRO) following laparoscopic cholecystectomy.From 2016 to 2017, a total of 476 patients from 5 institutions were enrolled. PRO was examined using the Numeric Rating Scale (NRS) pain score and the Gastrointestinal (GI) QoL Index questionnaire at postoperative 1 month and 1 year.Most of patients recovered well at postoperative 1 year compared to postoperative 1 month for the NRS pain score, QoL score, and GI symptoms. A high operative difficulty score (HR 1.740, P = .031) and pathology of acute or complicated cholecystitis (HR 1.524, P = .048) were identified as independent risk factors for high NRS pain scores at postoperative 1 month. Similarly, female sex (HR 1.571, P = .003) at postoperative 1 month and postoperative complications (HR 5.567, P = .001) at postoperative 1 year were independent risk factors for a low QoL. Also, age above 50 (HR 1.842, P = .001), female sex (HR 1.531, P = .006), and preoperative gallbladder drainage (HR 3.086, P = .001) were identified as independent risk factors for GI symptoms at postoperative 1 month.Most patients showed improved long-term PRO measurement in terms of pain, QoL, and GI symptoms. There were no independent risk factors for long-term postoperative pain and GI symptoms. However, postoperative complications were identified to affect QoL adversely at postoperative 1 year. Careful and long-term follow up is thus necessary for patients who experienced postoperative complications.


Assuntos
Colecistectomia Laparoscópica , Doenças da Vesícula Biliar/cirurgia , Gastroenteropatias/etiologia , Dor Pós-Operatória/etiologia , Qualidade de Vida , Adulto , Fatores Etários , Colecistectomia Laparoscópica/efeitos adversos , Colecistite/complicações , Colecistite/cirurgia , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Cuidados Pré-Operatórios , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Fatores de Tempo
11.
JAMA ; 324(9): 848-858, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32870298

RESUMO

Importance: In patients who undergo mechanical ventilation during surgery, the ideal tidal volume is unclear. Objective: To determine whether low-tidal-volume ventilation compared with conventional ventilation during major surgery decreases postoperative pulmonary complications. Design, Setting, and Participants: Single-center, assessor-blinded, randomized clinical trial of 1236 patients older than 40 years undergoing major noncardiothoracic, nonintracranial surgery under general anesthesia lasting more than 2 hours in a tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. The last date of follow-up was February 17, 2019. Interventions: Patients were randomized to receive a tidal volume of 6 mL/kg predicted body weight (n = 614; low tidal volume group) or a tidal volume of 10 mL/kg predicted body weight (n = 592; conventional tidal volume group). All patients received positive end-expiratory pressure (PEEP) at 5 cm H2O. Main Outcomes and Measures: The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, including pneumonia, bronchospasm, atelectasis, pulmonary congestion, respiratory failure, pleural effusion, pneumothorax, or unplanned requirement for postoperative invasive or noninvasive ventilation. Secondary outcomes were postoperative pulmonary complications including development of pulmonary embolism, acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, acute kidney injury, wound infection (superficial and deep), rate of intraoperative need for vasopressor, incidence of unplanned intensive care unit admission, rate of need for rapid response team call, intensive care unit length of stay, hospital length of stay, and in-hospital mortality. Results: Among 1236 patients who were randomized, 1206 (98.9%) completed the trial (mean age, 63.5 years; 494 [40.9%] women; 681 [56.4%] undergoing abdominal surgery). The primary outcome occurred in 231 of 608 patients (38%) in the low tidal volume group compared with 232 of 590 patients (39%) in the conventional tidal volume group (difference, -1.3% [95% CI, -6.8% to 4.2%]; risk ratio, 0.97 [95% CI, 0.84-1.11]; P = .64). There were no significant differences in any of the secondary outcomes. Conclusions and Relevance: Among adult patients undergoing major surgery, intraoperative ventilation with low tidal volume compared with conventional tidal volume, with PEEP applied equally between groups, did not significantly reduce pulmonary complications within the first 7 postoperative days. Trial Registration: ANZCTR Identifier: ACTRN12614000790640.


Assuntos
Pneumopatias/prevenção & controle , Respiração com Pressão Positiva/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Volume de Ventilação Pulmonar , Adulto , Feminino , Humanos , Incidência , Cuidados Intraoperatórios , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Método Simples-Cego , Procedimentos Cirúrgicos Operatórios/efeitos adversos
12.
Medicine (Baltimore) ; 99(36): e21401, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32898992

RESUMO

To compare the surgical outcomes of medial rectus advancement and lateral rectus recession in postoperative consecutive exotropia with single-stage adjustable suture surgery.Among 1003 patients who underwent bilateral medial rectus recession between November 1996 and March 2013, the patients who required surgery for consecutive exotopia were retrospectively reviewed. Nineteen patients underwent medial rectus advancement and 15 patients underwent lateral rectus recession. All patients underwent single-stage adjustable surgery under topical anesthesia and were followed up for at least 12 months.The mean follow-up duration was 2.4 years. At final follow-up, a successful surgical outcome was found in 12 patients (63.0%) in the medial rectus advancement group and 14 patients (93.3%) in the lateral rectus recession group (P = .039). The change in ocular deviation was correlated with the amount of recession (P = .008) and preoperative angle (P < .001) in the lateral rectus recession group.Lateral rectus recession showed a higher success rate with predictable and easily performed procedure than medial rectus advancement for the treatment of postoperative consecutive exotropia with adjustable suture.


Assuntos
Exotropia/cirurgia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Complicações Pós-Operatórias/cirurgia , Adolescente , Criança , Exotropia/etiologia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Período Pós-Operatório , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
13.
JBJS Case Connect ; 10(3): e2000288, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32910604

RESUMO

CASE: Coronavirus disease 2019 (COVID-19) is a pandemic respiratory disease. Patients typically present with fever, cough, and radiological lung changes. However, a significant proportion of these patients are asymptomatic. To date, we have limited information on the operations performed on these patients. We report our experience of a relatively asymptomatic elderly patient who underwent surgery for a hip fracture and was confirmed postoperatively to have COVID-19. CONCLUSION: Meticulous hand hygiene and use of surgical mask in daily practice is crucial to protect against asymptomatic and undiagnosed patients.


Assuntos
Doenças Assintomáticas , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Diagnóstico Tardio/prevenção & controle , Fraturas do Colo Femoral/diagnóstico , Hemiartroplastia/métodos , Controle de Infecções , Pandemias , Pneumonia Viral , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Período Pós-Operatório , Resultado do Tratamento , Precauções Universais/métodos
14.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(4): 395-399, 2020 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879063

RESUMO

OBJECTIVES: To analyze the risk factors for postoperative deep vein thrombosis (DVT) in neurosurgical patients to provide the basis for the prevention of postoperative DVT. METHODS: A total of 141 patients underwent neurosurgery were enrolled. Thrombelastography (TEG) test was performed before and at the end of surgery. According to whether there was DVT formation after operation, the patients were divided into a thrombosis group and a non-thrombosis group. T-test and rank sum test were used to compare the general clinical characteristics of the 2 groups, such as age, gender, intraoperative blood loss, D-dimer, intraoperative crystal input, colloid input, blood product transfusion, operation duration, length of postoperative hospitalization. The application of chi-square test and rank-sum test were used to compared TEG main test indicators such as R and K values between the 2 groups. Logistic regression was used to analyze the possible risk factors for postoperative DVT in neurosurgical patients. RESULTS: There were significant differences in postoperative TEG index R, clotting factor function, intraoperative blood loss, hypertension or not, length of postoperative hospital stay, and postoperative absolute bed time (all P<0.05). Logistic regression analysis showed hypercoagulability, more intraoperative blood loss and longer postoperative absolute bed time were risk factors for DVT formation after craniotomy. CONCLUSIONS: Hypercoagulability in postoperative TEG test of patients is an important risk factor for the formation of postoperative DVT after neurosurgery, which can predict the occurrence of postoperative DVT to some extent.


Assuntos
Trombofilia , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Craniotomia/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Fatores de Risco
15.
Middle East Afr J Ophthalmol ; 27(2): 110-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874044

RESUMO

PURPOSE: The purpose is to compare the clinical results of using silk versus nylon sutures for conjunctival autograft suturing in pterygium surgery. METHODS: In this prospective, randomized, controlled, clinical trial 50 eyes from 50 patients with primary nasal pterygium were randomized to undergo pterygium surgery with the use of either nylon sutures or silk sutures for conjunctival autograft suturing. Patients were followed up for 6 months. Main outcome measures included recurrence, postoperative discomfort according to a visual analog scale (VAS), graft hyperemia, and graft edema. RESULTS: According to the results, there was no significant difference between groups regarding recurrence rate of pterygium (P = 0.72). A significant decrease in the mean VAS discomfort score from day 1 to day 14 was observed in both groups (P = 0.001); postoperative discomfort during the first 2 weeks, was not significantly different between the two groups. At 2 weeks' postoperatively, significantly greater number of nylon sutures remained on the autograft (P = 0.021), some of which were buried and could not be removed. CONCLUSION: Both silk and nylon are effective suture materials for autograft suturing in pterygium surgery with similar postoperative discomfort and recurrence rate. Significantly greater number of nylon sutures remains buried on the autograft and could not be removed easily.


Assuntos
Túnica Conjuntiva/transplante , Nylons , Pterígio/cirurgia , Seda , Técnicas de Sutura , Suturas , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/métodos , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Transplante Autólogo , Resultado do Tratamento
16.
Middle East Afr J Ophthalmol ; 27(2): 123-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874046

RESUMO

PURPOSE: The purpose of this study was to evaluate predictive factors for intermittent exotropia (XT) recurrence after bilateral lateral rectus (BLR) recession. METHODS: This is a retrospective chart review of patients with XT who underwent BLR recession surgery between January 2007 and March 2017 with at least one postsurgical follow-up. Forty-one medical records were reviewed. Information collected included age, gender, systemic diseases, history of prematurity, family history of eye diseases, visual acuity, refraction, ocular alignment and control, stereoacuity, slit-lamp examination, fundoscopy, and amount of BLR recession. Successful alignment was defined as ≤8 prism diopters of esotropia or exotropia postoperatively. RESULTS: The mean age of patients at the time of surgery and follow-up time was 9.2 ± 12.3 years (y) and 23.6 ± 36.5 months (m), respectively. The mean amount of BLR recession was 6.5 ± 1.0 mm. Recurrence rate was 43.9% on the last follow-up. Age at surgery and at the time of last follow-up were significantly higher in the recurring group (P = 0.04 and P = 0.05, respectively). Postoperative angle of misalignment during the first 3 months was correlated with exotropia recurrence. No statistical significance was found among the remaining factors studied. CONCLUSIONS: The recurrence rate of XT in our study was 43.9%; it was increased in patients operated at older age and amid those with significant exotropia detected in the early postoperative period (within 3 months of surgery).


Assuntos
Exotropia/diagnóstico , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Adolescente , Criança , Pré-Escolar , Doença Crônica , Exotropia/fisiopatologia , Exotropia/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Oftalmoscopia , Período Pós-Operatório , Recidiva , Refração Ocular , Estudos Retrospectivos , Microscopia com Lâmpada de Fenda , Resultado do Tratamento , Visão Binocular/fisiologia , Acuidade Visual/fisiologia , Adulto Jovem
17.
Vestn Otorinolaringol ; 85(4): 40-42, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32885635

RESUMO

The state of the nasal cavity, especially the region of the osteomyomatic complex, plays a significant role in the development of chronic maxillary sinusitis. Odontogenic maxillary sinusitis, as a complication of dental implantological treatment on the upper jaw, is increasingly common. The aim of the study was to increase the effectiveness of prophylaxis and treatment of odontogenic purulent upper jaw sinusitis during reconstructive operations on the alveolar region of the upper jaw. 3 groups of patients were examined: before dental treatment, after dental treatment in the development of odontogenic maxillary sinusitis and 30 patients were selected and examined, who underwent reconstructive surgeries on the alveolar process of the upper jaw and in whom the postoperative period was without complications. The diagnoses of 1st and 2nd group patients required surgical treatment. FESS allows restoring the physiological aeration of maxillary sinuses as naturally as possible, which is important for correct reparative bone regeneration in the alveolar region of maxilla.


Assuntos
Sinusite Maxilar/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Maxila , Seio Maxilar/cirurgia , Período Pós-Operatório
18.
Cancer Radiother ; 24(6-7): 645-648, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32883627

RESUMO

Immediate breast reconstruction versus delayed breast reconstruction improves quality of life of breast cancer patients undergoing total mastectomy without impacting oncologic outcomes. Two types of immediate reconstruction are possible, implant-based reconstruction or autologous reconstruction. These reconstructions interpose a tissue in the operating bed, which modifies target volume definition compared to a wall without reconstruction Post mastectomy radiotherapy increases the rate of postoperative complications for both surgical procedures. Recent guidelines were published about target volume definition in the post mastectomy setting after implant-based reconstruction. Guidelines about target volume definition after autologous reconstruction are still awaited. The aim of our work is to present the different surgical procedures for immediate breast reconstruction, their complications, and the definition of the postmastectomy target volume.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mamoplastia , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Radioterapia Adjuvante/efeitos adversos , Fatores de Tempo
19.
Int Heart J ; 61(5): 1075-1078, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921664

RESUMO

Pulmonary valve stenosis (PVS) accounts for approximately 10% of all congenital heart defects. Echocardiography and right heart catheterization are the gold standards for diagnosis of PVS and for assessing disease severity and responsiveness to treatment.Recently, cardiac magnetic resonance imaging (cMRI) has been established as an important tool to comprehensively evaluate cardiac structure and function; however, research into the usefulness of cMRI for PVS management is limited. Here, we describe a case of a 59-year-old female with isolated, severe PVS who was successfully treated with balloon pulmonary valvuloplasty (BPV) followed by sequential cMRI at 1 and 12 months. Exertional dyspnea and elevated plasma BNP concentration were observed 1 month after BPV; however, echocardiographic findings did not indicate recurrent stenosis or increased pulmonary valve regurgitation but an increase in mitral E/e'. cMRI demonstrated improved systolic forward flow and RV function with enlargement of LV volume, and the rapid increase in LV preload might be associated with the transient deterioration in symptoms and BNP level, which both gradually improved within 3 months after BPV. cMRI further depicted that a reduced RV mass index and increased RV cardiac output were achieved gradually during the follow-up period.In conclusion, cMRI in combination with echocardiography was sufficiently informative to follow-up this PVS patient both before and after BPV. cMRI is easily reproducible in adult patients; therefore, cMRI should be recommended for long-term follow-up in adult PVS patients.


Assuntos
Valvuloplastia com Balão/métodos , Ecocardiografia , Imagem por Ressonância Magnética , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/cirurgia , Recuperação de Função Fisiológica , Técnicas de Imagem Cardíaca , Débito Cardíaco , Dispneia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Período Pós-Operatório , Estenose da Valva Pulmonar/congênito , Estenose da Valva Pulmonar/fisiopatologia , Índice de Gravidade de Doença , Função Ventricular Direita
20.
Plast Reconstr Surg ; 146(4): 734-741, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32969995

RESUMO

BACKGROUND: Current rates of opioid prescribing have deleterious consequences on both patient and societal levels. This study aims to evaluate responsible opioid prescribing and predictors of opioid consumption in immediate implant-based breast reconstruction. METHODS: Patients undergoing consultation for immediate, implant-based breast reconstruction were enrolled in a prospective, cohort survey study. A survey was administered at the preoperative and postoperative appointment to collect data on pain expectations and opioid use. A medical record review was performed. RESULTS: Of 100 enrolled patients, 97 (97.0 percent) underwent surgery and 85 (85.0 percent) completed the postoperative survey. Preoperatively, 27 patients (27.0 percent) had a history of a chronic pain syndrome, 34 (34.0 percent) had a history of a mental health comorbidity, and nine (9.0 percent) had a history of active preoperative opioid use. A total of 85 tissue expander (87.6 percent) and 12 direct-to-implant (12.4 percent) reconstructions were completed. Patients were prescribed an average of 36.0 5-mg oxycodone tablets postoperatively. Patients reported consuming an average of 20.6 tablets, or 57.0 percent of the average prescription amount. The majority of patients (75.3 percent) reported taking an opioid less than once per day at the time of survey completion, and 24 patients (28.2 percent) reported that they did not use any opioids postoperatively. Preoperative opioid use (p = 0.004), inpatient opioid consumption (p < 0.0001), and patient-reported anxiety related to pain control (p < 0.05) were predictors of opioid consumption. CONCLUSIONS: Patients undergoing mastectomy and implant-based breast reconstruction are prescribed nearly twice as many opioid tablets as consumed, and one in three patients report not using any opioids postoperatively. Clinical factors may help guide prescribing practices. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Analgésicos Opioides/uso terapêutico , Implante Mamário , Prescrições de Medicamentos/estatística & dados numéricos , Mastectomia , Dor Pós-Operatória/tratamento farmacológico , Adulto , Feminino , Previsões , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Fatores de Tempo
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