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Anticancer Res ; 39(10): 5761-5765, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570479


BACKGROUND/AIM: To clarify the usefulness of intraoperative colonoscopy (CS) for preventing postoperative anastomotic leakage and bleeding in rectal cancer surgery. PATIENTS AND METHODS: The data of rectal cancer patients who underwent circular-stapled anastomosis from January 2008 to December 2016 were compared between 162 patients who received intraoperative CS (the CS group) and 23 patients who did not receive intraoperative CS (the non-CS group). RESULTS: Anastomotic leakage rate in the CS group (8.6%) was similar to that in the non-CS group (4.3%) (p=0.70). Postoperative anastomotic bleeding rate was also similar between the CS and non-CS groups (2.4% vs. 0%, p=0.50). Although a positive air leak test was observed in two patients in the CS group, no postoperative leakage developed by adding intraoperative treatment. CONCLUSION: Although intraoperative CS did not significantly reduce the incidence of postoperative anastomotic leakage or bleeding, it can be useful for certain cases.

Anastomose Cirúrgica/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Colonoscopia/métodos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos
Anticancer Res ; 39(10): 5781-5787, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570482


BACKGROUND: Neoadjuvant chemotherapy (NAC) is established in the treatment of ductal pancreatic adenocarcinoma for downsizing borderline-resectable pancreatic cancer (BRPC) and may affect nodal positivity and rates of R0 resection. This study aimed to identify the impact of NAC on postoperative histopathological parameters with a prognostic relevance. PATIENTS AND METHODS: A one-to-three matched-pair analysis, including an overall total of 132 patients (25% treated with NAC and subsequent resection and 75% undergoing upfront surgery) was performed. Influence of NAC on nodal positivity, lymphatic, vascular and perineural invasion, as well as resection stage and grading, was examined. Furthermore, perioperative complications, in-hospital stay, re-admission rates, mortality, as well as preoperative body mass index and American Association of Anesthesiologist classification scores, were evaluated. RESULTS: Patients treated with NAC significantly less frequently had lymphatic tissue invasion (lymph node invasion: 51.5% vs. 72.7%; p=0.032, and lymphatic vessel invasion 9.4% vs. 55.3%; p=0.0004), whereas vascular and perineural invasion, as well as grading and resection state were not significantly different. Carbohydrate antigen 19-9 regression in correlation with nodal positivity also did not differ, and both groups showed comparable perioperative complication rates. Occurrence and severity of postoperative pancreatic fistula (18.2% vs. 24.3%; p=0.034) were significantly lower in patients who had undergone NAC. CONCLUSION: NAC significantly affects postoperative histopathological tumour stage in BRPC and appears to be a safe treatment option without increased perioperative complications, re-admission, in-hospital stay, or mortality. Further studies are mandatory to underline the suitability of NAC for ductal pancreatic adenocarcinoma subgroups in order to guide clinicians in their daily decision-making comprehensively.

Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/patologia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno CA-19-9/metabolismo , Carcinoma Ductal Pancreático/tratamento farmacológico , Carcinoma Ductal Pancreático/metabolismo , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/terapia , Quimioterapia Adjuvante/métodos , Feminino , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias/métodos , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/terapia , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos
Coluna/Columna ; 18(3): 196-199, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1019776


ABSTRACT Objective The aim of this study was to correlate the parameters of shoulder alignment with the Cobb angle value of the proximal thoracic curve in the pre and postoperative periods. Methods A retrospective data collection study was carried out, in which 30 medical records and radiographic examinations of patients submitted to surgical treatment for correction of deformity in AIS were performed in a single center from 2010 to 2017. Results The risk of CHD> 3 mm at 1 year postoperatively was similar between patients who had high thoracic curve (HTC) less than or equal to 25 degrees and those who had HTC greater than 25 degrees and not structured (relative risk = 1.75, P-value = 0.552). The risk of presenting CA> 2 degrees in the postoperative period of 1 year was similar between patients having HTC less than or equal to 25 degrees and those who had HTC greater than 25 degrees and not structured (relative risk = 1.31, P-value = 0.567). Conclusions We observed that when the proximal thoracic curve is not structured, even with a high Cobb angle, there is no need for instrumentation, presenting a satisfactory shoulder alignment in the postoperative period . Level of Evidence III; Retrospective and Comparative.

RESUMO Objetivo O objetivo deste estudo é correlacionar os parâmetros do alinhamento do ombro com o valor de ângulo Cobb da curva torácica proximal no pré e pós-operatório. Métodos Foi realizado um estudo com base em coleta de dados retrospectivos, em que foram avaliados 30 prontuários e exames radiográficos de pacientes submetidos ao tratamento cirúrgico para a correção da deformidade na EIA em um único centro, no período de 2010 a 2017. Resultados O risco de apresentar CHD >3mm no pós-operatório de 1 ano foi semelhante entre os pacientes que apresentavam CTA menor ou igual a 25 graus e naqueles em que esta era maior que 25 graus e não estruturadas. (Risco relativo=1.75, P-valor=0.552). O risco de apresentar CA>2 graus no pós-operatório de 1 ano foi semelhante entre os pacientes que apresentavam curva torácica alta (CTA) menor ou igual a 25 graus e naqueles em que esta era maior que 25 graus e não estruturadas (Risco relativo=1.31, P-valor=0.567). Conclusão Observamos que quando a curva torácica proximal não é estruturada, mesmo com elevado valor de ângulo Cobb, não há necessidade de instrumentação, apresentando um satisfatório alinhamento dos ombros no pós-operatório. Nível de Evidência III; Retrospectivo e Comparativo.

RESUMEN Objetivo El objetivo de este estudio fue correlacionar los parámetros de alineación del hombro con el valor de ángulo de Cobb de la curva torácica proximal en los periodos pre y postoperatorio. Métodos Se realizó un estudio retrospectivo de recolección de datos, en el que se evaluaron 30 registros médicos y exámenes radiográficos de pacientes sometidos al tratamiento quirúrgico para la corrección de la deformidad en EIA en un solo centro desde 2010 hasta 2017. Resultados El riesgo de CHD > 3 mm a 1 año de postoperatorio fue similar entre los pacientes que tenían curva torácica alta (CTA) menor o igual a 25 grados y los que tenían CTA mayor que 25 grados y no estructuradas (riesgo relativo = 1,75, P = 0,552). El riesgo de presentar CA > 2 grados en el postoperatorio de 1 año fue similar entre los pacientes que presentaban CTA menor o igual a 25 grados y en los con CTA mayor que 25 grados y no estructuradas (riesgo relativo = 1,31, P = 0,567). Conclusiones Observamos que cuando la curva torácica proximal no está estructurada, incluso con ángulo de Cobb grande, no es necesaria la instrumentación, y hay alineación satisfactoria del hombro en el postoperatorio. Nivel de Evidencia III; Retrospectivo y Comparativo.

Humanos , Período Pós-Operatório , Escoliose
BMJ ; 366: l4923, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31530561


OBJECTIVE: To develop and validate an integrative system to predict long term kidney allograft failure. DESIGN: International cohort study. SETTING: Three cohorts including kidney transplant recipients from 10 academic medical centres from Europe and the United States. PARTICIPANTS: Derivation cohort: 4000 consecutive kidney recipients prospectively recruited in four French centres between 2005 and 2014. Validation cohorts: 2129 kidney recipients from three centres in Europe and 1428 from three centres in North America, recruited between 2002 and 2014. Additional validation in three randomised controlled trials (NCT01079143, EudraCT 2007-003213-13, and NCT01873157). MAIN OUTCOME MEASURE: Allograft failure (return to dialysis or pre-emptive retransplantation). 32 candidate prognostic factors for kidney allograft survival were assessed. RESULTS: Among the 7557 kidney transplant recipients included, 1067 (14.1%) allografts failed after a median post-transplant follow-up time of 7.12 (interquartile range 3.51-8.77) years. In the derivation cohort, eight functional, histological, and immunological prognostic factors were independently associated with allograft failure and were then combined into a risk prediction score (iBox). This score showed accurate calibration and discrimination (C index 0.81, 95% confidence interval 0.79 to 0.83). The performance of the iBox was also confirmed in the validation cohorts from Europe (C index 0.81, 0.78 to 0.84) and the US (0.80, 0.76 to 0.84). The iBox system showed accuracy when assessed at different times of evaluation post-transplant, was validated in different clinical scenarios including type of immunosuppressive regimen used and response to rejection therapy, and outperformed previous risk prediction scores as well as a risk score based solely on functional parameters including estimated glomerular filtration rate and proteinuria. Finally, the accuracy of the iBox risk score in predicting long term allograft loss was confirmed in the three randomised controlled trials. CONCLUSION: An integrative, accurate, and readily implementable risk prediction score for kidney allograft failure has been developed, which shows generalisability across centres worldwide and common clinical scenarios. The iBox risk prediction score may help to guide monitoring of patients and further improve the design and development of a valid and early surrogate endpoint for clinical trials. TRIAL REGISTRATION: NCT03474003.

Rejeição de Enxerto/etiologia , Transplante de Rim , Adulto , Idoso , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco/métodos , Estados Unidos/epidemiologia
Cochrane Database Syst Rev ; 9: CD003843, 2019 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-31557307


BACKGROUND: The use of clinical signs, or end-tidal anaesthetic gas (ETAG), may not be reliable in measuring the hypnotic component of anaesthesia and may lead to either overdosage or underdosage resulting in adverse effects because of too deep or too light anaesthesia. Intraoperative awareness, whilst uncommon, may lead to serious psychological disturbance, and alternative methods to monitor the depth of anaesthesia may reduce the incidence of serious events. Bispectral index (BIS) is a numerical scale based on electrical activity in the brain. Using a BIS monitor to guide the dose of anaesthetic may have advantages over clinical signs or ETAG. This is an update of a review last published in 2014. OBJECTIVES: To assess the effectiveness of BIS to reduce the risk of intraoperative awareness and early recovery times from general anaesthesia in adults undergoing surgery. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and Web of Science on 26 March 2019. We searched clinical trial registers and grey literature, and handsearched reference lists of included studies and related reviews. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs in which BIS was used to guide anaesthesia compared with standard practice which was either clinical signs or end-tidal anaesthetic gas (ETAG) to guide the anaesthetic dose. We included adult participants undergoing any type of surgery under general anaesthesia regardless of whether included participants had a high risk of intraoperative awareness. We included only studies in which investigators aimed to evaluate the effectiveness of BIS for its role in monitoring intraoperative depth of anaesthesia or potential improvements in early recovery times from anaesthesia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of evidence with GRADE. MAIN RESULTS: We included 52 studies with 41,331 participants; two studies were quasi-randomized and the remaining studies were RCTs. All studies included participants undergoing surgery under general anaesthesia. Three studies recruited only participants who were at high risk of intraoperative awareness, whilst two studies specifically recruited an unselected participant group. We analysed the data according to two comparison groups: BIS versus clinical signs; and BIS versus ETAG. Forty-eight studies used clinical signs as a comparison method, which included titration of anaesthesia according to criteria such as blood pressure or heart rate and, six studies used ETAG to guide anaesthesia. Whilst BIS target values differed between studies, all were within a range of values between 40 to 60.BIS versus clinical signsWe found low-certainty evidence that BIS-guided anaesthesia may reduce the risk of intraoperative awareness in a surgical population that were unselected or at high risk of awareness (Peto odds ratio (OR) 0.36, 95% CI 0.21 to 0.60; I2 = 61%; 27 studies; 9765 participants). However, events were rare with only five of 27 studies with reported incidences; we found that incidences of intraoperative awareness when BIS was used were three per 1000 (95% CI 2 to 6 per 1000) compared to nine per 1000 when anaesthesia was guided by clinical signs. Of the five studies with event data, one included participants at high risk of awareness and one included unselected participants, four used a structured questionnaire for assessment, and two used an adjudication process to identify confirmed or definite awareness.Early recovery times were also improved when BIS was used. We found low-certainty evidence that BIS may reduce the time to eye opening by mean difference (MD) 1.78 minutes (95% CI -2.53 to -1.03 minutes; 22 studies; 1494 participants), the time to orientation by MD 3.18 minutes (95% CI -4.03 to -2.33 minutes; 6 studies; 273 participants), and the time to discharge from the postanaesthesia care unit (PACU) by MD 6.86 minutes (95% CI -11.72 to -2 minutes; 13 studies; 930 participants).BIS versus ETAGAgain, events of intraoperative awareness were extremely rare, and we found no evidence of a difference in incidences of intraoperative awareness according to whether anaesthesia was guided by BIS or by ETAG in a surgical population at unselected or at high risk of awareness (Peto OR 1.13, 95% CI 0.56 to 2.26; I2 = 37%; 5 studies; 26,572 participants; low-certainty evidence). Incidences of intraoperative awareness were one per 1000 in both groups. Only three of five studies reported events, two included participants at high risk of awareness and one included unselected participants, all used a structured questionnaire for assessment and an adjudication process to identify confirmed or definite awareness.One large study (9376 participants) reported a reduced time to discharge from the PACU by a median of three minutes less, and we judged the certainty of this evidence to be low. No studies measured or reported the time to eye opening and the time to orientation.Certainty of the evidenceWe used GRADE to downgrade the evidence for all outcomes to low certainty. The incidence of intraoperative awareness is so infrequent such that, despite the inclusion of some large multi-centre studies in analyses, we believed that the effect estimates were imprecise. In addition, analyses included studies that we judged to have limitations owing to some assessments of high or unclear bias and in all studies, it was not possible to blind anaesthetists to the different methods of monitoring depth of anaesthesia.Studies often did not report a clear definition of intraoperative awareness. Time points of measurement differed, and methods used to identify intraoperative awareness also differed and we expected that some assessment tools were more comprehensive than others. AUTHORS' CONCLUSIONS: Intraoperative awareness is infrequent and, despite identifying a large number of eligible studies, evidence for the effectiveness of using BIS to guide anaesthetic depth is imprecise. We found that BIS-guided anaesthesia compared to clinical signs may reduce the risk of intraoperative awareness and improve early recovery times in people undergoing surgery under general anaesthesia but we found no evidence of a difference between BIS-guided anaesthesia and ETAG-guided anaesthesia. We found six studies awaiting classification and two ongoing studies; inclusion of these studies in future updates may increase the certainty of the evidence.

Anestesia Geral , Anestésicos/administração & dosagem , Consciência no Peroperatório , Monitorização Intraoperatória/métodos , Período de Recuperação da Anestesia , Eletroencefalografia , Humanos , Consciência no Peroperatório/prevenção & controle , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto
Anticancer Res ; 39(9): 5019-5026, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519609


BACKGROUND: Portal vein thrombosis (PVT) is a life-threatening complication after hepatectomy. However, the relationship between postoperative PVT and morphometric features of the PV has not been fully elucidated yet. PATIENTS AND METHODS: A total of 81 patients who underwent hepatectomy for perihilar cholangio-carcinoma (PHCC) were studied. We investigated the diameters and angles of PV using pre- and postoperative computed tomography (CT) reconstructed by SYNAPSE VINCENT®. RESULTS: The incidence of PVT after hepatectomy was 11.1%. There were significant differences with respect to the remnant liver PV diameter (p=0.015), the diameter ratio (p=0.001), and the postoperative PV angle (p=0.001) between patients with and without PVT. Multivariate analysis revealed that a postoperative PV angle of less than 90° (p=0.008) and a diameter ratio of less than 45% (p=0.041) were independent risk factors for PVT. CONCLUSION: A postoperative PV angle of less than 90° and diameter ratio of less than 45% eventually lead to PVT after hepatectomy for PHCC.

Hepatectomia/efeitos adversos , Tumor de Klatskin/complicações , Tumor de Klatskin/cirurgia , Veia Porta/patologia , Complicações Pós-Operatórias , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Gerenciamento Clínico , Feminino , Hepatectomia/métodos , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Veia Porta/anatomia & histologia , Veia Porta/diagnóstico por imagem , Período Pós-Operatório , Prognóstico , Tomografia Computadorizada por Raios X
J Cancer Res Clin Oncol ; 145(9): 2251-2259, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31385026


PURPOSE: Fibroblast Growth Factor Receptor 4 (FGFR4) was proposed to hold prognostic significance in high-grade serous ovarian carcinoma (HGSOC). However, information on this deriving from large, representative patient panels is still missing, though such data would be indispensable to validate suitability of FGFR4 as prognostic marker or even pharmacological target. METHODS: 1063 ovarian cancer cases were included in this study. Immunohistochemistry (IHC) was performed using two different anti-FGFR4 specific antibodies (HPA027273, sc-124) on an automated staining system. IHC data of both FGFR4 antibodies were available from 995 cases. FGFR4 immunostaining was correlated to prognostic factors including survival using uni- and multivariate proportional hazard models. RESULTS: FGFR4 was positively associated with advanced FIGO stage, high grade and presence of residual disease. When progression free (PFS) of FGFR4 negative vs. positive patients was compared, patients scored as FGFR4 positive had significantly shortened PFS as compared to those that stained negative. All associations of FGFR4 and shortened PFS were lost during multivariate testing. No significant associations were found in terms of OS. CONCLUSIONS: We were not able to confirm FGFR4 as an independent negative prognosticator as described before. However, FGFR4 was highly prevalent in those cases harboring residual disease after debulking surgery. Since especially patients that could only be debulked sub-optimally may benefit from targeted adjuvant treatment, tyrosine kinase inhibitors targeting FGFRs might turn out to be an interesting future treatment option.

Cistadenocarcinoma Seroso/diagnóstico , Cistadenocarcinoma Seroso/cirurgia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Receptor Tipo 4 de Fator de Crescimento de Fibroblastos/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Cistadenocarcinoma Seroso/metabolismo , Cistadenocarcinoma Seroso/patologia , Progressão da Doença , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Neoplasia Residual , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/patologia , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Análise Serial de Tecidos , Resultado do Tratamento
BMC Ophthalmol ; 19(1): 182, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409385


BACKGROUND: To compare and correlate anterior segment measurements of myopic eyes implanted with Implantable Collamer lens (ICL V4c) by using anterior segment optical coherence tomography (AS-OCT), Pentacam and ultrasound biomicroscopy (UBM). METHODS: Anterior chamber depth (ACD), distance between corneal endothelium and anterior surface of ICL(C-ICL) and central vault were measured in 82 phakic myopic eyes of 82 patients who underwent ICL surgery, by using AS-OCT, Pentacam and UBM consecutively at 3 months follow up. The correlation and agreement of instruments were accessed by using Intraclass correlation coefficient (ICC) and the Bland-Altman plot. RESULTS: AS-OCT showed higher ACD, C -ICL and central vault measurements than both of Pentacam and UBM (P < 0.001), while Pentacam showed lower measurements than UBM (P < 0.05). The Pearson correlation coefficient (r) was 0.91 to 0.96, and ICC was 0.95 to 0.98 for all measurements between difference devices (all P < 0.001). The 95% limits of agreement of ACD, C-ICL, vault measurements were 0.13 to 0.38 mm, - 0.07 to 0.27 mm, 0.08 to 0.34 mm between AS-OCT and Pentacam, - 0.03 to 0.33 mm, - 0.16 to 0.31 mm, - 0.10 to 0.26 mm between AS-OCT and UBM, and - 0.29 to 0.07 mm, - 0.25 to 0.20 mm, - 0.31 to 0.05 mm between Pentacam and UBM, respectively. CONCLUSIONS: AS-OCT demonstrated significantly higher value, while Pentacam demonstrated significantly lower value than UBM for ACD, C-ICL and central vault measurements in myopic eyes after ICL surgery. Measurements with these instruments were highly correlated, but could not replace each other especially for vault. This study provided valuable information about how to judge the results of anterior segment parameters of eyes implanted with ICL V4c from different devices. TRIAL REGISTRATION: Registration number: ChiCTR-OOC-16008987 . Retrospectively registered: 08 August 2016.

Segmento Anterior do Olho/diagnóstico por imagem , Microscopia Acústica/métodos , Miopia/diagnóstico , Lentes Intraoculares Fácicas , Refração Ocular/fisiologia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adulto , Feminino , Seguimentos , Humanos , Masculino , Miopia/fisiopatologia , Miopia/cirurgia , Período Pós-Operatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
BMC Ophthalmol ; 19(1): 183, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412813


BACKGROUND: To evaluate the efficacy of epiretinal membrane removal in patients with good best-corrected visual acuity (BCVA) for improving visual function and quality of life (QOL). METHODS: This prospective case study compared 37 subjects with preoperative BCVA ≦ 0.046 logMAR (Good group) to 35 patients with 0.10-0.52 logMAR (Moderate group) at 3 and 6 months. Linear mixed-effect models were used for statistical analysis. The primary outcome was the horizontal metamorphopsia score (MH) at 6 months postoperatively (post-6 M), while secondary outcomes were postoperative BCVA, vertical metamorphopsia score (MV), aniseikonia, stereopsis and central foveal thickness. In the Good group, QOL was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) at 6 and 12 months. RESULTS: MH was significantly improved at post-3 M and post-6 M in the both groups but there were no significant differences between the two groups. MV showed no improvement at the final observation in either group. LogMAR BCVA was significantly improved at post-6 M in the Good group, which had significantly better vision than the Moderate group. Preoperative vertical and horizontal aniseikonia scores remained unchanged in the Good group at post-6 M but worsened in the Moderate group. The NEI VFQ-25 score improved in the Good group, reflecting improved general health, general vision, and mental health. CONCLUSIONS: Early epiretinal surgery for patients with BCVA ≦ 0.046 logMAR was effective for improvement of HM, BCVA, and QOL and prevented worsening of aniseikonia. TRIAL REGISTRATION: UMIN000021220 . Registered 10 September 2015. UMIN Clinical Trials Registry.

Percepção de Profundidade/fisiologia , Membrana Epirretiniana/cirurgia , Qualidade de Vida , Acuidade Visual/fisiologia , Vitrectomia/métodos , Idoso , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Retina/diagnóstico por imagem , Tomografia de Coerência Óptica
BMC Ophthalmol ; 19(1): 187, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426775


BACKGROUND: To evaluate the clinical outcomes of extended depth of focus (EDOF) and monofocal intraocular lenses (IOLs) that share identical aspheric platform and compare their visual acuity tolerance to postoperative refractive errors. METHODS: This non-randomized, prospective comparative study included 120 eyes undergoing cataract surgery with implantation of either Tecnis ZCB00 IOL (Abbott Medical Optics Inc., Santa Ana, CA) (monofocal group: 60 eyes of 30 patients) or Tecnis Symfony IOL (Abbott Medical Optics, Inc.) (EDOF group: 60 eyes of 30 patients). Monocular and binocular visual outcomes, changes in refraction, defocus curve, contrast sensitivity, and perception of photic phenomena (Halo & Glare Simulator; Eyeland Design Network, Vreden, Germany) were evaluated 3 months postoperatively. To compare the refractive tolerance, each group was divided into three subgroups according to the postoperative uncorrected distance visual acuity (UDVA) and postoperative spherical equivalent (SE). RESULTS: In the EDOF group, the mean 3-months postoperative monocular UDVA, intermediate (UIVA), and near (UNVA) visual acuities were 0.03 ± 0.07, 0.09 ± 0.15, and 0.24 ± 0.16 logMAR, respectively. A total of 100, 96.55, and 68.97% of eyes in the EDOF group achieved binocular UDVA, UIVA, and UNVA values of 0.20 logMAR or better, respectively. In respect to refractive tolerance, the EDOF group showed higher SE values and statistically significantly better mean UDVA than the monofocal group in all subgroups, with UDVA of - 0.013 and 0.028 logMAR for EDOF and monofocal groups (p = 0.037), respectively, in the subgroup where SE was within ±0.50 D, UDVA of 0.004 and 0.048 logMAR for EDOF and monofocal groups (p = 0.046), respectively, in the subgroup where SE was within - 1.00 D, and UDVA of 0.020 and 0.083 logMAR for EDOF and monofocal groups (p = 0.026), respectively, in the subgroup where SE was more than - 1.00 D. The mean patient satisfaction scores for spectacle-free distance, intermediate, and near visual acuities were 86.0, 85.0, and 66.0, respectively. CONCLUSIONS: The EDOF IOL provided excellent postoperative visual outcomes in far and intermediate distances, with high patient satisfaction rate. Regarding the postoperative refractive tolerance to SE, the Tecnis Symfony IOL showed better tolerance to residual postoperative refractive error than the monofocal IOL with the same material and optical platform.

Percepção de Profundidade/fisiologia , Lentes Intraoculares , Óptica e Fotônica , Refração Ocular/fisiologia , Erros de Refração/fisiopatologia , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Facoemulsificação , Período Pós-Operatório , Estudos Prospectivos , Erros de Refração/epidemiologia , República da Coreia/epidemiologia
BMC Ophthalmol ; 19(1): 188, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426784


BACKGROUND: To evaluate the correlating and predicting factors of visual outcome after implantation of newly developed diffractive quadrifocal intraocular lens (IOL). METHODS: A retrospective longitudinal study was conducted. Patients who underwent diffractive quadrifocal IOL implantation with a follow-up period longer than six months and records of wavefront aberrometer within one week perioperatively were enrolled. Accordingly, a total of 73 eyes from 73 patients were included. The postoperative distance and near visual acuity, ocular aberrations and postoperative symptoms were collected. The correlation and predictability between ocular aberrations and the postoperative visual outcome were evaluated. RESULTS: The corrected distance visual acuity (CDVA) one month postoperatively was significantly better than the preoperative status, and insignificant improvement was found six months postoperatively. Preoperative Tracey refraction spherical equivalent (TRSE), angle alpha, and spherical aberration (SA) were significantly correlated with postoperative CDVA and near corrected visual acuity (NCVA). For postoperative ocular aberrations, TRSE, angle alpha, and SA were significantly correlated with CDVA six months postoperatively and NCVA, while the trefoil, internal higher order aberration (HOA) and total HOA were associated with NCVA. Preoperative angle alpha could predict all postoperative visual performances, while postoperative TRSE and angle alpha could predict the CDVA six months postoperatively and NCVA. A large angle alpha is associated with visual disturbance and dissatisfaction. CONCLUSION: The angle alpha preoperatively and postoperatively was correlated with the postoperative vision and could predict visual outcome in patients who had diffractive quadrifocal IOL implanted. Furthermore, the majority of ocular aberrations were also associated with certain postoperative vision.

Lentes Intraoculares Multifocais , Pseudofacia/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Aberrometria , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Desenho de Prótese , Pseudofacia/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
BMC Ophthalmol ; 19(1): 167, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370817


BACKGROUND: The aim of this study was to compare the postoperative corneal biomechanical properties between small incision lenticule extraction (SMILE) and other corneal refractive surgeries. METHODS: A systematic review and meta-analysis were conducted. Articles from January 2005, to April 2019, were identified searching PubMed, EMBASE, Web of Science, and International Clinical Trials Registry Platform. Studies that compared SMILE with other corneal refractive surgeries on adult myopia patients and evaluated corneal biomechanics were included. Multiple effect sizes in each study were combined. Random-effects model was conducted in the meta-analysis. RESULTS: Twenty-two studies were included: 5 randomized controlled trials (RCTs), 9 prospective and 6 retrospective cohort studies, and 2 cross-sectional studies. Using the combined effect of corneal hysteresis (CH) and corneal resistance factor (CRF), which were obtained from ocular response analyzer (ORA), the pooled Hedges' g of SMILE versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) was 0.41 (95% CI, 0.00 to 0.81; p = 0.049; I2 = 78%), versus LASIK was 1.31 (95% CI, 0.54 to 2.08; p < 0.001; I2 = 77%), versus femtosecond lenticule extraction (FLEX) was - 0.01 (95% CI, - 0.31 to 0.30; p = 0.972; I2 = 20%), and versus the group of photorefractive keratectomy (PRK) and laser-assisted sub-epithelial keratectomy (LASEK) was - 0.26 (95% CI, - 0.67 to 0.16; p = 0.230; I2 = 54%). The summary score of Corvis ST (CST) after SMILE was comparable to FS-LASIK/LASIK with the pooled Hedges' g = - 0.05 (95% CI, - 0.24 to 0.14; p = 0.612, I2 = 55%). CONCLUSIONS: In terms of preserving corneal biomechanical strength after surgeries, SMILE was superior to either FS-LASIK or LASIK, while comparable to FLEX or PRK/LASEK group based on the results from ORA. More studies are needed to apply CST on evaluating corneal biomechanics after refractive surgeries.

Córnea/fisiopatologia , Ceratectomia Subepitelial Assistida por Laser/métodos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Refração Ocular/fisiologia , Acuidade Visual , Fenômenos Biomecânicos , Córnea/cirurgia , Humanos , Miopia/fisiopatologia , Período Pós-Operatório
Saude e pesqui. (Impr.) ; 12(2): 275-282, maio/ago 2019. tab
Artigo em Português | LILACS | ID: biblio-1015843


Verificar o comportamento da mulher mastectomizada e as complicações mais frequentes no pós-operatório tardio. Pesquisa transversal do tipo descritiva de natureza quantitativa em uma organização não governamental. A população foi constituída por 40 mulheres. Dos 87,50% receberam orientações sobre os cuidados pós-operatórios e 67,50% orientações de enfermagem. Além disso, 27,50% não realizaram a mamografia após a cirurgia, 15,00% não tinham o hábito de palpar a mama e 55,00% não realizaram automassagem no pós-operatório. Quanto à realização de movimentos simples como pentear os cabelos com o membro do lado operado, 57,50% não realizaram. O comportamento das mulheres submetidas à mastectomia foi em maioria de acordo com o que é recomendado. No entanto, ainda há necessidade de aumentar a qualidade das orientações, visto que apesar de existir seguimento recomendado entre as mulheres pesquisadas, o percentual de complicações foi considerável e a redução da ADM do ombro, dor crônica e ISC foram as mais prevalentes.

To assess the behavior of mastectomized females and the most frequent post-operation complications. Current transversal and descriptive research was undertaken in a non-governmental organization, with 40 females. 87.5% received monitoring on post-operation care and 67.5% received nursing guidelines. Further, 27.50% failed to have a mammography after surgery; 15.00% were not accustomed to touch their breasts; 55.00% failed to self-massage during the post-operation period; 57.5% did not undertake simples movements such as combing hair with the hand on the side of the operated side. Behavior of females with mastectomy complied with recommended habits. However, quality of monitoring should increase. Although most females followed guidelines, the perception of complications was significant and reduction of ADM of the shoulder, chronic pain and ISC were prevalent.

Humanos , Feminino , Reabilitação , Neoplasias da Mama , Mastectomia , Período Pós-Operatório
Asia Pac J Ophthalmol (Phila) ; 8(4): 285-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397676


PURPOSE: The aim was to study the visual performance of a new refractive extended depth of focus (EDOF) intraocular lens (IOL). DESIGN: Prospective, comparative study. METHODS: Consenting patients with age-related cataract willing for bilateral cataract surgery within 2 weeks were implanted with the Supraphob EDOF IOL and those willing for 1 eye surgery were implanted with a monofocal IOL. The uncorrected and best-corrected distance, intermediate and near visual acuity, and contrast sensitivity were evaluated at 1 and 3 months postoperatively. We also inquired about glare, halos, difficulties in night driving, requirement for spectacles, and overall satisfaction with vision. RESULTS: The Supraphob EDOF group (n = 72 eyes) and the monofocal IOL group (n = 54 eyes) were comparable with respect to all preoperative parameters including biometry, visual acuity, and cataract status. The mean age of participants was 58.4 ±â€Š10.6 years. Both groups had similar distance vision but the EDOF group had significantly better intermediate (0.2 ±â€Š0.2 logMAR vs 0.75 ±â€Š0.19 logMAR, P < 0.001) and near vision (median = N6 vs N12, P < 0.001) compared to the monofocal group at 3 months. The contrast sensitivity was similar in both groups. Patients in the EDOF IOL group had much greater satisfaction for intermediate and near vision. Less than 10% patients reported glare, halos, and difficulty in driving at night in the EDOF group. CONCLUSIONS: The Supraphob EDOF IOL was effective in improving the distance, intermediate and near vision in majority of patients, and retained good contrast sensitivity with most patients reporting excellent satisfaction.

Sensibilidades de Contraste/fisiologia , Percepção de Profundidade/fisiologia , Lentes Intraoculares , Facoemulsificação , Acuidade Visual/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Desenho de Prótese
Rev Col Bras Cir ; 46(3): e20192175, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389524


OBJECTIVE: to evaluate the feasibility of abbreviated fasting in oncologic colorectal surgeries, as well as the impact on the surgical outcome of the patients. METHODS: prospective randomized comparative study with patients undergoing elective colorectal cancer surgeries from May to September 2017. Patients were randomized electronically into two groups according to the preoperative fast to be adopted: conventional or abbreviated. RESULTS: of the 33 patients included, 15 followed the abbreviated fasting protocol and 18 the conventional fasting. Both groups had comparable profiles. No patient underwent mechanical preparation of the colon. In 69.7% of the cases, surgery involved low rectal dissection. The procedures were equivalent in relation to intraoperative variables and severe complications. The time to achieve complete oral intake was shorter for abbreviated fasting (10 versus 16 days, p=0.001), as well as the length of inhospital stay (2 versus 4 days, p=0.009). Hospital costs were lower in the abbreviated fasting (331 versus 682 reais, p<0.001). The univariable analysis revealed a correlation between complete oral intake and abbreviated fasting [HR 0.29 (IC95%: 0.12-0.68] and abdominal distension [HR 0.12 (IC95% 0.01-0.94)]. After multivariable analysis, abbreviated fasting presented a lower time for complete oral intake [HR 0.39 (IC95%: 0.16-0.92]. CONCLUSION: the abbreviated preoperative fasting favors the metabolic-nutritional recovery, reducing the time for complete oral intake. The implementation of the abbreviation protocol reduces hospital admission costs.

Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos Eletivos/economia , Jejum , Cuidados Pré-Operatórios/métodos , Idoso , Neoplasias Colorretais/economia , Método Duplo-Cego , Feminino , Custos Hospitalares , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos
Arch Endocrinol Metab ; 63(4): 394-401, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365627


OBJECTIVE: To measure type 1 serum amino-terminal propeptide procollagen (P1NP) and type 1 cross-linked C-terminal telopeptide collagen (CTX) before parathyroidectomy (PTX) in PHPT patients, correlating these measurements with bone mineral density (BMD) changes. SUBJECTS AND METHODS: 31 primary hyperparathyroidism (HPTP) were followed from diagnosis up to 12-18 months after surgery. Serum levels of calcium, parathyroid hormone (PTH) vitamin D, CTX, P1NP, and BMD were measured before and 1 year after surgery. RESULTS: One year after PTX, the mean BMD increased by 8.6%, 5.5%, 5.5%, and 2.2% in the lumbar spine, femoral neck (FN), total hip (TH), and distal third of the nondominant radius (R33%), respectively. There was a significant correlation between BMD change 1 year after the PTX and CTX (L1-L4: r = 0.614, p < 0.0003; FN: r = 0.497, p < 0.0051; TH: r = 0.595, p < 0.0005; R33%: r = 0.364, p < 0.043) and P1NP (L1-L4: r = 0,687, p < 0,0001; FN: r = 0,533, p < 0,0024; TH: r = 0,642, p < 0,0001; R33%: r = 0,467, p < 0,0079) preoperative levels. The increase in 25(OH)D levels has no correlation with BMD increase (r = -0.135; p = 0.4816). On linear regression, a minimum preoperative CTX value of 0.331 ng/mL or P1NP of 37.9 ng/mL was associated with a minimum 4% increase in L1-L4 BMD. In TH, minimum preoperative values of 0.684 ng/mL for CTX and 76.0 ng/mL for P1NP were associated with a ≥ 4% increase in BMD. CONCLUSION: PHPT patients presented a significant correlation between preoperative levels of turnover markers and BMD improvement 1 year after PTX.

Densidade Óssea , Colágeno Tipo I/metabolismo , Hiperparatireoidismo Primário/metabolismo , Paratireoidectomia/reabilitação , Fragmentos de Peptídeos/metabolismo , Peptídeos/metabolismo , Pró-Colágeno/metabolismo , Idoso , Biomarcadores/sangue , Cálcio/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fragmentos de Peptídeos/sangue , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Pró-Colágeno/sangue , Estudos Retrospectivos , Vitamina D/sangue
Stud Health Technol Inform ; 264: 1809-1810, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438355


Multiple orthogonal challenges around escalating costs and providing quality care plague healthcare delivery, especially in OECD countries. This research in progress paper addresses the post-operative discharge phase of the patient journey and proffers a technology-enabled model that both supports a quality care experience post-discharge but also prudent management to minimise costly unplanned readmissions and thereby subscribe to a value-based care paradigm. The chosen context is stoma patients but the solution can be easily generalised to other contexts. Next steps include the conduct of clinical trials to establish proof of concept, validity and usability.

Alta do Paciente , Readmissão do Paciente , Assistência à Saúde , Humanos , Período Pós-Operatório , Qualidade da Assistência à Saúde
Rev. SOBECC ; 24(2): 85-90, abr-.jun.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1006169


Objetivo: Avaliar a prevalência, a intensidade e o desconforto da sede no período pós-operatório imediato. Método: Estudo epidemiológico, transversal, descritivo, quantitativo, realizado em um hospital universitário do Sul do Brasil, de agosto a setembro de 2012. A amostra foi composta de 386 pacientes em recuperação anestésica de cirurgias eletivas e de urgência. Foi utilizado um questionário semiestruturado composto de dados demográficos, clínicos e variáveis relacionadas à sede. Resultados: A prevalência de sede foi de 78% (303 pacientes), com intensidade média de 6,94 (desvio padrão ­ DP=2,2) e queixa espontânea de sede em 38,3% dos casos (116 pacientes). Os desconfortos relatados foram: boca seca, procura por água, hipossalivação, garganta seca, lábios ressecados, língua seca e vontade de deglutir. Todos os desconfortos apresentaram correlação de Pearson positiva em relação à presença de sede. Conclusão: A sede no pós-operatório imediato é intensa, prevalente e com sinais periféricos desconfortáveis. Essas evidências fundamentam a necessidade da identificação, da mensuração, da avaliação e do tratamento do sintoma sede de forma intencional neste período

Objective: To assess the prevalence, intensity and discomfort of thirst in the immediate postoperative period. Method: This is a cross-sectional, descriptive, quantitative epidemiological study conducted in a university hospital in the South of Brazil, from August to September 2012. The sample consisted of 386 patients in anesthesia recovery from elective and emergency surgeries. A semi-structured questionnaire was used, consisting of demographic, clinical, and thirst-related variables. Results: The prevalence of thirst was 78% (303 patients), with an average intensity of 6.94 (standard deviation ­ SD=2.2) and spontaneous complaint of thirst in 38.3% of the cases (116 patients). The discomforts reported were: dry mouth, search for water, hyposalivation, dry throat, dry lips, dry tongue and willingness to swallow. All discomforts presented a positive Pearson correlation as to the presence of thirst. Conclusion: Immediate postoperative thirst is intense, prevalent and with uncomfortable peripheral signs. These facts substantiate the need to intentionally identify, measure, evaluate and treat thirst in this period

Objetivo: Evaluar la prevalencia, la intensidad y el malestar de la sed en el período postoperatorio inmediato. Método: Estudio epidemiológico, transversal, descriptivo, cuantitativo, realizado em un hospital universitario del sur de Brasil, de agosto a septiembre de 2012. La muestra fue compuesta de 386 pacientes en recuperación anestésica de cirugías electivas y de urgencia. Se utilizó un cuestionario semiestructurado compuesto de datos demográficos, clínicos y variables relacionados con la sed. Resultados: La prevalencia de sed fue de 78% (303 pacientes), con una intensidad media de 6,94 (desviación estándar o standard deviation ­ SD=2,2) y queja espontánea de sed en el 38,3% de los casos (116 paciente). Las incomodidades reportadas fueron: boca seca, busca por agua, hiposalivación, garganta seca, labios secos, lengua seca y voluntad de deglutir. Todas las incomodidades presentaron correlación de Pearson positiva en relación a la presencia de sed. Conclusión: La sed en el postoperatorio inmediato es intensa, prevalente y con señales periféricas incómodas. Estas evidencias fundamentan la necesidad de identificar, medir, evaluar y tratar el síntoma de forma intencional en este período

Humanos , Período Pós-Operatório , Sede , Análise Quantitativa , Prevalência