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1.
Einstein (Sao Paulo) ; 17(4): eAO4905, 2019 Sep 09.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31508661

RESUMO

OBJECTIVE: To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. METHODS: The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. RESULTS: For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg±37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL±58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block. CONCLUSION: Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay. Level of evidence: III.


Assuntos
Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Artroplastia de Quadril , Dor Pós-Operatória/tratamento farmacológico , Músculos Abdominais/inervação , Analgésicos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Período de Recuperação da Anestesia , Anestesia Geral , Raquianestesia , Anestésicos Locais/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Relação Dose-Resposta a Droga , Bloqueio Nervoso/métodos , Manejo da Dor , Dor Pós-Operatória/etiologia , Período Perioperatório/métodos , Estudos Retrospectivos , Fatores de Tempo
2.
Medicine (Baltimore) ; 98(34): e16929, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441880

RESUMO

To examine the characteristics and short-term outcome of perioperative myocardial infarction (PMI), a single-center retrospective study was carried out. The electronic medical records of 278,939 patients aged 45 years or older who underwent non-cardiac surgery at Renji Hospital from January 2003 to December 2015 were screened based on diagnostic codes (ICD121, ICD121.0, ICD121.1, ICD121.2, ICD121.3, ICD121.4, or ICD121.9). The incidence and characteristics of PMI and mortality risk factors were analyzed after non-cardiac surgery. PMI was reported in 45 patients, with an incidence rate of 1.61 per 10,000 and a mortality rate of 75.6% (34/45). The PMI incidence rate increased significantly with age. The PMI incidence rate was the highest for vascular surgery (5.82 per 10,000 cases). PMI occurs mainly within 48 h of surgery, with most cases showing an onset in the general wards. Logistic analysis showed that the use of nitrates is the independent protective factor for the outcomes of patients with PMI. The incidence of PMI in non-cardiac surgery is approximately 2 of 10,000 in patients aged 45 years or older, and increased significantly with age. The use of nitrates might be helpful for their survival.


Assuntos
Infarto do Miocárdio/mortalidade , Período Perioperatório/mortalidade , Complicações Pós-Operatórias/mortalidade , Idoso , China , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Nitratos/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
3.
Medicine (Baltimore) ; 98(35): e16626, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464899

RESUMO

Gastric cancer (GC) is one of the common malignant tumors in China, with a high morbidity and mortality. With the development and application of high-throughput sequencing technologies and metagenomics, a great quantity of studies have shown that gastrointestinal microbiota is closely related to digestive system diseases. Although some studies have reported the effect of long-term follow-up after subtotal gastrectomy on intestinal flora changes in patients with GC. However, the features of gut microbiota and their shifts in patients with GC in perioperative period remain unclear.This study was designed to characterize fecal microbiota shifts of the patients with GC before and after the radical distal gastrectomy (RDG) during their hospital staying periods. Furthermore, fecal microbiota was also compared between the GC patients and healthy individuals.Patients who were diagnosed with advanced gastric adenocarcinoma at distal stomach were enrolled in the study. The bacterial burden within fecal samples was determined using quantitative polymerase chain reaction. To analyze the diversity and composition of gut microbiota from fecal DNA of 20 GC patients and 22 healthy controls, amplicons of the 16S rRNA gene from all subjects were pyrosequenced. To study gut microbiota shifts, the fecal microbiota from 6 GC patients before and after RDG was detected and subsequently analyzed. Short-chain fatty acids were also detected by chromatography spectrometer in these 6 GC patients.RDG had a moderate effect on bacterial richness and evenness, but had pronounced effects on the composition of postoperative gut microbiota compared with preoperative group. The relative abundances of genera Akkermansia, Esherichia/Shigella, Lactobacillus, and Dialister were significant changed in perioperative period. Remarkably, higher abundances of Escherichia/Shigella, Veillonella, and Clostridium XVIII and lower abundances of Bacteroides were observed in gut microbiota of overall GC patients compared to healthy controls.This study is the first study to characterize the altered gut microbiota within fecal samples from GC patients during perioperative period, and provide a new insights on such microbial perturbations as a potential effector of perioperative period phenotype. Further research must validate these discoveries and may evaluate targeted microbiota shifts to improve outcomes in GC patients.


Assuntos
Bactérias/classificação , RNA Ribossômico 16S/genética , Análise de Sequência de DNA/métodos , Neoplasias Gástricas/cirurgia , Adulto , Bactérias/genética , Bactérias/isolamento & purificação , China , DNA Bacteriano/genética , DNA Ribossômico/genética , Feminino , Gastrectomia , Microbioma Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Filogenia , Neoplasias Gástricas/microbiologia
4.
JAMA ; 322(1): 82, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265093
5.
Kyobu Geka ; 72(8): 599-603, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31353352

RESUMO

FreeStyle Libre (flash glucose monitoring) is useful to control the blood sugar levels of outpatients with diabetes. We used FreeStyle Libre for a patient with type 1 diabetes mellitus during the perioperative period of cardiac surgery except during and just after surgery. We adjusted the insulin amount according to the glucose level of the device before surgery and prevented prolonged hypoglycemia. After surgery, we could also adjust the blood sugar levels using the device until discharge. All data were within zones A and B of the Clarke error grid analysis when referred to as arterial blood sugar levels in the intensive care unit. In the general ward after surgery, 95% of the data referred to as venous blood sugar levels were within zones A and B. FreeStyle Libre was useful for adjusting the amount of insulin for a patient with type 1 diabetes mellitus during the perioperative period of cardiac surgery in the ward and also might be useful for decreasing the frequency of arterial blood collection in the intensive care unit.


Assuntos
Diabetes Mellitus Tipo 1 , Hipoglicemia , Glicemia , Automonitorização da Glicemia , Humanos , Assistência Perioperatória , Período Perioperatório
6.
Schmerz ; 33(4): 287-294, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31342162

RESUMO

BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.


Assuntos
Agranulocitose , Dipirona , Dor Aguda/tratamento farmacológico , Dor Aguda/prevenção & controle , Agranulocitose/induzido quimicamente , Agranulocitose/prevenção & controle , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anestesiologia/normas , Associação , Cuidados Críticos , Dipirona/administração & dosagem , Dipirona/efeitos adversos , Humanos , Período Perioperatório
7.
Rev Lat Am Enfermagem ; 27: e3143, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340340

RESUMO

OBJECTIVE: to develop, evaluate and correlate the acceptability of an educational mobile application to patients submitted to orthognathic surgery. METHOD: methodological study based on systematic instructional design with contents aimed at patient learning through a mobile application. Usability and user satisfaction were evaluated by 30 patients in the perioperative stage through an electronic questionnaire sent by social networks, e-mail and business card, measured using the System Usability Scale instrument validated in Portuguese and user satisfaction with an instrument based on another study, after its applications. Data were analyzed with descriptive statistics and Spearman correlation. RESULTS: the application named "OrtogApp" features content validated in a previous study included five learning content sessions essential for managing perioperative care, and it is available on IOS and Android platforms. Usability corresponded to 79.8 + 15.4 points and the satisfaction index was 82.9%; correlation of age, schooling and uses of the application with the instruments was not significant. CONCLUSION: OrtogApp is an educational application with content validated by professionals, resulting in high user satisfaction and good usability. Patients may use the application as supportive educational material to supplement guidance provided by perioperative nurses and/or surgeons during perioperative care.


Assuntos
Aplicativos Móveis , Cirurgia Ortognática , Período Perioperatório/educação , Cuidados Pós-Operatórios/educação , Adulto , Brasil , Telefone Celular/instrumentação , Comportamento do Consumidor , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Autocuidado/métodos , Inquéritos e Questionários , Telemedicina/métodos , Adulto Jovem
8.
Zhonghua Yi Xue Za Zhi ; 99(26): 2052-2056, 2019 Jul 09.
Artigo em Chinês | MEDLINE | ID: mdl-31315376

RESUMO

Objective: To investigate the feasibility and safety of enhanced recovery after surgery (ERAS) in perioperative period of liver operation. Methods: One hundred and sixty-six patients who underwent liver operation were enrolled as control group, and additional 170 patients were chosen as ERAS group. Preoperative and postoperative indexes of the two groups were compared. Results: Compared with the control group, patients in ERAS group had higher preoperative enteral nutrition support rate, lower incidence of thirst and hunger, earlier initial postoperative feeding, higher prophylactic analgesia rate, lower incidence of outbreak pain, more daily activities, lower incidence of abdominal distention and shorter hospitalization days (all P<0.05). Conclusion: Application of enhanced recovery after surgery on perioperative nursing care in elective liver surgical patients is safe, and it can relieve patients' perioperative discomfort and accelerate postoperative rehabilitation.


Assuntos
Procedimentos Cirúrgicos Eletivos , Fígado/cirurgia , Manejo da Dor , Humanos , Tempo de Internação , Assistência Perioperatória , Período Perioperatório , Complicações Pós-Operatórias , Período Pós-Operatório
9.
JAMA ; 322(1): 82-83, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265096
10.
Cancer Immunol Immunother ; 68(8): 1341-1350, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31324947

RESUMO

Gastric cancer (GC) is the most common malignant tumor in digestive organs, and the prognosis of GC patients who have undergone surgery remains poor because of frequent recurrence. Therefore, the identification of new markers to predict the outcome of these patients is needed. Monocyte count is a negative prognostic factor associated with inflammation. We investigated the relationship between peripheral monocytes in the peri-operative period and prognosis in GC patients. A high pre-operative monocyte count was identified as a prognostic factor in a retrospective analysis of 278 stage II and III GC patients who underwent curative gastrectomy. In contrast, an increased post-operative monocyte count compared to the pre-operative monocyte count was a marker of poor prognosis, particularly for early relapse. In a prospective analysis of 75 GC patients, a subset of the increased post-operative monocytes was similar to CD14+ HLA-DR- CD11b+ CD33+ cells by flow cytometry, and these monocytes produced IDO and arginase and suppressed T cell functions; therefore, we classified these cells as monocytic myeloid-derived suppressive cells (M-MDSCs). Peri-operative neutrophils and C-reactive protein (CRP), which are also related to inflammation, did not affect the prognosis of GC patients, and a neutrophil immunosuppressive function was not observed. These results suggest that peripheral monocytes in the peri-operative period in GC patients are a useful marker for the prognosis of GC patients, and a subset of increased post-operative monocytes may be characterized as M-MDSCs.


Assuntos
Biomarcadores Tumorais , Contagem de Células/métodos , Monócitos/patologia , Células Supressoras Mieloides/patologia , Neoplasias Gástricas/diagnóstico , Idoso , Células Cultivadas , Feminino , Citometria de Fluxo , Gastrectomia , Humanos , Masculino , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Período Perioperatório , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/imunologia , Neoplasias Gástricas/mortalidade , Análise de Sobrevida
11.
Tokai J Exp Clin Med ; 44(2): 25-28, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31250421

RESUMO

The finding of an intraneural blood flow (IBF) signal on Doppler sonography (DS) in non-surgical cases is interpreted in several ways and usually represents a pathologic condition with entrapment neuropathy. There have been no reports of the IBF signal on DS after surgery for ulnar neuropathy at the elbow (UNE). IBF was investigated before and after surgery in two cases diagnosed with UNE before surgery and confirmed after surgery. Both underwent electrodiagnostic (EDX) studies, grey scale sonography (GS), and DS before and after surgery and were diagnosed as having UNE by EDX study and GS. On DS, an IBF signal was not detected in both cases before surgery. After surgery, both cases improved their clinical and EDX findings, and an IBF signal and pulsatility were detected on DS. With respect to vascular problems, recovering venous and arterial blood supplies and dilated vessels would show much more blood flow during recovery of the affected ulnar nerve site following decompression surgery. The IBF signal would not always implicate pathology. When assessing recovery from UNE after surgery, it may be useful to evaluate intraneural vascularity at the affected site with DS.


Assuntos
Cotovelo/inervação , Fluxo Sanguíneo Regional , Nervo Ulnar/irrigação sanguínea , Nervo Ulnar/diagnóstico por imagem , Neuropatias Ulnares/diagnóstico por imagem , Neuropatias Ulnares/cirurgia , Ultrassonografia Doppler , Adulto , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Humanos , Masculino , Período Perioperatório , Período Pós-Operatório
12.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 633-636, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198154

RESUMO

OBJECTIVE: To observe the incidence of spinal cord injury (SCI) following aortic surgery in Fuwai Hospital of Chinese Academy of Medical Sciences, and evaluate the effect of standardized multidisciplinary spinal cord protection strategies, to summarize the experience in the prevention and treatment of SCI at perioperative period of aortic surgery. METHODS: The clinical data of patients underwent aortic surgery admitted to vascular center of Fuwai Hospital from January 2011 to December 2018 were retrospectively analyzed. The patients receiving traditional spinal cord protection strategies from January 2011 to December 2016 were defined as the control group, while the patients receiving standardized multidisciplinary spinal cord protection strategies from January 2017 to December 2018 were defined as the standardized treatment group. The standardized multidisciplinary treatment included preoperative cerebrospinal fluid drainage (CSFD), respiratory tract management, and maintenance of effective circulation of the lowest venous pressure; at the same time, anticoagulation, glucocorticoid, improve microcirculation, scavenge oxygen free radicals and other adjuvant treatments were started, and nerve function was monitored to prevent complications. The changes in SCI incidence after aortic surgery between the two groups were observed in order to evaluate the effect of standardized multidisciplinary spinal cord protection strategies. Meanwhile, the types of SCI after operation and the safety of CSFD were analyzed. RESULTS: During the 8-year period, 7 724 patients underwent aortic surgery at vascular center of Fuwai Hospital, 64 of which suffered from SCI after aortic surgery with total incidence of 0.83%. The onset of SCI was immediate in 39 patients (60.94%) and was delayed in 25 patients (39.06%), more than half of patients were immediate SCI. Of 64 patients with SCI, 52 patients (81.25%) underwent paraplegia and 12 (18.75%) underwent paraparesis. SCI persisted beyond discharge in 38 patients (59.38%) and 25 patients (39.06%) fully or partly recovered form SCI. One patient (1.56%) died. Compared with the control group, the incidence of SCI was decreased significantly after application of standardized multidisciplinary spinal cord protection strategies. The total incidence of SCI after aortic surgery was decreased from 1.06% (52/4 893) to 0.42% (12/2 831), the incidence after aortic arch replacement under deep hypothermic circulatory arrest was decreased from 3.66% (40/1 092) to 1.11% (5/450), and the incidence after thoraco-abdominal aortic replacement was decreased from 9.40% (11/117) to 2.47% (2/81) with statistically significant difference (all P < 0.05). Perioperative CSFD analysis showed that the incidence of CSFD-related complications was low, the overall incidence was 5.45% (3/55), including 1 patient of cerebrospinal fluid leakage, 2 patients of blood cerebrospinal fluid. No serious complications such as hemorrhage and infection of central nervous system occurred. CONCLUSIONS: The main type of SCI after aortic surgery was immediate, about 39% SCI patients fully or partly recovered. Standardized multidisciplinary spinal cord protection strategies which included preoperative CSFD, reduced incidence of SCI after aortic surgery. The incidence of CSFD-related complications was low, which was safe and effective.


Assuntos
Aorta/cirurgia , Traumatismos da Medula Espinal/prevenção & controle , China/epidemiologia , Hospitais , Humanos , Período Perioperatório , Estudos Retrospectivos , Traumatismos da Medula Espinal/epidemiologia , Resultado do Tratamento
13.
J Cardiothorac Surg ; 14(1): 98, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151461

RESUMO

OBJECTIVES: Despite a long history of concerns regarding patient safety during clinical care, some patients undergoing thoracic surgery continue to experience adverse events (AEs). AEs are a major significant source of perioperative morbidity and mortality following thoracic surgery. This study analysed the causes, treatment and prognosis of perioperative AEs to provide a reference for further surgical safety. METHODS: The authors collected a total of 62,571 thoracic surgery anaesthesia records via the Anaesthesia Information Management System (AIMS) from 14 August 2006 to 14 August 2017 and obtained 150 cases of perioperative serious AEs from the "adverse events registration" subsystem. The related hospitalization data of the 150 patients were analysed, including anaesthesia, recovery room time, ICU records and follow-up outcomes. The causes of these AEs were classified as follows: events related to the patients' pathogenic conditions(P); surgery-related factors(S); anaesthesia-related factors(A); and interactions between pathogenic, surgical and anaesthesia factors (P&S&A). We then analysed the main clinical manifestations, causes and treatment of these events. RESULTS: The overall rate of perioperative AEs in thoracic surgery (n = 62,571) was 0.2%. Of these, 10.7% were. caused by P and 23.3% by A; neither cause led to patient death. S and P&S&A accounted for 55.3 and 10.7% of AEs, respectively; together, they accounted for 66%. Twelve patients with postoperative AEs caused by S or P&S&A died within 3 days (8% of 150 cases). A total of 33%(50/150) of patients experienced sudden cardiac arrest (SCA) and recovered successfully. Surgical massive haemorrhage (22%, 33/150) was reported as a predominant mortality-related outcome in this group, and 8 of the 12 deaths were caused by massive haemorrhage. CONCLUSIONS: The rate of perioperative AEs after thoracic surgery was 0.2%. AEs must be identified and treated immediately. An important factor in anaesthesia-related events was respiratory management. Two major clinical manifestations of surgery-related events were cardiac arrest and massive haemorrhage. Cardiac arrest was the major factor contributing to AEs, but its adverse consequences could be avoided with timely discovery and proper treatment. Massive haemorrhage is a significant cause of mortality that can be prevented with a surgeon's early diagnosis and appropriate interventions.


Assuntos
Anestesia/efeitos adversos , Países em Desenvolvimento/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Perda Sanguínea Cirúrgica/mortalidade , China/epidemiologia , Parada Cardíaca/etiologia , Humanos , Complicações Intraoperatórias/epidemiologia , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
14.
Medicine (Baltimore) ; 98(18): e15383, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045788

RESUMO

BACKGROUND: Neuroprotective effects of dexmedetomidine are reported in preclinical and clinical studies but evidence regarding the postoperative neurocognitive function is still unclear. This study performed a meta-analysis on outcomes of studies which examined neurocognitive performance and inflammatory factors to investigate the effects of dexmedetomidine on postoperative cognitive dysfunction (POCD) and inflammation in patients after general anaesthesia. METHODS: Literatures were searched in several electronic databases and studies were selected by following precise inclusion criteria. We searched PubMed, EMBASE, the Cochrane Library, China Academic Journals full-text database (CNKI), and Google Scholar to find randomized controlled trials (RCTs) of the influence of dexmedetomidine on POCD and inflammation in patients who had undergone general anaesthesia. Two researchers independently screened the literature, extracted data, and evaluated quality of methodology against inclusion and exclusion criteria. Meta-analyses of pooled ORs of POCD incidences and mean differences in neurocognitive assessment scores and inflammation levels were carried out and subgroup analyses were performed. Stata 12.0 was used to conduct our meta-analysis. RESULTS: Twenty-six RCTs were included. Compared with controls, perioperative dexmedetomidine treatment significantly reduced the incidence of POCD (pooled ORs = 0.59, 95% confidence interval (CI) 0.45-2.95) and improved Mini-Mental State Examination (MMSE) score (standardized mean difference (SMD) = 1.74, 95% CI 0.43-3.05) on the first postoperative day. Furthermore, perioperative dexmedetomidine treatment significantly decreased IL-6 (SMD = -1.31, 95% CI -1.87-0.75, P < .001) and TNF-α (SMD = -2.14, 95% CI -3.14-1.14, P < .001) compared to saline/comparators treatment. In the stratified analysis by surgical type, age, type of control, and study region, the differences were also significant between dexmedetomidine- and saline-treated patients. CONCLUSION: Perioperative dexmedetomidine treatment is associated with significantly reduced incidence of POCD and inflammation and better neurocognitive function postoperatively in comparison with both saline controls and comparator anaesthetics.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Anestesia Geral/efeitos adversos , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/prevenção & controle , Dexmedetomidina/administração & dosagem , China , Humanos , Inflamação/tratamento farmacológico , Mediadores da Inflamação/metabolismo , Interleucina-6/biossíntese , Testes de Estado Mental e Demência , Razão de Chances , Período Perioperatório , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fator de Necrose Tumoral alfa/biossíntese
15.
Medicine (Baltimore) ; 98(20): e15248, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096433

RESUMO

BACKGROUND: This study aimed to compare the efficacy and safety of oral tranexamic acid (TXA) with intravenous (IV) TXA in reducing perioperative blood loss in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). METHODS: PubMed, Web of Science, Embase, and Cochrane Library were fully searched for relevant studies. Studies comparing the efficacy and safety of oral TXA with IV TXA in TKA and THA were included in this research. Odds ratio (OR) or risk difference (RD) was applied to compare dichotomous variables, while mean difference (MD) was used to compare continues variables. RESULTS: A total of 7 studies (5 randomized controlled trials and 2 retrospective studies) were included into this study. As for patients undergoing TKA or THA, there were no obvious differences between oral TXA group and IV TXA group in hemoglobin (Hb) drop (MD = 0.06, 95% confidence interval [CI] = -0.01 to 0.13, P = .09), transfusion rate (OR = 0.78, 95% CI = 0.54-1.13, P = .19), total blood loss (MD = 16.31, 95% CI = -69.85 to 102.46, P = .71), total Hb loss (MD = 5.18, 95% CI = -12.65 to 23.02, P = .57), length of hospital stay (MD = -0.06, 95% CI = -0.30 to 0.18, P = .63), drain out (MD = 21.04, 95% CI = -15.81 to 57.88, P = .26), incidence of deep vein deep vein thrombosis (RD = 0.00, 95% CI = -0.01 to 0.01, P = .82) or pulmonary embolism (RD = 0.00, 95% CI = -0.01 to 0.01, P = .91). The sample size of this study was small and several included studies were with relatively low quality. CONCLUSION: Oral TXA is equivalent to IV TXA in reducing perioperative blood loss and should be recommended in TKA and THA. More high-quality studies are needed to elucidate this issue.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/uso terapêutico , Administração Intravenosa , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/efeitos adversos , Antifibrinolíticos/uso terapêutico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Perioperatório/estatística & dados numéricos , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Ácido Tranexâmico/efeitos adversos , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
16.
Medicine (Baltimore) ; 98(20): e15354, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096435

RESUMO

Circulating tumor cells (CTCs) have received enormous attention as a novel biomarker in various malignant diseases. We investigated the clinical association between the presence of perioperative CTCs and survival outcomes in women with ovarian cancer. In a total of 30 women who were scheduled to undergo a surgical treatment for ovarian cancer, peripheral blood samples were obtained before and after surgery. CTCs were isolated and counted using the optimized tapered-slit filter (TSF) platform. The association between the presence of perioperative CTCs and tumor features was evaluated. The impact of the presence of perioperative CTCs on progression-free survival (PFS) and overall survival (OS) rates were analyzed using a Kaplan-Meier method. The median age was 58 (range, 24-77) years, and the median follow-up period was 31.5 (range, 1-41) months. Overall, the CTC detection rate was not significantly different before and after surgery (76.7% vs 57.1%, P = .673). The presence of postoperative CTCs was not significantly associated with 3-year PFS (29.1% vs 58.3%, P = .130) and OS (84.4% vs 80.0%, P = .559) rates in the whole study population. In advanced stage, PFS rate in patients with postoperative CTCs had lower PFS rates than those without postoperative CTCs, although there was no statistical significance (18.8% vs 57.1%, P = .077). Postoperative CTC was more frequently detected in women who had lymph node involvement than those who did not (7/7 [100%] vs 3/10 [30.0%], P = .010). The presence of postoperative CTCs as detected using the TSF platform seems to be associated with poorer PFS rates in women with ovarian cancer of advanced stage. Further study with a larger population is warranted to validate our study findings.


Assuntos
Biomarcadores Tumorais/metabolismo , Células Neoplásicas Circulantes/metabolismo , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Antígeno Ca-125/metabolismo , Feminino , Humanos , Linfonodos/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Células Neoplásicas Circulantes/patologia , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Período Perioperatório , Período Pós-Operatório , Prognóstico , Intervalo Livre de Progressão , Estudos Prospectivos
17.
Anticancer Res ; 39(5): 2641-2646, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092463

RESUMO

BACKGROUND/AIM: Prognoses of patients with cancer can be predicted on the basis of preoperative nutrition- or inflammation-based scores; however, predicting the prognostic impact of undergoing surgery remains challenging. In this study, we investigated the usefulness of the perioperative C-reactive protein/albumin (CRP/Alb) ratio in patients with intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHODS: We retrospectively investigated 80 patients who had undergone curative resection of primary ICC between April 2002 and December 2017. We identified the time at which perioperative CRP/Alb ratio most influences the prognosis, and investigated the correlations among the perioperative CRP/Alb ratio, clinicopathological features and patient outcomes. RESULTS: The only perioperative CRP/Alb ratios significantly associated with shorter overall survival (OS) was a high CRP/Alb ratio on POD14. High CRP/Alb ratio on POD 14 was significantly associated with older age, male sex, and the presence of postoperative complications. Finally, a high CRP/Alb ratio at POD 14 was an independent prognostic factor for poor OS. CONCLUSION: CRP/Alb ratio on POD 14 may be a useful prognostic factor in patients with ICC who have undergone curative resections.


Assuntos
Proteína C-Reativa/metabolismo , Colangiocarcinoma/sangue , Inflamação/sangue , Albumina Sérica/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Inflamação/patologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Prognóstico , Estudos Retrospectivos
19.
Int Braz J Urol ; 45(4): 747-753, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136115

RESUMO

PURPOSE: This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. MATERIALS AND METHODS: A total of 272 patient's medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. RESULTS: 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the fi rst 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. CONCLUSIONS: During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.


Assuntos
Adrenalectomia/efeitos adversos , Adrenalectomia/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Perioperatório , Período Pós-Operatório , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estatísticas não Paramétricas , Resultado do Tratamento , Carga Tumoral , Adulto Jovem
20.
BMC Cancer ; 19(1): 390, 2019 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023318

RESUMO

BACKGROUND: Upfront cytoreductive surgery with HIPEC (CRS-HIPEC) is the standard treatment for isolated resectable colorectal peritoneal metastases (PM) in the Netherlands. This study investigates whether addition of perioperative systemic therapy to CRS-HIPEC improves oncological outcomes. METHODS: This open-label, parallel-group, phase II-III, randomised, superiority study is performed in nine Dutch tertiary referral centres. Eligible patients are adults who have a good performance status, histologically or cytologically proven resectable PM of a colorectal adenocarcinoma, no systemic colorectal metastases, no systemic therapy for colorectal cancer within six months prior to enrolment, and no previous CRS-HIPEC. Eligible patients are randomised (1:1) to perioperative systemic therapy and CRS-HIPEC (experimental arm) or upfront CRS-HIPEC alone (control arm) by using central randomisation software with minimisation stratified by a peritoneal cancer index of 0-10 or 11-20, metachronous or synchronous PM, previous systemic therapy for colorectal cancer, and HIPEC with oxaliplatin or mitomycin C. At the treating physician's discretion, perioperative systemic therapy consists of either four 3-weekly neoadjuvant and adjuvant cycles of capecitabine with oxaliplatin (CAPOX), six 2-weekly neoadjuvant and adjuvant cycles of 5-fluorouracil/leucovorin with oxaliplatin (FOLFOX), or six 2-weekly neoadjuvant cycles of 5-fluorouracil/leucovorin with irinotecan (FOLFIRI) followed by four 3-weekly (capecitabine) or six 2-weekly (5-fluorouracil/leucovorin) adjuvant cycles of fluoropyrimidine monotherapy. Bevacizumab is added to the first three (CAPOX) or four (FOLFOX/FOLFIRI) neoadjuvant cycles. The first 80 patients are enrolled in a phase II study to explore the feasibility of accrual and the feasibility, safety, and tolerance of perioperative systemic therapy. If predefined criteria of feasibility and safety are met, the study continues as a phase III study with 3-year overall survival as primary endpoint. A total of 358 patients is needed to detect the hypothesised 15% increase in 3-year overall survival (control arm 50%; experimental arm 65%). Secondary endpoints are surgical characteristics, major postoperative morbidity, progression-free survival, disease-free survival, health-related quality of life, costs, major systemic therapy related toxicity, and objective radiological and histopathological response rates. DISCUSSION: This is the first randomised study that prospectively compares oncological outcomes of perioperative systemic therapy and CRS-HIPEC with upfront CRS-HIPEC alone for isolated resectable colorectal PM. TRIAL REGISTRATION: Clinicaltrials.gov/ NCT02758951 , NTR/ NTR6301 , ISRCTN/ ISRCTN15977568 , EudraCT/ 2016-001865-99 .


Assuntos
Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Neoplasias Peritoneais/tratamento farmacológico , Peritônio/cirurgia , Adulto , Bevacizumab/administração & dosagem , Quimioterapia Adjuvante/efeitos adversos , Neoplasias Colorretais/patologia , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Intervalo Livre de Doença , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Leucovorina/administração & dosagem , Leucovorina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Oxaliplatina/administração & dosagem , Oxaliplatina/efeitos adversos , Período Perioperatório , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Peritônio/efeitos dos fármacos , Peritônio/patologia , Intervalo Livre de Progressão , Qualidade de Vida
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