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Dos Santos Goiabeira L, Meireles SS, Leocadio ASS, J S Medeiros H, Soares FC, da Silva WA. Intraoperative and immediate postoperative transfusion: Clinical-hematological profile of transfunded patients in a university hospital. Transfus Clin Biol 2024; 31:102-107. [PMID: 38462031 DOI: 10.1016/j.tracli.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The transfusion practice by surgery blood reserve, varied among services, must be performed through the rational and restrictive use of blood components because it is a scarce and expensive resource for health care services. OBJECTIVE Analyze the use of blood products for surgery blood reserve by means of the study of the clinical-hematological profile of patients submitted to intraoperative and immediate postoperative transfusions. METHODS This was an observational, cross-sectional, and retrospective study, conducted by collecting biological, operational, and laboratory variables, involving 680 patients at a university hospital who had elective surgery with surgery blood reserve request sent during the period from October 2021 to October 2022. RESULTS The overall transfusion rate was 25.44%, and the mean preoperative hemoglobin level of transfused patients was 9.74 ± 2.50 g/dL, with the mean number of transfusions packed red blood cell units was 1.58 ± 0.77. Patients with higher preoperative hemoglobin levels were less likely to have transfusion (p < 0.001) and patients who had surgical oncologic were more likely to require transfusion (p = 0.048). The transfusion rate of packed red blood cells and platelets concentrates, compared to what was requested, was 15.86% and 5.82%. CONCLUSION There is a tendency of transfusions to follow restrictive models, with higher transfusion probability in surgical oncologic. Furthermore, there should be more a conscise use of the surgery blood reserves request.
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Affiliation(s)
| | - Sara Silva Meireles
- Department of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Heitor J S Medeiros
- Department of Anesthesiology, University Hospital Onofre Lopes, Natal, Brazil
| | - Fernanda Cunha Soares
- Post-Graduation Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
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Karahan E, Ayri AU, Çelik S. Evaluation of pressure ulcer risk and development in operating rooms. J Tissue Viability 2022; 31:707-713. [PMID: 36153203 DOI: 10.1016/j.jtv.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
AIM This study aimed to determine the risk and development of pressure ulcers in operating rooms. MATERIALS AND METHODS The sample of the study included a total of 250 patients. In the study, the risk of pressure ulcers was assessed before the operation, and the development of pressure ulcers was evaluated within 24 h after the operation. RESULTS The risk of pressure ulcers was low before the operation, and Stage I pressure ulcer developed in 12.8% of the patients within 24 h after the operation. The patients had pressure ulcers mostly in their sacrum. Their mean 3S Intraoperative Risk Assessment Scale of Pressure Sore score was 15.68 ± 4.84, suggesting that they were not at risk of developing pressure ulcers. Having a chronic disease (OR = 8.986; 95% CI = 3.697-21.845), undergoing general anesthesia (OR = 3.084; 95% CI = 1.323-7.194), and orthopedic surgery (OR = 10.172; 95% CI = 3.121-33.155) were statistically significant risk factors for pressure ulcers (p < 0.001). Additionally, moderately edematous skin (OR = 3.838; 95% CI = 1.024-14.386), overweight/underweight (OR = 16.333; 95% CI = 3.779-70.602), intraoperative bleeding greater than 800 ml (OR = 13.000; 95% CI = 3.451-48.969), operation time longer than 5 h (OR = 21.667; 95% CI = 2.122-221.223), moderate intraoperative stress (OR = 4.917; 95% CI = 0.425-56.916), body temperature higher than 38.3 °C or lower than 36.1 °C (OR = 5.462; 95% CI = 2.161-13.805), and intraoperative prone position (OR = 3.354; 95% CI = 1.386-8.115) were statistically significant risk factors for the development of pressure ulcers. CONCLUSION According to our preoperative pressure ulcer risk assessment, it is very important to take additional protective measures both during and after surgical operations to prevent pressure ulcers.
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Affiliation(s)
- Elif Karahan
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartın, Turkey.
| | - Aysun Uslu Ayri
- Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey.
| | - Sevim Çelik
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartın, Turkey.
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Putowski Z, Czok M, Krzych ŁJ. The impact of intraoperative blood pressure variability on the risk of postoperative adverse outcomes in non-cardiac surgery: a systematic review. J Anesth 2022; 36:316-322. [PMID: 35028755 PMCID: PMC8967760 DOI: 10.1007/s00540-022-03035-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/31/2021] [Indexed: 10/26/2022]
Abstract
Hemodynamic stability during surgery seems to account for positive postoperative outcomes in patients. However, little is known about the impact of intraoperative blood pressure variability (IBPV) on the postoperative complications. The aim was to investigate whether IBPV is associated with the development of postoperative complications and what is the nature of this association. We conducted a systematic search in PubMed, Medical Subject Headings, Embase, Web of Science, SCOPUS, clinicaltrials.gov, and Cochrane Library on the 8th of April, 2021. We included studies that only focused on adults who underwent primarily elective, non-cardiac surgery in which intraoperative blood pressure variation was measured and analyzed in regard to postoperative, non-surgical complications. We identified 11 papers. The studies varied in terms of applied definitions of blood pressure variation, of which standard deviation and average real variability were the most commonly applied definitions. Among the studies, the most consistent analyzed outcome was a 30-day mortality. The studies presented highly heterogeneous results, even after taking into account only the studies of best quality. Both higher and lower IBPV were reported to be associated for postoperative complications. Based on a limited number of studies, IBPV does not seem to be a reliable indicator in predicting postoperative complications. Existing premises suggest that either higher or lower IBPV could contribute to postoperative complications. Taking into account the heterogeneity and quality of the studies, the conclusions may not be definitive.
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Affiliation(s)
- Zbigniew Putowski
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14 Street, 40752, Katowice, Poland.
| | - Marcelina Czok
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14 Street, 40752, Katowice, Poland
| | - Łukasz J Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Zhao X, Li ST, Chen LH, Liu K, Lian M, Wang HJ, Fang YJ. Identification of independent risk factors for intraoperative gastroesophageal reflux in adult patients undergoing general anesthesia. World J Clin Cases 2021; 9:10861-10870. [PMID: 35047597 PMCID: PMC8678853 DOI: 10.12998/wjcc.v9.i35.10861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/25/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux (GER) affects up to 20% of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation. GER produces significantly harmful impacts on quality of life and precipitates poor mental well-being. However, the potential risk factors for the incidence and extent of GER in adults undergoing general anesthesia remain unclear.
AIM To explore independent risk factors for the incidence and extent of GER during general anesthesia induction.
METHODS A retrospective study was conducted, and 601 adult patients received general anesthesia intubation or laryngeal mask surgery between July 2016 and January 2019 in Shanghai General Hospital of Nanjing Medical University. This study recruited a total of 601 adult patients undergoing general anesthesia, and the characteristics of patients and the incidence or extent of GER were recorded. The potential risk factors for the incidence of GER were explored using multivariate logistic regression, and the risk factors for the extent of GER were evaluated using multivariate linear regression.
RESULTS The current study included 601 adult patients, 82 patients with GER and 519 patients without GER. Overall, we noted significant differences between GER and non-GER for pharyngitis, history of GER, other digestive tract diseases, history of asthma, and the use of sufentanil (P < 0.05), while no significant differences between groups were observed for sex, age, type of surgery, operative time, body mass index, intraoperative blood loss, smoking status, alcohol intake, hypertension, diabetes mellitus, psychiatric history, history of respiratory infection, history of surgery, the use of lidocaine, palliative strategies, propofol, or rocuronium bromide, state anxiety inventory, trait anxiety inventory, and self-rating depression scale (P > 0.05). The results of multivariate logistic regression indicated that female sex [odds ratio (OR): 2.702; 95% confidence interval (CI): 1.144-6.378; P = 0.023], increased age (OR: 1.031; 95%CI: 1.008-1.056; P = 0.009), pharyngitis (OR: 31.388; 95%CI: 15.709-62.715; P < 0.001), and history of GER (OR: 11.925; 95%CI: 4.184-33.989; P < 0.001) were associated with an increased risk of GER, whereas the use of propofol could protect against the risk of GER (OR: 0.942; 95%CI: 0.892-0.994; P = 0.031). Finally, age (P = 0.004), operative time (P < 0.001), pharyngitis (P < 0.001), history of GER (P = 0.024), and hypertension (P = 0.017) were significantly associated with GER time.
CONCLUSION This study identified the risk factors for GER in patients undergoing general anesthesia including female sex, increased age, pharyngitis, and history of GER.
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Affiliation(s)
- Xiao Zhao
- Anesthesiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai 200000, China
| | - Shi-Tong Li
- Anesthesiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai 200000, China
| | - Lian-Hua Chen
- Anesthesiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai 200000, China
| | - Kun Liu
- Anesthesiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai 200000, China
| | - Ming Lian
- Anesthesiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai 200000, China
| | - Hui-Juan Wang
- Anesthesiology Department, Shanghai General Hospital of Nanjing Medical University, Shanghai 200000, China
| | - Yi-Jiao Fang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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5
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Zheng R, Bonaroti J, Ng B, Jagannathan G, Jiang W, Lavu H, Yeo CJ, Winter JM. Is the Use of Intraoperative Frozen Section During Pancreaticoduodenectomy Justified? J Gastrointest Surg 2021; 25:728-736. [PMID: 32185653 DOI: 10.1007/s11605-020-04564-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intraoperative frozen section (IFS) is routinely utilized by many surgeons during pancreaticoduodenectomy. However, its utility has not been rigorously studied. METHODS Patients who underwent pancreaticoduodenectomy between 2006 and 2015 were identified from institutional data. Measures of diagnostic accuracy of frozen section and multivariate logistic regression are reported. RESULTS The cohort included 1076 patients. Of resected specimens, 73.3% were malignant. IFS and final pathologic review (the gold standard) were discrepant for (1) pathologic diagnosis or (2) resection margin status in 5.3% and 3.3% of cases. The sensitivity, specificity, and accuracy of IFS for histologic determination of malignancy were 97.2%, 95.3%, and 96.7% respectively. For resection margins, they were 92.3%, 99.3%, and 96.8%, respectively. Positive bile duct and neck margins were revised intraoperatively 62% and 65% of the time, respectively; positive uncinate margins were never resected but led surgeons to avoid revision of a second positive margin in 13% of cases (4.2% of all PDA). Operative changes were rarely noted in the presence of benign disease (n = 11, 1.0%); conversion to total pancreatectomy based on positive margins was performed in just 13 cases (1.2%). Upon multivariable analysis, a positive neck margin proved to be the greatest predictor for a revised resection margin (AOR 16.9 [4.8-59.8]), whereas a positive uncinate margin or a diagnosis of chronic pancreatitis was protective against IFS-driven operative changes (AOR 0.25 [0.09-0.73]; AOR 0.16 [0.13-0.19]). CONCLUSIONS IFS is highly accurate and guides reresection of margins. However, selective omission of IFS may be justified for cases where benign disease is suspected.
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Affiliation(s)
- Richard Zheng
- Department of Surgery and the Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Jillian Bonaroti
- Department of Surgery and the Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Beverly Ng
- Department of Surgery and the Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Geetha Jagannathan
- Department of Pathology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Wei Jiang
- Department of Pathology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Harish Lavu
- Department of Surgery and the Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Charles J Yeo
- Department of Surgery and the Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia University and Thomas Jefferson University, Philadelphia, PA, USA
| | - Jordan M Winter
- Department of Surgery, University Hospitals Cleveland Medical Center and the Case Comprehensive Cancer Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
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Shang JJ, Zhang ZD, Luo DZ, Cheng H, Zhang H. Effectiveness of Multi-Modal Blood Management in Bernese Periacetabular Osteotomy and Periacetabular Osteotomy with Proximal Femoral Osteotomy. Orthop Surg 2020; 12:1748-1752. [PMID: 33043623 PMCID: PMC7767769 DOI: 10.1111/os.12794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/05/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Bernese periacetabular osteotomy (PAO), an effective treatment for patients with developmental dysplasia of the hip (DDH), is characterized by wide exposure, cancellous bone surgery, and difficult techniques. In addition, the hip joint is deep and of rich muscles and neurovascular supply, which significantly increases bleeding. For patients who had combined proximal femoral osteotomy (PFO), the blood loss may be tremendous. The blood management for PAO is still challenging. We aimed to evaluate the effectiveness of multi‐modal blood management for PAO and PAO combined with PFO. Patients and Methods We retrospectively evaluated patients who had PAO with or without combined procedures from June 2010 to December 2018 in our department. The multi‐modal blood management protocol included three parts: (i) pre‐operation – autologous component blood donation and iron supplement/erythropoietin; (ii) during operation – controlled hypotension anesthesia, intraoperative auto‐blood transfusion, tranexamic acid (20 mg/kg, IV / 0.5 g local), and standardized surgical procedure to shorten surgical time; and (iii) post‐operation – no drainage used, selective allo‐blood transfusion, and ice packing technique. As the lacking of the above standard blood management protocol during PAO or PAO + PFO initially, we divided all the patients into three groups: Group A (PAO) – before protocol started, 74 hips; Group B (PAO) – after protocol finalized, 178 hips; Group C (PAO + PFO) – after protocol finalized, 55 hips. The intraoperative blood loss, surgical time, allo‐transfusion rate, pre‐ and postoperative hemoglobin were compared among groups. Results Both the general characteristics and preoperative hemoglobin were comparable among the three groups (P < 0.001). The intraoperative blood loss was 797.1 ± 312.2, 381.7 ± 144.0 and 544.1 ± 249.1 mL, respectively. The surgical time was 109.6 ± 18.5, 80.2 ± 20.0 and 154.3 ± 44.7 min, respectively. The allo‐transfusion rate was 86.5%, 0%, and 2%, respectively. The mean decreased value of hemoglobin on the first postoperative day of group B and group C was greater than that of group A, which was associated with the higher allo‐transfusion rate of group A. However, on the third postoperative day, the mean decreased value of hemoglobin of group B was less than that of group A and group C. Conclusion Perioperative multi‐modal blood management for PAO or PAO + PFO can significantly decrease intraoperative blood loss, reduce allo‐transfusion rate from over 80% to 0%, and ensure the rapid recovery of postoperative hemoglobin level.
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Affiliation(s)
- Ji-Jun Shang
- Department of Orthopaedics, Orthopaedic Hospital of Xinmi City, Zhengzhou, China.,Department of Orthopaedics, The Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhen-Dong Zhang
- Department of Orthopaedics, The Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Dian-Zhong Luo
- Department of Orthopaedics, The Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hui Cheng
- Department of Orthopaedics, The Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hong Zhang
- Department of Orthopaedics, The Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Vermeulin T, Lahbib H, Lottin M, Brifault C, Diot J, Lucas M, Huet E, Di Fiore F, Michel P, Czernichow P, Merle V. Patients' perception and attitude to totally implantable venous access for urologic or digestive cancer: A cross-sectional study. Bull Cancer 2019; 106:959-968. [PMID: 31623835 DOI: 10.1016/j.bulcan.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/22/2019] [Accepted: 09/04/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Totally implanted venous access (TIVA) improves the safety and welfare of patients treated with cancer chemotherapy (CCT). We aimed to evaluate patients' perception of TIVA placement, TIVA use, and information on TIVA, and to assess the association between patients' perception and their attitude regarding a potential TIVA re-implantation. METHODS We conducted a single center cross-sectional survey in a university hospital in Northern France. Patients included were consecutive urologic or digestive cancer inpatients admitted for a CCT cycle via TIVA between April 9th and May 9th 2014. We analyzed patients' satisfaction, experience, and attitude, especially when requiring potential TIVA re-implantation under local anesthesia (LA), using a standardized questionnaire and medical records. We analyzed risk factors for refusing potential TIVA re-implantation under LA using multivariate logistic regression. RESULTS Eighty-one patients were interviewed (no refusals), including 57 with a TIVA device placed under LA in our university hospital. Among them, 52/57 (91%) reported satisfactory TIVA placement, but respectively 21/57 (37%) and 18/57 (32%) complained of painful or uncomfortable TIVA placement; 51/57 (89%) were satisfied with care provided during CCT cycles. Risk factors for refusing potential re-implantation under LA were: TIVA placement considered painful (P=0.012) or uncomfortable (P=0.038) and dissatisfaction with care provided during CCT cycles (P=0.028). DISCUSSION We show that despite good overall satisfaction regarding TIVA, some aspects were less positive and warrant improvement actions. It suggests that these actions could not only improve patients' experience of TIVA use but could also facilitate continuation of treatment in the long term.
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Affiliation(s)
- Thomas Vermeulin
- Centre Henri Becquerel, department of Medical Information, 76038 Rouen, France; Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France.
| | - Hana Lahbib
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Marion Lottin
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Caroline Brifault
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Josselin Diot
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Mélodie Lucas
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Emmanuel Huet
- Rouen University Hospital, department of Digestive Surgery, 76000 Rouen, France
| | - Frédéric Di Fiore
- Rouen University Hospital, department of Hepatogastroenterology, 76000 Rouen, France
| | - Pierre Michel
- Rouen University Hospital, department of Hepatogastroenterology, 76000 Rouen, France
| | - Pierre Czernichow
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
| | - Véronique Merle
- Rouen University Hospital, Research group "Dynamics and Events of Care Pathways", 76000 Rouen, France
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Lu Y, Zheng TY, Xu J. [Several controversial issues in astigmatism correction in cataract surgery]. Zhonghua Yan Ke Za Zhi 2019; 55:485-490. [PMID: 31288351 DOI: 10.3760/cma.j.issn.0412-4081.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cataract surgery has entered the era of refractive surgery, and patients have higher requirements for visual quality. Astigmatism correction in cataract surgery is increasingly valued, but the astigmatism correction results are not ideal, and the principles of corneal astigmatism correction are not well established. In this article, the issues including how to dialectically decide to treat the corneal astigmatism or not, how to choose the corneal astigmatism estimating method and the calculation formula for astigmatism correction, the range of corneal astigmatism suitable for applying multifocal intraocular lens, selection of intraoperative corneal astigmatism correction method, etc., were discussed based on relevant authoritative guidelines, expert consensus and literatures, and corresponding suggestions were given. (Chin J Ophthalmol, 2019, 55: 485-490).
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Affiliation(s)
- Y Lu
- Department of Ophthalmology, Shanghai Eye and ENT Hospital of Fudan University, Shanghai 200031, China
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Li J, Zhao Y, Zhao M, Cao P, Liu X, Ren H, Zhang D, Zhang Y, Wang R, Zhao J. High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease. Neurosurg Rev 2019; 43:759-769. [PMID: 31203482 DOI: 10.1007/s10143-019-01118-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/05/2019] [Accepted: 05/17/2019] [Indexed: 01/28/2023]
Abstract
Few studies focused on the intraoperative blood pressure in Moyamoya disease (MMD) patients. We aimed to clarify whether or not it relates to early cerebral infarction after revascularization. We reviewed a retrospective cohort of Moyamoya disease from 2011 to 2018 in Beijing Tiantan Hospital, and patients with radiologically confirmed early postoperative infarction were included in the analysis. Controls were matched based on age, sex, and revascularization modality at a ratio of 1:5. Perioperative clinical factors and intraoperative blood pressure data were collected and analyzed. A total of 52 patients out of 1497 revascularization surgeries (3.5%) who experienced CT or MRI confirmed early postoperatively cerebral infarction, aged 38.46 ± 11.70; 26 were male (50.0%). Average real variability (ARV)-systolic blood pressure (SBP) (OR 3.29, p = 0.003), ARV-diastolic blood pressure (DBP) (OR 4.10, p = 0.005), ARV-mean arterial pressure (MAP) (OR 4.08, p = 0.004), and the maximum drops of DBP (OR 1.08, p = 0.003) and MAP (OR 1.06, p = 0.004) were associated with early postoperative infarction. In patients who experienced massive cerebral infarction, the maximum drops of DBP (OR 1.11, p = 0.004) and MAP (OR 1.11, p = 0.003) are independent risk factors, whereas ARVs of SBP (OR 3.90, p < 0.001), DBP (OR 4.69, p = 0.008), and MAP (OR 4.72, p = 0.003) are significantly associated with regional infarction. High variance of intraoperative blood pressure and drastic blood pressure decline are independent risk factors for postoperative infarction in MMD patients who underwent revascularization surgery. Maintaining stable intraoperative blood pressure is suggested to prevent early postoperative cerebral infarction in MMD patients.
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Affiliation(s)
- Jiaxi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Yahui Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Penghui Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Hao Ren
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases (NCRC-ND), No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China. .,Center of Stroke, Beijing Institute for Brain Disorders, No.119, S. 4th Ring Road West, Fengtai District, Beijing, 100070, China.
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10
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Fang CH, Fastenberg JH, Fried MP, Jerschow E, Akbar NA, Abuzeid WM. Antibiotic use patterns in endoscopic sinus surgery: a survey of the American Rhinologic Society membership. Int Forum Allergy Rhinol 2018; 8:522-529. [PMID: 29334432 DOI: 10.1002/alr.22085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/17/2017] [Accepted: 12/19/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a paucity of data supporting antibiotic use in endoscopic sinus surgery (ESS). The objective of this study is to determine perioperative antibiotic use patterns and factors which influence use in ESS. METHODS An online-based survey was distributed to members of the American Rhinologic Society (ARS). Outcomes included timing of perioperative antibiotic use, practice environment, years of experience, and patient factors that influenced antibiotic use. RESULTS There were 204 responses (response rate 18.3%); 36.8% of respondents were in academic positions, 32.8% were in private practice, and 30.4% were in academic-affiliated private practice; 20.6% routinely gave preoperative antibiotics, most commonly to reduce bacterial burden (59.5%) and mucosal inflammation (59.5%); 54.4% routinely gave intraoperative antibiotics, most commonly to reduce the risk of postoperative infection (63.1%); 62.3% routinely gave postoperative antibiotics, citing the need to reduce the risk of postoperative infection (75.6%). Diagnosis influenced postoperative antibiotic use in 63.0%. Preoperative antibiotics were more likely to be prescribed by respondents with more than 5 years of experience (odds ratio [OR] 2.97; 95% confidence interval [CI], 1.04 to 8.54; p = 0.043). Compared to private practitioners, academicians were more likely to give intraoperative antibiotics (OR 2.68; 95% CI, 1.39 to 5.17; p = 0.003), but not preoperative or postoperative antibiotics. Use of nonabsorbable packing was significantly associated with use of postoperative antibiotics (OR 2.01; 95% CI, 1.07 to 3.77; p = 0.031). CONCLUSION This study demonstrates the significant variation in perioperative antibiotic use among otolaryngologists. These results provide support for the establishment of evidence-based practice guidelines for perioperative antibiotic use in ESS.
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Affiliation(s)
- Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY
| | - Judd H Fastenberg
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY
| | - Marvin P Fried
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY
| | - Elina Jerschow
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY
| | - Nadeem A Akbar
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY
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11
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Ma DY, Guo Y, Cao J, Pang CY, Zhang WK, Cheng MP. [Clinical application of intraoperative CT in management of maxillofacial fracture]. Zhonghua Kou Qiang Yi Xue Za Zhi 2017; 52:695-7. [PMID: 29972950 DOI: 10.3760/cma.j.issn.1002-0098.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nine patients with maxillofacial fracture that received intraoperative CT examination in Lanzhou General Hospital of Lanzhou Military Command from January 2017 to March 2017 were retrospectively studied. The procedure of intraoperative CT was introduced. The value of this technique was preliminarily discussed in order to provide a new method for the accurate implementation of maxillofacial fracture surgery.
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12
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Lawson McLean A, Frank S, Staribacher D, Kalff R, Reichart R. Biplanar Fluoroscopy-Guided Percutaneous Lead Implantation for Spinal Cord Stimulation: Technical Note. World Neurosurg 2017. [PMID: 28645599 DOI: 10.1016/j.wneu.2017.06.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The correct positioning of spinal cord stimulator leads is assessed radiographically during their percutaneous implantation for trial stimulation. Usually the C-arm is repositioned several times to allow imaging in different planes, which may extend the total duration of surgery. The study aimed to evaluate whether the concurrent intraoperative use of 2 C-arms could safely reduce the duration of surgery. MATERIALS This retrospective study included cases of percutaneous implantation of a spinal cord stimulation (SCS) lead for trial neurostimulation between 2006 and 2011. The duration of the surgical intervention was recorded, along with the duration of the preparation stage in the operating room. In addition, total radiation exposure time per case was recorded. RESULTS Ninety-four patients underwent percutaneous implantation of an SCS lead (72 thoracolumbar, 22 cervical). In 73 cases 2 C-arms were used, with 21 cases performed with a single C-arm. In both the cervical and thoracolumbar groups, a biplanar configuration was associated with significant reduction in the mean length of the surgical phase, by 29 minutes (P = 0.017) and 14 minutes, respectively (P = 0.016), albeit while increasing the duration of the preoperative preparation stage. There was no significant difference in the total duration in the operating room or in the total radiation exposure time between groups. CONCLUSIONS Here we present a technical note on the use of a biplanar fluoroscopy configuration for percutaneous implantation of SCS leads. This arrangement correlated with a reduction in surgery duration without increasing total radiation exposure, representing a practical and safe adjustment to current practice.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
| | - Susanne Frank
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Daniel Staribacher
- Department of Emergency Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Rolf Kalff
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Rupert Reichart
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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13
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Lim H, Doo AR, Son JS, Kim JW, Lee KJ, Kim DC, Ko S. Effects of intraoperative single bolus fentanyl administration and remifentanil infusion on postoperative nausea and vomiting. Korean J Anesthesiol 2016; 69:51-6. [PMID: 26885302 PMCID: PMC4754267 DOI: 10.4097/kjae.2016.69.1.51] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the use of postoperative opioids is a well-known risk factor for postoperative nausea and vomiting (PONV), few studies have been performed on the effects of intraoperative opioids on PONV. We examined the effects of a single bolus administration of fentanyl during anesthesia induction and the intraoperative infusion of remifentanil on PONV. METHODS Two hundred and fifty women, aged 20 to 65 years and scheduled for thyroidectomy, were allocated to a control group (Group C), a single bolus administration of fentanyl 2 µg/kg during anesthesia induction (Group F), or 2 ng/ ml of effect-site concentration-controlled intraoperative infusion of remifentanil (Group R) groups. Anesthesia was maintained with sevoflurane and 50% N2O. The incidence and severity of PONV and use of rescue antiemetics were recorded at 2, 6, and 24 h postoperatively. RESULTS Group F showed higher incidences of nausea (60/82, 73% vs. 38/77, 49%; P = 0.008), vomiting (40/82, 49% vs. 23/77 30%; P = 0.041) and the use of rescue antiemetics (47/82, 57% vs. 29/77, 38%; P = 0.044) compared with Group C at postoperative 24 h. However, there were no significant differences in the incidence of PONV between Groups C and R. The overall incidences of PONV for postoperative 24 h were 49%, 73%, and 59% in Groups C, F, and R, respectively (P = 0.008). CONCLUSIONS A single bolus administration of fentanyl 2 µg/kg during anesthesia induction increases the incidence of PONV, but intraoperative remifentanil infusion with 2 ng/ml effect-site concentration did not affect the incidence of PONV.
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Affiliation(s)
- Hyungsun Lim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - A Ram Doo
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ji-Seon Son
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jin-Wan Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ki-Jae Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Dong-Chan Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seonghoon Ko
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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Braam HJ, Schellens JH, Boot H, van Sandick JW, Knibbe CA, Boerma D, van Ramshorst B. Selection of chemotherapy for hyperthermic intraperitoneal use in gastric cancer. Crit Rev Oncol Hematol 2015; 95:282-96. [PMID: 25921419 DOI: 10.1016/j.critrevonc.2015.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/22/2015] [Accepted: 04/07/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Several studies have shown the potential benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients. At present the most effective chemotherapeutic regime in HIPEC for gastric cancer is unknown. The aim of this review was to provide a comprehensive overview of chemotherapeutic agents used for HIPEC in gastric cancer. METHODS A literature search was conducted using the PubMed database to identify studies on chemotherapy used for HIPEC in gastric cancer patients. RESULTS AND CONCLUSION The chemotherapeutic regime of choice in HIPEC for gastric cancer has yet to be determined. The wide variety in studies and study parameters, such as chemotherapeutic agents, dosage, patient characteristics, temperature of perfusate, duration of perfusion, carrier solutions, intraperitoneal pressure and open or closed perfusion techniques, warrant more experimental and clinical studies to determine the optimal treatment schedule. A combination of drugs probably results in a more effective treatment.
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Affiliation(s)
- H J Braam
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - J H Schellens
- Division of Clinical Pharmacology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Science Faculty, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - H Boot
- Division of Gastroenterology and Hepatology, Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J W van Sandick
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C A Knibbe
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands; Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - D Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - B van Ramshorst
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Esquinas AM, Jover JL, Úbeda A, Belda FJ. [Non-invasive mechanical ventilation in the pre- and intraoperative period and difficult airway]. ACTA ACUST UNITED AC 2015; 62:502-11. [PMID: 25702198 DOI: 10.1016/j.redar.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival. There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period. The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications. Its intraoperative use will mainly depend on the type of surgery, type of anaesthetic technique, and the clinical status of the patient. Its use allows greater anaesthetic depth without deterioration of oxygenation and ventilation of patients.
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Affiliation(s)
- A M Esquinas
- Servicio de Medicina Intensiva, Hospital Morales Meseguer, Murcia, España
| | - J L Jover
- Servicio de Anestesiología y Reanimación, Hospital Virgen de los Lirios, Alcoy, Alicante, España.
| | - A Úbeda
- Servicio de Medicina Intensiva, Hospiten Estepona, Estepona, Málaga, España
| | - F J Belda
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Valencia, España
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Akan A, Şimsek Ş. Intraoperative Period and Breast Cancer: Review. J Breast Health 2014; 10:190-196. [PMID: 28331670 DOI: 10.5152/tjbh.2014.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/13/2014] [Indexed: 11/22/2022]
Abstract
Intraoperative radiation therapy in breast cancer (IORT) delivers a concentrated dose of radiation therapy to a tumor bed during surgery. IORT offers some of the following advantages with typically fewer complications like; maximum effect, sparing healthy tissues and organs, to help the patients finish treatment and get back to their normal activities. The goal of IORT is to improve local tumor control and survival rates for patients with breast cancer. IORT can both be performed with electron beams (ELIOT) and X-rays. Two main randomised trials testing intraoperative partial breast radiotherapy are TARGIT trial and the ELIOT (intraoperative radiotherapy with electrons) trial, but the techniques are fundamentally different. Whereas TARGIT delivers radiation from within the undisturbed tumour bed, for ELIOT, the mammary gland is mobilised, a prepectoral lead shield is inserted, the edges of the tumour bed are apposed, and radiation is delivered from without.
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Affiliation(s)
- Arzu Akan
- Clinic of General Srugery, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Şerife Şimsek
- Clinic of Breast Surgery, EMSEY Hospital, İstanbul, Turkey
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Zigman T, Davila S, Dobric I, Antoljak T, Augustin G, Rajacic D, Kovac T, Ehrenfreund T. Intraoperative measurement of bone electrical potential: a piece in the puzzle of understanding fracture healing. Injury 2013; 44 Suppl 3:S16-9. [PMID: 24060011 DOI: 10.1016/s0020-1383(13)70191-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bone electrical potentials change with the force applied. Also, fracture alters the bone electrical potential, so it becomes more electronegative. These potentials have an important role in fracture healing, bone growth and remodelling. Literature data on the influence of fracture operative treatment on bone electrical potentials, and possible consequences of this influence, are sparse. The objective of this study was to establish a method of intraoperative bone potential measurement, and to try to find a correlation between electrical potential and fracture type, osteosynthesis method and prognosis. PATIENTS AND METHODS 52 patients with a pertrochanteric fracture were included in the study. Bone electrical potentials were measured intraoperatively using a thin Kirschner wire introduced through bone cortex at the selected point and pointed to opposite cortex, not penetrating it. Kirschner wires were connected using clamps to multimeter (YF-78 Multimeter) device. Neutral electrode (inductive rubber) was placed behind ipsilateral gluteus. RESULTS Near the fracture site potentials of -199 up to -267 mV were recorded. Mean measured potential of bone plate after fixation was -240 mV. Bone potentials correlated with the subtype of fracture and early mobilisation of patients. CONCLUSIONS Bone potentials, caused by fracture, can be measured intraoperatively; the operative procedure appears to influence their generation. Measured potentials depend on the fracture type, and could be correlated with prognosis.
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Affiliation(s)
- Tomislav Zigman
- Department of Surgery, University Hospital Centre Zagreb and School of Medicine University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
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Abstract
Peutz-Jeghers syndrome (PJS) is an inherited, autosomal dominant disorder distinguished by hamartomatous polyps in the gastrointestinal tract and pigmented mucocutaneous lesions. Prevalence of PJS is estimated from 1 in 8300 to 1 in 280 000 individuals. PJS predisposes sufferers to various malignancies (gastrointestinal, pancreatic, lung, breast, uterine, ovarian and testicular tumors). Bleeding, obstruction and intussusception are common complications in patients with PJS. Double balloon enteroscopy (DBE) allows examination and treatment of the small bowel. Polypectomy using DBE may obviate the need for repeated urgent operations and small bowel resection that leads to short bowel syndrome. Prophylaxis and polypectomy of the entire small bowel is the gold standard in PJS patients. Intraoperative enteroscopy (IOE) was the only possibility for endoscopic treatment of patients with PJS before the DBE era. Both DBE and IOE facilitate exploration and treatment of the small intestine. DBE is less invasive and more convenient for the patient. Both procedures are generally safe and useful. An overall recommendation for PJS patients includes not only gastrointestinal multiple polyp resolution, but also regular lifelong cancer screening (colonoscopy, upper endoscopy, computed tomography, magnetic resonance imaging or ultrasound of the pancreas, chest X-ray, mammography and pelvic examination with ultrasound in women, and testicular examination in men). Although the incidence of PJS is low, it is important for clinicians to recognize these disorders to prevent morbidity and mortality in these patients, and to perform presymptomatic testing in the first-degree relatives of PJS patients.
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