Recovery of deambulation after cardiothoracic surgery: a single center experience

BACKGROUND

Surgical procedure and postoperative bed rest lead to musculoskeletal system alterations with a possibility of new walking dependence of patients who undergo cardiothoracic surgery, which is sometimes associated with prolonged hospitalization and increased health expenditure.

AIM

The aim of this study was to assess the postoperative motor disability in inpatients admitted to the cardiothoracic surgical ward, and the results of customized rehabilitation in terms of recovery of postural changes and walking capacity with respect to the preoperative condition and destination after discharge.

DESIGN

A prospective observational study was conducted.

SETTING AND POPULATION

Four hundred seventeen inpatients, who had undergone cardiothoracic surgery, were enrolled between March 2011 and January 2012 in a Hospital Unit of Cardiothoracic Surgery.

METHODS

A computerized system was used to collect data about ambulation at home, type and number of rehabilitation sessions proposed, ambulation at discharge, destination after discharge from ward of origin. All patients, who give their consent, undergone rehabilitative treatment on the ward of origin with an expert physiotherapist.

RESULTS

Three hundred seventy-five inpatients were examined in Cardiac Surgery. One patient (0.26%) refused rehabilitative treatment. Two patients (0.53%) died. At the time of discharge 236 (74.45%) patients had recovered the ability to walk independently. After discharge 87.64% of patients was transferred to a specialist ward for intensive rehabilitation. Forty-two inpatients were enrolled in thoracic surgery. Two patients died whilst in hospital. At the time of discharge, 36 patients (94.73%) were able to walk independently. After discharge 80% of patients returned home.

CONCLUSION

In our study, the application of an early and simple rehabilitation program on the ward of origin after surgery has made possible the recovery of ambulation of most inpatients who referred independence at home in a few days, limiting hospitalization and health expenditure.

CLINICAL REHABILITATION IMPACT

Data about recovery of ambulation with respect to the preoperative condition and destination after discharge resume the importance of identifying motor impairment after surgery, in order to apply an adequate, early and feasible rehabilitation protocol to inpatients, limiting hospitalization and health expenditure.

A study of cytopathic rotavirus strains isolated from calves with acute enteritis

Nine cytopathic bovine rotavirus strains were isolated in MA-104 cell cultures from fecal specimens of dairy calves suffering from diarrhea. Isolation of the virus was accomplished from three outbreaks which occurred on dairy farms located in Central and Southern Italy. Fecal suspensions were treated with a high concentration (1000 micrograms/ml) of trypsin, and inoculated into MA-104 cell cultures grown out in Eagle's minimum essential medium (MEM) containing 5 micrograms/ml of the enzyme. Cytopathic effects (CPE), characterized by intracytoplasmic inclusion bodies of different sizes and shapes, were observed on the 1st passage with five of the strains and on the 2nd (2 strains) or the 3rd (2 strains) passage for the others. The presence of trypsin and the use of MA-104 cells appeared to be essential for the occurrence of CPE, inasmuch as no CPE was detected when trypsin was omitted in the MA-104 cell system. Replication failed to occur when primary bovine embryo kidney cell cultures with or without trypsin were used. Electron microscopy revealed the presence of particles with a typical rotavirus morphology. In MA-104 cells, the titre of virus reached its maximum 48 hr after inoculation. Small, clear-cut plaques were produced by the isolates in MA-104 cells under the overlay of MEM containing carboxymethyl cellulose, trypsin and DEAE-dextran. The nine rotavirus strains were antigenically related, whereas the relationship to either the Nebraska or the Compton rotaviruses was quite weak.