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https://www.readbyqxmd.com/read/28107785/blood-management-strategies-to-reduce-transfusions-after-elective-lower-extremity-joint-arthroplasty-surgeries
#1
Ankit Kansagra, Chester Andrzejewski, Robert Krushell, Andrew Lehman, Jordan Greenbaum, Paul Visintainer, Joan McGirr, Kathleen Mahoney, Darlene Cloutier, Alice Ehresman, Mihaela S Stefan
Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post...
January 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28104466/age-related-differences-pre-intra-and-postcholecystectomy
#2
Hadia Maqsood, Kalpesh Patel, Hamid Ferdosi, Anne M Sill, Bin Wu, Thomas Buddensick, Amanda Sautter, Haroon Shaukat, Gisela Sulkowski, Dusty Marie Narducci, Mustafa Siddique, Farin Kamangar, Gopal C Kowdley, Steven C Cunningham
BACKGROUND: Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database. MATERIALS AND METHODS: A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed. ROC analysis identified the optimal age cutoff when complications reached a significant inflection point (<55 and >55 years)...
January 16, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28103372/the-effect-of-epidural-levobupivacaine-and-fentanyl-on-stress-response-and-pain-management-in-patients-undergoing-percutaneous-nephrolithotomy
#3
A Ahiskalioglu, O Ahiskalioglu, A Dostbil, C Abdullah, A Megnet, M Celik, I Ilker, K Husnu
Objective: The perioperative stress response of patients who were scheduled to have percutaneous nephrolithotomy under epidural anaesthesia with opioids and local anaesthetics has not been investigated in detail yet. Our hypothesis is that the stress response following percutaneous nephrolithotomy can be lessened by epidural analgesia. Methods: A total of 48 patients, between 18-65 years of age and ASA I-II, for whom elective percutaneous nephrolithotomy was planned, were randomly divided into two groups namely: Group GA (n = 24): general anaesthesia by sevoflurane and fentanyl and postoperative intravenous PCA; Group GE (n = 24): epidural anaesthesia and general anaesthesia together with postoperative epidural analgesia (0...
March 14, 2016: West Indian Medical Journal
https://www.readbyqxmd.com/read/28100266/arranging-blood-for-elective-thyroid-surgeries-dilemma-continues-in-the-developing-world
#4
Salman Faridi, Aman Ahmad, Mirza Arshad Beg, Faisal Siddiqui, Muhammad Muzzammil Edhi, Mehmood Khan
BACKGROUND: Cross matched blood is frequently ordered based on a subjective anticipation of blood loss for a procedure. Excessive blood arrangement and wastage overburdens the blood bank in terms of work load and storage of blood, increases cost of medical care and results in injudicious use of a limited resource. The aim of this short report is to assess the current practice for arranging cross matched blood in elective thyroid surgeries by comparing cross match to blood transfused ratio...
January 18, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28098709/multimodal-imaging-during-the-evolution-of-blood-brain-barrier-disruption-maculopathy
#5
Bikramjit P Pal, Tapani Palosaari, Tero Kivelä
PURPOSE: To highlight the course of blood-brain barrier disruption maculopathy in a patient with successfully managed relapsed central nervous system lymphoma. METHODS: Case report with fundus autofluorescence and optical coherence tomography imaging, and literature review. RESULTS: A 57-year-old patient diagnosed with central nervous system large B-cell lymphoma had a normal ophthalmic evaluation on his first visit. Subsequently, when his malignancy recurred locally, he was started on blood-brain barrier disruption therapy and intraarterial methotrexate...
January 16, 2017: Retinal Cases & Brief Reports
https://www.readbyqxmd.com/read/28098040/-hypocortisolism-associated-with-nephrotic-syndrome
#6
R H Westerdijk, B H R Wolffenbuttel, I P Kema, R S M E Wouters
BACKGROUND: With nephrotic syndrome, cortisol levels may be falsely lowered by loss of cortisol-binding globulin (CBG) in the urine. An incorrect diagnosis of adrenal insufficiency could therefore be made. CASE DESCRIPTION: We describe the case of a 52-year-old female with nephrotic syndrome that did not sufficiently respond to medication. Treatment management was complicated by symptomatic hypotension, which was thought to be caused by adrenal insufficiency. The cortisol levels in the blood were low and a clinical cause could not be identified...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28094428/intra-operative-results-and-post-operative-clinical-outcomes-of-lumbar-microdiscectomy-in-patients-received-transforaminal-anterior-epidural-steroid-injection-earlier-for-lumbar-radiculopathy
#7
Sait Ozturk, Bekir Akgun, Fatih Serhat Erol, Selami Ates Onal, Metin Kaplan
AIM: We have aimed to describe the intra and postoperative results of patients who received transforaminal anterior epidural steroid injection (TAESI) prior to undergoing lumbar microdiscectomy. MATERIAL AND METHODS: 64 of 2461 patients evaluated who had received minimally invasive technique (MIT) for lumbar radiculopathy and who felt no relief after the procedures. 32 patients of them treated with different techniques other than TAESI and those receiving thrombolytic or anticoagulant drugs before microdiscectomy were excluded...
December 14, 2016: Turkish Neurosurgery
https://www.readbyqxmd.com/read/28093996/challenges-related-to-glycemic-control-in-type-2-diabetes-mellitus-patients
#8
Masoumeh Kheirandish, Hamidreza Mahboobi, Maryam Yazdanparast, Mohammad Amjad Kamal
Diabetes mellitus (DM) is a chronic disease with long-term complications. Glycemic control is an important part in management of DM. The first line in treatment of type 2 DM (T2DM) is diet and life style change. Metformin is the first choice of medication in T2DM patients. Sulfonylureas have high risk of hypoglycemia. Glinides are associated with lower risk of hypoglycemia in comparison to sulfonylureas. Also α-glucosidase inhibitors decrease the polysacarides digestion in small intestine and less effective in comparison to metformin and sulfonylureas in lowering hemoglobin A1c (HbA1c)...
January 15, 2017: Current Drug Metabolism
https://www.readbyqxmd.com/read/28093571/roux-en-y-gastric-bypass-increases-systemic-but-not-portal-bile-acid-concentrations-by-decreasing-hepatic-bile-acid-uptake-in-minipigs
#9
O Chávez-Talavera, G Baud, V Spinelli, M Daoudi, M Kouach, J-F Goossens, E Vallez, R Caiazzo, M Ghunaim, T Hubert, S Lestavel, A Tailleux, B Staels, F Pattou
Roux-en-Y gastric bypass (RYGB) surgery is widely used in the management of morbid obesity. RYGB improves metabolism independently of weight loss by still unknown mechanisms. Bile acids (BAs) are good candidates to explain this benefit, since they regulate metabolic homeostasis and their systemic concentrations increase upon RYGB. Here we analyzed the mechanisms underlying the increase in systemic BA concentrations after RYGB and the role of the liver therein. To this aim, we used the Göttingen-like minipig, a human-size mammalian model, which allows continuous sampling and simultaneous analysis of pre-hepatic portal and systemic venous blood...
January 17, 2017: International Journal of Obesity: Journal of the International Association for the Study of Obesity
https://www.readbyqxmd.com/read/28091794/the-impact-of-liver-disorders-on-perioperative-management-of-reoperative-cardiac-surgery-a-retrospective-study-in-adult-congenital-heart-disease-patients
#10
Koko Adachi, Hiroaki Toyama, Yu Kaiho, Osamu Adachi, Hiroto Hudeta, Masanori Yamauchi
PURPOSE: We evaluated the preoperative prevalence of risk factors for liver disorders and the relationship between the liver disorders and perioperative outcomes in adult congenital heart disease (ACHD) patients. METHODS: This retrospective study included 32 ACHD patients who underwent reoperative cardiac surgery. RESULTS: Preoperatively, 38% of the study patients had risk factors, including congestive liver (CL) due to right heart failure (31%), chronic hepatitis C (HC) (22%), and both CL and HC (16%)...
January 16, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28091770/relevance-of-surgery-in-patients-with-non-variceal-upper-gastrointestinal-bleeding
#11
S Dango, T Beißbarth, E Weiss, A Seif Amir Hosseini, D Raddatz, V Ellenrieder, J Lotz, B M Ghadimi, A Beham
INTRODUCTION: Upper GI bleeding remains one of the most common emergencies with a substantial overall mortality rate of up to 30%. In severe ill patients, death does not occur due to failure of hemostasis, either medical or surgical, but mainly from comorbidities, treatment complications, and decreased tolerated blood loss. Management strategies have changed dramatically over the last two decades and include primarily endoscopic intervention in combination with acid-suppressive therapy and decrease in surgical intervention...
January 14, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28091392/the-impact-of-viral-load-and-time-to-onset-of-cytomegalovirus-replication-on-long-term-graft-survival-after-kidney-transplantation
#12
Tomas Reischig, Martin Kacer, Petra Hruba, Pavel Jindra, Ondrej Hes, Daniel Lysak, Mirko Bouda, Ondrej Viklicky
BACKGROUND: Asymptomatic cytomegalovirus (CMV) infection is associated with graft dysfunction and failure. However, no study assessed CMV viral load in terms of the risk for graft failure. METHODS: In prospective cohort of kidney transplant recipients, we assessed the impact of CMV DNAemia on the overall graft survival and the incidence of moderate-to-severe interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsy at 36 months. CMV DNAemia was stratified by viral load in whole blood...
January 16, 2017: Antiviral Therapy
https://www.readbyqxmd.com/read/28074747/liraglutide-a-glucagon-like-peptide-1-agonist-for-chronic-weight-management
#13
Kendra R Manigault, Maria Miller Thurston
OBJECTIVE: To review the efficacy and safety of liraglutide 3.0 mg for weight loss. DATA SOURCE: A literature search was performed using PubMed and MEDLINE from 2000 to 2016. The following key terms were used alone or in combination: glucagon-like peptide-1 agonist, liraglutide, obesity, overweight, and weight loss. Additional supporting literature was identified utilizing the reference lists of the preceding articles. STUDY SELECTION: Analyzed studies were published in English and investigated use of liraglutide and its impact on weight loss...
December 1, 2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28073597/en-bloc-resection-of-the-pelvis-enbrp-in-patients-with-stage-iiic-iv-ovarian-cancer-a-10-steps-standardised-technique-surgical-and-survival-outcomes-of-primary-vs-interval-surgery
#14
Roberto Tozzi, Kieran Hardern, Kumar Gubbala, Riccardo Garruto Campanile, Hooman Soleymani Majd
OBJECTIVE: In this study we describe the technique of the En-bloc resection of the pelvis (EnBRP) in 10 standardised and reproducible steps, whereby all pelvic organs, except the bladder, are removed together with the peritoneum. In addition, we compare the surgical and survival outcomes of patients who underwent upfront vs. interval surgery. METHODS: Retrospective analysis of patients with FIGO Stage IIIC-IV ovarian cancer treated with Visceral Peritoneal Debulking (VPD) who had EnBRP...
January 7, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28067588/health-benefits-of-fiber-fermentation
#15
Wendy J Dahl, Nicole C Agro, Åsa M Eliasson, Kaley L Mialki, Joseph D Olivera, Carley T Rusch, Carly N Young
Although fiber is well recognized for its effect on laxation, increasing evidence supports the role of fiber in the prevention and treatment of chronic disease. The aim of this review is to provide an overview of the health benefits of fiber and its fermentation, and describe how the products of fermentation may influence disease risk and treatment. Higher fiber intakes are associated with decreased risk of cardiovascular disease, type 2 diabetes, and some forms of cancer. Fiber may also have a role in lowering blood pressure and in preventing obesity by limiting weight gain...
January 9, 2017: Journal of the American College of Nutrition
https://www.readbyqxmd.com/read/28058475/strategies-for-intravenous-fluid-resuscitation-in-trauma-patients
#16
Robert Wise, Michael Faurie, Manu L N G Malbrain, Eric Hodgson
Intravenous fluid management of trauma patients is fraught with complex decisions that are often complicated by coagulopathy and blood loss. This review discusses the fluid management in trauma patients from the perspective of the developing world. In addition, the article describes an approach to specific circumstances in trauma fluid decision-making and provides recommendations for the resource-limited environment.
January 5, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28058213/face-transplantation-anesthetic-challenges
#17
REVIEW
Aparna Dalal
Face transplantation is a complex vascular composite allotransplantation (VCA) surgery. It involves multiple types of tissue, such as bone, muscles, blood vessels, nerves to be transferred from the donor to the recipient as one unit. VCAs were added to the definition of organs covered by the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act. Prior to harvest of the face from the donor, a tracheostomy is usually performed. The osteotomies and dissection of the midface bony skeleton may involve severe hemorrhagic blood loss often requiring transfusion of blood products...
December 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/28041320/image-guided-resection-of-aggressive-sacral-tumors
#18
Doniel Drazin, Neil Bhamb, Lutfi T Al-Khouja, Ari D Kappel, Terrence T Kim, J Patrick Johnson, Earl Brien
OBJECTIVE The aim of this study was to identify and discuss operative nuances utilizing image guidance in the surgical management of aggressive sacral tumors. METHODS The authors report on their single-institution, multi-surgeon, retrospective case series involving patients with pathology-proven aggressive sacral tumors treated between 2009 and 2016. They also reviewed the literature to identify articles related to aggressive sacral tumors, their diagnosis, and their surgical treatment and discuss the results together with their own experience...
January 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28038460/the-comprehensive-therapeutic-effects-of-rectal-surgery-are-better-in-laparoscopy-a-systematic-review-and-meta-analysis
#19
Jiabin Zheng, Xingyu Feng, Zifeng Yang, Weixian Hu, Yuwen Luo, Yong Li
BACKGROUND: Laparoscopic-assisted radical resection of rectal cancer was reported as advantageous compared to laparotomy resection. However, this finding remains controversial, especially given the two recent randomized controlled trials published on The Journal of the American Medical Association (JAMA). OBJECTIVE: To perform a meta-analysis that compares the short-term and long-term outcomes of laparoscopic and open surgery for rectal cancer. DATA SOURCE: To identify clinical trials comparing laparoscopic and open surgery for rectal cancer published by August 2016, we searched the PubMed, Cochrane Library, Springer Link and Clinicaltrials...
December 26, 2016: Oncotarget
https://www.readbyqxmd.com/read/28032156/complex-truncal-masses-in-the-setting-of-cloves-syndrome-aesthetic-and-functional-implications
#20
Jason M Weissler, Valeriy Shubinets, Martin J Carney, David W Low
BACKGROUND: Congenital lipomatous overgrowth, vascular malformations, epidermal nevi, and skeletal abnormalities (CLOVES) is a complex overgrowth syndrome with dramatic aesthetic and functional implications. The truncal masses characteristic of CLOVES syndrome are described as vascular malformations or lipomatous lesions with variable vascular components. Herein, we describe our single-institution experience with surgical excision of CLOVES-related truncal masses and discuss future directions in treatment of these complex anomalies...
December 28, 2016: Aesthetic Plastic Surgery
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