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Perioperative management of diabetes

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https://www.readbyqxmd.com/read/28202829/-treatment-strategy-and-results-of-carotid-endarterectomy-in-chronic-renal-failure-patients
#1
Takeo Murahashi, Kenji Kamiyama, Toshiaki Osato, Toshiichi Watanabe, Tatsuya Ogino, Hironori Sugio, Hideki Endo, Kazuki Takahira, Koichiro Shindo, Shuhei Takahashi, Hirohiko Nakamura
INTRODUCTION: The number of patients receiving chronic dialysis treatment in Japan currently exceeds 300,000 people. Few reports have described carotid endarterectomy(CEA)for chronic renal failure patients because of the unacceptable rate of perioperative stroke and other morbidities. A strategy for and treatment results of CEA for chronic renal failure patients in our hospital are described herein. METHODS: The present study included 6 patients who underwent CEA while receiving dialysis treatment between April 2011 and November 2014...
February 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/28190720/endarterectomy-versus-stenting-in-patients-with-prior-ipsilateral-carotid-artery-stenting
#2
Isibor J Arhuidese, Besma Nejim, Susruth Chavali, Satinderjit Locham, Tammam Obeid, Caitlin W Hicks, Mahmoud B Malas
OBJECTIVE: In-stent restenosis is a recognized complication of carotid angioplasty and stenting (CAS), and it is associated with an increased risk of stroke. Few case series have reported outcomes separately following carotid endarterectomy (CEA) and CAS for the treatment of in-stent restenosis. In this study, we perform an evaluation of redo-CAS vs CEA in a large contemporary cohort of patients who underwent prior ipsilateral CAS. METHODS: We studied all patients in the Vascular Quality Initiative (VQI) database, who underwent CEA or CAS between January 1, 2003, and April 30, 2016, after prior ipsilateral CAS...
February 9, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28184260/perioperative-management-of-left-ventricular-diastolic-dysfunction-and-heart-failure-an-anesthesiologist-s-perspective
#3
REVIEW
Taeha Ryu, Seok-Young Song
Anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries. These patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations. The symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease. Patients with diastolic dysfunction, and even with diastolic heart failure, have the potential to develop a hypertensive crisis or pulmonary congestion...
February 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28168619/pure-endoscopic-management-of-epileptogenic-hypothalamic-hamartomas
#4
S Chibbaro, H Cebula, J Scholly, J Todeschi, I Ollivier, A Timofeev, M Ganau, P Di Emidio, M P Valenti, A M Staack, T Bast, B J Steinhoff, E Hirsch, P Kehrli, F Proust
Hypothalamic hamartomas (HH) are rare congenital malformations located in the region of the tuber cinereum and third ventricle. Their usual clinical presentation is characterized by gelastic/dacrystic seizures which often become pharmaco-resistant and progress to secondary focal/generalized intractable epilepsy causing mostly in children cognitive and behavioral problems (particularly in cases of progressive epileptic encephalopathy) and precocious puberty. Whereas gelastic seizures can be surgically controlled either by resection of the lesion or disconnection (tissue-destructive) procedures, aimed at functionally prevent the spreading of the epileptic burst; generalized seizures tend to respond better to HH excision rather than isolated neocortical resections, which generally fail to control them...
February 7, 2017: Neurosurgical Review
https://www.readbyqxmd.com/read/28158300/impact-of-diabetes-mellitus-on-clinical-outcomes-of-pancreatic-cancer-after-surgical-resection-a-systematic-review-and-meta-analysis
#5
Xinghua Lv, Wenhui Qiao, Yufang Leng, Lupeng Wu, Yanming Zhou
BACKGROUND AND OBJECTIVE: Diabetes mellitus (DM) is a risk factor for pancreatic cancer but its impact on postoperative outcomes and long-term survival after cancer resection remains controversial. A meta-analysis of published studies was conducted to address this issue. METHODS: An extensive electronic search of four databases was performed for relevant articles. Data were processed for meta-analysis using Review Manager version 5.1. RESULTS: Seventeen observational studies involving 5407 patients were subjected to the analysis...
2017: PloS One
https://www.readbyqxmd.com/read/28128657/patients-with-type-2-diabetes-anesthetic-management-in-the-ambulatory-setting-part-2-pharmacology-and-guidelines-for-perioperative-management
#6
Bryant W Cornelius
Type 2 diabetes is a disease of metabolism in which the afflicted patient cannot properly utilize carbohydrates, fats, and proteins. Because the prevalence of type 2 diabetes is rapidly increasing throughout the general population, anesthesia providers must realize that a significant percentage of their patients will present with the disease. Anesthesia providers should have an intimate knowledge of the comorbidities and complications that are associated with type 2 diabetes and know the specific pharmacokinetics and pharmacodynamics of the drugs used to treat the disease...
2017: Anesthesia Progress
https://www.readbyqxmd.com/read/28128542/management-of-ambulatory-day-case-endovascular-procedures-for-peripheral-arterial-disease
#7
REVIEW
Alexandra Hauguel, Blandine Maurel, Nicolas Bague, Flora Gouaillier-Vulcain, Alain Costargent, Philippe Chaillou, Yann Gouëffic
INTRODUCTION: Thanks to exceptional improvements in technological developments and vascular teams' expertise, endovascular repair of peripheral arterial disease (PAD) has drastically increased these past decades. Incidence of PAD rising, pressure to reduce costs and patient's empowerment make outpatient endovascular procedures for PAD an attractive alternative to conventional hospitalization. This review describes outpatient endovascular procedures for PAD in the literature. EVIDENCE ACQUISITION: We used PRISMA guidelines and Medline to conduct this systematic review...
April 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28106608/a-perioperative-systems-design-to-improve-intraoperative-glucose-monitoring-is-associated-with-a-reduction-in-surgical-site-infections-in-a-diabetic-patient-population
#8
Jesse M Ehrenfeld, Jonathan P Wanderer, Maxim Terekhov, Brian S Rothman, Warren S Sandberg
BACKGROUND: Diabetic patients receiving insulin should have periodic intraoperative glucose measurement. The authors conducted a care redesign effort to improve intraoperative glucose monitoring. METHODS: With approval from Vanderbilt University Human Research Protection Program (Nashville, Tennessee), the authors created an automatic system to identify diabetic patients, detect insulin administration, check for recent glucose measurement, and remind clinicians to check intraoperative glucose...
March 2017: Anesthesiology
https://www.readbyqxmd.com/read/28045816/risk-factors-predicting-nasoseptal-flap-failure-in-the-endoscopic-endonasal-transsphenoidal-approach
#9
Boo-Young Kim, Ji Hyeon Shin, Sung Won Kim, Yong Kil Hong, Sin-Soo Jeun, Soo Whan Kim, Jin Hee Cho, Yong Jin Park
OBJECTIVE: Reconstruction of the skull base using a pedicled nasoseptal flap (NSF) seems to be advantageous after the endoscopic endonasal transsphenoidal approach (EETSA). A few reports have evaluated the cause of flap failure in EETSA using NSFs. The aim of this study was to evaluate the perioperative risk factors for NSF failure. STUDY DESIGN: Patient series. SETTING: Retrospective review of medical records at a tertiary referral center...
March 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28029328/when-what-and-why-of-perioperative-treatment-of-potentially-curable-pancreatic-adenocarcinoma
#10
Kimberly Perez, Thomas E Clancy, Joseph D Mancias, Michael H Rosenthal, Brian M Wolpin
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice...
December 28, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/27973934/patients-with-type-2-diabetes-anesthetic-management-in-the-ambulatory-setting-part-1-pathophysiology-and-associated-disease-states
#11
Bryant W Cornelius
The increasing prevalence of diabetes mellitus in the general population has many implications for the ambulatory anesthesia provider. Complications, particularly associated with poor glycemic control, can affect multiple organ systems and jeopardize the safety of any planned anesthetic. It is essential that anesthesiologists and sedation providers have in-depth knowledge of the pathophysiology of diabetes mellitus and the comorbid conditions that commonly accompany it. Anesthesiologists and sedation providers must also understand certain surgical and anesthetic considerations when planning an effective and safe anesthetic for diabetic patients...
2016: Anesthesia Progress
https://www.readbyqxmd.com/read/27903337/-risk-factors-for-perioperative-stroke-in-aged-patients-undergoing-nonneurologic-and-noncardiovascular-surgery
#12
B L Jiang, L Yao, Y Feng, J H Liu
Objective: To assess the incidence, risk factors, and outcomes of perioperative stroke in aged patients undergoing nonneurologic and noncardiovascular surgery. Methods: A total of 21 419 in-patients who were older than 65 years undergoing nonneurologic and noncardiovascular surgery in Peking University People's Hospital from January 2010 to May 2016 were retrospectively recruited in this study.The patients were divided into two groups: patients with perioperative stroke were allocated in stroke group, and the other patients were in the non-stroke group...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27876245/perioperative-medicine-and-taiwan-national-health-insurance-research-database
#13
REVIEW
C C Chang, C C Liao, T L Chen
"Big data", characterized by 'volume', 'velocity', 'variety', and 'veracity', being routinely collected in huge amounts of clinical and administrative healthcare-related data are becoming common and generating promising viewpoints for a better understanding of the complexity for medical situations. Taiwan National Health Insurance Research Database (NHIRD), one of large and comprehensive nationwide population reimbursement databases in the world, provides the strength of sample size avoiding selection and participation bias...
September 2016: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
https://www.readbyqxmd.com/read/27819771/glycemic-outcomes-3-years-after-implementation-of-a-peri-operative-glycemic-control-algorithm-in-an-academic-institution
#14
Lindsay M Arnold, Mufaddal Mahesri, Marie E McDonnell, Sara M Alexanian
OBJECTIVE: While hyperglycemia in the postoperative setting has been linked to an increase in surgical complications, limited data are available to inform the management of patients with diabetes in the operating room and the immediate peri-operative period. We describe the results of a peri-operative glycemic control program that standardized intravenous insulin with a target glucose (BG) range of 120 to 180 mg/dL for patients with diabetes presenting with a BG level >180 mg/dL and included transition to subcutaneous insulin...
February 2017: Endocrine Practice
https://www.readbyqxmd.com/read/27772602/aortic-valve-stenosis-in-a-dialysis-patient-waitlisted-for-kidney-transplantation
#15
Stefan Büttner, Helge Weiler, Carolin Zöller, Benjamin Koch, Andreas Zierer, Andreas M Zeiher, Helmut Geiger, Mariuca Vasa-Nicotera, Ingeborg A Hauser, Stephan Fichtlscherer
Management of dialysis patients with valvular heart disease waitlisted for kidney transplantation is challenging. Development of severe aortic valve stenosis can lead to the exclusion from the transplant program or even death while on the waiting list. In dialysis patients, surgical aortic valve replacement is associated with a high perioperative risk with increased morbidity and mortality. In contrast, transcatheter aortic valve implantation emerges as a viable option for dialysis patients. Herein, we present the long-term follow-up of successful kidney transplantation after TAVI in a diabetic patient receiving long-term hemodialysis...
November 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27771235/relationship-between-diabetic-variables-and-outcomes-after-coronary-artery-bypass-grafting-in-diabetic-patients
#16
Tom Kai Ming Wang, Andrew Woodhead, Tharumenthiran Ramanathan, James Pemberton
BACKGROUND: Nearly half of the patients undergoing coronary artery bypass grafting (CABG) have diabetes. There is mixed data as to whether preoperative (haemoglobin A1c{HbA1c}) and/or perioperative diabetes control is associated with mortality and morbidity after CABG. We reviewed the characteristics and outcomes of diabetic patients undergoing CABG with a focus on HbA1c, perioperative glucose levels and diabetic treatment regimens. METHODS: Diabetic patients undergoing CABG during July 2010 to June 2012 were studied (n=306)...
July 4, 2016: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/27767680/postoperative-urinary-retention-in-patients-undergoing-elective-spinal-surgery
#17
David Altschul, Andrew Kobets, Jonathan Nakhla, Ajit Jada, Rani Nasser, Merritt D Kinon, Reza Yassari, John Houten
OBJECTIVE Postoperative urinary retention (POUR) is a common problem leading to morbidity and an increased hospital stay. There are limited data regarding its baseline incidence in patients undergoing spinal surgery and the risk factors with which it may be associated. The purpose of this study was to evaluate the incidence of POUR in elective spine surgery patients and determine the factors associated with its occurrence. METHODS The authors retrospectively reviewed the records of patients who had undergone elective spine surgery and had been prospectively monitored for POUR during an 18-month period...
February 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27761041/acute-post-operative-diabetic-ketoacidosis-atypical-harbinger-unmasking-latent-diabetes-mellitus
#18
Rudrashish Haldar, Ankur Khandelwal, Devendra Gupta, Shashi Srivastava, Prabhat K Singh
Hyperglycaemia following surgical and anaesthetic stress is a well-established entity which might have undesirable clinical consequences in known diabetics. We encountered a rare event where an undiagnosed diabetic patient developed ketoacidosis in the immediate post-operative period which was her initial presenting symptom of deranged glucoregulation. Presumably, the stress induced by surgery and anaesthesia lead to the genesis of this event. We discuss the management of this case. In addition, we highlight the importance of glycosylated haemoglobin as a subject of future research in identifying such "at risk" patients and for stratifying the risk of hyperglycaemic complications in perioperative settings...
October 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27752032/starvation-ketoacidosis-as-a-cause-of-unexplained-metabolic-acidosis-in-the-perioperative-period
#19
Monique Mostert, Anthony Bonavia
BACKGROUND Besides providing anesthesia for surgery, the anesthesiologist's role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient's perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient's surgical outcome. Thus, the presence of an acute acid-base disturbance requires a thorough workup, the results of which will influence the patient's anesthetic management...
October 18, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27633164/a-comparison-between-aortobifemoral-bypass-and-aortoiliac-kissing-stents-in-patients-with-complex-aortoiliac-obstructive-disease
#20
Walter Dorigo, Gabriele Piffaretti, Filippo Benedetto, Antonino Tarallo, Patrizio Castelli, Francesco Spinelli, Aaron Fargion, Carlo Pratesi
OBJECTIVE: The aim of this study was to retrospectively compare early and late results of aortobifemoral bypass and endovascular recanalization with the kissing stent technique in the management of TransAtlantic Inter-Society Consensus II (TASC II) C and D lesions in the aortoiliac district in a multicenter study. METHODS: From January 2006 to December 2013, 210 open and endovascular interventions for TASC II class C and D aortoiliac obstructive lesions were performed at three Italian teaching hospitals...
January 2017: Journal of Vascular Surgery
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