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https://www.readbyqxmd.com/read/28538964/effect-of-a-modified-hospital-elder-life-program-on-delirium-and-length-of-hospital-stay-in-patients-undergoing-abdominal-surgery-a-cluster-randomized-clinical-trial
#1
Cheryl Chia-Hui Chen, Hsiu-Ching Li, Jin-Tung Liang, I-Rue Lai, Jerry Dwi Trijoyo Purnomo, Yi-Ting Yang, Been-Ren Lin, John Huang, Ching-Yao Yang, Yu-Wen Tien, Chiung-Nien Chen, Ming-Tsan Lin, Guan-Hua Huang, Sharon K Inouye
Importance: Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS). Objective: To examine whether a modified Hospital Elder Life Program (mHELP) reduces incident delirium and LOS in older patients undergoing abdominal surgery. Design, Setting, and Participants: This cluster randomized clinical trial of 577 eligible patients enrolled 377 older patients (≥65 years of age) undergoing gastrectomy, pancreaticoduodenectomy, and colectomy at a 2000-bed urban medical center in Taipei, Taiwan, from August 1, 2009, through October 31, 2012...
May 24, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28537413/two-stage-surgical-treatment-of-inferior-vena-cava-traumatic-rupture-including-urgent-transport-to-a-specialized-unit
#2
J Kristek, P Hromádka, M Konarik, J Froněk
Inferior vena cava injury as well as major liver injury remains a formidable treatment challenge. The most imminent danger is life-threatening bleeding. In this report, we present a case of polytrauma (Injury Severity Score 35) with arupture of the juxtahepatic inferior vena cava which was successfully treated using two-stage approach. The first part of the treatment consisted of damage control laparotomy at a level I trauma center. After stabilization, the patient was air-transported to receive the definitive treatment at a tertiary care facility experienced in hepatopancreatobiliary and transplantation surgery...
2017: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/28537037/abdominal-paragangliomas-a-quantitative-prognostic-score-as-predictive-factor-of-the-feasibility-of-the-laparoscopic-approach
#3
Giovanni Alemanno, Carlo Bergamini, Riccardo Somigli, Paolo Prosperi, Alessandro Bruscino, Andrea Valeri
The gold standard treatment for abdominal paraganglioma is the complete surgical excision. The surgical approach may be either open or laparoscopic. The aim of this study is to identify clinical-pathological predictive factors for the failure of the laparoscopic approach in the treatment of abdominal paragangliomas, with the aim of reducing the rate of conversion to the open technique. A retrospective review was conducted on the medical records of patients who underwent laparoscopic surgery for suspected abdominal paraganglioma...
May 23, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28535763/using-e-health-in-perioperative-care-a-survey-study-investigating-shortcomings-in-current-perioperative-care-and-possible-future-solutions
#4
Eva van der Meij, Esther V A Bouwsma, Baukje van den Heuvel, H Jaap Bonjer, Johannes R Anema, Judith A F Huirne
BACKGROUND: An e-health care program has previously shown to have a positive effect on return to work, quality of life and pain in patients who underwent gynaecological surgery. Plausibly, providing the care program to a population undergoing other types of surgery will be beneficial as well. The objectives of this study are to evaluate patients' opinions, needs and preferences regarding the information and guidance supplied to patients during the perioperative period, to investigate whether e-health may be of assistance and to explore if gender specific needs exist...
May 23, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28535549/epidural-dexamethasone-influences-postoperative-analgesia-after-major-abdominal-surgery
#5
Jeong-Min Hong, Kyung-Hoon Kim, Hyeon Jeong Lee, Jae-Young Kwon, Hae-Kyu Kim, Hyae-Jin Kim, Ah-Reum Cho, Wang-Seok Do, Hyo Sung Kim
BACKGROUND: Epidurally administered dexamethasone might reduce postoperative pain. However, the effect of epidural administration of dexamethasone on postoperative epidural analgesia in major abdominal surgery has been doubtful. OBJECTIVES: To investigate the effects and optimal dose of epidural dexamethasone on pain after major abdominal surgery. STUDY DESIGN: A prospective randomized, double-blind study. SETTING: University hospital...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28534258/closed-incision-prophylactic-negative-pressure-wound-therapy-in-patients-undergoing-major-complex-abdominal-wall-repair
#6
F E E de Vries, J J Atema, O Lapid, M C Obdeijn, M A Boermeester
PURPOSE: To evaluate if incisional prophylactic negative pressure wound therapy (pNPWT) reduces wound infections and other wound complications in high-risk patients undergoing major complex ventral abdominal wall repair. METHODS: Retrospective before-after comparison nested in a consecutive series of patients undergoing elective major complex abdominal wall repair. Starting January 2014, pNPWT was applied on the closed incisional wound for a minimum of 5 days. To minimize selection bias, we compared two periods of 14 months before and after January 2014...
May 23, 2017: Hernia: the Journal of Hernias and Abdominal Wall Surgery
https://www.readbyqxmd.com/read/28533573/comparison-of-early-results-and-complications-between-multi-and-single-port-sleeve-gastrectomy-a-randomized-clinical-study
#7
Seyed Vahid Hosseini, Seyed Ali Hosseini, Ahmed Mohammed Ali Hussein Al-Hurry, Hajar Khazraei, Fatemeh Ganji, Fatemeh Sadeghi
BACKGROUND: In recent years, laparoscopic sleeve gastrectomy (LSG) has become more acceptable for obese patients. Single-port sleeve gastrectomy (SPSG) is more popular since each abdominal incision carries the risk of bleeding, hernia, and internal organ injury as well as exponentially affecting cosmesis. This cross-sectional study aimed at comparing multi-port sleeve gastrectomy (MPSG) and SPSG in terms of their early results and complications. METHODS: Out of129 obese patients candidated for LSG, 102 patients were assigned to 2 groups of SPSG and MPSG...
May 2017: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28529193/laparoscopy-has-a-therapeutic-role-in-the-management-of-abdominal-trauma-a-matched-pair-analysis
#8
Saurav Chakravartty, Ameet Patel, Diwakar R Sarma, Muhammad Noor, Spyros Panagiotopoulos, Ameet G Patel
INTRODUCTION: Laparoscopy is increasingly utilised as a diagnostic tool in management of abdominal trauma; however its role in therapeutic intervention remains unexplored. The aim of this study is to compare laparoscopy with laparotomy in the treatment of abdominal trauma in haemodynamically stable patients. METHODS: A review of patients undergoing surgery for abdominal trauma between January 2004-2014 identified 25 patients who underwent laparoscopy for therapeutic intervention (TL)...
May 18, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28528215/patients-criteria-determining-difficulty-of-the-laparoscopic-lateral-transperitoneal-adrenalectomy-a-retrospective-cohort-study
#9
Michał Natkaniec, Jadwiga Dworak, Michał Pędziwiatr, Magdalena Pisarska, Piotr Major, Marcin Dembiński, Marek Winiarski, Andrzej Budzyński
BACKGROUND: Identification of patients in whom adrenalectomy may be more difficult, can help in decision making in borderline and doubtful cases. The aim of the study was to determine patients criteria influencing difficulty of laparoscopic lateral transperitoneal adrenalectomy (LTA). MATERIAL AND METHODS: The study enrolled 275 patients who underwent LTA. We analyzed the impact of gender, age, history of previous abdominal surgery, body mass index, risk of anesthesia measured as ASA scale, size, localization (left/right), and histological type of the tumor on parameters reflecting the level of difficulty of the procedure: operative time, intraoperative blood loss, conversion rate and intraoperative complications rate...
May 17, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28520955/effect-of-intrathecally-administered-ketamine-morphine-and-their-combination-added-to-bupivacaine-in-patients-undergoing-major-abdominal-cancer-surgery-a-randomized-double-blind-study
#10
Ahmad M Abd El-Rahman, Ashraf A Mohamed, Sahar A Mohamed, Mohamed A M Mostafa
Objective. : Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study Design. : Prospective, randomized, double-blind. Setting. : Academic medical center. Patients and Methods.:  Ninety ASA I-III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10 mg of hyperbaric bupivacaine 0...
May 17, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28518089/laparoscopic-technique-for-serial-collection-of-liver-and-mesenteric-lymph-nodes-in-macaques
#11
Alexander S Zevin, Cassie Moats, Drew May, Solomon Wangari, Charlene Miller, Joel Ahrens, Naoto Iwayama, Megan Brown, Debbie Bratt, Nichole R Klatt, Jeremy Smedley
The mesenteric lymph nodes (MLN) and the liver are exposed to microbes and microbial products from the gastrointestinal (GI) tract, making them immunologically unique. The GI tract and associated MLN are sites of early viral replication in human immunodeficiency virus (HIV) infection and the MLN are likely important reservoir sites that harbor latently-infected cells even after prolonged antiretroviral therapy (ART). The liver has been shown to play a significant role in immune responses to lentiviruses and appears to play a significant role in clearance of virus from circulation...
May 2, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28515528/perioperative-management-of-a-patient-with-haemophilia-a-for-major-abdominal-surgery
#12
Mamta Sethi, Pavan Gurha
No abstract text is available yet for this article.
April 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28513820/intra-abdominal-hypertension-and-abdominal-compartment-syndrome-in-acute-pancreatitis-hepato-pancreato-biliary-operations-and-liver-transplantation
#13
Alexsander K Bressan, Chad G Ball
Intra-abdominal hypertension, even preceding the onset of abdominal compartment syndrome, is still recognized as an adverse prognostic factor. Unfortunately, most of the current supporting evidence within the critical care environment remains observational in nature. In acute pancreatitis, an active role for intra-abdominal hypertension early in the disease process follows a strong intuitive basis, and it is corroborated by preliminary evidence from animal models. Additional studies are needed to better characterize the optimal fluid resuscitation strategy, as well as the importance of intra-abdominal hypertension as an early therapeutic target...
May 17, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28509325/an-alternative-approach-to-gynecological-wound-healing
#14
Jakub Rzepka, Katarzyna Mosoń, Romuald Dębski
An 89-year-old woman was reffered to our Clinic with vulvar cancer. She also suffered from obesity [with body mass index (BMI) 35 kg/m2], persistent hypertension, diabetes mellitus type 2 treated with oral medications. In 2015 she underwent a surgery due to endometrial carcinoma. Total abdominal hysterectomy with bilateral salphingoophorectomy, omentectomy and pelvical node dissection was performed (histopathology revealed adenocarcinoma serosum G2; FIGO stage Ib). In January 2016 after vulvar ulceration biopsy plano-epithelial squamous vulvar cancer was diagnosed...
2017: Ginekologia Polska
https://www.readbyqxmd.com/read/28506945/urinary-fistula-a-continuing-problem-with-changing-trends
#15
Sunesh Kumar, Richa Vatsa, Juhi Bharti, Kallol Kumar Roy, Jai Bhagwan Sharma, Neeta Singh, Jyoti Meena, Seema Singhal
OBJECTIVE: Urinary fistula is a distressing complication after difficult vaginal deliveries, obstetric, and gynecologic surgeries. The present study describes a single center's experience in the management of urinary fistula at a tertiary care hospital. It was performed to analyze the etiology of genitourinary fistula, to assess the outcome after surgical repair, and to determine the changing trends in the etiology and management of urinary fistula. MATERIAL AND METHODS: This retrospective study was conducted over 5 years in the department of obstetrics and gynecology, All India Institute of Medical Sciences, New Delhi...
March 15, 2017: Journal of the Turkish German Gynecological Association
https://www.readbyqxmd.com/read/28504118/direct-evidence-of-central-nervous-system-axonal-damage-in-patients-with-postoperative-delirium-a-preliminary-study-of-pnf-h-as-a-promising-serum-biomarker
#16
Reo Inoue, Masahiko Sumitani, Toru Ogata, Hirotaka Chikuda, Takehiro Matsubara, So Kato, Nobutake Shimojo, Kanji Uchida, Yoshitsugu Yamada
INTRODUCTION: Approximately 50%-80% patients experience postoperative delirium, an acute cognitive dysfunction associated with prolonged hospitalization, increased mortality, excess healthcare costs, and persistent cognitive impairment. Elucidation of the mechanism of delirium and associated diagnostic and therapeutic measures are urgently required. Here we investigated the role of phosphorylated neurofilament heavy subunit (pNF-H), a major structural protein in axons, as a predictive maker of postoperative delirium...
May 11, 2017: Neuroscience Letters
https://www.readbyqxmd.com/read/28498018/full-robotic-colorectal-resections-for-cancer-combined-with-other-major-surgical-procedures
#17
Luca Morelli, Gregorio Di Franco, Simone Guadagni, Matteo Palmeri, Desirée Gianardi, Matteo Bianchini, Andrea Moglia, Vincenzo Ferrari, Giovanni Caprili, Cristiano D'Isidoro, Franca Melfi, Giulio Di Candio, Franco Mosca
BACKGROUND: The da Vinci Xi has been developed to overcome some of the limitations of the previous platform, thereby increasing the acceptance of its use in robotic multiorgan surgery. METHODS: Between January 2015 and October 2015, 10 patients with synchronous tumors of the colorectum and others abdominal organs underwent robotic combined resections with the da Vinci Xi. Trocar positions respected the Universal Port Placement Guidelines provided by Intuitive Surgical for "left lower quadrant," with trocars centered on the umbilical area, or shifted 2 to 3 cm to the right or to the left, depending on the type of combined surgical procedure...
March 1, 2017: Surgical Innovation
https://www.readbyqxmd.com/read/28494906/the-effect-of-morphine-added-to-bupivacaine-in-ultrasound-guided-transversus-abdominis-plane-tap-block-for-postoperative-analgesia-following-lower-abdominal-cancer-surgery-a-randomized-controlled-study
#18
Fatma Adel El Sherif, Sahar Abdel-Baky Mohamed, Shereen Mamdouh Kamal
OBJECTIVES: Transversus abdominis plane (TAP) block used for management of surgical abdominal pain by injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscles. We aimed to explore the effect of adding morphine to bupivacaine in ultrasound guided TAP-block in patients undergoing lower abdominal cancer surgery. STUDY DESIGN: Randomized, double-blind, prospective study. Clinical trial identifier: NCT02566096. SETTING: Academic medical center...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28493943/open-lung-approach-versus-standard-protective-strategies-effects-on-driving-pressure-and-ventilatory-efficiency-during-anesthesia-a-pilot-randomized-controlled-trial
#19
Carlos Ferrando, Fernando Suarez-Sipmann, Gerardo Tusman, Irene León, Esther Romero, Estefania Gracia, Ana Mugarra, Blanca Arocas, Natividad Pozo, Marina Soro, Francisco J Belda
BACKGROUND: Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM) can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia...
2017: PloS One
https://www.readbyqxmd.com/read/28492998/enhanced-recovery-after-surgery-can-we-rely-on-the-key-factors-or-do-we-need-the-bel-ensemble
#20
Jonas Jurt, Juliette Slieker, Pierre Frauche, Valerie Addor, Josep Solà, Nicolas Demartines, Martin Hübner
BACKGROUND: The success of enhanced recovery (ERAS) pathways depends on the actual application of the intended protocol (adherence), but its full implementation remains challenging. In order to potentially streamline the pathway, it is indispensable to know the impact of individual items and the entire protocol on clinical outcomes. METHODS: Retrospective analysis including all consecutive colorectal ERAS patients since implementation (May 2011) until February 2014; demographics, adherence and outcomes were retrieved from a prospectively maintained database...
May 10, 2017: World Journal of Surgery
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