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Early Postoperative Period (early + postoperative_period)
Selected AbstractsAccessory nerve function after level 2b,preserving selective neck dissectionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2009Bilge Celik MD Abstract Background. The aim of this prospective study was to evaluate the relationship between accessory nerve functions and level 2b,preserving selective neck dissection. Methods. Forty-one necks of 30 patients with laryngeal cancer who underwent unilateral or bilateral level 2b,preserving neck dissections, between February 2003 and July 2005, were evaluated. Neck and shoulder movements and muscle strengths were examined and electroneuromyography (ENMG) was performed preoperatively at the postoperative 21st day and 6th month. Pathological anatomical findings at the postoperative 6th month were also evaluated. Results. All shoulder movements and muscle strengths were preserved. Neck extension, rotation movements, and flexion strengths were restricted. ENMG values were affected moderately in the early postoperative period and improved slightly in the late postoperative period. None of the patients developed shoulder syndrome or adhesive capsulitis. Conclusion. Preserving level 2b during selective neck dissection decreases trauma to the accessory nerve and improves functional results. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Comparison of pharyngoesophageal segment pressure in total laryngectomy patients with and without pharyngeal neurectomyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2003Ahmet Köyba, lu MD Abstract Background. To compare pharyngoesophageal segment (PES) pressure values in total laryngectomy patients with and without pharyngeal neurectomy (PN) in the early postoperative period. Methods. Forty-five previously untreated laryngeal carcinoma patients were enrolled into this prospective randomized study. Twenty of them underwent total laryngectomy with PN, and 25 underwent total laryngectomy without PN. PES pressures were measured on the tenth postoperative day with a four-channel catheter. Results. Average PES pressures in patients with and without pharyngeal neurectomy were 12.82 ± 6.11 mmHg and 17.40 ± .72 mmHg respectively (p < .05). When compared with the critical point of 20 mmHg that is closely related to voice attainment in the group without pharyngeal neurectomy, 10 (40%) patients had pressure levels greater than 20 mmHg and in the other group only 1 (5%) patient had a pressure level greater than 20 mmHg. The difference between the groups with pressure levels greater than 20 mmHg was found to be statistically significant (p < .05). Conclusions. Pharyngeal neurectomy results in a statistically significant decrease of PES pressures in total laryngectomy patients. © 2003 Wiley Periodicals, Inc. Head Neck 25: 617,623, 2003 [source] Temporary Epicardial Ventricular Stimulation in Patients with Atrial Fibrillation: Acute Effects of Ventricular Pacing Site on Bypass Graft FlowsJOURNAL OF CARDIAC SURGERY, Issue 4 2009Navid Madershahian M.D. This study aimed to evaluate the optimal epicardial ventricular pacing site in patients with AF following coronary artery bypass surgery (CABG). Methods: In 23 consecutive patients (mean age = 69.2 ± 1.9 years, gender = 62% male, ejection fraction [EF]= 50.4 ± 2.1%) monoventricular stimulations (VVI) were tested with a constant pacing rate of 100 bpm. The impact of ventricular pacing on bypass graft flow (transit-time flow probe) and pulsatility index (PI) were measured after lead placement on the mid paraseptal region of the right (RVPS) and the left (LVPS) ventricle, on the right inferior wall (RVIW), and on the right ventricular outflow tract (RVOT). In addition, hemodynamic parameters were measured. Patients served as their own control. Results: Comparison of all tested pacing locations revealed that RVOT stimulation provided the highest bypass grafts flows (59.9 ± 6.1 mL/min) and PI (2.2 ± 0.1) when compared with RVPS (51.3 ± 4.7 mL/min, PI = 2.6 ± 0.2), RVIW (54.0 ± 5.1 mL/m; PI = 2.4 ± 0.2), and LVPS (53.1 ± 4.5 mL/min; PI = 2.3 ± 0.1), respectively (p < 0.05). When analyzing patients according to their preoperative LV function (group I = EF > 50%; group II = EF < 50%), higher bypass graft flows were observed with RVOT pacing in patients with lower EF (p = n.s.). Conclusions: Temporary RVOT pacing facilitates optimal bypass graft flows when compared with other ventricular pacing sites and should be the preferred method of temporary pacing in cardiac surgery patients with AF. Especially in patients with low EF following CABG, RVOT pacing may improve myocardial oxygen conditions for the ischemic myocardium and enhance graft patency in the early postoperative period. [source] Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatmentJOURNAL OF DIGESTIVE DISEASES, Issue 2 2006Ke DONG Postsurgical gastroparesis syndrome (PGS) is a complex disorder characterized by post-prandial nausea and vomiting, and gastric atony in the absence of mechanical gastric outlet obstruction, and is often caused by operation at the upper abdomen, especially by gastric or pancreatic resection, and sometimes also by operation at the lower abdomen, such as gynecological or obstetrical procedures. PGS occurs easily with oral intake of food or change in the form of food after operation. These symptoms can be disabling and often fail to be alleviated by drug therapy, and gastric reoperations usually prove unsuccessful. The cause of PGS has not been identified, nor has its mechanism quite been clarified. PGS after gastrectomy has been reported in many previous studies, with an incidence of approximately 0.4,5.0%. PGS is also a frequent complication of pylorus-preserving pancreatoduodenectomy (PPPD), and the complication occurs in the early postoperative period in 20,50% of patients. PGS caused by pancreatic cancer cryoablation (PCC) has been reported about in 50,70% of patients. Therefore, PGS has a complex etiology and might be caused by multiple factors and mechanisms. The frequency of this complication varies directly with the type and number of gastric operations performed. The loss of gastric parasympathetic control resulting from vagotomy contributes to PGS via several mechanisms. It has been reported that the interstitial cells of Cajal (ICC) may play a role in the pathogenesis of PGS. Recent studies in animal models of diabetes suggest specific molecular changes in the enteric nervous system may result in delayed gastric emptying. The absence of the duodenum, and hence gastric phase III, may be a cause of gastric stasis. It was thought that PGS after PPPD might be attributable, at least in part, to delayed recovery of gastric phase III, due to lowered concentrations of plasma motilin after resection of the duodenum. The damage to ICC might play a role in the pathogenesis of PGS after PCC, for which multiple factors are possibly responsible, including ischemic and neural injury to the antropyloric muscle and the duodenum after freezing of the pancreatoduodenal regions or reduction of circulating levels of motilin. As the treatment of gastroparesis is far from ideal, non-conventional approaches and non-standard medications might be of use. Multiple treatments are better than single treatment. This article reviews almost all the papers related to PGS from various journals published in English and Chinese in recent years in order to facilitate a better understanding of PGS. [source] Comparison between intubation and the laryngeal mask airway in moderately obese adultsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009M. ZOREMBA Background: Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period. Methods: We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30° head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t -test analysis. Statistical significance was considered to be P<0.05. Results: Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group (P<0.001; ANOVA). Conclusions: In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function. [source] The Immune,Endocrine Interaction Varies with the Duration of the Inflammatory Process in Cardiac Surgery PatientsJOURNAL OF NEUROENDOCRINOLOGY, Issue 6 2000A. Roth-Isigkeit The present study investigated the perioperative course of cytokine release and hypothalamic-pituitary-adrenal (HPA) axis activation in relation to the duration of the inflammatory response in cardiac surgery patients. Twelve male patients scheduled for elective coronary artery bypass grafting surgery with cardiopulmonary bypass and general anaesthesia were divided into two study groups: group 1 (n=6) underwent surgery at 13.00 h±30 min, group 2 (n=6) at 08.30 h±50 min. Blood samples were collected preoperatively and up to the first postoperative day. Postoperatively, on the day of surgery, serum concentrations of the proinflammatory cytokines interleukin (IL)-6, IL-1, and tumour necrosis factor (TNF)- , were not significantly different between the two groups, while blood concentrations of cortisol, adrenocorticotrophic hormone (ACTH) and , -endorphin in group 2 patients were significantly higher than in group 1 patients. Postoperatively, on the day of surgery, ACTH and cortisol concentrations in group 1 patients were positively correlated to the blood concentrations of IL-1,, IL-6 and TNF- ,. By contrast, group 2 patients showed no significant relationship between cytokine release and activation of HPA axis at this time. Our results suggest that in patients undergoing cardiac surgery, the cytokine response is initiated before the HPA axis is fully activated. In the early postoperative period, cytokines appear to be involved in the activation of the HPA axis, while in the later postoperative period, high cortisol concentrations may inhibit the release of IL-6. [source] Supraspinatus tendon repair into a bony trough in the rabbit: Mechanical restoration and correlative imagingJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2010Guy Trudel Abstract Recurrence of tears is a common complication after rotator cuff surgery. Retearing seems to occur early after surgery and may be attributed to too early or too vigorous exercises. We found no experimental data correlating the strength of the rotator cuff early after surgery and imaging. Our objectives were to measure the peak load to failure of rabbit supraspinatus tendon,bone constructs at early times postoperatively, to determine their mode of failure, and to determine whether computed tomography (CT) can predict their strength. We divided one supraspinatus tendon of 40 adult female white New Zealand rabbits and, after resection of the enthesis, sutured the tendon into a bony trough. Ten rabbits were killed immediately and 10 each at 1, 2, and 6 weeks postoperatively. The explanted tendons of both shoulders were imaged on CT and tested to failure. Compared to normal tendons (mean 210,±,42 N), the mean strength was very low at 0 weeks (57,±,21 N) and 1 week (86,±,33 N) (both p,<,0.05); it had recovered by 6 weeks (324,±,66 N). Early on, suture pullout was the most common mode of failure, whereas at 6 weeks, mid-substance tears predominated (p,<,0.05). Hypoattenuation on CT was associated with increased strength of the tendon,bone construct (p,<,0.05). The strength of the surgical construct is very low in the early postoperative period. Therefore, the shoulder should be submitted only to loads not interfering with healing. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:710,715, 2010 [source] Predicting immunosuppressant dosing in the early postoperative period with noninvasive indocyanine green elimination following orthotopic liver transplantationLIVER TRANSPLANTATION, Issue 1 2008Brian M. Parker Twenty adult patients undergoing orthotopic liver transplantation (OLT) were enrolled in this study, with the noninvasive indocyanine green plasma disappearance rate (ICG-PDR) measured both during and after OLT to assess the relationship between ICG-PDR and the ability of patients to achieve therapeutic postoperative tacrolimus immunosuppressant blood levels. Liver function was determined at both 2 and 18 hours post reperfusion with the ICG-PDR k value (1/min). Postoperative standard serum measures of liver function as well as liver biopsies were also collected and analyzed. The median ICG-PDR k value for the study group at 2 hours post reperfusion was 0.20 (0.16, 0.27), whereas at 18 hours post reperfusion, it was 0.22 (0.18, 0.35). The median change in the k value between the two ICG-PDR measurements was 0.05 (,0.02, 0.07) with P = 0.02. There was an interaction between the postoperative day 1 (18 hours post reperfusion) ICG-PDR k value and the linear increase in the tacrolimus blood level, such that the greater the k value was, the more gradual the observed rise was in tacrolimus over time [that is, the longer it took to achieve a therapeutic blood level (>12 ng/mL), P = 0.003]. Of the 16 patients that received tacrolimus, comparable dosing on a per kilogram body weight basis was observed. Also, no significant association between ICG-PDR k values and postoperative liver biopsy results was seen. This study demonstrates that the ICG-PDR measurement is a modality with the potential to assist in achieving adequate blood levels of tacrolimus following OLT. Liver Transpl 14:46,52, 2008. © 2007 AASLD. [source] KICG value, a reliable real-time estimator of graft function, accurately predicts outcomes in adult living-donor liver transplantation,LIVER TRANSPLANTATION, Issue 4 2006Tomohide Hori Reliable monitoring enabling evaluation of graft function is crucial after living-donor liver transplantation (LDLT). A method to identify poor graft function at an early postoperative period would allow opportune intensive clinical management to bring about further improvements in LDLT outcomes. This study assessed the reliability of the indocyanine green (ICG) elimination rate constant (KICG) value as an estimator of graft function and determined the actual temporal changes of KICG after LDLT. KICG values were measured using a noninvasive method in 30 adult recipients up to 28 days after LDLT. The receptor index (LHL15) based on liver scintigraphy, and graft parenchymal damage score based on histopathological findings were evaluated after LDLT and correlated well with simultaneous KICG. Thus, KICG measured by noninvasive method was confirmed as accurately evaluating graft function. Changes of KICG after LDLT in recipients with good graft function were maintained, after some falls in the early periods, and had a significant difference compared with those for recipients without good graft function; moreover, there were already significant differences in KICG 24 hours after LDLT. Mean transit time reflecting systemic hemodynamics revealed that recipients without good outcomes fell into an unstable systemic hemodynamic state, and effective hepatic blood flow has a large influence on liver regeneration after LDLT. In conclusion, we suggested that KICG values can predict clinical outcomes at the early postoperative period after LDLT by sharply reflecting the influence of systemic dynamics on splanchnic circulation. Liver Transpl 12:605,613, 2006. © 2006 AASLD. [source] Hemodynamic alterations in the transferred tissue to lower extremitiesMICROSURGERY, Issue 2 2009Hiroyuki Sakurai M.D., Ph.D. A higher incidence of failure has been reported for free flaps transplanted to the lower extremities. However, the physiological background of this phenomenon has not been elucidated. We reviewed the 3-day postoperative hemodynamic data for 103 free flaps, including the in situ venous pressure (N = 103), arterial pressure (N = 53), and surface blood flow (N = 42). The cases were divided into two groups based on the recipient site, i.e., lower extremity (the LE group: N = 29) and the other (non-LE group: N = 74). The venous pressure was significantly higher in the LE group (26.6 ± 2.2 vs. 14.8 ± 1.2 mmHg), whereas the arterial pressure immediately after surgery was lower than the non-LE group. The hemodynamic data within the transferred tissues demonstrated significant differences between groups, especially in the early postoperative period. There is a possibility that the high venous pressure may aggravate the poor perfusion in tissues transferred to the lower extremities. © 2008 Wiley-Liss, Inc. Microsurgery, 2009. [source] Reliability of free-flap coverage in diabetic foot ulcersMICROSURGERY, Issue 2 2005Ömer Özkan M.D. As microsurgery advances, microsurgical free-tissue transfers have become the reconstructive method of choice over staged or primary amputation, and enabling independent ambulation in difficult lower-extremity wounds. In this report, we present our experiences with free-tissue transfer for the reconstruction of soft-tissue defects in 13 diabetic foot ulcers. Following radical debridement, soft-tissue reconstruction was achieved in the following ways: anterolateral thigh fasciocutaneous flap in 5 patients, radial forearm fasciocutaneous flap in 3 patients, lateral arm fasciocutaneous flap in 1 patient, gracilis musculocutaneous flap in 1 patient, tensor fascia latae flap in 1 patient, deep inferior epigastric perforator flap in 1 patient, and a parascapular flap in the remaining patient. In 8 cases, diabetic wounds were in the foot, while wounds were at the level of the lower leg in the remaining patients. In all patients, vascular patency was confirmed by the Doppler technique. In suspicious cases, arteriography was then performed. While all flaps survived well in the postoperative period, one patient died from cardiopulmonary problems on postoperative day 16 in an intensive care unit. Amputation was necessary in the early postoperative period because of healing problems. In the remaining 10 cases, all flaps survived intact. In one case, arterial revision was performed successfully. The ultimate limb salvage rate was 83% for the 12 patients. Independent ambulation was achieved in these cases. During the follow-up period of 8 months to 2 years, no ulcer recurrence was noted, and no revascularization or vascular bypass surgery was needed before or after the free-tissue transfers. The authors conclude that free-tissue transfer for diabetic foot ulcers is a reliable procedure, despite pessimistic opinions regarding the flap survival and low limb salvage rates. It should be considered a useful reconstructive option for serious defects in well-selected cases. © 2005 Wiley-Liss, Inc. Microsurgery 25:107,112, 2005. [source] Vascular complications in living-related and deceased donation pediatric liver transplantation: Single center's experience from TurkeyPEDIATRIC TRANSPLANTATION, Issue 2 2007Aygen Yilmaz Abstract:, The aim of the study was to assess early and long-term incidence of venous complications, in both deceased donation (DD) and living-related (LR) liver transplantation (LT) in a pediatric population. Seventy-five liver transplants performed in 69 (39 boys, 30 girls) children at Ege University Hospital between 1997 and 2004 were prospectively monitored and reviewed. Age, sex, primary diagnosis, graft type, vascular complications and their management were evaluated. All patients received Doppler ultrasonographic examination both during operation and daily for the first three postoperative days and when necessary thereafter. The complications were classified as early and late presented. Thirty-three grafts (47.8%) were from DD and 36 (52.2%) were from LR donors. Recipients of DD were older than LR donors (mean age 10.5 ± 5.1 and 5.0 ± 0.7, respectively) (p < 0.05). Vascular complication occurrence was not statistically different between DDLT and LRLT recipients (p = 0.2), and between infants and children (p = 0.9). Overall, stenosis was more common than thrombosis. We observed hepatic artery (HA) thrombosis, in five of 75 (6.7%) transplants within 30 days post-transplant. Portal vein (PV) thrombosis and hepatic vein (HV) thrombosis were detected in six and one patients (8.7% and 1.3%), respectively. Six PV stenosis were identified (8.7%), while HA and HV-VC (vena cava) stenosis occurred in one and six patients (1.4% and 8.7%), respectively. All PV stenosis (6/33, 18.2%) and one PV aneurysm occurred in DDLT recipients while HV-VC stenosis were detected almost equally in LRLT and DDLT recipients (4/36 vs. 2/33). Except one, all PV stenosis were detected as a late complication and no intervention were needed. Stenosis of HV-VC was more common in girls (5/30 vs. 1/39) (p < 0.05) and the incidence was not different in DDLT and LRLT recipients (p = 0.8). In conclusion, overall incidences of thrombosis and stenosis formation after orthotopic liver transplantation (OLT) were 17.4% and 18.8%, respectively in our center. We suggest that in the cases with HA thrombosis manifested intra-operatively or within the early postoperative period, graft salvage was successful. Thrombosis of HA causes significant mortality. Thrombosis of PV was among the causes of mortality and morbidity. Stenosis of HV-VC could be managed by angioplasty and endovascular stenting with no significant effect to mortality. [source] Postoperative Pain and Side Effects After Uvulopalatopharyngoplasty, Laser-Assisted Uvulopalatoplasty, and Radiofrequency Tissue Volume Reduction in Primary SnoringTHE LARYNGOSCOPE, Issue 12 2003Philippe Rombaux MD Abstract Objectives We compared, in a prospective study, the side effects and the postoperative complications of three procedures commonly used for the treatment of primary snoring. Method Forty-nine patients underwent velopharyngeal surgery for primary snoring (17 for uvulopalatopharyngoplasty [UPPP]; 15 for laser-assisted uvulopalatoplasty [LAUP], and 17 for radiofrequency tissue volume reduction [RFTVR]). Preoperative full polysomnographic studies ruled out obstructive sleep apnea syndrome. Each patient's evaluation encompassed postoperative pharyngeal pain (as measured by a 5-point visual analogue scale) and use of narcotic drugs in the early postoperative period as well as a subjective evaluation of late postoperative complaints. A surgeon's examination was performed to report postoperative complications in the oropharynx. Results Postoperative pharyngeal pain was less important in the RFTVR group than in the UPPP and LAUP groups. Mean scores at days 3, 7, 16 were as follows: 4.2, 4.0, and 2.4, respectively, for UPPP; 4.6, 3.8, and 1.6 for LAUP; and 2.4, 2.0, and 0.7 for RFTVR. Mean duration of pain with a score greater than 2 was calculated as follows: UPPP, 21.3 days; LAUP, 15.1 days; and RFTVR, 6.1 days. Mean duration of narcotic drug use for the patients who needed this medication was 10.1 days for UPPP, 7.2 days for LAUP, and 1.3 for RFTVR. Postoperative side effects (trouble with smell and taste, pharyngeal dryness, globus sensation, voice change, and pharyngonasal reflux) were more present in the UPPP and LAUP groups than in the RFTVR group. Surgeon's assessment for postoperative complications reported more wound infection, dehiscence, and posterior pillar narrowing in the UPPP and LAUP groups than in the RFTVR group. Conclusion RFTVR is a safer and less painful procedure than UPPP and LAUP for the treatment of primary snoring. Postoperative discomfort after LAUP and after UPPP appears to be very similar. [source] Patency and Flow of the Internal Jugular Vein After Functional Neck Dissection,THE LARYNGOSCOPE, Issue 1 2000María P. Prim MD Abstract Objectives: To assess the patency and flow of the internal jugular vein after functional neck dissection. Study Design: Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997. Methods: Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography. Results: In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery. Conclusions: According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure. [source] The pathophysiology of peri-operative myocardial infarctionANAESTHESIA, Issue 7 2010B. M. Biccard Summary It is generally believed that plaque rupture and myocardial oxygen supply-demand imbalance contribute approximately equally to the burden of peri-operative myocardial infarction. This review critically analyses data of post-mortem, pre-operative coronary angiography, troponin surveillance, other pre-operative non-invasive investigations, and peri-operative haemodynamic predictors of myocardial ischaemia and/or myocardial infarction. The current evidence suggests that myocardial oxygen supply-demand imbalance predominates in the early postoperative period. It is likely that flow stagnation and thrombus formation is an important pathway in the development of a peri-operative myocardial infarction, in addition to the more commonly recognised role of peri-operative tachycardia. Research and therapeutic interventions should be focused on the prediction and therapy of flow stagnation and thrombus formation. Plaque rupture appears to be a more random event, distributed over the entire peri-operative admission. [source] Inadvertent hypothermia and mortality in postoperative intensive care patients: retrospective audit of 5050 patientsANAESTHESIA, Issue 9 2009D. Karalapillai Summary We proposed that many Intensive Care Unit (ICU) patients would be hypothermic in the early postoperative period and that hypothermia would be associated with increased mortality. We retrospectively reviewed patients admitted to ICU after surgery. We recorded the lowest temperature in the first 24 h after surgery using tympanic membrane thermometers. We defined hypothermia as < 36 °C, and severe hypothermia as < 35 °C. We studied 5050 consecutive patients: 35% were hypothermic and 6% were severely hypothermic. In-hospital mortality was 5.6% for normothermic patients, 8.9% for all hypothermic patients (p < 0.001), and 14.7% for severely hypothermic patients (p < 0.001). Hypothermia was associated with in-hospital mortality: OR 1.83 for each degree Celsius (°C) decrease (95% CI: 1.2,2.60, p < 0.001). Given the evidence for improved outcome associated with active patient warming during surgery we suggest conducting prospective studies of active warming of patients admitted to ICU after surgery. [source] Viral reactivation is not related to septic complications after major surgical resections,APMIS, Issue 4 2008T. VOGEL Anastomotic leakage and septic complications are the most important determinants of postoperative outcome after major surgical resections. Malignant diseases and surgical trauma can influence immune responses and the ability to react against infectious factors, such as bacteria and viruses. Comparable immune suppression can cause viral reactivation in transplantation and trauma patients. In this prospective study, patients who underwent major surgical resections for oesophageal or pancreatic cancer were investigated for the potential involvement of viral reactivation in the development of septic complications. 86 patients (40 oesophageal resections, 27 pancreatic resections, 19 surgical explorations) were included. Viral antigens, viral DNA, antibodies against viral structures (IgG, IgM, IgA) and, in part, viral cultivation were performed for CMV, EBV, HSV1, HSV2, HZV6 and VZV in serum, urine, sputum and swabs from buccal mucosa preoperatively and at postoperative days 1, 3 and 5. Test results were compared with the postoperative outcome (30-day morbidity, in-hospital mortality) and clinical scores (SOFA, TISS). For statistical analyses Student's t -tests and Chi2 -tests were used. The overall complication rate was 19.8% (30-day morbidity) with an in-hospital mortality of 1.2% (1/86 patients). Postoperatively, anti-CMV-IgG titres were significantly reduced (p<0.05) and remained suppressed in patients with septic complications. Anti-CMV-gB-IgG were also reduced, but showed considerable interindividual differences. Anti-CMV-IgA and -IgM did not show significant alterations in the postoperative course. In addition, direct viral detection methods did not support viral reactivation in patients in any of the investigated groups. The reduction of anti-CMV antibodies is likely caused by an immune suppression, specifically by reduced B-cell counts after major surgical interventions. Viral reactivation, however, did not occur in the early postoperative period as a specific risk for septic complications. [source] Lobar Torsion After Lung Transplantation,A Case Report and Review of the LiteratureARTIFICIAL ORGANS, Issue 7 2009Hasan Shakoor Abstract Lobar torsion is a rare complication following lung transplantation. Early detection and immediate therapeutic intervention can lead to a favorable outcome. We report an unusual case of left lingular torsion following single lung transplantation performed for idiopathic pulmonary fibrosis. The patient experienced severe ventilatory compromise immediately after leaving the operating room, and a chest X-ray revealed a well-demarcated area of consolidation involving the left mid- and lower lung zones. Lingular torsion was promptly diagnosed and corrected surgically. The possibility of acute lobar torsion should be considered in lung transplant recipients who experience acute respiratory compromise in the early postoperative period. Early diagnosis and correction can avoid pulmonary infarction and the need for lobar resection. [source] 1352: Glass beads implantation in the scleral cavity during eviscerationACTA OPHTHALMOLOGICA, Issue 2010N ROSEN Purpose To review the background for developing the surgical modification of glass bead implantation in the scleral cavity during evisceration, to demonstrate the technique, and to highlight its indications, advantages and complications. Methods Personal experience is used to demonstrate the technique, its indications, advantages and complications. This includes the follow-up data of 17 patients who underwent evisceration with glass bead implantation during 1993-1996 and our experience from 164 eviscerations performed in our eye institute during the last 14 years. Results All patients achieved good cosmetic results with relatively good motility of the prosthesis. Complications included transient chemosis at the early postoperative period; three patients had local dehiscence of the wound, two patients developed a cyst in the socket and one patient was afflicted with thinning of the conjunctiva over the surgical wound. Conclusion The use of glass beads to fill the scleral cavity during evisceration has the advantage of an excellent fit in accordance with the scleral cavity volume, as well as ease of treatment in case of extrusion. The prosthesis movement is good because of its engagement with the scleral bulges caused by the glass beads. [source] Phacoemulsification in vitrectomized eyes: results using a ,phaco chop' techniqueACTA OPHTHALMOLOGICA, Issue 4 2009Nishant Sachdev Abstract. Purpose:, To evaluate the intraoperative and early postoperative complications of phacoemulsification using a ,phaco chop' technique in previously vitrectomized eyes. Methods:, A prospective interventional case series. Seventy-five previously vitrectomized eyes of 73 consecutive patients underwent phacoemulsification using a ,phaco chop' technique via clear corneal incision. Patients were observed for any intraoperative or early postoperative complications. Results:, Fifty-four eyes (72%) had predominant nuclear sclerosis or posterior subcapsular cataract. The intraoperative findings included intraoperative miosis [seen in 21 eyes (28%)] and posterior capsule plaques [in 15 eyes (20%)]. No other significant intraoperative complication (posterior capsule rupture, zonular lysis or dropped nuclei) was observed. In the early postoperative period, one patient had massive serous choroidal detachment, which resolved with conservative treatment. Mean preoperative visual acuity (LogMar scale) was 0.74, which improved to 0.36 postoperatively (p < 0.001). Conclusion:, Phacoemulsification using a ,phaco chop' technique is a safe procedure in vitrectomized eyes. [source] Long term outcome of bleb needling revisions following mitomycin C trabeculectomy in Afro-Caribbean eyesACTA OPHTHALMOLOGICA, Issue 2007TA WILLIAMS Purpose: To assess the frequency, risk factors and outcome of patients requiring bleb needling revisions (BNR)following Mitomycin-C (MMC) augmented trabeculectomies in Afro-Caribbean eyes in Birmingham, United Kingdom. Methods: ReGAE (Research in Glaucoma and Ethinicity) is a UK based multidisciplinary based research group whose research is aimed at preventing glaucomatous blindness in the diverse ethnic population of the West Midlands. A prospective study of consecutive Afro-Caribbean patients with refractory advanced glaucoma who had undergone Mitomycin C augmented trabeculectomy (modified Cairns type trabeculectomy with fornix based conjunctival flap mitomycin C 0.1-0.4mg/ml) was completed. Bleb needling revisions in the operating theatre with subconjunctival 5 fluro-uracil (5FU) 0.1ml 25mg/ml) were required in a subset of eyes. The frequency, timing, complications and outcome of BNRs was studied. Results: 38 eyes (35 patients) were included in the study; mean age 52 years (range 11-77 years); male:female 21:14. 9 of 38 eyes (24%)required BNR. Aetiology of glaucoma POAG 44%; JOAG 23%; traumatic 11%; fuchs 11%; pseudoexfoliation 11%. Of the patients requring BNR 6 eyes required BNR within 1 month of MMC- trabeculectomy. BNRs were performed 1-48 months postopereratively. Number of BNRs required 1.7 per eye (range 1-4) over a 2 year post operative follow up period. No complications occurred during BNR. Conclusions: Afro-Caribbean patients have a significant risk of requiring BNR following MMC trabeculectomy. Although such bleb manipulations are most commonly required during the early postoperative period, late subtenon's fibrosis may necessitate late BNR in this ethnic group. [source] Effect of topical steroids on corneal epithelial healing after vitreoretinal surgeryACTA OPHTHALMOLOGICA, Issue 3 2006Fatma Yülek Abstract. Purpose:,Topical steroid use is usually avoided in cases of corneal epithelial defect. We evaluated the effect of topical steroid treatment on corneal epithelial healing after epithelial debridement in vitreoretinal surgery. Methods:,Our study population included 85 eyes undergoing vitreoretinal surgeries in our clinic. We prospectively compared the duration of corneal epithelial wound healing in 43 eyes in which topical dexamethasone was used with that in 42 eyes in which topical dexamethasone was not used in the early postoperative period after epithelial debridement. Factors that may retard corneal epithelial healing, including pre- and intraoperative topical solutions, median operative time, the presence of diabetes mellitus, prior ocular surgeries, pseudophakia, aphakia and the presence of intraocular gas or silicone oil in aphakic patients, were not significantly different between the two groups. Results:,The mean corneal epithelial defect closure time was 59.7 ± 2.6 hours (mean ± SEM) in the group receiving topical steroid treatment, and 61.9 ± 2.6 hours in the group that did not receive steroids. Conclusion:,Topical dexamethasone administered five times/day did not significantly retard corneal epithelial healing in subjects undergoing vitreoretinal surgery with postoperative topical steroid treatment, compared with subjects who did not receive steroid treatment. [source] Autologous blood injection for marked overfiltration early after trabeculectomy with mitomycin CACTA OPHTHALMOLOGICA, Issue 3 2001Koji Okada ABSTRACT. Purpose: After trabeculectomy with mitomycin C, extremely low intraocular pressure (IOP) with excess filtration may cause hypotonous maculopathy in the early postoperative period. We evaluated the effect of injecting autologous blood on reversing early postoperative marked hypotony after trabeculectomy with mitomycin C. Methods: Trabeculectomy with mitomycin C was performed in 258 eyes between 1994 and 1998. Peribleb autologous blood injection was performed in five eyes in which pressure patches were ineffective in reversing excess filtration. Approximately 0.1 to 0.3 ml of whole unclotted blood was slowly injected at least 3 mm from the edge of the flap using a sterile 27-gauge needle. Results: None of these eyes developed hypotonous maculopathy after injection. After a mean 31-month follow-up, all eyes had well-controlled IOP and visual acuity in three eyes was much improved. Postoperative complications included mild IOP elevation in one eye treated with laser suturelysis, and fibrinous pupillary membrane in one eye. Conclusion: In the early postoperative period, autologous blood injection is effective in reversing excess filtration. [source] | |||||||||||||||||||