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Postoperative Day (postoperative + day)
Kinds of Postoperative Day Selected AbstractsPattern of carcinoembryonic antigen drop after laparoscopic radiofrequency ablation of liver metastasis from colorectal carcinomaCANCER, Issue 1 2006Mohammed Ghanamah M.D. Abstract BACKGROUND Laparoscopic radiofrequency ablation (RFA) is being increasingly used for local control of hepatic metastasis from colorectal carcinoma (CRC). After surgical resection of colorectal liver metastasis, carcinoembryonic antigen (CEA) values fall within 2 weeks, making this a useful parameter to follow shortly after surgery. Little is known, however, about the expected pattern of the CEA drop after RFA. METHODS From September 1998 to October 2002, RFA to CRC liver metastasis was performed on 144 patients. A subset of 17 patients were studied who had no evidence of extrahepatic disease preoperatively, had all detectable tumor ablated intraoperatively, and who on long-term follow-up (up to 15 months) had no evidence of recurrent disease. Serum CEA was determined preoperatively, on the first postoperative day, at 1 week, and every 3 months afterwards. A computed tomography (CT) scan of the abdomen and pelvis was obtained every 3 months postoperatively. RESULTS Ten (58.8%) patients showed an increase in CEA on postoperative Day 1, averaging 38.3% compared with the preoperative value. CEA then fell to 50% of the preoperative value, on average, on Day 7 postoperatively and only reached its nadir at 3 months. CONCLUSIONS Unlike resection patients, those undergoing ablation show an initial rise in CEA, probably due to release from the ablated tissue. Although heating of RFA would be expected to destroy CEA, the initial rise and slow drop postoperatively argue for a release of immunoreactive CEA from the ablated zone. This slow decline in CEA indicates that several months should pass before assessing the extent of potential residual disease. Cancer 2006. © 2006 American Cancer Society. [source] Perioperative plasma active and total ghrelin levels are reduced in acromegaly when compared with in nonfunctioning pituitary tumours even after normalization of serum GHCLINICAL ENDOCRINOLOGY, Issue 1 2007Takakazu Kawamata Summary Objective, Ghrelin is a novel gastric peptide known to stimulate GH secretion, but the relationship between ghrelin and the GH-insulin-like growth factor (IGF)-1 axis in GH excess or deficiency is poorly understood. This study investigated dysregulation of ghrelin secretion in acromegaly and its short-term postoperative recovery. Methods, A prospective study was conducted on eight patients who underwent complete transsphenoidal resection of GH-producing pituitary adenomas (acromegaly group) and 22 for endocrinologically nonfunctioning pituitary tumours (control group). Active and total plasma ghrelin levels were measured serially before and after surgery. Results, Preoperative active and total plasma ghrelin concentrations (mean ± SD; fmol/ml) were significantly reduced in acromegalic patients when compared with those in the controls (9·6 ± 4·3 and 157·4 ± 65·6 vs. 21·8 ± 13·0 and 267·1 ± 111·4; P = 0·023 and P = 0·021, respectively). Both levels were still significantly suppressed on postoperative Day 7 in the acromegaly group when compared with those in the control group (11·7 ± 4·3 and 197·8 ± 68·9 vs. 22·5 ± 12·6 and 302·7 ± 100·0; P = 0·038 and P = 0·018, respectively). The ratios of active to total ghrelin were not significantly different between the two groups before and after operation. In acromegalic patients, active and total ghrelin levels remained significantly suppressed even after normalization of serum GH levels. Conclusions, The putative negative feedback mechanism of GH on ghrelin secretion may in part account for the low ghrelin levels observed in acromegalic patients, and the mechanism may persist even after normalization of serum GH. [source] Postoperative discomfort associated with surgical and nonsurgical endodontic retreatmentDENTAL TRAUMATOLOGY, Issue 2 2000T. Kvist Abstract , Endodontic retreatment decision-making must include an appraisal of the costs of the different strategies proposed. In addition to direct costs, postoperative discomfort may have other consequences in terms of time off work, unscheduled visits and suffering. To establish a foundation for the appraisal of such indirect and intangible costs the present study was set up in which patients' assessments of pain and swelling after surgical and nonsurgical retreatment procedures were recorded. Ninety-two patients with 95 root-filled incisors and canine teeth exhibiting apical periodontitis were included in the study. The mode of retreatment was randomly assigned. Each day during the first post-treatment week patients assessed their degree of swelling and pain on horizontal 100-mm visual analog scales (VAS). The scales ranged from "no swelling" to "very severe swelling" and "no pain" to "intolerable pain", respectively. Consumption of self-prescribed analgesics and time off work were also recorded. Significantly more patients reported discomfort after surgical retreatment than after nonsurgical procedures. High pain scores were most frequent on the operative day while swelling reached its maximum on the first postoperative day followed by progressive decrease both in frequency and magnitude. Postoperative symptoms associated with nonsurgical retreatment were less frequent but reached high VAS values in single cases. Analgesics were significantly more often consumed after periapical surgery. Patients reported absence from work mainly due to swelling and discoloration of the skin. This was found to occur only after surgical retreatment. Conclusively, surgical retreatment resulted in more discomfort and tended to bring about greater indirect costs than nonsurgical retreatment. [source] Occlusive Dressing versus Oxygen Mist Therapy Following CO2 Laser ResurfacingDERMATOLOGIC SURGERY, Issue 6 2000Teri Onouye BA Background. Oxygen is an essential element for collagen synthesis and reepithelialization. The use of topical oxygen after CO2 laser resurfacing has not been studied. Objective. To compare the rate and quality of healing in wounds treated with an oxygen mist to those treated with occlusive dressing following CO2 laser resurfacing. Methods. Three patients underwent CO2 laser resurfacing to each half of the face 3 weeks apart. Postoperatively, half of the face was treated with an oxygen mist protocol for 5 days, while the other half was treated with occlusive dressing for 4 days. Results. At postoperative day 5, significantly less crusting was observed on the half of the face treated with the oxygen mist protocol (p < 0.05). Conclusion. The oxygen mist postoperative protocol may offer patients similar overall healing rates and significantly less crusting compared to occlusive dressing. [source] PEUTZ,JEGHERS POLYPOSIS WITH BLEEDING FROM POLYPS OF THE SIGMOID COLON SUCCESSFULLY TREATED BY LAPAROSCOPIC SURGERYDIGESTIVE ENDOSCOPY, Issue 1 2003Kazuhiro Yada We report a case of colonic bleeding complicating congestive heart failure in a patient with Peutz,Jeghers (P,J) polyposis successfully treated by laparoscopic surgery. A 49-year-old woman was admitted for severe cough and edema of the extremities. Chest X-ray revealed bilateral pleural effusion and cardiomegaly. Her cardiac function was within normal limits, but anemia and severe hypoproteinemia were observed. During the treatment, anal bleeding was observed. Endoscopic and radiographic examinations revealed hundreds of polyps from the duodenum to the rectum. 99mTc-diethylene triamine penta-acetic acid human serum albumin scintigraphy showed radiotracer collected in the sigmoid colon, the area having the most polyps. After some intestinal polypoid lesions were resected endoscopically, laparoscopy-assisted sigmoid colectomy and cecectomy were performed. In the postoperative course, she complained less about abdominal pain and her first flatus occurred on the third postoperative day. She recovered uneventfully. The anemia, hypoproteinemia, and congestive heart failure resolved and gastrointestinal bleeding has not been seen. It was thought that protein loss and hemorrhage due to the P,J polyposis caused congestive heart failure. When congestive heart failure is accompanied by gastrointestinal hemorrhage, it is important to consider hypoproteinemia due to gastrointestinal polyposis, such as that characterizing P,J syndrome. Laparoscopic surgery was very useful for the treatment of colonic bleeding. [source] Serum concentrations of high-mobility group box chromosomal protein 1 before and after exposure to the surgical stress of thoracic esophagectomy: a predictor of clinical course after surgery?DISEASES OF THE ESOPHAGUS, Issue 1 2006K. Suda SUMMARY., High-mobility group box chromosomal protein 1 (HMGB-1) has recently been shown as an important late mediator of endotoxin shock, intra-abdominal sepsis, and acute lung injury. However, its role in the systemic inflammatory response syndrome after major surgical stress, which may lead to multiple organ dysfunction syndrome, has not been thoroughly investigated. We hypothesized that serum HMGB-1 participates in the pathogenesis of postoperative organ system dysfunction after exposure to major surgical stress. A prospective clinical study was performed to consecutive patients (n = 24) with carcinoma of the thoracic esophagus who underwent transthoracic esophagectomy with three field lymph node resection between 1998 and 2003 at Keio University Hospital, Japan. Serum HMGB-1 concentrations were measured by enzyme-linked immunosorbent assay. Preoperative serum HMGB-1 levels correlated with postoperative duration of SIRS, mechanical ventilation, and intensive care unit stay. Three of the 24 patients had serious postoperative complications: sepsis in two, and acute lung injury in one. Serum HMGB-1 levels in patients without complications increased within the first 24 h postoperatively, remained high during postoperative days 2,3, and then decreased gradually by postoperative day 7. In patients with serious complications, serum HMGB-1 was significantly higher than that found in patients without postoperative complications at every time point except postoperative day 2. Preoperative serum HMGB-1 concentration seems to be an important predictor of the postoperative clinical course. Transthoracic esophagectomy induces an increase in HMGB-1 in serum even in patients without complications. Postoperative serum HMGB-1 concentrations were higher in patients who developed complications, and may be a predictive marker for complications in this setting. [source] Endoscopic stapling technique for redundant free jejunal interposition graftDISEASES OF THE ESOPHAGUS, Issue 2 2003C. A. Gutschow SUMMARY Dysphagia may occur after reconstruction of the cervical esophagus by jejunal interposition. It may be caused by redundancy and subsequent development of a diverticulum. The present report relates to the case of a patient who developed complete aphagia 2 months after surgery and was treated transorally by division of a common wall between diverticulum and descending jejunal limb with the use of an endoscopic stapling device. The patient started swallowing the first postoperative day and remained able to take oral food at follow-up. [source] Management of acquired von Willebrand's sryndrome in a patient requiring major surgeryHAEMOPHILIA, Issue 6 2005J. M. Maddox Summary., We present the case of a patient with acquired von Willebrand's syndrome and a monoclonal gammopathy of undetermined significance who required cystectomy for relapsed transitional cell carcinoma (TCC) of the bladder. We demonstrated that infused von Willebrand factor (VWF) containing factor VIII concentrates had an unacceptably short half-life, but that this was significantly prolonged following combined therapy with plasma exchange and intravenous immunoglobulin (IVIgG). This approach was successfully utilized peri-operatively, with the total surgical blood loss less than would be expected even for a haemostatically normal patient. Trough VWF antigen and Ristocetin co-factor activity levels fell on the second postoperative day and we therefore administered further IVIgG. Levels again fell on the fifth postoperative day with the development of a Staphylococcus aureus septicaemia. At this point bleeding occurred from a surgical drain site requiring ,factor VIII inhibitor bypass activity' to secure haemostasis while further plasma exchange and IVIgG were administered. Now 5 years later, there is no evidence of recurrence of the TCC or progression of the monoclonal gammopathy. [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] ,Cross-section gastroenterostomy' in patients with irresectable periampullary carcinomaHPB, Issue 2 2001O Horstmann Background The most frequent complication following gastroenterostomy (GE) for gastric outlet obstruction is delayed gastric emptying (DGE), which occurs in roughly 20% of patients. There is evidence that DGE may be linked to the longitudinal incision of the jejunum and that a transverse incision (cross-section GE) may decrease the incidence of DGE following GE. Patients and methods In contrast to the orthodox GE, the jejunum is severed transversely up to a margin of 1.5 cm at the mesenteric border and the anastomosis is created with a single running suture. A Braun anastomosis is added 20,30 cm distally to the GE. Patients were followed prospectively with special regard to the occurrence of DGE. Results Between 1 August 1994 and 1 August 1998, 25 patients underwent cross-section GE, mostly because of an irresectable periampullary carcinoma. Eight patients exhibited clinical signs of gastric outlet obstruction preoperatively, while in 17 the GE was performed on a prophylactic basis. A biliary bypass was added in 15 patients. There was no disruption of the GE, but one patient died in hospital (4%). The nasogastric tube was withdrawn on the first postoperative day (range 0,6 days), a liquid diet was started on the fifth day (range 2,7 days) and a full regular diet was tolerated at a median of 9 days (6,14 days). The incidence of DGE was 4%: only the single patient who died fulfilled the formal criteria for DGE. Discussion In contrast to orthodox GE, DGE seems to be of minor clinical importance following cross-section GE. As the technique is easy to perform, is free of specific complications and leads to a low incidence of DGE, it should be considered as an alternative to conventional GE. [source] Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: Our experienceINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2009Choichiro Ozu Objectives: To assess the outcomes of patients undergoing radical retropubic prostatectomy (RRP) with a running vesicourethral anastomosis and catheter removal on postoperative day 3 or 5. Methods: From February 2006 through December 2007, 55 patients underwent RRP at our institution. All procedures were performed by a single surgeon using a running suture for the vesicourethral anastomosis. A cystogram was carried out before catheter removal in all patients. The initial 23 of 55 patients (Group 1; n = 23) had the cystogram on postoperative day 5, the other 32 patients (Group 2; n = 32) had the cystogram on postoperative day 3. Removal of the catheter was only carried out if there was no anastomotic extravasation. Results: The success rate of catheter removal in group 1 and 2 was 100% and 96.9%, respectively. Overall continence rates were 83.3%, 87% and 90.7% at 24, 48 and 72 h after removal of the catheter, respectively. There was no significant difference in terms of continence rate between groups 1 and 2. None of the patients had acute urinary retention and/or anastomotic stricture after catheter removal. Conclusions: These findings suggest that an advanced running vesicourethral anastomosis during RRP is technically feasible, allowing safe early catheter removal in most patients. [source] Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapseINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009Kumiko Kato Objectives: To evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP). Methods: Between May 2006 and December 2007, 305 consecutive women with POP quantification stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital. Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling urethral catheter on the next morning, discharge on postoperative day 3) was applied to the remaining 300 patients. The perioperative complications and postoperative hospitalization were prospectively evaluated in this case series. Results: Perioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma (two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were removed on the next morning as in the pathway in 287 cases (95.6%), and none required clean intermittent catheterization at home. Postoperative hospitalization was within 3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were due to complications (two cases of bladder injury, one of rectal injury, one of blood loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis). Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal pain. Conclusions: Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay. [source] Original Article: Prospective comparative study of single dose versus 3-day administration of antimicrobial prophylaxis in minimum incision endoscopic radical prostatectomyINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2008Mizuaki Sakura Objective: From the critical stand point against the overuse of antimicrobial agents, appropriate reduction of antimicrobial prophylaxis (AMP) should be considered. We have prospectively reduced AMP and evaluated the occurrence of surgical site infection (SSI) following radical retropubic prostatectomy (RRP) by minimum incision endoscopic surgery (MIES). Methods: A total of 101 consecutive patients who underwent MIES-RRP for prostate carcinoma were classified into two groups according to AMP dose. The 3-day group of 52 patients received tazobactam sodium/piperacillin sodium (TAZ/PIPC) 2.5 g intravenously before the operation and continued twice daily until postoperative day 2, and the single dose group of 49 patients received TAZ/PIPC 2.5 g intravenously only once before the operation. Additional antimicrobial agents were given only when SSI occurred. The occurrence of SSI and remote infection (RI) were analyzed. Results: There was no significant difference in the rate of SSI occurrence between the 3-day group (3.8%) and single dose group (6.1%) (P = 0.6). RI did not increase in the single dose group. Conclusion: Antimicrobial prophylaxis dose was successfully reduced without increasing SSI or RI. A single dose of AMP is feasible to prevent SSI and RI and would be a standard regimen in MIES-RRP. Active surveillance of postoperative infection is mandatory to promptly administer antimicrobial treatment as the need arises. [source] Mycotic aneurysm of the renal transplant arteryINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006SHIRO FUJIKATA Abstract, A case of mycotic aneurysm secondary to septicemia is reported. A 59-year-old man with end-stage renal failure underwent renal transplantation from a living donor. On the fifteenth postoperative day, he was febrile and his arm around an entry wound of the drip infusion had infectious signs. Cultures of the blood and pus discharge grew Methicillin-resistant Staphylococcus aureus. Vancomycin was administered intravenously for 30 days. Then the existence of a mycotic aneurysm on the transplant artery was not suspected by computed tomography. After his infectious signs disappeared, examinations revealed a pseudoaneurysm measuring 4 cm in diameter at the site of anastomosis between the renal transplant and external iliac arteries by computed tomography. He has been carefully followed up with a conservative management. This is the first case of a mycotic aneurysm treated conservatively and displaying an uneventful course without rupture. [source] Color Doppler sonography examination of partially obstructed kidneys associated with ureteropelvic junction stone before and after percutaneous nephrolithotripsy: Preliminary reportINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2005SÜLEYMAN KILIÇ Abstract Aim: To evaluate resistive index (RI) changes before and after unilateral percutaneous nephrolithotripsy in chronic partially obstructed kidneys due to ureteropelvic junction (UPJ) stones. Methods: Intrarenal RI of obstructed and contralateral normal kidneys of 18 patients were recorded immediately before the operations and at postoperative days 1, 7 and 30. Postoperative RI measurements were compared with baseline values for all patients without grouping and separately for different groups according to the preoperative RI value of the obstructed kidney. Results: Mean age and symptom duration were 27.5 years and 43.8 weeks, respectively. Preoperatively and at all postoperative controls, kidney diameters and renal parenchyma thicknesses were normal in all patients. Mean RI of obstructed kidneys decreased from 0.68 to 0.63 for all patients (P = 0.032), from 0.64 to 0.63 for those with preoperative RI < 0.70 (P = 0.850) and from 0.73 to 0.62 for those with preoperative RI , 0.70 (P = 0.001). In patients with preoperative RI , 0.70 in obstructed kidney, significant RI decreases were recorded at postoperative day 7 and RI differences between obstructed and contralateral kidneys disappeared after then. No difference was present pre- and postoperatively between the mean RI of obstructed and contralateral kidneys of the patients with RI < 0.70. Mean RI of contralateral kidneys were normal preoperatively and showed no significant change postoperatively. Conclusions: Preoperative RI levels may indirectly reflect the presence of functionally significant obstruction in chronic obstructed kidneys related to UPJ stones. Patients with RI , 0.70 may have a good indication for a surgical approach. Normalization of high RI occurs rapidly after percutaneous nephrolithotripsy. [source] Portless endoscopic adrenalectomy via a single minimal incision using a retroperitoneal approach: Experience with initial 30 casesINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2004YUKIO KAGEYAMA Abstract Aim: To assess the feasibility of portless endoscopic adrenalectomy via a single minimum incision that narrowly permits extraction of the specimen. Methods: For, 30 cases of adrenal tumor, portless endoscopic surgery through a single flank incision (3,9 cm; mean, 5.6 cm) was performed without gas inflation or trocar port placement. All of the instruments used during surgery were reusable. The cases included primary aldosteronism (12), Cushing's syndrome (6), preclinical Cushing's syndrome (3), pheochromocytoma (1), non-functioning cortical adenoma (6), adrenocortical carcinoma (1) and adrenocortical hemorrhage (1). Results: Resection of the tumor was successfully completed, without complications, in all of the cases. Operative time was between 83 and 240 min (mean, 147 min). Estimated blood loss was 5,470 mL (mean, 139 mL). None of the patients required blood transfusion. Postoperative course was uneventful. Wound pain was mild and walking and full oral feeding were resumed on the first and second postoperative day, respectively, in the majority of cases. Conclusions: Adrenal tumors are good candidates for portless endoscopic surgery, which is safe, cost-effective, minimally invasive and matches favorably with laparoscopic surgery. [source] Assessment of a protocol for prophylactic antibiotics to prevent perioperative infection in urological surgery: A preliminary studyINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2004SOJUN KANAMARU Abstract Background: The aim of the present study was to assess the usability and efficacy of our new protocol of prophylactic antibiotic use to prevent perioperative infection in urological surgery. Methods: We prospectively investigated 339 cases of typical urological surgery in our department between April 2001 and March 2002 (group I). We classified surgical procedures into four categories by invasiveness and contamination levels: category A, clean less invasive or endoscopic surgery; category B, clean invasive or clean contaminated surgery; category C, urinary tract diversion using the intestine; and category D, infected surgery. Antibiotics were administrated intravenously according to our protocol: category A, first or second generation cephems or penicillins during the operative day only; category B, first and second generation cephems or penicillins for 3 days; and category C, second or third generation cephems for 4 days. Category D was excluded from the analysis. To judge perioperative infections, the wound condition and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 14. We retrospectively reviewed 308 patients who underwent urological surgery between April 2000 and March 2001 (group II) as reference cases that were administered antibiotics without any restriction. Results: Perioperative infection rates (SSI + RI) in group I and group II were 25 of 339 (7.4%) and 35 of 308 (11.4%), respectively. Surgical site infection rates of categories A, B, and C in group I were 1.8%, 7.6%, and 30.0%, respectively, while those in group II were 2.0%, 7.4%, and 46.2%, respectively. There was no significant difference in infection rates in terms of RI and SSI between group I and group II. The amounts, as well as the prices, for intravenously administrated antibiotics and oral antibiotics decreased to approximately half and one-fifth, respectively. Conclusion: Our protocol effectively decreased the amount of antibiotics used without increasing perioperative infection rates. Thus, our protocol of prophylactic antibiotic therapy would be recommended as an appropriate method for preventing perioperative infection in urological surgery. [source] Chrono and clinical pharmacokinetic study of tacrolimus in continuous intravenous administrationINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2001Shigeru Satoh Abstract Background: The circadian variation of clinical pharmacokinetics of tacrolimus in kidney transplant recipients receiving continuous intravenous administration has not been clarified. The aim of this study was to evaluate the circadian variation of this drug in continuous intravenous administration, with regard to the dosing scheme for conversion from intravenous to oral therapy. Methods: The blood concentration,time curve was studied in 10 living-related kidney transplant recipients, aged 18,51 years (mean, 36.5 years), 1 day before operation for preoperative oral administration, the third postoperative day for continuous intravenous administration and the sixth postoperative day at the conversion from intravenous to oral therapy. Results: Although the total body clearance of daytime was slightly higher than that of night-time, the intravenous tacrolimus infusion maintained an adequate therapeutic blood concentration for 24 h. There were significant differences between the preoperative and the postoperative state in the area under the curve, total body clearance and bioavailability for the oral administration. The mean absolute bioavailability was 17.7% in preoperative and 11.1% in postoperative state, respectively and a large interindividual variation was confirmed in this parameter, which was 7.0,27.2% for preoperative and 6.4,22.0% for postoperative area under the curve, respectively. Conclusion: This study proposes that intravenous administration is a safe and appropriate method to achieve the required blood concentration in patients with various tacrolimus metabolism in the early post-transplant period. As the oral tacrolimus absorption was found to be variable between preoperative and postoperative states in identical patients, the conversion dosage cannot be calculated from preoperative oral or postoperative intravenous pharmacokinetics. Frequent blood concentration monitoring is needed to ensure safe treatment. [source] Pain-Sensitive Temperament and Postoperative PainJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2007Charmaine Kleiber PURPOSE.,To describe the relationship between pain-sensitive temperament and self-report of pain intensity following surgery. DESIGN AND METHODS.,Fifty-nine adolescents and young adults (average age 14 years) undergoing spinal fusion for adolescent idiopathic scoliosis completed the Sensitivity Temperament Inventory for Pain,Child version (STIP-C). The Pearson correlation between STIP-C scores and the highest pain intensity for each of the first three postoperative days was investigated. RESULTS.,There was a small but significant correlation between the Perceptual Sensitivity and Symptom Reporting subscales of the STIP-C and pain intensity measured on the third postoperative day. PRACTICE IMPLICATIONS.,Aspects of the pain-sensitive temperament may be important in understanding the variability in postoperative pain. This is the first investigation of the relationship between pain-sensitive temperament and surgical pain. More research is needed in this area. [source] Deep Hypothermia and Circulatory Arrest in the Surgical Management of Renal Tumors with Cavoatrial ExtensionJOURNAL OF CARDIAC SURGERY, Issue 6 2009Panagiotis Dedeilias M.D. Their intraluminar extension to the cardiac cavities occurs with a tumor-thrombus formation at a percentage of 1%. The aim of this study is to present the principles of "radical" management that should be targeted to excision of the kidney together with the cavoatrial tumor-thrombus. Material: From 2003 through 2008, we treated six patients with renal-cell carcinoma involving the IVC and/or the right cardiac chambers. The main symptoms leading to the diagnosis were hematuria, dyspnea, or lower limb edema. The extension of the tumor was type IV in three cases, type III in two, and type II in one case. Method: Extracorporeal circulation combined with a short period of hypothermic circulatory arrest was the method used. Radical nephrectomy combined with cavotomy and atriotomy was performed to an "en-block" extirpation of the tumor-thrombus and allowed oncologic surgical clearance of the disease. Results: There was no operative death. The mean postoperative course duration was 11 days, apart from one obese patient who presented postoperative pancreatitis and died on the 44th postoperative day due to respiratory failure. During the cumulative postoperative follow-up of 171 months the patients remain free of recurrence. Conclusions: The use of extracorporeal circulation and deep hypothermic circulatory arrest provides a good method for radical excision of renal carcinomas involving the IVC with satisfactory morbidity and long-term survival results. Cooperation of urologists and cardiac surgeons is necessary for this type of operation. [source] Successful Mitral Valve Surgery in a Patient with Myasthenia GravisJOURNAL OF CARDIAC SURGERY, Issue 2 2009Cüneyt Narin M.D. Most of the patients die because of a respiratory failure toward the end of the disease. A 49-year-old male patient with MG in whom a thymectomy operation had been performed five years ago had dyspnea, palpitation, and chest pain during his admission. After his examination, a severe mitral regurgitation was detected, and he underwent a successful mitral valve replacement. A general anesthesia management was performed using sufentanyl and propophol without any muscle relaxant agent. He was extubated seven hours after the surgery. He had difficulty in swallowing at postoperative day three, and his medication doses were increased. He was discharged from the hospital at postoperative day seven without any complication. MG is a rare disease and may cause morbid complications during the cardiac surgery, but can be successfully managed. [source] Third Left Pulmonary Vein with Abnormal Return Associated with Arteriovenous FistulaJOURNAL OF CARDIAC SURGERY, Issue 4 2008Ali Can Hatemi M.D., Ph.D. A 20-year-old woman with complaints of effort-induced dyspnea and easy fatigability was diagnosed with a third left pulmonary vein with abnormal return and arteriovenous fistula accompanied by a secundum atrial septal defect (ASD). Complete surgical repair was performed by ASD closure with a pericardial patch and triple ligation of the left vertical vein and associated third pulmonary vein. The patient was discharged on the seventh postoperative day in good health. Her last control examination was performed in the second postoperative year, revealing normal echocardiographic findings with an excellent clinical course. [source] Closure of Adult Patent Ductus Arteriosus Under Cardiopulmonary Bypass by Using Foley Balloon CatheterJOURNAL OF CARDIAC SURGERY, Issue 3 2007Yildirim Tekin M.D. Method: We present a 43-year-old female patient who underwent successful ductal closure operation under cardiopulmonary bypass (CPB) via a transpulmonary route. Results: The operation was uneventful and the patient was discharged from the hospital on the 4th postoperative day. Conclusion: Transpulmonary route for the closure of the PDA by using CPB is a safe and acceptable approach in adult patients. [source] Can the Use of the Radial Artery Be Expanded to All Patients with Different Surgical Grafting Techniques?JOURNAL OF CARDIAC SURGERY, Issue 1 2005Angiographic Results in 600 Patients, Early Clinical Encouraged by our satisfactory early experience with the use of the RA conduit, we have expanded its use to more than 90% of all coronary surgery patients. The aim of the present study was to review our clinical and angiographic results when the use of the RA conduit was expanded to all patients including those aged 65 years and older and diabetics with different surgical grafting techniques. Methods: The records of 600 consecutive patients who underwent isolated CABG using the RA graft at Harefield Hospital between January 1999 and August 2002 were reviewed retrospectively. Ninety-three (15.5%) patients consented and underwent angiography before discharge at the earliest on the fourth postoperative day, aiming to look at the quality of anastomoses and the patency of the RA grafts. Results: The 600 patients had 613 RA grafts to perform 652 distal RA anastomoses. The proximal ends of 515 (84%) RA grafts were anastomosed to the aorta, 98 (16%) RA grafts were constructed as Y-grafts with 49 (8%) RA off a vein graft hood, and 49 (8%) RA grafts were constructed as T- or Y-grafts off an internal thoracic artery (ITA) graft. The proximal ends of 19 (19/294 or 6.5%) vein grafts were constructed as Y-grafts off the RA grafts. Two hundred and sixty-one (43.5%) patients were above the age of 65 years and 111 (18.5%) patients were diabetics. There were four in-hospital deaths (0.6%) among the study patients. Six (1%) patients developed forearm hematoma/seroma postoperatively. The operation time, the hospital stay, and the incidence of conduit harvest site infection for the patients who had vein grafts in addition to the RA grafts were significantly higher than those of patients who had RA grafts only. On postoperative angiography, 86 out of 93 (92.5%) RA grafts were found to be patent with good quality distal anastomoses. The maximum stenosis of the coronary arteries bypassed by the patent 86 RA grafts was 82.6 ± 6.2%, while it was 56.3 ± 15.4% for the coronary arteries bypassed by the occluded seven RA grafts, p < 0.001. Conclusion: The use of the RA can be expanded to all patients with different surgical grafting techniques and provides satisfactory clinical and angiographic outcomes. [source] Prednisone Prevents Inducible Atrial Flutter in the Canine Sterile Pericarditis ModelJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2008ROBERT N. GOLDSTEIN M.D. Background: Atrial fibrillation (AF) and atrial flutter (AFL) are common following cardiac surgery and are associated with significant morbidity. We tested the hypothesis that suppression of the inflammatory response with steroids would significantly modify the inducibility of postoperative AF/AFL in the canine sterile pericarditis model. Methods: Twenty-three dogs were studied daily from creation of pericarditis to the fourth postoperative day: 11 dogs were treated with oral prednisone (PRED) starting 2 days preoperatively until the end of the study; 12 dogs were controls (CON). EP testing was performed daily using epicardial electrodes placed at initial surgery. High-resolution (404 sites) epicardial mapping was performed during the terminal study. Baseline and daily CRP levels were obtained in all dogs. Results: Sustained AFL was absent in PRED (0%) versus CON dogs (91%; P < 0.001); AF induced in the early postoperative course in PRED dogs was of very short CL (mean 66 ms). Tissue inflammation was significantly attenuated in PRED dogs. Thresholds were lower in PRED versus CON dogs, significantly so on postoperative day (POD) 3. There was a trend toward lower ERPs in the PRED group at all CLs. CRP levels were markedly reduced in PRED versus CON dogs (peak CRP 78 ± 7 mg/L vs 231 ± 21 mg/L, P < 0.001), and returned to baseline in PRED dogs by POD 4, correlating with a virtual absence of sustained arrhythmia. During open chest mapping studies on POD 4, PRED dogs showed only nonsustained AF/AFL. Conclusions: Prednisone eliminated postoperative AFL, affected all EP parameters studied, and attenuated the inflammatory response associated with pericarditis. [source] Effectiveness of bran supplement in older orthopaedic patients with constipationJOURNAL OF CLINICAL NURSING, Issue 5 2007Zennure Kaçmaz MSc Aim., The purpose of the study was to evaluate the effectiveness of planned nursing interventions, including bran supplement, on the bowel management of older orthopaedic patients. Background., Constipation is prevalent among older people. Constipation is also well-known to be a problem for a range of orthopaedic patients. Orthopaedic diseases or conditions may, because of the specific problems, cause this. The problem may also arise as a result of the orthopaedic treatment options undertaken by patients. Design., A quasiexperimental design was employed. Methods., The patients were recruited from an orthopaedic clinic at a university hospital in Erzurum, eastern Turkey. Descriptive statistics, independent sample test t -test, chi-square and McNemar test were used to analyse the data. Constipation problems were identified through interviews by using the Constipation Diagnosis Form. Interviews were performed within the fourth postoperative day. After that, while the patients in the control group received routine nursing care according to clinic routine, the patients in the experimental group received bran supplement together with planned nursing interventions. The patents in both groups were followed by using the Constipation Follow Form. Results., While patients in the experimental group showed significant improvements in most characteristics of bowel elimination such as time of defecation, intensity of faeces, colour of faeces and amount of faeces, the control group showed a significant improvement in only duration of defecation. Conclusions., The results of the study indicate planned nursing interventions including bran supplement are more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients. Relevance to clinical practice., Nurses have an important part to play in both prevention and management of constipation. Constipation is a problem especially for older orthopaedic patients. Planned nursing interventions that include bran supplements may be more effective than routine nursing interventions for management of constipation problems in older orthopaedic patients. [source] Patients undergoing total hip arthroplasty: a perioperative pain experienceJOURNAL OF CLINICAL NURSING, Issue 4 2006Margareta Warrén Stomberg PhD Aim., The aim was to evaluate patient's perioperative pain experience after total hip replacement and patients' satisfaction with pain management. Background., Total hip arthroplasty is a common surgical procedure intended to reduce pain and return patients to better function. Realistic expectations about total hip arthroplasty is important for optimal postoperative recovery and the information must be adapted to fit the individual patient. Methods., A descriptive design was used comparing patients outcome data. Pitman's test was used for statistical analyses. Adult patients (n = 112) undergoing surgical hip replacement procedures answered a 17-item questionnaire on the fourth postoperative day. The questionnaire included given alternatives and visual analogue scales (0,100 mm) for the pain assessment. Result., The patients' postoperative pain experience after hip replacement surgery was in average low, 33·1 mm on a 100 mm visual analogue scale. Patient's pain experience was reported to be highest on the first postoperative day for most of the patients. The preoperative pain experience tends to be higher than the postoperative pain experience. Older patients reported less average pain level postoperatively. Satisfaction with pain management was high. Conclusion., The pain experience tends to be higher preoperatively than postoperatively. Patients who reported a higher pain experience postoperatively reported that their pain experience was significant higher than preoperative expected. Relevance to practice., It is important for the postoperative outcome measure that the patients have a realistic expectation of pain experiences after total hip arthroplasty. The nurse is one of the staff members responsible for information to the individual patient. [source] Nursing documentation of postoperative pain managementJOURNAL OF CLINICAL NURSING, Issue 6 2002Ewa Idvall PhD Summary ?,Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. ?,The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. ?,The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. ?,The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. ?,The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. ?,The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware. [source] Gingival blood flow changes following periodontal access flap surgery using laser Doppler flowmetryJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2007M. Retzepi Abstract Aim: To investigate the pattern of gingival blood flow changes following periodontal access flap surgery by laser Doppler flowmetry (LDF). Material and methods: Fourteen patients with chronic periodontitis presenting upper anterior sites with pocket depth 5 mm after initial treatment were included in the study. Periodontal access flap surgery was performed on the experimental areas and LDF recordings were taken at baseline, following anaesthesia, immediately postoperatively and on days 1, 2, 3, 4, 7, 15, 30 and 60 of healing, at nine predetermined sites per flap. Results: Significant ischaemia was observed at all flap sites following anaesthesia and immediately postoperatively. At the alveolar mucosal sites, a peak increase of the gingival blood flow was observed on postoperative day 1 (p<0.001), which persisted until day 7 (p=0.012) and resolved by day 15. The mucosal sites close to the flap periphery presented higher blood perfusion compared with the sites located centrally in the flap. The microcirculatory perfusion of the buccal and palatal papillae was maximum on postoperative day 7 (p=0.013 and <0.001, respectively) and returned to baseline by day 15. Conclusion: Topographically distinct areas of the periodontal access flap consistently present different patterns of microvascular blood flow alterations during the wound-healing period. [source] Simvastatin effects on portal-systemic collaterals of portal hypertensive ratsJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2010Hui-Chun Huang Abstract Background and Aim:, Portal-systemic collateral vascular resistance and vasoconstrictor responsiveness are crucial in portal hypertension and variceal bleeding control. Statins enhance vasodilators production, but their influence on collaterals is unknown. This study aimed to survey the effect of simvastatin on collaterals. Methods:, Partially portal vein-ligated rats received oral simvastatin (20 mg/kg/day) or distilled water from ,2 to +7 day of ligation. After hemodynamic measurements on the eighth postoperative day, baseline perfusion pressure (i.e. an index of collateral vascular resistance) and arginine vasopressin (AVP, 0.1 nM,0.1 µM) responsiveness were evaluated with an in situ perfusion model for collateral vascular beds. RT-PCR of endothelial NO synthase (eNOS), inducible NOS (iNOS), cyclooxygenase-1 (COX-1), COX-2, thromboxane A2 synthase (TXA2 -S) and prostacyclin synthase genes was performed in parallel groups for splenorenal shunt (SRS), the most prominent intra-abdominal collateral vessel. To determine the acute effects of simvastatin, collateral AVP response was assessed with vehicle or simvastatin. SRS RT-PCR of eNOS, iNOS, COX-1, COX-2 and TXA2 -S, and measurements of perfusate nitrite/nitrate, 6-keto-PGF1, and TXB2 levels were performed in parallel groups without AVP. Results:, Acute simvastatin administration enhanced SRS eNOS expression and elevated perfusate nitrite/nitrate and 6-keto-PGF1, concentrations. Chronic simvastatin treatment reduced baseline collateral vascular resistance and portal pressure and enhanced SRS eNOS, COX-2 and TXA2 -S mRNA expression. Neither acute nor chronic simvastatin administration influenced collateral AVP responsiveness. Conclusion:, Simvastatin reduces portal-systemic collateral vascular resistance and portal pressure in portal hypertensive rats. This may be related to the enhanced portal-systemic collateral vascular NO and prostacyclin activities. [source] | |||||||||||||||||||||||||||||||||||||