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Second Postoperative Day (second + postoperative_day)
Selected AbstractsManagement 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] 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] 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] Endoscopic Staple Diverticulostomy for Recurrent Zenker's Diverticulum,THE LARYNGOSCOPE, Issue 1 2003Richard L. Scher MD Abstract Objectives The purpose of this study was to evaluate the technical feasibility, effectiveness, and morbidity of using endoscopic staple diverticulostomy (ESD) as treatment for Zenker's diverticulum (ZD) recurring after either prior endoscopic treatment or external diverticulectomy or diverticulopexy. Study Design A retrospective review of a case series of 18 patients with recurrent ZD. Methods All patients cared for with ZD were evaluated to identify those patients with recurrent ZD. The clinical records of patients with recurrent ZD were reviewed for: demographics, prior treatment, time to recurrence, factors associated with recurrence, technical feasibility of treatment, complications, effectiveness and duration of symptom relief. Results Between March 1995 and July 2001, a total of 127 consecutive patients with ZD received care. Eighteen of these patients were treated for recurrent ZD: nine treated originally by ESD, and nine by external approach (seven by diverticulectomy and two by diverticulopexy), with three of these patients treated twice. Seventeen patients had partial or complete relief of symptoms after their initial treatment, with recurrence of symptoms noted 0 to 60 months later. Specific factors associated with recurrence of symptoms were identified in only one patient. Treatment of recurrent ZD by ESD was technically feasible in 16 of the patients. Complete or improved symptom relief has been reported by 16 of the patients after revision ESD, with follow-up from 9 to 69 months. No significant treatment complications occurred. Fifteen patients resumed clear liquid diet on the day of surgery, and one on the day after surgery. All patients were discharged from the hospital by the second postoperative day (mean = 0.6 d). Conclusions ESD is an effective, technically feasible, and safe treatment for patients with ZD recurring after prior endoscopic or external treatment, and it should be the initial treatment of choice for these patients. [source] Anaesthesia for Angelman syndromeANAESTHESIA, Issue 6 2008K. R. Ramanathan Summary We describe the administration of anaesthesia to a patient with Angelman syndrome, which is characterised by an abnormality of chromosome 15, where a subunit of the GABA receptor is coded. This has far-reaching anaesthetic implications as many drugs used in anaesthesia are thought to act via GABA receptors. Our patient had an uneventful peri-operative period and was discharged home on the second postoperative day. [source] Effect of perioperative steroids on renal function after liver transplantation,ANAESTHESIA, Issue 3 2006S. Turner Summary Subclinical renal dysfunction is thought to occur as a systemic manifestation of ischaemia-reperfusion injury of other organs. Liver transplantation is associated with major ischaemia-reperfusion injury. Thirty-four patients undergoing elective liver transplantation were randomly allocated to receive either saline or 10 mg.kg,1 methylprednisolone on induction of anaesthesia. Urine was taken for N-acetyl-,-D-glucosaminidase, creatinine and other markers of tubular function. Serum chemistry was measured for 7 days. Creatinine concentration increased in the saline group but not in the methylprednisolone group (p < 0.0001), with the greatest difference on the third postoperative day (mean (SD) 164.8 (135.8) ,mol.l,1vs 88.5 (39.4) ,mol.l,1, respectively). Similar changes were seen in postoperative alanine transferase (865 (739) U.l,1vs 517 (608) U.l,1, respectively; p <,0.0001) on the second postoperative day. Both groups exhibited increases in markers of renal tubular dysfunction and of glomerular permeability. Patients in the saline group sustained more adverse events (8/17 (47%) vs 2/17 (12%); p = 0.02). The data confirm increased proximal tubular lysosomal turnover, consistent with an increased tubular protein load, following liver transplantation, and suggest that methylprednisolone protects against renal and hepatic dysfunction. [source] Dynamics of visual improvement following chiasmal decompression.ACTA OPHTHALMOLOGICA, Issue 5 2002Quantitative pre-, postoperative observations ABSTRACT. Purpose:, To study early visual restoration following surgical removal of pituitary adenomas compressing the optic chiasm. Methods:, Eleven patients were examined with high-pass resolution perimetry (HRP) before and after trans-sphenoidal adenomectomy. Visual fields were examined on the second postoperative day. The result was interpreted in terms of the estimated fraction of functioning retino-cortical connections. Results:, In the upper and lower temporal visual field quadrants, the mean increases in the fraction of functioning neural channels were 19% (p <,0.001) and 17% (p =,0.001), respectively, on day 2 after surgery. These increased to 35% on day 12. The nasal hemifield showed no change on day 2, but functioning neural channels had increased by 15% on day 5 (p =,0.017). Mean visual acuity improved from 0.6 preoperatively to 1.0 on day 2 (p =,0.030) but did not change significantly thereafter. Conclusion:, All visual field sectors and visual acuity improved after surgery. Improvement starting in the temporal hemifield was already evident on the second postoperative day. [source] "Scleral tunnel incision"-trabeculectomy with one releasable sutureACTA OPHTHALMOLOGICA, Issue 3 2001Marja-Liisa Vuori ABSTRACT. Purpose: To describe a modified surgical technique, a scleral tunnel incision- trabeculectomy (STIT) and evaluate its safety and efficacy in lowering IOP in glaucoma patients. Methods: One hundred and three patients were included in a retrospective, nonrandomized clinical study. Fifty-three patients were operated conventionally and 40 patients underwent STIT. In the modified technique the sides of the scleral flap are opened only half-way to the limbus and the flap is closed with a single releasable "slipknot"-suture. Results: The mean IOP on the first postoperative day was 4.5±6.8 mmHg in the conventional group and 7.4±7.1 mmHg in the tunnel incision group (p=0.012). On the second postoperative day the mean IOP was 4.5±7.3 mmHg and 6.3±6.5 mmHg in the conventional group and tunnel incision group, respectively (p=0.065). There was no statistically significant difference in the mean postoperative IOP between the groups at one month and at 6,12 months. Shallow anterior chamber and iridocorneal touch occurred statistically significantly less in the tunnel incision group than in the conventional group. Conclusion: STIT appears to be equivalent to conventional trabeculectomy (CT) in lowering IOP during the first 6,12 months postoperatively. It is also relatively safe and has fewer early complications related to excessive aqueous outflow than CT. [source] | ||||||||||