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Aim:There is a need to assess the pain fear levels of surgical patients simply and appropriately before the surgery. This study aimed to develop and test the psychometrics of an instrument to evaluate the fear of postoperative pain.Methods:This methodological study was conducted at four surgical clinics including general surgery, orthopedics and traumatology, neurosurgery, heart and vessel surgery of a university hospital between 28 March and 19 October 2018. Totally, 150 patients who were scheduled for elective surgery and at their preoperative day were included. This scale contained 10 items related to the postoperative pain sources and aimed to identify the pain fear of patients preoperatively. To measure the sampling adequacy, Kaiser-Meyer-Olkin index and Bartlett’s test of sphericity was used. Explanatory and confirmatory factor analyses were conducted to evaluate the construct validity. The internal consistency of the scale was evaluated by Cronbach’s alpha calculation. All hypotheses were tested in two directions.Results:The total variance explained 55.5% of the variance for one factor structure consisting of 10 items. The model fit index values through the confirmatory factor analysis were found to support this structure.Conclusion:The scale is appropriate to be used in clinical settings to quickly evaluate the elective surgical patients’ fear level of postoperative pain preoperatively.

The widespread use of high-dose oxygen, to avoid perioperative hypoxemia along with WHO-recommended intraoperative hyperoxia to reduce surgical site infections, is an established clinical practice. However, growing pathophysiological evidence has demonstrated that hyperoxia exerts deleterious effects on many organs, mainly mediated by reactive oxygen species. The purpose of this narrative review was to present the pathophysiology of perioperative hyperoxia on surgical wound healing, on systemic macro and microcirculation, on the lungs, heart, brain, kidneys, gut, coagulation, and infections. We reported here that a high systemic oxygen supply could induce oxidative stress with inflammation, vasoconstriction, impaired microcirculation, activation of hemostasis, acute and chronic lung injury, coronary blood flow disturbances, cerebral ischemia, surgical anastomosis impairment, gut dysbiosis, and altered antibiotics susceptibility. Clinical studies have provided rather conflicting results on the definitions and outcomes of hyperoxic patients, often not speculating on the biological basis of their results, while this review highlighted what happens when supranormal PaO2 values are reached in the surgical setting. Based on the assumptions analyzed in this study, we may suggest that the maintenance of PaO2 within physiological ranges, avoiding unnecessary oxygen administration, may be the basis for good clinical practice.

Gangguan tidur dapat mempengaruhi penurunan toleransi nyeri, dan pemulihan pasca pembedahan ortopedi. Penelitian ini bertujuan untuk mengeksplorasi literatur terkait faktor – faktor yang mempengaruhi kualitas tidur pasien ortopedi pasca pembedahan yang menjalani rawat inap. Metode yang digunakan adalah dengan menganalisis artikel yang diperoleh dari database online Universitas Indonesia (ScienceDirect, Clinical Key, SAGE Journals) dan PubMed dengan menggunakan kata kunci Sleep disturbance, factors affecting sleep, sleep quality among orthopaedic patients, sleep on surgical patients, insomnia, sleep, hospitalization . Jurnal yang diperoleh dinilai menggunakan Critical Appraisal Skills Programme (CASP), dengan kriteria artikel yang dipilih dalam penulisan ini adalah memiliki desain cross sectional, cohort study, Randomized Controlled Trial (RCT),case control/series dan qualitative Research , full text,open access dan dipublikasi tahun 2014-2019, serta berbahasa Inggris. Hasilnya diperoleh lima artikel kuantitatif dan dua artikel kualitatif. Berdasarkan studi literatur yang dilakukan didapatkan bahwa nyeri, kebisingan, lingkungan (suhu, dan pencahayaan), dan faktor psikologi merupakan faktor – faktor yang mempengaruhi kualitas tidur pasien pasca pembedahan. Nyeri merupakan faktor terbanyak penyebab gangguan tidur. Pengetahuan perawat tentang pentingnya kualitas tidur dan faktor yang mempengaruhi sangat diperlukan untuk mengantisipasi terjadinya gangguan tidur yang dapat menghambat proses pemulihan pasien pasca pembedahan. ABSTRACT Sleep disturbance can reduce patients’ pain tolerance, and interrupt post-operative rehabilitation. This study aims to explore literature relating to factors that affecting sleep quality in post-operative orthopaedic patients undergoing hospitalization. The method used is the study of literature through Universitas Indonesia online database (ScienceDirect, Clinica Key, Sage journals) and PubMed by using sleep disturbance, factors affecting sleep, sleep quality among orthopaedic patients, sleep on surgical patients, insomnia, sleep, and hospitalization as keywords. The acquired journal was measured using Critical Appraisal Skills Program (CASP), with article criteria as follow: cross-sectional design, cohort study, Randomized Controlled Trial (RCT), Case-control/series and Qualitative Research, full text, open access, written in English and published years between 2014 and 2019. The results were obtained 5 quantitative journals and two qualitative journals. Based on literature studies conducted, pain, noise, environment (temperature, and lighting), and psychological factors are factors that affecting sleep quality among surgical patients. Pain is the dominant factor that affects sleep. Nurses' knowledge about the importance of sleep quality and factors that cause sleep disturbance are needed to anticipate sleep disturbance in the future that can affect post-operative rehabilitation.

Delayed neurocognitive recovery (DNR) is common in elderly patients after major noncardiac surgery. This study was designed to investigate the best statistical rule in diagnosing DNR with the Montreal cognitive assessment (MoCA) in elderly surgical patients. This was a cohort study. One hundred seventy-five elderly (60 years or over) patients who were scheduled to undergo major noncardiac surgery were enrolled. A battery of neuropsychological tests and the MoCA were employed to test cognitive function at the day before and on fifth day after surgery. Fifty-three age- and education-matched nonsurgical control subjects completed cognitive assessment with the same instruments at the same time interval. The definition of the international study of postoperative cognitive dysfunction (ISPOCD 1) was adopted as the standard reference for diagnosing DNR. With the MoCA, the following rules were used to diagnose DNR: the cut-off point of ≤26; the 1 standard deviation decline from baseline; the 2 scores decline from baseline; and the Z score of ≥1.96. The sensitivity and specificity as well as the area under receiver operating characteristic curve for the above rules in diagnosis of DNR were calculated. The incidence of DNR was 13.1% (23/175) according to the ISPOCD1 definition. When compared with the standard reference, the 2 scores rule showed the best combination of sensitivity (82.6%, 95% confidence interval [CI] 67.1%–98.1%) and specificity (82.2%, 95% CI 76.2%–88.3%); it also had the largest area under receiver operating characteristic curve (0.824, 95% CI 0.728–0.921, P

Objetivo: Analizar los factores atribuibles a la cancelación de cirugías de una institución de salud de tercer nivel en la ciudad de Valledupar, Cesar, Colombia (2017-2018). Material y métodos: Estudio descriptivo, retrospectivo, transversal. Se recopilaron datos del archivo de casos adversos de la unidad quirúrgica del hospital para 6 especialidades quirúrgicas. Resultados: Mostraron que en 2017 hubo una suspensión quirúrgica del 4% del total de cirugías programadas que fueron (3339), para 2018 la tasa fue del 3% con un total de cirugías programadas (1733). La razón de la suspensión para ambos períodos fue el factor relacionado con las condiciones adversas del paciente con 45.9 y 38.5% respectivamente. La especialidad más afectada para estos casos fue la especialidad de cirugía general con el mismo valor porcentual en ambos períodos del 4%. Conclusión: Los resultados nos dan una idea de los factores presentes para la cancelación de cirugías programadas y la necesidad de aplicar medidas para garantizar la seguridad del paciente. Objective: To analyze the factors attributable to the cancellation of surgeries of a third level health institution in the city of Valledupar, Cesar / Colombia (2017-2018). Material and methods: Descriptive, retrospective, cross-sectional study. Data from the hospital surgical unit adverse case file were collected for 6 surgical specialties. Results: They showed that in 2017 there was a surgical suspension of 4% of the total of scheduled surgeries that were (3339), for 2018 the rate was 3% with a total of scheduled surgeries (1733). The reason for the suspension for both periods was the factor related to the patient's adverse conditions with 45.9 and 38.5% respectively. The specialty most affected for these cases was the specialty of general surgery with the same percentage value in both periods of 4%. Conclusion: The results give us an idea of the factors present for the cancellation of scheduled surgeries and the need to apply measures to guarantee patient safety.

Introducción: el instrumentador quirúrgico cumple un papel importante en la atención del paciente quirúrgico, involucrándose en la manipulación de medicamentos que pueden generar incidentes y eventos adversos (EA). El presente estudio describe los EA publicados que ocurrieron durante la atención intraoperatoria. Materiales y métodos: revisión de la literatura en las plataformas Cochrane, MEDLINE, Embase y bases de datos de literatura de salud Pubmed, OVID, UptoDate y Scielo entre 2006 y 2017. Resultados: se localizaron 1.747 documentos eliminándose 1.697 por no cumplir con criterios de inclusión y de los 50 restantes se descartaron 41 por no contar con información de interés para el presente estudio. Conclusiones: aunque en los quirófanos los EA asociados con la manipulación de medicamentos no es infrecuente, se requieren más estudios con alto nivel de evidencia que permitan asociar la práctica asistencial del instrumentador quirúrgico con dichos EA intraoperatorios.

This study aimed to investigate the spread of methicillin-resistant coagulase-positive staphylococci (MRCoPS) among veterinary staff, hand-touch sites and surgical tissue during cystotomy operations on cats and dogs that were patients, and to analyze the genetic relatedness and antimicrobial resistance profiles of the isolates. Human and environmental samples were obtained from the nasal passageways of 12 surgeons and veterinary assistants and from 29 hand-touch sites of instruments in operative units and subjected to bacterial isolation and enumeration. Swab samples were collected in triplicate from 29 dogs and three cats at the site of incision, from the incision area, from the peritoneum during surgery and from the peritoneum before suture. MRCoPS were identified by mecA gene detection and characterized by their antibiogram profile, SCCmec type and pulsed-field gel electrophoresis. Twenty-four staphylococci were isolated, derived from one veterinary assistant, 12 operating room floor areas and hand-touch sites, three dogs and one cat. Methicillin-resistant S. pseudintermedius (MRSP) was found on an electric clipper and rebreathing circuits in the operating room. Three dogs were positive for MRSP during surgery, and one methicillin-resistant S. aureus (MRSA) was detected in a cat. All MRCoPS were resistant to doxycycline, erythromycin, clindamycin and enrofloxacin, but no patients developed surgical site infections. According to their genotypic patterns, the clones obtained from the environment and human sources differed from the animal clones. Despite intensive hygienic management, a variety of MRCoPS clones were present within the surgical unit and during surgery.

The term 'malnutrition' is a broad term used to describe any imbalance in the diet. In 2009 it was confirmed that malnutrition is an urgent health problem. The reasons for which malnutrition may develop are different. Loss on cellular, physical and physiological level happens as a consequence of malnutrition. Studies show that in surgical practice there is malnutrition in 50% of patients and that there is an association between inadequate nutritional status and surgical result. It leads to prolonged treatment, increasing of the level of morbidity and mortality, increased hospital costs, etc. Sometimes malnutrition is unrecognised, untreated and worsened in hospitals. For this reason this paper will elaborate: nutrition and a surgical patient, assessment of a nutritional status, assessment of energy requirements, and enteral and parenteral nutrition in order to determine the conditions and procedures that affect the appearance, recognition and treatment of malnutrition.

Objective: To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients. Background: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described. Methods: This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring. Results: The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%-22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%-20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%-3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46-25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1-29.1) and without an ischemic feature (12.2%; 95% CI, 5.3-25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6-82.4). Conclusions: Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.

WOS: 000401428700032, PubMed: 27083462, Transanal endorectal pull-through (TEPT) is the latest advancement in the treatment of Hirschsprung's disease (HD). The aim of this study was to evaluate the safety and efficacy of TEPT as a definitive treatment for patients with HD. A retrospective study of 50 patients who underwent TEPT at Uludag University, Bursa, Turkey, between June 2001 and April 2012 was conducted. These patients were evaluated with regard to their age, sex, preoperative findings, and length of the aganglionic segment, intraoperative and postoperative complications, and results of the follow-up. Forty-three patients were boys and seven were girls. The median age was 3 months (range 0-96 months). The most common symptoms were abdominal distention and vomiting. HD was diagnosed in 38 patients using barium enema and anorectal manometry, in 11 patients using rectal biopsy, and in 1 patient using laparotomy with biopsy. The mean time from the beginning of enteral feeding was 2.2 +/- 1.1 days. The mean follow-up period was 26.7 +/- 20.8 months. The postoperative complications included transient perianal excoriation in 12 patients, enterocolitis in 10, anastomotic stricture in 3, soiling in 3, recurrent constipation in 2, prolapse of the pulled through colon in 1, anastomotic leak in 1, and rectovestibular fistula in 1 patient. TEPT is a feasible and safe procedure in children with rectosigmoid HD.

Purpose:Methylphenidate (MPH) derivative drugs are used because of psychostimulants effects on attention-deficit hyperactivity disorder in children and adults. As far as we know, toxic or anti-proliferative effects of MPH against cartilage tissue were not studied in the literature. The present study was carried out to investigate the possible effects of MPH on the proliferation, viability and differentiation of primary human chondrocytes, in vitro.Methods:Monolayer primary chondrocyte cultures were prepared using osteochondral tissue obtained from patients who underwent a total knee prosthesis operation. Stock solution of MPH was prepared and aliquots having 1–1000 µM concentrations of the drug was composed. These solutions were applied to the wells containing cultured chondrocyte samples within the well plates. Control groups were composed of pure chondrocyte culture and no solution was added into them. All groups were evaluated at 24, 48 and 72 h in order to determine the possible negative effects of the drug on the chondrocytes. The data were evaluated by Tukey’s honestly significantly different test following analysis of variance.Results:In the group where MPH was applied, it was found that viability, proliferation and stage-specific embryonic antigen-1 protein expression were decreased in comparison to the control group.Conclusions:It was emphasized that clinicians should not disregard the fact that this drug might suppress chondrocyte cell proliferation and chondrogenic differentiation.

Background The use of a prophylactic antibiotic in an amputation surgery is a key element for the successful recovery of the patient. We aim to determine, from the perspective of the Colombian health system, the cost-effectiveness of administering a prophylactic antibiotic among patients undergoing lower limb amputation due to diabetes or vascular illness in Colombia. Methods A decision tree was constructed to compare the use and nonuse of a prophylactic antibiotic. The probabilities of transition were obtained from studies identified from a systematic review of the clinical literature. The chosen health outcome was reduction in mortality due to prevention of infection. The costs were measured by expert consensus using the standard case methodology, and the resource valuation was carried out using national-level pricing manuals. Deterministic sensitivity, scenarios, and probabilistic analyses were conducted. Results In the base case, the use of a prophylactic antibiotic compared with nonuse was a dominant strategy. This result was consistent when considering different types of medications and when modifying most of the variables in the model. The use of a prophylactic antibiotic ceases to be dominant when the probability of infection is greater than 48%. Conclusions The administration of a prophylactic antibiotic was a dominant strategy, which is a conclusion that holds in most cases examined; therefore, it is unlikely that the uncertainty around the estimation of costs and benefits change the results. We recommend creating policies oriented toward promoting the use of a prophylactic antibiotic during amputation surgery in Colombia. © 2016 Elsevier Inc.

Objective To investigate the effects of hysterectomy and/or oophorectomy on sexual satisfaction. Methods Forty sexually active women underwent a hysterectomy and/or oophorectomy, for benign gynecological diseases. Patients were interviewed 15 days prior to their operation and again in the 3rd and 6th months after the surgical procedure. Depressive symptoms, anxiety symptoms and sexual satisfaction were measured by the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Golombock Rust Inventory of Sexual Satisfaction (GRISS), respectively. Repeated-measures analyses of variance (ANOVA) examined alterations in anxiety, depression and sexual satisfaction. Independent t-test and Mann-Whitney U tests compared the numerical data. Results The women had mild depressive symptoms before the surgery; however, these symptoms lessened between 3 and 6 months after the surgery. Similarly, the level of anxiety symptoms decreased during the postoperative period. Based on the GRISS cut-off point, it was found that the patients had problems in the sub-dimensions of frequency, communication, and avoidance in the pre-operative period. This pre-existing sexual dissatisfaction continued after the surgery, and sensuality and anorgasmia problems increased. Satisfaction, sensuality, avoidance and anorgasmia GRISS scores were significantly higher after the operation than before. Therefore, the patients' sexual satisfaction was decreased after the operation. Conclusions Patients were dissatisfied with frequency and communication, and they had high levels of avoidance before operation. In the postoperative period, sexual dissatisfaction increased. Although depression and anxiety decreased after the operation, we found that hysterectomy and/or oophorectomy had negative effects on sexual satisfaction. © 2011 International Menopause Society.

ObjectiveThe study describes the clinical characteristics, bacteriology and risk factors for mortality of patients with necrotizing fasciitis (NF), seen in a university medical centre.MethodsThe medical charts of NF patients admitted to the institution from January 2004 to July 2007 were retrieved and reviewed retrospectively.ResultsThe majority of the 67 patients included in the study presented with localized nonspecific inflammatory manifestations: tenderness (94%), warmth (86%), oedema (76%), skin necrosis (75%), and ulceration (68%). Diabetes mellitus (22%) was the most common predisposing medical condition. The most frequent isolates were Escherichia coli (44%), Acinetobacter baumannii (19%), Staphylococcus aureus (15%) and Enterococcus faecium (15%). Overall mortality rate was 36%. Risk factors significantly associated with mortality were truncal involvement (p = 0.034), leukocytosis (p = 0.038), acidosis (p = 0.001), hypoalbuminaemia (p = 0.004), hypocalcaemia (p = 0.000) and hyponatraemia (p = 0.023). Logistic regression analysis revealed acidosis [p < 0.05, odds ratio (OR) = 9] and hypoalbuminaemia (p < 0.05, OR = 14) as significant independent risk factors for mortality.ConclusionThe identified risk factors can inform clinicians of increased mortality risks for certain patients with NF. They should serve as a trigger for more aggressive surgical and critical care, and antimicrobial therapy for these patients.

Introduction: Pharmacological prophylaxis for venous thromboembolism is recommended for the vast majority of patients undergoing major orthopedic surgery. Increased risk of bleeding after the use of these agents has been widely documented in general population. Conversely, the frequency of this complication has not been studied in the subpopulation of elderly patients. The purpose of this study is to determine whether the risk of major bleeding after major orthopedic surgery is higher in elderly patients, compared to those operated at a younger age. Methods: We performed a retrospective cohort study including patients who underwent total hip and total knee arthroplasty during five consecutive years. Patients with other causes of bleeding were excluded. Medical records were reviewed in order to determine the occurrence and manifestation of major bleeding. A nested case-control analysis was used to determine which age group had the greatest odds ratio (OR) for major bleeding. Then, we compared two cohorts grouped by age. Relative risks (RR) and confidence intervals (CI) were calculated and a multivariate analysis was performed. Results: A total of 1048 patients were included in the analysis. Of these, 56% corresponded to hip joint replacements and 44% to knee joint replacements. The case control analysis reported that patients who were 70 years or older at the time of surgery had the highest OR (2.61) for major bleeding, therefore a limit of 70 years old was established to create two cohorts. At the time of surgery 553 (53%) patients were 70 years or older while 495 (47%) were younger. Patients who were ≥70 years old showed an increased risk of major bleeding: RR 2,42 (95% CI: 1.54-3.81). After total hip arthroplasty the RR was 2,61 (95%CI: 1.50-4.53) and after total knee arthroplasty was 2.25 (95% CI: 1.03-4.94). After the multivariate analysis, age continued to be independently associated with a higher risk of major bleeding. Conclusion: This study allows to conclude that patients who are 70 years or older are at a higher risk of major bleeding after major orthopedic surgery than younger patients. Therefore, the use of appropriate strategies to mitigate the risk in this group of patients is encouraged

High efficiency leukocyte reducing filters can remove more than 99.9- 99.99% of white cells from cellular blood components and are considered to be effective in decreasing HLA alloimmunization of patients with haematological malignancies. A multi-institution study was performed to determine whether white cell filtration would also be effective in preventing alloimmunization in surgical transfu­ sion recipients. Patients who were to receive red cell blood transfusions during and/ or within 48 hours after surgery were randomly assigned to receive red cells/ fresh frozen plasma that had been leukoreduced using a high efficiency filter at the bedside or buffycoat-depleted red cells transfused through an aggregate filter. Of 87 patients with no alloantibodies at entry, 17% (8/47) of those in the leukoreduction group, who received a mean of 0.3 X 10 6 leukocytes as a result of their transfusions, produced lymphocytotoxic antibodies at day 14 after transfusion, compared to 5% (2/40) in the buffycoat-depleted group, who had received a mean of 1,234.2 X 10 6 leukocytes. This difference in the .alloimmunization rate between the two arms was not statistically significant. Reduction of leukocytes by bedside filtration does not appear to be effective in preventing HLA alloimmunization in surgical transfusion recipients. The alloim­ munized cases suggest that an indirect allorecognition pathway may be involved in the formation of anti-HLA. Further measures are needed to reduce alloimmuniza­ tion of immunocompetent patients.

Objective: Although numerous studies have assessed patient satisfaction in diverse settings, in the realm of nursing surgical care, standardization of measurement for patient experience and satisfaction is lacking. Therefore, the aim of this study was to assess the satisfaction of surgical patients with perioperative nursing care. Method: A descriptive cross-sectional survey was conducted. Sociodemographic characteristics and clinical data were recorded. Patient satisfaction was measured with a modified version of the La Monica–Oberst Patient Satisfaction Scale (LOPSS-12). Results: 150 patients (73 women, 49% and 77 men; 51%) completed the survey. The mean age was 63 years (standard deviation, 16 years). The mean overall satisfaction score on the La Monica–Oberst Patient Satisfaction Scale was 3.17 (standard deviation, 0.21). The scale showed adequate content validity (Lawshe’s Content Validity Index was 0.76) and moderate reliability (Cronbach’s alpha = 0.70). Two variables—patient sex and the presence of comorbidities—were significantly associated with overall satisfaction: men and patients with comorbidities were more satisfied with the care received. Patients with university studies were significantly more likely than patients with less education to consider nurses “impatient,” but also considered the nurses’ advice to be “useful.” Patients with hospital-acquired complications were more likely to perceive nurses to be “more interested in completing tasks than in listening,” although they also felt that nurses worked “conscientiously.” Conclusion: Overall, patient satisfaction with perioperative nursing care was good. This study identified several areas of nursing care in need of improvement, particularly the need to spend more time with patients and to keep them better informed about the perioperative process. The modified La Monica–Oberst Patient Satisfaction Scale is suitable for measuring surgical patient satisfaction with perioperative nursing care. The findings presented here may be of value to nursing administrators, educators, and nursing care providers to improve patient satisfaction and to develop strategies to prevent patient dissatisfaction.

Background: Untreated postoperative urinary retention can result in permanent lower urinary tract dysfunction and can be prevented by timely bladder catheterization. The author hypothesized that the incidence of postoperative bladder catheterization can be decreased by using the patient's own maximum bladder capacity (MBC) instead of a fixed bladder volume of 500 ml as a threshold for catheterization. Methods: Randomized parallel-arm and single-blinded comparative effectiveness trial conducted in 1,840 surgical patients, operated under general or spinal anesthesia without an indwelling urinary catheter. Patients were randomized to either use their individual MBC (index) or a fixed bladder volume of 500 ml (control) as a threshold for postoperative bladder catheterization. Preoperatively, the MBC was determined at home by voiding in a calibrated bowl. All other bladder volumes were measured by ultrasound. Postoperatively, bladder catheterization was performed when spontaneous voiding was impossible, and the ultrasound measurement exceeded the threshold for the group in which the patient was randomized (500 or MBC). The primary outcome was the incidence of bladder catheterization. Results: The average MBC in the control group was 582 ml (199 ml) and in the index group 611 ml (+/- 209 ml). The incidence of catheterization decreased from 11.8% (107 of 909 patients) in the control group to 8.6% (80 of 931) in the index group (relative risk 0.73, 95% CI 0.55 to 0.96, P = 0.025). There were no adverse events in either group. Conclusions: In patients undergoing surgery under general or spinal anesthesia using the MBC rather than a fixed 500 ml threshold for bladder catheterization is a safe approach that significantly reduces the incidence of postoperative bladder catheterizations.

Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS.Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures.Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed.Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation.

Study Objective: To compare the recovery characteristics of two widely used anesthetic techniques: remifentanyl-propofol and sevoflurane-fentanyl in a standardized ambulatory population. Design: Randomized, single-blinded study. Setting: University-affiliated medical center. Patients: 50 ASA physical status I and II patients undergoing elective ambulatory otorhinolaryngeal surgery. Interventions: Patients were randomized two groups to receive total intravenous anesthesia (TIVA group) with remifentanil and propofol or sevoflurane-fentanyl (SF group). TIVA patients received induction with propofol 1.5 mg/kg intravenously (IV) and remifentanil 0.5 ?/kg IV. The anesthesia was continued with a continuous infusion of propofol 100 ?g/kg/min and remifentanil 0.0625-0.25 ?g/kg/min. The SF group received, at induction, fentanyl 2 ?g/kg followed by propofol 1.5 mg/kg IV. Maintenance was obtained with 1 to 1.5 minimum alveolar concentration of sevoflurane and bolus of fentanyl 1 ?g/kg IV as needed. Measurements and Main Results: Early recovery times (eye opening, response to commands, extubation, orientation, operating room stay after surgery, and Aldrete score ?9) and patient satisfaction were similar between the two groups. Postanesthetic discharge scoring system (PADSS) ? 9 was significantly shorter for the TIVA group (135.9 ± 51 vs. 103 ± 32 min) (p less than 0.01) but this difference was not associated with a shorter postanesthesia care unit (PACU) length of stay. Conclusion: Early recovery times are comparable between total intravenous anesthesia and sevoflurane-based anesthesia. Even though patients in the TIVA group achieved home readiness criteria in a significantly shorter time, this technique does not shorten PACU length of stay, which depends instead on multiple nonmedical and administrative issues. © 2002 by Elsevier Science Inc.

Objective There are a few scoring systems in emergency departments (ED) to establish critically ill patients quickly and properly and to predict hospitalisation. We aim to compare the efficacy of Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) on in-hospital mortality, and as predictor of hospitalisation in general medical and surgical patients admitted to ED. Methods This is a prospective, multicentre and observational cohort study. The study included general medical and surgical patients admitted to the EDs of three education and research hospitals during a period of 6 months. The primary outcome of the study is the admission of the patient to a ward/an intensive care unit (ICU)/high dependency unit (HDU) and in-hospital mortality. Receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare the performances of two scores. Results Total patients were 2000 (51.95% male, 48.05% female). The mean age was 61.41±18.92. Median MEWS and REMS values of the patients admitted to the ICU/HDU from ED were 1 and 6, respectively; and there was a significant difference in terms of REMS values, compared with patients discharged from ED. REMS (area under the curve (AUC): 0.642) was found to have a better predictive strength than MEWS (AUC: 0.568) in discriminating in-patients and discharged patients. Additionally, REMS (0.707) was superior to MEWS (AUC 0.630) in terms of predicting in-hospital mortality of patients presenting to ED. Conclusions The efficiency of REMS was found to be superior to MEWS as a predictor of in-hospital mortality and hospitalisation in medical and surgical patients admitted to ED.

The primary aim of this study is to evaluate the effects of previous abdominal surgery on the feasibility of performing and the safety of total laparoscopic hysterectomy (TLH).In this retrospective study, we analysed 62 laparoscopic hysterectomies which were performed at our institute between February 2011 and January 2013. We chose to perform laparoscopic surgery for all patients, including those who had previously undergone abdominal surgery. The patients were classified into two groups: Group 1 included patients with a history of abdominal surgery (n=24) and Group 2 included patients without a history of abdominal surgery (n=38).THE OPERATING PERIOD WAS COMPARED IN BOTH GROUPS: 184.43±51.0 min. for Group 1 and 195.41±64.1 min. for Group 2 (p=0.471). Postoperative hospital stay and blood loss was also compared. There was just 1 conversion from TLH to a laparotomy in both groups. None of the patients in Group 1 needed a blood transfusion, whereas 1 in Group 2 did.We found that operation time, postoperative hospital stay, blood loss, rate of operative complications or conversion rate to open surgery between patients with and without a history of abdominal surgery were comparable. Therefore, it appears that a history of abdominal surgery does not adversely affect the safety of TLH.Bu çalışmanın öncelikli amacı, daha önce geçirilmiş abdominal cerrahinin, total laparoskopik histerektomi (TLH) yapılabilirliği ve güvenliği üzerine etkisini değerlendirmektir.Bu retrospektif çalışmada, Şubat 2011 ve Ocak 2013 tarihleri arasında kurumumuzda gerçekleştirilen 62 TLH operas-yonun kayıtları incelendi. Laparoskopik cerrahiyi, geçirilmiş abdominal cerrahisi olsa da tüm hastalarda düşündük. Hastalar iki gruba ayrıldı. Grup 1 geçirilmiş abdominal cerrrahisi olanları, Grup 2 geçirilmiş abdominal cerrahisi olmayanları içerdi.Operasyon süresi her iki grupta da karşılaştırılabilirdi (184.43±51.0 dk. Grup1 ve 195.41±64.1 dk. Grup 2; p=0.471). İki grup arasında intraoperatif komplikasyon açısından anlamlı fark bulunmadı. Operasyon sonrası hastanede kalış süresi ve kan kaybı da karşılaştırılabilirdi. Her iki grupta da sadece 1 vakada laparotomiye geçiş yapıldı. Grup 1’de hiçbir hastada kan transfüzyonu ihtiyacı olmazken, Grup 2’de 1 hastada oldu.Çalışmamızda cerrahi geçirmiş ve geçirmemiş olan grup arasında, operasyon süresi, postoperatif kalış süresi, kan kaybı, operatif komplikasyon oranı veya açık cerrahiye geçiş oranı karşılaştırabilir bulundu. Sonuç olarak, abdominal cerrahi hikayesinin olması TLH nin güvenliğini olumsuz etkilememektedir.

Background Adverse drug events (ADEs) are a considerable cause of inhospital morbidity and mortality. Patient flow differs substantially for surgical and nonsurgical patients: surgical patients are subjected to multiple medication changes related to surgical intervention or postoperative care. The objective of this study is to systematically review the occurrence and nature of ADEs in surgical patients. Also, a comparison with nonsurgical patients was made. Methods A search was conducted in Embase and Medline identifying studies that reported observational data on the occurrence and nature of ADEs in surgical hospitalised adult patients. If sufficient data were available, the occurrence of (preventable) ADEs was compared between surgical and nonsurgical patients. Results Six studies fulfilled the inclusion criteria. The occurrence of ADEs in surgical patients ranged from 2.0 to 27.7 per 100 admissions, from 4.7 to 8.9 per 1,000 patient days, or involved 8.9% of the patients. Proportions of preventable ADEs in surgical patients were 18% and 54%, described in two studies. A head-to-head comparison of surgical patients and nonsurgical patients was possible for five of six studies. The occurrence of ADEs in nonsurgical patients was significantly higher than in surgical patients in three studies. Conclusions ADEs are a relevant problem in surgical patients and nonsurgical patients, with a high proportion of preventable ADEs. The occurrence of ADEs appears to be higher in nonsurgical patients than in surgical patients. However, studies lack details on the differences in nature of ADEs between hospital populations. To improve medication safety this knowledge is essential.

Backgrounds and aims: Paraoxonase 1 (PON1) is a novel marker that has been shown to exert protective functions on atherosclerosis by preventing oxidative modification of serum lipoproteins. In this study, we investigated the effects of PON1 on CA-IMT in renal transplant patients. Methods: A total of 98 adult renal transplant recipients was enrolled in the study. CA-IMT was determined by B-mode Doppler ultrasonography. PON1 activity was assessed by the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. Results: Mean age was 39.4 ± 9.6 years and 10% of the patients were diabetic. Time after transplant was 76 ± 59 months. Mean PON1 level was 62.1 ± 43.3 U/l. PON1 levels were negatively correlated with CA-IMT and positively with HDLcholesterol. Mean CA-IMT was 0.62 ± 0.10 mm (0.40-0.98). CA-IMT was positively correlated with age, male gender and negatively with proteinuria and PON1 levels. In linear regression analysis, PON1 levels were associated with CA-IMT. Conclusion: Reduced PON1 activity is significantly associated with increased carotid atherosclerosis in renal transplant patients. © 2013 Dustri-Verlag Dr. K. Feistle.

Background and purpose: Health-related quality of life (HRQoL) instruments have been of increasing interest for evaluation of medical treatments over the past 10-15 years. In this prospective, long-term follow-up study we investigated the influence of preoperative factors and the change in HRQoL over time after lumbar disc herniation surgery. Methods: 117 patients surgically treated for lumbar disc herniation (L4-L5 or L5-S1) were evaluated with a self-completion HRQoL instrument (EQ-5D) preoperatively, after 2 years (96 patients) and after 7 years (89 patients). Baseline data (age, sex, duration of leg pain, surgical level) and degree of leg and back pain (VAS) were obtained preoperatively. The mean age was 39 (18-66) years, 54% were men, and the surgical level was L5-S1 in 58% of the patients. The change in EQ-5D score at the 2-year follow-up was analyzed by testing for correlation and by using a multiple regression model including all baseline factors (age, sex, duration of pain, degree of leg and back pain, and baseline EQ-5D score) as potential predictors. Results: 85% of the patients reported improvement in EQ-5D two years after surgery and this result remained at the long-term follow-up. The mean difference (change) between the preoperative EQ-5D score and the 2-year and 7-year scores was 0.59 (p < 0.001) and 0.62 (p < 0.001), respectively. However, the HRQoL for this patient group did not reach the mean level of previously reported values for a normal population of the same age range at any of the follow-ups. The changes in EQ-5D score between the 2- and 7-year follow-ups were not statistically significant (mean change 0.03, p = 0.2). There was a correlation between baseline leg pain and the change in EQ-5D at the 2-year (r = 0.33, p = 0.002) and 7-year follow-up (r = 0.23, p = 0.04). However, when using regression analysis the only statistically significant predictor for change in EQ-5D was baseline EQ-5D score. Interpretation: Our findings suggest that HRQoL (as measured by EQ-5D) improved 2 years after lumbar disc herniation surgery, but there was no further improvement after 5 more years. Low quality of life and severe leg pain at baseline are important predictors of improvement in quality of life after lumbar disc herniation surgery. CC BY NC

JUSTIFICATIVA E OBJETIVOS: Avaliar a sedação, a pressão intraocular e as alterações hemodinâmicas com o uso de doses baixas de clonidina, 100 µg e 200 µg por via oral, como medicação pré-anestésica para operações de catarata em regime ambulatorial. MÉTODO: O trabalho foi realizado pela Universidade Federal de São Paulo, sendo um estudo clínico aleatório e duplamente encoberto em 60 pacientes, de ambos os sexos, estado físico ASA 1 e 2, com idade mínima de 18 anos e máxima de 80 anos. Os pacientes foram divididos em três grupos: placebo, clonidina 100 µg e 200 µg. As medidas de pressão intraocular, frequência cardíaca e pressão arterial, além da avaliação de sedação, foram feitas antes e após 90 minutos da administração da clonidina. Os níveis de sedação foram classificados de acordo com a escala de sedação de Ramsay. RESULTADOS: Pacientes que receberam placebo e 100 µg de clonidina não apresentaram redução da frequência cardíaca com diferença estatística significativa, enquanto os que receberam 200 µg de clonidina, sim. Os que receberam clonidina na dose de 200 µg apresentaram redução na pressão arterial sistólica e diastólica (p < 0,05). Um paciente que utilizou 200 µg de clonidina desenvolveu hipotensão arterial grave com pressão sistólica < 80 mmHg. Os pacientes tratados com clonidina apresentaram redução da pressão intraocular (p < 0,05). Quanto à sedação, 90 minutos após a administração de placebo e clonidina 100 µg e 200 µg por via oral, 25%, 60% e 80% dos pacientes encontravam-se, respectivamente, em Ramsay 3 ou 4. CONCLUSÕES: A dose de 100 µg de clonidina pode ser indicada como medicação pré-anestésica para facectomia, possuindo efeito na sedação, diminuição da pressão intraocular e ausência de efeitos adversos na pressão arterial sistêmica e frequência cardíaca. BACKGROUND AND OBJECTIVES: The objective of the present study was to evaluate the degree of sedation, intraocular pressure, and hemodynamic changes with premedication with low doses of oral clonidine, 100 µg and 200 µg, in outpatient cataract surgeries. METHODS: This is a randomized, double-blind, clinical study undertaken at the Universidade Federal de São Paulo with 60 patients of both genders, physical status ASA 1 and 2, ages 18 to 80 years. Patients were separated into three groups: placebo, clonidine 100 µg, and clonidine 200 µg. Intraocular pressure, heart rate, and blood pressure besides assessment of sedation were measured before and 90 minutes after the administration of clonidine. Sedation levels were classified according to the Ramsay sedation scale. RESULTS: Patients who received placebo and 100 µg of clonidine did not show reduction in heart rate, while a reduction in heart rate was observed in patients who received 200 µg of clonidine, and this difference was statistically significant. Patients who received 200 µg of clonidine also had a reduction in systolic and diastolic blood pressure (p < 0.05). One patient who received 200 µg of clonidine developed severe hypotension, with systolic pressure < 80 mmHg. Patients treated with clonidine had a reduction in intraocular pressure (p < 0.05). Ninety minutes after the oral administration of placebo and 100 µg and 200 µg of clonidine, 25%, 60%, and 80% of the patients respectively were classified as Ramsay 3 or 4. CONCLUSIONS: Clonidine 100 µg can be indicated as premedication for fasciectomies, being effective in sedation and reduction of intraocular pressure, without adverse effects on blood pressure and heart rate. JUSTIFICATIVA Y OBJETIVOS: Evaluar la sedación, la presión intraocular y las alteraciones hemodinámicas con el uso de bajas dosis de clonidina, 100 µg y 200 µg por vía oral, como medicación preanestésica para operaciones de catarata en el ambulatorio. MÉTODO: El trabajo fue realizado por la Universidad Federal de São Paulo, siendo un estudio clínico aleatorio y doble ciego en 60 pacientes de los dos sexos, estado físico ASA 1 y 2, con edad mínima de 18 años y máxima de 80 años. Los pacientes fueron divididos en tres grupos: placebo, clonidina 100 µg y 200 µg. Las medidas de presión intraocular, frecuencia cardiaca y presión arterial, además de la evaluación de sedación, fueron hechas antes y después de los 90 minutos iniciales en que se administró la clonidina. Los niveles de sedación se clasificaron de acuerdo con la escala de sedación de Ramsay. RESULTADOS: Los pacientes que recibieron placebo y 100 µg de clonidina, no presentaron una reducción de la frecuencia cardiaca con diferencia estadística significativa, mientras que los que recibieron 200 µg de clonidina, sí la presentaron. Los que recibieron clonidina en dosis de 200 µg presentaron una reducción en la presión arterial sistólica y diastólica (p < 0,05). Un paciente que utilizó 200 µg de clonidina, debutó con hipotensión arterial grave y presión sistólica < 80 mm Hg. Los pacientes tratados con clonidina, presentaron una reducción de la presión intraocular (p < 0,05). En cuanto a la sedación, 90 minutos después de la administración del placebo y la clonidina 100 µg y 200 µg por vía oral, 25%, 60% y 80% de los pacientes estaba respectivamente en Ramsay 3 ó 4. CONCLUSIONES: La dosis de 100 µg de clonidina puede ser indicada como una medicación preanestésica para facectomía, con efecto en la sedación, reducción de la presión intraocular y ausencia de efectos adversos en la presión arterial sistémica y en la frecuencia cardiaca.

Midazolam has only sedative properties. However, dexmedetomidine has both analgesic and sedative properties that may prolong the duration of sensory and motor block obtained with spinal anesthesia. This study was designed to compare intravenous dexmedetomidine with midazolam and placebo on spinal block duration, analgesia, and sedation in patients undergoing transurethral resection of the prostate. In this double-blind randomized placebo-controlled trial, 75 American Society of Anesthesiologists' I and II patients received dexmedetomidine 0.5 mu g center dot A kg(-1), midazolam 0.05 mg center dot A kg(-1), or saline intravenously before spinal anesthesia with bupivacaine 0.5% 15 mg (n = 25 per group). The maximum upper level of sensory block and sensory and motor regression times were recorded. Postoperative analgesic requirements and sedation were also recorded. Sensory block was higher with dexmedetomidine (T 4.6 +/- A 0.6) than with midazolam (T 6.4 +/- A 0.9; P < 0.001) or saline (T 6.4 +/- A 0.8; P < 0.001). Time for sensory regression of two dermatomes was 145 +/- A 26 min in the dexmedetomidine group, longer (P < 0.001) than in the midazolam (106 +/- A 39 min) or the saline (97 +/- A 27 min) groups. Duration of motor block was similar in all groups. Dexmedetomidine also increased the time to first request for postoperative analgesia (P < 0.01 compared with midazolam and saline) and decreased analgesic requirements (P < 0.05). The maximum Ramsay sedation score was greater in the dexmedetomidine and midazolam groups than in the saline group (P < 0.001). Intravenous dexmedetomidine, but not midazolam, prolonged spinal bupivacaine sensory blockade. It also provided sedation and additional analgesia.

Frequency and Pattern of Endoscopic Recurrence in Crohn's Disease Patients With Ileocolonic Resection Using a Laparoscopic Versus Laparotomic Approach: A Prospective Longitudinal Study

Background: Factors affecting the mortality in elderly patients vary among different studies. This study investigates the influence of the patient-related factors, especially the effect of the diseased organ system on the mortality risk in the elderly. Methods: Records of 942 operated patients aged 70 years and over were retrospectively examined. Age, sex, site of the diseased organ system, type of admission, benign/malign nature, American Society for Anesthesiologists (ASA) score, main surgical diagnosis, method of surgical therapy and concomitant diseases were examined for their influence on the mortality. Results: There were 501 men and 441 women. Mean age was 75.5 years. Most of the patients had colorectal pathologies. Emergency surgery was carried out in 313 patients. Mortality rate was 11.8%. Cardiogenic shock was the leading cause of mortality. There was a strong linear correlation between ASA score and mortality. Logistic regression analysis concluded that higher (≥3) ASA scores, operations under emergent conditions and diseases of the colorectal and upper gastrointestinal systems were significantly associated with higher mortality rates. Conclusion: When combined with ASA score and type of admission, site of the diseased organ system may be a good indicator of mortality in the elderly patients undergoing surgery.

Purpose To evaluate the complications associated with the primary placement of a motility coupling post (MCP) in spherical porous polyethylene (PP) implants at the time of enucleation. Design Retrospective, interventional case series. Methods The records of all patients who had undergone primary enucleation and spherical PP implant with MCP insertion, and who were followed for at least six months were reviewed. The MCP was screwed to a wrapped implant to protrude 3 mm to 4 mm anteriorly. After placing the implant into the orbit, the extraocular muscles were sutured to the implant, and the Tenon capsule and conjunctiva were closed onto the MCP. When the MCP was not exposed spontaneously within two months after surgery, it was externalized with a conjunctival cut-down procedure. Results The study included 52 patients (29 male, 23 female; age range, three to 76 years). The MCP became exposed spontaneously in 10 patients (19%). In the early postoperative period, we recorded nine complications in seven patients (13%), which might be related to primary MCP placement. These included prominent MCP decentration associated with implant motility restriction (6%), preseptal cellulitis (4%), and conjunctival prolapsus (8%). An ocular prosthesis was fit successfully onto the MCP in 51 patients. During the late period, 22 complications occurred in 15 patients (29%), including excessive discharge (15%), MCP decentration (4%), implant exposure (6%), implant infection (2%), pyogenic granuloma (8%), conjunctival overgrowth over the MCP (2%), conjunctival discoloration (4%), and lax eyelid syndrome (2%). Mean follow-up time was 34 months (range, six to 68 months). Conclusions Although MCP placement in the spherical PP implant during enucleation is a useful technique, it may be associated with complications such as MCP decentration, excessive discharge, exposure, and infection of the implant.

Objective: To determine the effect of esmolol on the frequency and severity of pain and withdrawal reactions after injection of rocuronium and to compare it with lidocaine and placebo. Design: Prospective, randomized, double-blind, placebo-controlled study. Setting: Single university hospital. Patients: 120 ASA physical status I and 11 patients undergoing general anesthesia for elective surgery. Interventions: Patients were randomized to receive esmolol (0.5 mg/kg), lidocaine (0.5 mg/kg), or placebo, followed by a subparalyzing dose of rocuronium. After induction of anesthesia with propofol and fentanyl, an intubating dose of rocuronium 0.6 mg/kg was given. Measurements: Patients were observed after injection of rocuronium 0.05 mg/kg, then immediately asked if they had pain in the arm. The response was assessed; discomfort, pain, and withdrawal of the hand were recorded and graded using a 4-point scale (none, mild, moderate, or severe). After the intubating dose of rocuronium, withdrawal reactions were scored as follows: (a) no pain response, (b) pain limited to the wrist, (c) pain limited to the elbow/shoulder, or (d) generalized pain response. Results: 31 patients (77.5%) in the esmolol group, 32 (80%) in the lidocaine group, and 15 (37.5%) in the placebo group reported no pain (both groups vs placebo, P < 0.001). Moderate pain was seen in only one patient receiving lidocaine, in 6 placebo patients, but in none in the esmolol group (esmolol vs placebo, P < 0.05). Severe pain was felt by 8 patients receiving placebo, but by none receiving esmolol or lidocaine (P < 0.01). Frequency of withdrawal response after rocuronium was 2.5%, 17.5%, and 40% in the esmolol, lidocaine, and placebo groups, respectively (esmolol group vs placebo, P < 0.001; lidocame group vs placebo, P < 0.05). Conclusion: Esmolol, like lidocame, reduces the frequency of pain and withdrawal reaction associated with rocuronium injection.

Local injection of infliximab in Crohn's disease (CD) lesions may reduce the risk of rare side effects, reduce the dose, and increase the efficacy of the drug. The objective was to prospectively assess the feasibility and the safety of local injection of infliximab for the postoperative recurrence of patients with CD who were followed for at least 1 year.In a pilot, open-label study, 8 patients with CD (3 men; median age 48 years, range 35-82 years) undergoing ileocolonoscopy were prospectively enrolled. Inclusion criteria included the following: (1) localized (5 cm) recurrence, (2) inflammatory pattern, and (3) clinically inactive CD. At the first endoscopy, lesions were injected with infliximab (median, 30 mg; range, 8-60 mg); a control endoscopy was performed at 2 weeks in 4 patients (3 received a second injection followed by a control endoscopy at 6 weeks) and at 4 weeks in 4 patients (2 received a second injection followed by a control endoscopy at 8 weeks).No patients showed side effects or clinical relapse in the short term and the long term (median follow-up, 20 months; range, 14-21 months). Endoscopic score improved in 3/8 patients. The histologic scores were reduced in 4 patients, worsened in 3, and were unchanged in one patient with CD.Local injection of infliximab into patients with CD recurrence is feasible and safe, requiring a low dose. Present findings suggest the need of placebo-controlled trials to assess the efficacy of this new and safe procedure in subgroups of patients with CD.

In this study, the psychological effects of single-dose corticosteroids administered to patients who had undergone rhinoplasty were assessed. A total of 30 rhinoplasty patients were included in the study and were randomly assigned to 1 of 2 groups. Preoperatively, patients completed the Bech Rafaelsen Mania Scale and the Beck Depression Inventory. Dexamethasone 10 mg was given intravenously just before surgery to the first group, but no medication was administered to the second group. On the first postoperative day, patients were seen again, and the Bech Rafaelsen Mania Scale and the Beck Depression Inventory were again completed. Periorbital edema and ecchymosis were graded, and psychological well-being was measured on a standard visual analog scale. All patients and physicians were blinded to treatment until the end of the study. Results show that administration of a single-dose of dexamethasone 10 mg caused neither euphoria nor depression. No significant differences were observed between steroid and control groups in terms of patients' psychological well-being. With single-dose dexamethasone, periorbital edema was significantly reduced on the first 2 postoperative days, and upper eyelid ecchymosis was significantly decreased only on the first postoperative day. However, preoperative steroid administration had no influence on ecchymosis of the lower eyelid. The authors conclude that single-dose dexamethasone 10 mg can be used safely to reduce periorbital edema and ecchymosis in rhinoplasty patients. C1 Pamukkale Univ, Fac Med, Dept Otorhinolaryngol, TR-20010 Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Psychiat, TR-20010 Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Plast Reconstruct & Aesthet Surg, TR-20010 Denizli, Turkey.

35th Annual Meeting of the American-Society-of-Ophthalmic-Plastic-and-Reconstructive-Surgery -- OCT 23, 2004 -- New Orleans, LA Yazici, Bulent/0000-0001-8889-1933 WOS: 000240459300009 PubMed: 16935232 Purpose: To evaluate the technical properties and clinical efficacy of bicanalicular silicone intubation with the Ritleng method in children with congenital nasolacrimal duct obstruction. Methods. The Ritleng method was used for lacrimal intubation in 50 eyes of 42 consecutive patients (mean age, 37.3 months). All procedures were done by or under the supervision of one surgeon. The hollow Ritleng probe was inserted via the canaliculus into the inferior meatus. The polypropylene (Prolene) thread-guide, attached to the silicone tube, was advanced through the probe. Either the Prolene emerged from the nose spontaneously or it was retrieved using a hook without visualization. The tube ends were sutured to the nasal wall. Tube removal was planned for 3 months postoperatively. Resolution of signs and symptoms of lacrimal obstruction was assessed. The mean follow-up time was 18.1 months (range, 3 to 48 months). Results. The silicone tube was placed successfully in all eyes except 1 (98%). The mean procedure time was 26 minutes for each eye (range, 15 to 45 minutes). Both Prolene guides spontaneously emerged from the nose in only 8 eyes (16%). In the others, one or both Prolene guides were retrieved with a hook. Inadvertent tube dislodgement occurred in 21% of the eyes and required early tube removal. Success, ie, relief of signs and symptoms, was achieved in 86% of eyes. Conclusions:The Ritleng method of intubation for congenital nasolacrimal duct obstruction yields a high rate of success. Contrary to previous reports, our experience suggests that the surgeon must be prepared to retrieve the Prolene guide from the nose. Amer Soc Ophthalm Plast & Reconstruct Surg

Background General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic pulmonary resection. We assessed in a randomized study the feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Methods Between March 2001 and February 2003, 60 patients were randomized into two 30-patients arms: a general anesthesia arm entailing double-lumen intubation and thoracic epidural anesthesia (control group); and an awake arm entailing sole thoracic epidural anesthesia at T4-T5 (awake group). Anesthesia time; operative time; global operating room time; patient satisfaction with the anesthesia and technical feasibility scored into 4 grades (from 1=poor to 4=excellent); visual analog pain score (VAS), nursing care (number of patient calls per day), 24 hours changes in arterial oxygenation (ΔPaO 2 ), and hospital stay were assessed. Results There was no mortality. There was no difference in technical feasibility between the groups although 2 patients in the awake group required conversion to thoracotomy due to severe adhesions. Other 2 patients in each group required conversion due to unexpected lung cancer requiring lobectomy. Comparisons of awake versus control group results showed that in the awake group, anesthesia satisfaction score was greater (4 vs 3, p = 0.04), whereas ΔPaO 2 (-3 mm Hg vs –6.5 mm Hg, p = 0.002); nursing care (2.5 calls per day vs 4 calls per day, p = 0.0001), and hospital stay (2 days vs 3 days, p = 0.02) were significantly reduced. Conclusions In our study, awake thoracoscopic resection of solitary pulmonary nodules proved safely feasible. It resulted in better patient satisfaction, less nursing care and shorter in-hospital stay than procedures performed under general anesthesia.

Objective: To determine the incidence, reasons and prognosis about Horner's syndrome in thoracic surgical patients. Methods: In this prospective clinical study, 933 adult patients were assessed between the years of 1998 and 2002. All patients who underwent chest tube insertion (n: 662 patients) or thoracotomy (n: 342 patients), or who had thoracic trauma (n: 268 patients) were routinely examined to detect of Horner's syndrome. The patients with Horner's syndrome due to the invasion of malignant tumour to sympathetic chain were not included in the study. Results: Horner's syndrome was detected in twelve patients from these 933 patients (1.3%). The considered etiologic factors were chest tube pressure in five patients, operative complication in two patients and trauma in five patients. In patients with chest tube pressure were fully recovered from Horner's syndrome but the remaining did not. Conclusions: Malposition of the chest tube is an important aetiological factor of Horner's syndrome, and it is reversible if the tube position is corrected urgently. (C) 2003 Elsevier B.V. All rights reserved.

In three clinical centres, we compared a new method for measuring cardiac output with conventional thermodilution. The new method computes beat-to-beat cardiac output from radial artery pressure by simulating a three-element model of aortic input impedance, and includes non-linear aortic mechanical properties and a self-adapting systemic vascular resistance. We compared cardiac output by continuous model simulation (MF) with thermodilution cardiac output (TD) in 54 patients (18 female, 36 male) undergoing coronary artery bypass surgery. We made three or four conventional thermodilution estimates spread equally over the ventilatory cycle. In 490 series of measurements, thermodilution cardiac output ranged from 2.1 to 9.3, mean 5.0 litre min(-1). MF differed +0.32 (1.0) litre min(-1) on average with limits of agreement of -1.68 and +2.32 litre min(-1). Differences decreased when the first series of measurements in a patient was used to calibrate the model. In 436 remaining series, the mean difference became -0.13 (0.47) litre min(-1) with limits of agreement of -1.05 and +0.79 litre min(-1). When consecutive measurements were made, the change was greater than 0.5 litre min(-1), on 204 occasions. The direction of change was the same with both methods in 199. The difference between the methods remained near zero during surgery suggesting that a single calibration per patient was adequate. Aortic model simulation with radial artery pressure as input reliably monitors changes in cardiac output in cardiac surgery patients. Before calibration, the model cannot replace thermodilution, but after calibration the model method can quantitatively replace further thermodilution estimates.

Context and objectives: The appropriate use of antibiotic prophylaxis in the perioperative period may reduce the rate of infection in the surgical site. The purpose of this review was to evaluate adherence to guidelines for surgical antibiotic prophylaxis. Methods: The present systematic review was performed according to the Cochrane Collaboration methodology. The databases selected for this review were: Medline (via PubMed), Scopus and Portal (BVS) with selection of articles published in the 2004–2014 period from the Lilacs and Cochrane databases. Results: The search recovered 859 articles at the databases, with a total of 18 studies selected for synthesis. The outcomes of interest analyzed in the articles were as follows: appropriate indication of antibiotic prophylaxis (ranging from 70.3% to 95%), inappropriate indication (ranging from 2.3% to 100%), administration of antibiotic at the correct time (ranging from 12.73% to 100%), correct antibiotic choice (ranging from 22% to 95%), adequate discontinuation of antibiotic (ranging from 5.8% to 91.4%), and adequate antibiotic prophylaxis (ranging from 0.3% to 84.5%). Conclusions: Significant variations were observed in all the outcomes assessed, and all the studies indicated a need for greater adherence to guidelines for surgical antibiotic prophylaxis. Keywords: Antibiotic prophylaxis, Antimicrobial prophylaxis, Guideline adherence, Surgical patient

O ensino do paciente cirúrgico tem sido considerado como uma estratégia de atuação do enfermeiro, com o objetivo de facilitar a recuperação e minimizar as conseqüências que possam repercutir na qualidade de vida pós-cirúrgica. O objetivo deste estudo é apresentar considerações sobre o ensino do paciente cirúrgico no período perioperatório.

A significant number of surgical patients are at risk of intra- or post-operative complications or both, which are associated with increased lengths of stay, costs, and mortality. Reducing these risks is important for the individual patient but also for health-care planners and managers. Insufficient tissue perfusion and cellular oxygenation due to hypovolemia, heart dysfunction or both is one of the leading causes of perioperative complications. Adequate perioperative management guided by effective and timely hemodynamic monitoring can help reduce the risk of complications and thus potentially improve outcomes. In this review, we describe the various available hemodynamic monitoring systems and how they can best be used to guide cardiovascular and fluid management in the perioperative period in high-risk surgical patients., SCOPUS: re.j, info:eu-repo/semantics/published