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[PMID]: 29505504 [Au] Autor: Bae HS; Lee MY; Park JU [Ad] Endereço: Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Medical Center. [Ti] Título: Intraoperative burn from a grounding pad of electrosurgical device during breast surgery: A CARE-compliant case report. [So] Source: Medicine (Baltimore);97(1):e8370, 2018 Jan. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: RATIONAL: Burns at the site of the return electrode (i.e., grounding pad) are possible effects of electrosurgery. Despite this knowledge, however, ignorance or negligence with regards to proper handling of the grounding pads still often occurs. Burn injuries can be easily prevented by taking the necessary precautions; thus, during plastic surgery, careful attention should to be paid. PATIENT CONCERNS: A 38-year-old female patient was admitted to our ward to be performed augmentation mammoplasty. Before the start of the procedure, the grounding pad was placed on the surgical table and the left calf of the patient was placed on the grounding pad. Before using the endoscope, we found a burn on patient's left calf, where the grounding pad had been placed. DIAGNOSIS: It was a 3-cm-by-3-cm-sized full thickness burn. The surrounding areas had no painful sensation with noninfectious sign. INTERVENTION: Debridement and direct closure was performed with elliptical incision of eschar. OUTCOMES: The patient did not require additional surgical procedure anymore and satisfied with the scar. LESSONS: Through this case, we present the appropriate management of electrical burns from a grounding pad, and emphasize the understanding of the mechanism of burn because of electrosurgery, and how to use the grounding pad optimally to minimize the patient's risk. [Mh] Termos MeSH primário: Queimaduras/etiologia Eletrocirurgia/instrumentação Complicações Intraoperatórias/etiologia [Mh] Termos MeSH secundário: Adulto Feminino Seres Humanos Mamoplastia [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180309 [Lr] Data última revisão: 180309 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180306 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000008370

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[PMID]: 28448298 [Au] Autor: Katz JA; Murphy GS [Ad] Endereço: Northshore University Health System, University of Chicago, Pritzker School of Medicine, Illinois, USA. [Ti] Título: Anesthetic consideration for neuromuscular diseases. [So] Source: Curr Opin Anaesthesiol;30(3):435-440, 2017 Jun. [Is] ISSN: 1473-6500 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: PURPOSE OF REVIEW: The aim of this review is to examine data relating to perioperative management of the patient with neuromuscular disorders RECENT FINDINGS: Patients with pre-existing neuromuscular disorders are at risk for a number of postoperative complications that are related to anesthetic drugs that are administered intraoperatively. Careful preoperative assessment is necessary to reduce morbidity and mortality. In particular, the risk of postoperative respiratory failure and need for long-term ventilation should be reviewed with patients. The use of succinylcholine should be avoided in muscular dystrophies, motor neuron diseases, and intrinsic muscle disease due to a risk of malignant hyperthermia, hyperkalemia, rhabdomyolysis, and cardiac arrest. The use of quantitative neuromuscular monitoring should be strongly considered whenever nondepolarizing neuromuscular blocking agents are administered. A number of case series and reports have been recently published demonstrating that sugammadex can be safely used in patients with neuromuscular disease; the risk of residual neuromuscular is nearly eliminated when this agent is administered intraoperatively. SUMMARY: Careful assessment and management of patients with underlying neuromuscular diseases is required to reduce postoperative complications. This article reviews the anesthetic implications of patients undergoing surgery with neuromuscular disorder. [Mh] Termos MeSH primário: Anestesia/efeitos adversos Anestésicos/efeitos adversos Bloqueadores Neuromusculares/efeitos adversos Doenças Neuromusculares/complicações Assistência Perioperatória/métodos Complicações Pós-Operatórias/etiologia Procedimentos Cirúrgicos Operatórios/efeitos adversos [Mh] Termos MeSH secundário: Anestesia/métodos Anestésicos/administração & dosagem Parada Cardíaca/induzido quimicamente Parada Cardíaca/prevenção & controle Seres Humanos Hiperpotassemia/induzido quimicamente Complicações Intraoperatórias/induzido quimicamente Complicações Intraoperatórias/prevenção & controle Hipertermia Maligna/etiologia Bloqueadores Neuromusculares/administração & dosagem Doenças Neuromusculares/epidemiologia Monitoração Neuromuscular Complicações Pós-Operatórias/prevenção & controle Prevalência Insuficiência Respiratória/prevenção & controle Rabdomiólise/induzido quimicamente Rabdomiólise/prevenção & controle Medição de Risco Succinilcolina/administração & dosagem Succinilcolina/efeitos adversos gama-Ciclodextrinas/administração & dosagem gama-Ciclodextrinas/efeitos adversos [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Anesthetics); 0 (Neuromuscular Blocking Agents); 0 (gamma-Cyclodextrins); 361LPM2T56 (Sugammadex); J2R869A8YF (Succinylcholine) [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180309 [Lr] Data última revisão: 180309 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170428 [St] Status: MEDLINE [do] DOI: 10.1097/ACO.0000000000000466

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[PMID]: 29489689 [Au] Autor: Jiang L; Tao T; Zheng J; Jia Z; Xu H; Ni Y [Ad] Endereço: Department of Cardiothoracic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China. [Ti] Título: Case report of refractory pericardial effusion associated with lymphatic fistula due to surgical injury during sternotomy. [So] Source: Medicine (Baltimore);97(9):e9892, 2018 Mar. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: RATIONALE: A 35-year old Chinese female was admitted to hospital with refractory pericardial effusions 10 days post mitral valve replacement via median sternotomy. We performed an exploratory resternotomy and found lymphatic leakage on the surface of the diaphragm which was continuously emitting a light yellow fluid. PATIENT CONCERNS: The patient complained of no obvious discomfort except for the concern of massive pericardial effusion drainage. DIAGNOSES: Exploratory resternotomy and biochemical testing lead to a supradiaphragmatic lymphatic fistula being diagnosed as the cause of the refractory pericardial effusion. INTERVENTIONS: The fistula was closed with a continuous suture and no other fistulas were found after a thorough exploration. OUTCOMES: The patient was discharged home on postoperative day 5 and recovery was uneventful. LESSONS: In this case a timely exploratory resternotomy proved effective in seeking the cause of and treating pericardial effusion following cardiac surgery. [Mh] Termos MeSH primário: Complicações Intraoperatórias/etiologia Doenças Linfáticas/complicações Derrame Pericárdico/etiologia Fístula do Sistema Respiratório/complicações Esternotomia/efeitos adversos [Mh] Termos MeSH secundário: Adulto Diafragma/patologia Diafragma/cirurgia Drenagem Feminino Seres Humanos Complicações Intraoperatórias/patologia Doenças Linfáticas/patologia Derrame Pericárdico/cirurgia Fístula do Sistema Respiratório/patologia [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180307 [Lr] Data última revisão: 180307 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180301 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000009892

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[PMID]: 28454700 [Au] Autor: Akkermans J; de Vries SM; Zhao D; Peeters SHP; Klumper FJ; Middeldorp JM; Oepkes D; Slaghekke F; Lopriore E [Ad] Endereço: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: j.akkermans@lumc.nl. [Ti] Título: What is the impact of placental tissue damage after laser surgery for twin-twin transfusion syndrome? A secondary analysis of the Solomon trial. [So] Source: Placenta;52:71-76, 2017 Apr. [Is] ISSN: 1532-3102 [Cp] País de publicação: Netherlands [La] Idioma: eng [Ab] Resumo: BACKGROUND: The introduction of the Solomon technique for the treatment of twin-twin transfusion syndrome (TTTS) increased placental exposure to laser energy. This study aims to identify the impact of power and energy used in laser treatment on placental tissue and pregnancy outcome. METHODS: Pictures of all dye-injected placentas since the start of the Solomon trial were analyzed. Placental damage was scored using a grading system including visual scar depth and affected proportion of the vascular equator. Parameters analyzed included laser power and total energy, gestational age (GA) at laser, GA at birth, laser-to-delivery interval and preterm prelabor rupture of membranes (PPROM). RESULTS: We included 122 cases in the analysis. More placental damage occurred more often in the Solomon group (42%) compared to the selective group (15%) (p < 0.001). In multivariate analysis, more placental damage was associated with higher laser energy (regression coefficient B 0.002) but not with higher power setting (regression coefficient B -0.442). More damage was associated with earlier GA at birth (regression coefficient B -0.167), higher incidence of PPROM <32 weeks (regression coefficient B 0.003) and a shorter laser-to-delivery interval (regression coefficient B -0.168). CONCLUSIONS: Placental damage is positively associated with more laser energy but negatively associated with higher power setting. More placental damage was associated with a lower GA at birth, shorter laser-to-delivery interval and higher PPROM rate. Whether these results should lead to a change in surgical technique requires more research, both further ex-vivo experiments on human placentas and clinical studies. [Mh] Termos MeSH primário: Transfusão Feto-Fetal/cirurgia Complicações Intraoperatórias/patologia Terapia a Laser/efeitos adversos Placenta/cirurgia [Mh] Termos MeSH secundário: Adulto Feminino Transfusão Feto-Fetal/patologia Seres Humanos Placenta/irrigação sanguínea Placenta/patologia Gravidez [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180305 [Lr] Data última revisão: 180305 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170430 [St] Status: MEDLINE

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[PMID]: 29465576 [Au] Autor: Diao Y; Sun Y; Wang S; Zhang F; Pan S; Liu Z [Ad] Endereço: Department of Orthopaedics, Peking University Third Hospital, Beijing, China. Beijing Key Laboratory of Spinal Disease, Beijing, China. [Ti] Título: Delayed epidural pseudoaneurysm following cervical laminectomy and instrumentation in a patient with canal stenosis secondary to skeletal fluorosis: A case report. [So] Source: Medicine (Baltimore);97(8):e9883, 2018 Feb. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: RATIONALE: The typical intraoperative presentation of vertebral artery injury (VAI) usually involves profuse bleeding and requires immediate treatment. However, an occult VAI may occur intraoperatively and result in delayed life-threatening epidural pseudoaneurysm several days postoperatively. PATIENT CONCERNS: A 21-year-old man with compressive cervical myelopathy resulting from canal stenosis of skeletal fluorosis underwent decompression of C1 to C7 and instrumentation from C2 to C7. No impressive bleeding event occurred during the operation. On postoperative day 40, progressive quadriplegia developed. DIAGNOSES: Pseudoaneurysm of the VA was established by angiography. INTERVENTIONS: After occlusion of the right VA, the patient underwent hematoma clearing. OUTCOMES: Fortunately, the patient experienced significant recovery of neurologic function after the second surgery. LESSONS: From this case, we realize even in the absence of obvious signs of VAI during a cervical operation, postoperative evaluation should be mandatory for suspected bleeding events occurring at VAI-prone sites during surgery. Moreover, the bone morphological abnormality of skeletal fluorosis was determined to be the most important risk contributing to VAI in this case. The safety limits of bone removal should be determined preoperatively to avoid the effects of bone morphological abnormalities. [Mh] Termos MeSH primário: Falso Aneurisma/etiologia Doenças Ósseas/complicações Vértebras Cervicais/cirurgia Intoxicação por Flúor/complicações Laminectomia/efeitos adversos Compressão da Medula Espinal/cirurgia Estenose Espinal/cirurgia Artéria Vertebral/lesões [Mh] Termos MeSH secundário: Constrição Patológica Seres Humanos Complicações Intraoperatórias Masculino Complicações Pós-Operatórias Compressão da Medula Espinal/etiologia Estenose Espinal/etiologia Adulto Jovem [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180227 [Lr] Data última revisão: 180227 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180222 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000009883

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[PMID]: 29227514 [Au] Autor: Ganesh S; Brar S; Lazaridis A [Ti] Título: Management and Outcomes of Retained Lenticules and Lenticule Fragments Removal After Failed Primary SMILE: A Case Series. [So] Source: J Refract Surg;33(12):848-853, 2017 Dec 01. [Is] ISSN: 1081-597X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: PURPOSE: To describe the management of and report the outcomes following the removal of retained lenticules or lenticule fragments after a complicated small incision lenticule extraction (SMILE). METHODS: Three patients were referred for consultation due to intraoperative complications during SMILE. In case 1, the lenticule was torn during extraction and a central fragment was retained in the pocket. In case 2, the inferior part of the lenticule remained attached at the anterior plane and its detached, superior part was dislocated and folded at the inferior part of the pocket. In case 3, the lenticule was completely attached at the anterior plane. All cases underwent secondary surgery. The lenticule fragment was detached using the dissector's body and tip and was extracted using the advanced lenticule forceps. The retained lenticules were extracted after dissection of tissue bridges at the anterior plane and periphery. RESULTS: Postoperatively, all eyes showed improvement of visual acuity and topographic regularization of the anterior corneal curvature. Complete removal of lenticule remnants was accomplished in cases 1 and 2. In case 3, the photodisruption during primary SMILE was incomplete at a peripheral area next to the incision. A small peripheral fragment, corresponding to the described peripheral area, remained attached after the lenticule removal and was left in situ but did not have any impact on visual acuity and quality. CONCLUSIONS: Retained lenticules or lenticule fragments may induce irregular astigmatism and loss of visual acuity. Prompt removal restores visual acuity and induces the desired effect of the primary SMILE procedure. [J Refract Surg. 2017;33(12):848-853.]. [Mh] Termos MeSH primário: Astigmatismo/cirurgia Substância Própria/patologia Cirurgia da Córnea a Laser/efeitos adversos Complicações Intraoperatórias Transtornos da Visão/cirurgia [Mh] Termos MeSH secundário: Adulto Astigmatismo/etiologia Astigmatismo/fisiopatologia Substância Própria/diagnóstico por imagem Cirurgia da Córnea a Laser/métodos Topografia da Córnea Feminino Seres Humanos Masculino Refração Ocular/fisiologia Reoperação Tomografia de Coerência Óptica Resultado do Tratamento Transtornos da Visão/etiologia Transtornos da Visão/fisiopatologia Acuidade Visual/fisiologia [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180223 [Lr] Data última revisão: 180223 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171212 [St] Status: MEDLINE [do] DOI: 10.3928/1081597X-20171004-01

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[PMID]: 27774838 [Au] Autor: Myles PS; Smith JA; Forbes A; Silbert B; Jayarajah M; Painter T; Cooper DJ; Marasco S; McNeil J; Bussières JS; McGuinness S; Byrne K; Chan MT; Landoni G; Wallace S; ATACAS Investigators of the ANZCA Clinical Trials Network [Ad] Endereço: From the Alfred Hospital (P.S.M., D.J.C., S. Marasco, S.W.) and Monash University (P.S.M., J.A.S., A.F., D.J.C., S. Marasco, J.M., S.W.), Melbourne, VIC, St. Vincent's Hospital, Fitzroy, VIC (B.S.), and the Royal Adelaide Hospital, Adelaide, SA (T.P.) - all in Australia; South West Cardiac Centre, D [Ti] Título: Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. [So] Source: N Engl J Med;376(2):136-148, 2017 01 12. [Is] ISSN: 1533-4406 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. METHODS: In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery. RESULTS: Of the 4662 patients who were enrolled and provided consent, 4631 underwent surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patients (16.7%) in the tranexamic acid group and in 420 patients (18.1%) in the placebo group (relative risk, 0.92; 95% confidence interval, 0.81 to 1.05; P=0.22). The total number of units of blood products that were transfused during hospitalization was 4331 in the tranexamic acid group and 7994 in the placebo group (P<0.001). Major hemorrhage or cardiac tamponade leading to reoperation occurred in 1.4% of the patients in the tranexamic acid group and in 2.8% of the patients in the placebo group (P=0.001), and seizures occurred in 0.7% and 0.1%, respectively (P=0.002 by Fisher's exact test). CONCLUSIONS: Among patients undergoing coronary-artery surgery, tranexamic acid was associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery. Tranexamic acid was associated with a higher risk of postoperative seizures. (Funded by the Australian National Health and Medical Research Council and others; ATACAS Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639 .). [Mh] Termos MeSH primário: Antifibrinolíticos/uso terapêutico Ponte de Artéria Coronária Hemorragia/prevenção & controle Complicações Intraoperatórias/prevenção & controle Ácido Tranexâmico/uso terapêutico [Mh] Termos MeSH secundário: Idoso Idoso de 80 Anos ou mais Antifibrinolíticos/efeitos adversos Aspirina/uso terapêutico Transfusão de Sangue/estatística & dados numéricos Doença da Artéria Coronariana/mortalidade Doença da Artéria Coronariana/cirurgia Método Duplo-Cego Feminino Valvas Cardíacas/cirurgia Hemorragia/induzido quimicamente Seres Humanos Masculino Meia-Idade Inibidores da Agregação de Plaquetas/uso terapêutico Complicações Pós-Operatórias/induzido quimicamente Reoperação/estatística & dados numéricos Convulsões/induzido quimicamente Trombose/induzido quimicamente Ácido Tranexâmico/efeitos adversos [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Antifibrinolytic Agents); 0 (Platelet Aggregation Inhibitors); 6T84R30KC1 (Tranexamic Acid); R16CO5Y76E (Aspirin) [Em] Mês de entrada: 1701 [Cu] Atualização por classe: 180222 [Lr] Data última revisão: 180222 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 161025 [St] Status: MEDLINE [do] DOI: 10.1056/NEJMoa1606424

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[PMID]: 28454636 [Au] Autor: Udesh R; Mehta A; Gleason T; Thirumala PD [Ad] Endereço: Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. [Ti] Título: Carotid artery disease and perioperative stroke risk after surgical aortic valve replacement: A nationwide inpatient sample analysis. [So] Source: J Clin Neurosci;42:91-96, 2017 Aug. [Is] ISSN: 1532-2653 [Cp] País de publicação: Scotland [La] Idioma: eng [Ab] Resumo: To study the role of carotid stenosis (CS) and cerebrovascular disease as independent risk factors for perioperative stroke following surgical aortic valve replacement (SAVR). The National Inpatient Sample (NIS) database was used for our study. All patients who underwent SAVR from 1999 to 2011 were identified using ICD-9 codes. Univariate and multivariate analysis of baseline characteristics, Elixhauser comorbidities and other covariates were examined to identify independent predictors of perioperative strokes following SAVR. Data on 50,979 patients who underwent SAVR from 1999 to 2011 was obtained. The mean age of the study cohort was 60.5. The study patients were predominantly Caucasian (79.3%) and males (60.01%). The incidence of perioperative stroke was 2.48%. CS (OR 1.8, 95%CI 1.1-2.8, p=0.009) and cerebral arterial occlusion (OR 3.4, 95% CI 1.3-8.9) significantly increased perioperative stroke risk following SAVR. Infective endocarditis (OR 4.6, 95%CI 3.8-5.6, p=0.00) and neurological disorders (OR 4.8, 95% CI 4-5.8, p=0.00) appeared to be the strongest risk factors for strokes. Other risk factors found to be significant predictors of perioperative strokes (p<0.05) were - age, higher VWR scores, CS, cerebral arterial occlusion, infective endocarditis, DM, HTN, renal failure, neurological disorders, coagulopathy and hypothyroidsm. In conclusion, perioperative stroke risk has remained more or less constant despite advancements in surgical techniques with risk having gone up in patients <65years of age. CS and cerebral arterial occlusion significantly increase stroke risk following SAVR. Improved patient selection with pre-operative risk stratification and institution of preventive strategies are necessary to improve operative outcomes following SAVR. [Mh] Termos MeSH primário: Estenose da Valva Aórtica/epidemiologia Valva Aórtica/cirurgia Estenose das Carótidas/epidemiologia Transtornos Cerebrovasculares/epidemiologia Complicações Intraoperatórias/epidemiologia Acidente Vascular Cerebral/epidemiologia [Mh] Termos MeSH secundário: Idoso Comorbidade Feminino Próteses Valvulares Cardíacas Seres Humanos Incidência Pacientes Internados Masculino Meia-Idade Fatores de Risco Estados Unidos/epidemiologia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180219 [Lr] Data última revisão: 180219 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170430 [St] Status: MEDLINE

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[PMID]: 29394929 [Au] Autor: Vasquez-Perez A; Simpson A; Nanavaty MA [Ad] Endereço: Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF, UK. [Ti] Título: Femtosecond laser-assisted cataract surgery in a public teaching hospital setting. [So] Source: BMC Ophthalmol;18(1):26, 2018 Feb 02. [Is] ISSN: 1471-2415 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: To evaluate the efficiency and practicality of femtosecond laser assisted cataract surgery (FLACS) in a public teaching hospital setting using a mobile FLACS system compared to conventional phacoemulsification cataract surgery (CPCS). METHODS: Ninety eyes from 90 patients underwent either FLACS or CPCS (45 in each group). Cataracts were graded using the Lens Opacities Classification System III system. Outcome measures included total surgery duration, femtosecond laser treatment time, vacuum time (VT), total phacoemulsification time (TPT) and total phacoemulsification power (TPP). RESULTS: No differences were observed in the preoperative mean cataract grades and co-morbidities. FLACS took longer than CPCS with a mean difference of 5.2 ± 4.5 min (range: 0-18.8 min). The average femtosecond laser treatment time was 4.3 ± 3.4 min (range: 1-15.5 min). The VT was 2.51 ± 0.45 min (range: 1.59-4.10 min). Although not significant, TPT in FLACS showed a trend towards improvement (mean 1.0 ± 0.6 s; range: 0.1-2.4 s) compared to CPCS (mean 1.2 ± 0.6 min; range: 0.5-2.5 min). Whereas, TPP was significantly less in FLACS (mean 17.9 ± 5.0%; range: 5-27%) compared to CPCS (mean 20.3 ± 4.1%; range: 12.0-28.7%)(p = 0.031). CONCLUSIONS: The mobile FLACS system housed in the same operating room increased the surgical duration by 5.2 min. The average VT was 2.51 min, which was lower in comparison to published experience using non-mobile FLACS systems. [Mh] Termos MeSH primário: Extração de Catarata/métodos Terapia a Laser/métodos Implante de Lente Intraocular [Mh] Termos MeSH secundário: Idoso Idoso de 80 Anos ou mais Feminino Hospitais Públicos Hospitais de Ensino Seres Humanos Complicações Intraoperatórias Masculino Meia-Idade Duração da Cirurgia Facoemulsificação Estudos Prospectivos Pseudofacia/fisiopatologia Acuidade Visual/fisiologia [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180216 [Lr] Data última revisão: 180216 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180204 [St] Status: MEDLINE [do] DOI: 10.1186/s12886-018-0693-6

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[PMID]: 29391088 [Au] Autor: Spence LH; Schwartz S; Kaji AH; Plurad D; Kim D [Ad] Endereço: Department of Surgery, Harbor UCLA Medical Center, Torrance, California, USA. [Ti] Título: Concurrent Biliary Disease Increases the Risk for Conversion and Bile Duct Injury in Laparoscopic Cholecystectomy: A Retrospective Analysis at a County Teaching Hospital. [So] Source: Am Surg;83(10):1024-1028, 2017 Oct 01. [Is] ISSN: 1555-9823 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Biliary tract disease remains a common indication for operative intervention. The incidence of concurrent biliary tract disease (>2 biliary tract disease processes) is unknown and the impact of more than one biliary tract diagnosis on outcomes remains to be defined. The objective of this study was to determine the effect of concurrent biliary tract disease on conversion rate and outcomes after laparoscopic cholecystectomy. A 5-year retrospective analysis of all patients who underwent a laparoscopic cholecystectomy was performed comparing those with a single biliary diagnosis to patients with concurrent biliary tract disease. Variables analyzed were conversion to open cholecystectomy, incidence of bile duct injury, use of endoscopic retrograde cholangiopancreatography and/or intraoperative cholangiogram, length of surgery, and duration of hospitalization. The incidence of concurrent biliary tract disease was 9 per cent and a conversion to open cholecystectomy was performed in 16 per cent of patients. After adjusting for confounding factors, concurrent biliary tract disease was predictive of conversion (odds ratio 1.6, 95% confidence interval 1.1-2.3, P = 0.03) and bile duct injury (odds ratio 2.5, 95% confidence interval 0.8-5, P = 0.01). Concurrent biliary tract disease patients were more likely to undergo intraoperative cholangiogram or endoscopic retrograde cholangiopancreatography, as well as longer operation and length of stay. [Mh] Termos MeSH primário: Ductos Biliares/lesões Doenças Biliares/cirurgia Colecistectomia Laparoscópica/efeitos adversos Conversão para Cirurgia Aberta/estatística & dados numéricos Complicações Intraoperatórias/etiologia [Mh] Termos MeSH secundário: Adulto Idoso Ductos Biliares/cirurgia Feminino Hospitais de Condado Hospitais de Ensino Seres Humanos Incidência Complicações Intraoperatórias/epidemiologia Modelos Logísticos Masculino Meia-Idade Razão de Chances Estudos Retrospectivos Fatores de Risco Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180214 [Lr] Data última revisão: 180214 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180203 [St] Status: MEDLINE

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