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[PMID]:29268647
[Au] Autor:Kaufmann M; Lampart A
[Ad] Endereço:1 Departement Anästhesiologie, Universitätsspital Basel.
[Ti] Título:Präoperative Untersuchungen und Abklärungen vor elektiven Eingriffen..
[So] Source:Ther Umsch;74(7):345-350, 2017.
[Is] ISSN:0040-5930
[Cp] País de publicação:Switzerland
[La] Idioma:ger
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Eletivos/efeitos adversos
Procedimentos Cirúrgicos Eletivos/métodos
Segurança do Paciente
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/prevenção & controle
Cuidados Pré-Operatórios/métodos
[Mh] Termos MeSH secundário: Medicina Baseada em Evidências
Feminino
Seres Humanos
Masculino
Prognóstico
Medição de Risco/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE
[do] DOI:10.1024/0040-5930/a000925


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[PMID]:29267501
[Au] Autor:Peng HM; Wang LC; Zhai JL; Weng XS; Feng B; Wang W
[Ad] Endereço:Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
[Ti] Título:Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study.
[So] Source:Braz J Med Biol Res;51(2):e6736, 2017 Dec 18.
[Is] ISSN:1414-431X
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Staphylococcus aureus colonization in the nares of patients undergoing elective orthopedic surgery increases the potential risk of surgical site infections. Methicillin-resistant S. aureus (MRSA) has gained recognition as a pathogen that is no longer only just a hospital-acquired pathogen. Patients positive for MRSA are associated with higher rates of morbidity and mortality following infection. MRSA is commonly found in the nares, and methicillin-sensitive S. aureus (MSSA) is even more prevalent. Recently, studies have determined that screening for this pathogen prior to surgery and diminishing staphylococcal infections at the surgical site will dramatically reduce surgical site infections. A nasal mupirocin treatment is shown to significantly reduce the colonization of the pathogen. However, this treatment is expensive and is currently not available in China. Thus, in this study, we first sought to determine the prevalence of MSSA/MSRA in patients undergoing elective orthopedic surgery in northern China, and then, we treated the positive patients with a nasal povidone-iodine swab. Here, we demonstrate a successful reduction in the colonization of S. aureus. We propose that this treatment could serve as a cost-effective means of eradicating this pathogen in patients undergoing elective orthopedic surgery, which might reduce the rate of surgical site infections.
[Mh] Termos MeSH primário: Anti-Infecciosos Locais/uso terapêutico
Procedimentos Cirúrgicos Eletivos
Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos
Cavidade Nasal/microbiologia
Procedimentos Ortopédicos
Povidona-Iodo/uso terapêutico
[Mh] Termos MeSH secundário: Administração Intranasal
Adulto
Anti-Infecciosos Locais/economia
Antibioticoprofilaxia/economia
Antibioticoprofilaxia/métodos
China
Estudos Transversais
Procedimentos Cirúrgicos Eletivos/economia
Feminino
Seres Humanos
Masculino
Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento
Meia-Idade
Cavidade Nasal/efeitos dos fármacos
Procedimentos Ortopédicos/economia
Complicações Pós-Operatórias/prevenção & controle
Povidona-Iodo/economia
Estudos Prospectivos
Reprodutibilidade dos Testes
Infecções Estafilocócicas/prevenção & controle
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); 85H0HZU99M (Povidone-Iodine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


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[PMID]:29215512
[Au] Autor:Gibbs Pickens CM; Kramer MR; Howards PP; Badell ML; Caughey AB; Hogue CJ
[Ad] Endereço:Department of Epidemiology, Rollins School of Public Health, and Laney Graduate School and the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia; and the Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
[Ti] Título:Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring.
[So] Source:Obstet Gynecol;131(1):12-22, 2018 Jan.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate whether elective induction of labor between 39 through 41 weeks of gestation, as compared with expectant management, is associated with reduced cesarean delivery and other adverse outcomes among obese women and their offspring. METHODS: We conducted a retrospective cohort study using the 2007-2011 California Linked Patient Discharge Data-Birth Cohort File of 165,975 singleton, cephalic, nonanomalous deliveries to obese women. For each gestational week (39-41), we used multivariable logistic regression models, stratified by parity, to assess whether elective induction of labor or expectant management was associated with lower odds of cesarean delivery and other adverse outcomes. RESULTS: At 39 and 40 weeks of gestation, cesarean delivery was less common in obese nulliparous women who were electively induced compared with those who were expectantly managed (at 39 weeks of gestation, frequencies were 35.9% vs 41.0%, respectively [P<.05]; adjusted odds ratio [OR] 0.82, 95% CI 0.77-0.88). Severe maternal morbidity was less frequent among electively induced obese nulliparous patients (at 39 weeks of gestation, 5.6% vs 7.6% [P<.05]; adjusted OR 0.75, 95% CI 0.65-0.87). Neonatal intensive care unit admission was less common among electively induced obese nulliparous women (at 39 weeks of gestation, 7.9% vs 10.1% [P<.05]; adjusted OR 0.79, 95% CI 0.70-0.89). Patterns were similar among obese parous women at 39 weeks of gestation (crude frequencies and adjusted ORs [95% CIs] were as follows: for cesarean delivery, 7.0% vs 8.7% [P<.05] and 0.79 [0.73-0.86]; for severe maternal morbidity, 3.3% vs 4.0% [P<.05] and 0.83 [0.74-0.94]; for neonatal intensive care unit admission: 5.3% vs 7.4% [P<.05] and 0.75 [0.68-0.82]). Similarly, elective induction at 40 weeks of gestation was associated with reduced odds of cesarean delivery, maternal morbidity, and neonatal intensive care unit admission among both obese nulliparous and parous patients. CONCLUSION: Elective labor induction after 39 weeks of gestation was associated with reduced maternal and neonatal morbidity among obese women. Further prospective investigation is necessary.
[Mh] Termos MeSH primário: Cesárea/estatística & dados numéricos
Procedimentos Cirúrgicos Eletivos
Saúde do Lactente
Trabalho de Parto Induzido/métodos
Obesidade/complicações
Resultado da Gravidez
[Mh] Termos MeSH secundário: Adulto
Índice de Massa Corporal
Estudos de Coortes
Feminino
Idade Gestacional
Seres Humanos
Recém-Nascido
Trabalho de Parto
Modelos Logísticos
Análise Multivariada
Obesidade/diagnóstico
Razão de Chances
Gravidez
Estudos Retrospectivos
Medição de Risco
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002408


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[PMID]:29367198
[Au] Autor:Boden I; Skinner EH; Browning L; Reeve J; Anderson L; Hill C; Robertson IK; Story D; Denehy L
[Ad] Endereço:Department of Physiotherapy, Launceston General Hospital, Launceston, TAS, 7250, Australia ianthe.boden@ths.tas.gov.au.
[Ti] Título:Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial.
[So] Source:BMJ;360:j5916, 2018 01 24.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery. DESIGN: Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial. SETTING: Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand. PARTICIPANTS: 441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were randomly assigned through concealed allocation to receive either an information booklet (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months. 432 completed the trial. INTERVENTIONS: Preoperatively, participants received an information booklet (control) or an additional 30 minute physiotherapy education and breathing exercise training session (intervention). Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery. Postoperatively, all participants received standardised early ambulation, and no additional respiratory physiotherapy was provided. MAIN OUTCOME MEASURES: The primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score. Secondary outcomes were hospital acquired pneumonia, length of hospital stay, utilisation of intensive care unit services, and hospital costs. Patient reported health related quality of life, physical function, and post-discharge complications were measured at six weeks, and all cause mortality was measured to 12 months. RESULTS: The incidence of PPCs within 14 postoperative hospital days, including hospital acquired pneumonia, was halved (adjusted hazard ratio 0.48, 95% confidence interval 0.30 to 0.75, P=0.001) in the intervention group compared with the control group, with an absolute risk reduction of 15% (95% confidence interval 7% to 22%) and a number needed to treat of 7 (95% confidence interval 5 to 14). No significant differences in other secondary outcomes were detected. CONCLUSION: In a general population of patients listed for elective upper abdominal surgery, a 30 minute preoperative physiotherapy session provided within existing hospital multidisciplinary preadmission clinics halves the incidence of PPCs and specifically hospital acquired pneumonia. Further research is required to investigate benefits to mortality and length of stay. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTR 12613000664741.
[Mh] Termos MeSH primário: Abdome/cirurgia
Modalidades de Fisioterapia
Complicações Pós-Operatórias/prevenção & controle
Cuidados Pré-Operatórios
Doenças Respiratórias/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Idoso
Austrália
Método Duplo-Cego
Procedimentos Cirúrgicos Eletivos/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Nova Zelândia
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5916


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[PMID]:29202650
[Au] Autor:Wrede A; Wiberg F; Acosta S
[Ad] Endereço:These authors contributed equally to this work.
[Ti] Título:Increasing the Elective Endovascular to Open Repair Ratio of Popliteal Artery Aneurysm.
[So] Source:Vasc Endovascular Surg;52(2):115-123, 2018 Feb.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Open repair (OR) for popliteal artery aneurysm (PAA) has recently been challenged by endovascular repair (ER) as the primary choice of treatment. The aim of the present study was to evaluate time trends in treatment modality and compare outcomes between OR and ER among electively operated patients after start of screening in 2010 for abdominal aortic aneurysm (AAA), a disease highly associated with PAA. METHODS: Between January 1, 2009, and April 30, 2017, 102 procedures and 36 acute and 66 elective repairs for PAA were identified. RESULTS: Over time, a trend ( P = .089) for an increasing elective to acute repair ratio of PAA and an increase in elective ER to OR ratio ( P = .003) was found. Among electively repaired PAAs, the ER group was older ( P = .047) and had a higher ankle-brachial index (ABI; P = .044). The ER group had fewer wound infections ( P = .003), fewer major bleeding complications ( P = .046), and shorter in-hospital stay ( P < .001). After 1 year of follow-up, the ER group had a higher rate of major amputations ( P = .037). Amputation-free survival at the end of follow-up did not differ between groups ( P = .68). Among the 17 patients with PAA eligible for AAA screening, 4 (24%) were diagnosed with PAA through the screening program of AAA. CONCLUSION: The epidemiology of elective repair of PAA has changed toward increased ER, although ER showed a higher rate of major amputations at 1 year. Confounding was considerable and a randomized trial is needed for evaluation of the best therapeutic option.
[Mh] Termos MeSH primário: Aneurisma/cirurgia
Implante de Prótese Vascular
Procedimentos Endovasculares
Artéria Poplítea/cirurgia
Veia Safena/transplante
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Amputação
Aneurisma/diagnóstico por imagem
Aneurisma/epidemiologia
Implante de Prótese Vascular/efeitos adversos
Implante de Prótese Vascular/tendências
Procedimentos Cirúrgicos Eletivos
Procedimentos Endovasculares/efeitos adversos
Procedimentos Endovasculares/tendências
Feminino
Seres Humanos
Salvamento de Membro
Masculino
Meia-Idade
Artéria Poplítea/diagnóstico por imagem
Complicações Pós-Operatórias/etiologia
Estudos Retrospectivos
Fatores de Risco
Suécia/epidemiologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417742762


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[PMID]:28460770
[Au] Autor:Graziano FD; Banga S; Busman DK; Muthusamy P; Wohns DH
[Ad] Endereço:Spectrum Health, Grand Rapids, MI, USA.
[Ti] Título:Barriers to Early Discharge after Elective Percutaneous Coronary Intervention (BED PCI): A Single-Center Study.
[So] Source:Indian Heart J;69(2):217-222, 2017 Mar - Apr.
[Is] ISSN:0019-4832
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To identify patient characteristics and procedural factors that may play a role in hindering same-day discharge (SDD) practices. BACKGROUND: Multiple studies have shown the safety and cost effectiveness of SDD following elective percutaneous coronary intervention (PCI), but factors that hinder SDD practices have not been thoroughly studied. MATERIAL AND METHODS: A retrospective comparative analysis of elective PCI patients who had an overnight stay (OS) (n=345) vs. SDD patients (n=222) was conducted to identify significant differences between the two groups in baseline patient characteristics, procedural, and postprocedural factors. RESULTS: Comparing OS to SDD patients, OS patients had a lower prevalence of radial access (20.29% vs. 39.64%, P<0.0001); a higher incidence of suboptimal angiographic results (14.49% vs. 1.80%, P=0.0027); CRCL values lower than 60mL/min (26.38% vs. 15.32%, P=0.0019); and greater femoral vascular site hemostasis with manual compression (69.09% vs. 36.57%, P=0.0027). OS patients received larger sheath sizes (P=0.0209), more bivalirudin (45.80% vs. 36.70%) and glycoprotein IIb/IIIa inhibitors (5.51% vs. 2.25%), but less heparin (51.30% vs. 53.21%). Chest pain (8.12% vs. 0.92%, P=0.0042) and vascular access site concerns (20.58% vs. 0%, P=0.0027) were more common among OS patients. CONCLUSIONS: Pre-, peri-, and post-procedural factors play a role in SDD eligibility. Understanding factors that limit as well as those that facilitate SDD may enable institutions to establish or enhance a SDD program.
[Mh] Termos MeSH primário: Doença da Artéria Coronariana/cirurgia
Procedimentos Cirúrgicos Eletivos/métodos
Alta do Paciente/tendências
Intervenção Coronária Percutânea/métodos
Medição de Risco
[Mh] Termos MeSH secundário: Idoso
Doença da Artéria Coronariana/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Período Pós-Operatório
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29385235
[Au] Autor:Eamer G; Taheri A; Chen SS; Daviduck Q; Chambers T; Shi X; Khadaroo RG
[Ad] Endereço:Department of Surgery, University of Alberta, Edmonton, Canada.
[Ti] Título:Comprehensive geriatric assessment for older people admitted to a surgical service.
[So] Source:Cochrane Database Syst Rev;1:CD012485, 2018 Jan 31.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Aging populations are at increased risk of postoperative complications. New methods to provide care for older people recovering from surgery may reduce surgery-related complications. Comprehensive geriatric assessment (CGA) has been shown to improve some outcomes for medical patients, such as enabling them to continue living at home, and has been proposed to have positive impacts for surgical patients. CGA is a coordinated, multidisciplinary collaboration that assesses the medical, psychosocial and functional capabilities and limitations of an older person, with the goal of establishing a treatment plan and long-term follow-up. OBJECTIVES: To assess the effectiveness of CGA interventions compared to standard care on the postoperative outcomes of older people admitted to hospital for surgical care. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trials registers on 13 January 2017. We also searched grey literature for additional citations. SELECTION CRITERIA: Randomized trials of people undergoing surgery aged 65 years and over comparing CGA with usual surgical care and reporting any of our primary (mortality and discharge to an increased level of care) or secondary (length of stay, re-admission, total cost and postoperative complication) outcomes. We excluded studies if the participants did not receive a complete CGA, did not undergo surgery, and if the study recruited participants aged less than 65 years or from a setting other than an acute care hospital. DATA COLLECTION AND ANALYSIS: Two review authors independently screened, assessed risk of bias, extracted data and assessed certainty of evidence from identified articles. We expressed dichotomous treatment effects as risk ratio (RR) with 95% confidence intervals and continuous outcomes as mean difference (MD). MAIN RESULTS: We included eight randomised trials, seven recruited people recovering from a hip fracture (N = 1583) and one elective surgical oncology trial (N = 260), conducted in North America and Europe. For two trials CGA was done pre-operatively and postoperatively for the remaining. Six trials had adequate randomization, five had low risk of performance bias and four had low risk of detection bias. Blinding of participants was not possible. All eight trials had low attrition rates and seven reported all expected outcomes.CGA probably reduces mortality in older people with hip fracture (RR 0.85, 95% CI 0.68 to 1.05; 5 trials, 1316 participants, I² = 0%; moderate-certainty evidence). The intervention reduces discharge to an increased level of care (RR 0.71, 95% CI 0.55 to 0.92; 5 trials, 941 participants, I² = 0%; high-certainty evidence).Length of stay was highly heterogeneous, with mean difference between participants allocated to the intervention and the control groups ranging between -12.8 and 8.3 days. CGA probably leads to slightly reduced length of stay (4 trials, 841 participants, moderate-certainty evidence). The intervention probably makes little or no difference in re-admission rates (RR 1.00, 95% CI 0.76 to 1.32; 3 trials, 741 participants, I² = 37%; moderate-certainty evidence).CGA probably slightly reduces total cost (1 trial, 397 participants, moderate-certainty evidence). The intervention may make little or no difference for major postoperative complications (2 trials, 579 participants, low-certainty evidence) and delirium rates (RR 0.75, 95% CI 0.60 to 0.94, 3 trials, 705 participants, I² = 0%; low-certainty evidence). AUTHORS' CONCLUSIONS: There is evidence that CGA can improve outcomes in people with hip fracture. There are not enough studies to determine when CGA is most effective in relation to surgical intervention or if CGA is effective in surgical patients presenting with conditions other than hip fracture.
[Mh] Termos MeSH primário: Avaliação Geriátrica
Fraturas do Quadril/cirurgia
Tempo de Internação
Neoplasias/cirurgia
[Mh] Termos MeSH secundário: Idoso
Delírio/epidemiologia
Procedimentos Cirúrgicos Eletivos/mortalidade
Fraturas do Quadril/mortalidade
Seres Humanos
Neoplasias/mortalidade
Readmissão do Paciente/estatística & dados numéricos
Complicações Pós-Operatórias/epidemiologia
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012485.pub2


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[PMID]:27778168
[Au] Autor:Docimo S; Lee Y; Chatani P; Rogers AM; Lacqua F
[Ad] Endereço:Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA. sdocimo@gmail.com.
[Ti] Título:Visceral to subcutaneous fat ratio predicts acuity of diverticulitis.
[So] Source:Surg Endosc;31(7):2808-2812, 2017 Jul.
[Is] ISSN:1432-2218
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: There is an association between obesity and more complicated diverticular disease. We hypothesize that this link may be due to an increased level of visceral fat rather than an elevated body mass index alone. Adipose tissue secretes inflammatory cytokines, and chronic inflammation may account for the link between obesity and a more severe presentation of diverticular disease. We have applied a quantitative measure of visceral fat content in a series of patients admitted with diverticulitis, comparing those who required emergent versus elective surgical procedures for diverticulitis. METHODS: We performed a retrospective review of all adult patients who underwent emergent or elective surgery at our institution for diverticulitis from 2010 to 2014. Data were collected on demographics, comorbidities, operative findings, complications, and length of stay. Radiologic measurements of adiposity were obtained from preoperative CT scans. Visceral fat areas and subcutaneous fat areas were measured, and the V/S ratio was calculated. RESULTS: Thirty-four patients underwent emergent and 32 patients underwent elective surgery. The mean age was 66.3 years for the emergent and 57.11 for the elective group (p = 0.04178). The perinephric, visceral, subcutaneous fat, and V/S ratio for the emergent group were 1.71, 185.22, 338.22, and 0.56 and were 1.11, 127.18, 295.28, and 0.46 for the elective group. The difference between the V/S ratio for each group was significant (p = 0.0238). The emergent group had an average LOS of 16.11 days compared to 5.15 for the elective group (p = <0.00001). The complication rate was significantly higher (p = 0.024) in the emergent group (n = 12, 35.2 %) compared to the elective group (n = 4, 12.5 %). CONCLUSION: Our study demonstrates a clinically significant link between visceral fat and severity of presentation of diverticulitis. Patients with higher V/S fat ratios were more likely to require emergency surgery and have more complications and a longer LOS.
[Mh] Termos MeSH primário: Diverticulite/diagnóstico
Gordura Intra-Abdominal
Gravidade do Paciente
Gordura Subcutânea
[Mh] Termos MeSH secundário: Adulto
Idoso
Técnicas de Apoio para a Decisão
Diverticulite/cirurgia
Procedimentos Cirúrgicos Eletivos
Emergências
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação: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:161026
[St] Status:MEDLINE
[do] DOI:10.1007/s00464-016-5290-2


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[PMID]:29254322
[Au] Autor:De Iuliis V; Dadorante V; Marino A; Griffo I; Pennelli A; Breda V; Robuffo I; Ursi S; Martinotti S; Caputi S; Toniato E
[Ad] Endereço:Department of Medical, Oral and Biotechnological Sciences, University G. d’Annunzio of Chieti, Italy.
[Ti] Título:Cytokine expression profile and blood parameter evaluation of patients undergoing cardiac surgery.
[So] Source:J Biol Regul Homeost Agents;31(4):1109-1113, 2017 Oct-Dec.
[Is] ISSN:0393-974X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Cardiac surgery is accompanied by an important immune response that is poorly understood. This inflammatory response is caused by several stimuli: surgical trauma, cardiopulmonary bypass apparatus, aortic-cross clamping, reperfusion injury and hypothermia. The aim of the present study is to investigate the cytokine level profile involved in the inflammatory pathway of patients undergoing cardiac surgery. One hundred and two patients undergoing elective cardiac surgery utilizing cardiopulmonary bypass (CPB) apparatus were enrolled in the study. In the hematological and biochemical profiles investigated, we observed a significant increase of WBC and blood glucose concentration and a strong decrease of RBC, HB, HCT and PLT 24 h post-surgery compared to baseline and immediately after surgery groups. Furthermore, we found a modulation of cytokine levels mostly for IL-10 and an increase of IL-6, detected at 6 h post-surgery, IL-8 at 6 and 24 h, and TNFα only at 24 h post-surgery. In conclusion, these findings evidence a time course profile on cytokine levels and a balance between pro- and anti-inflammatory cytokine activation during and after cardiac surgery. In fact, IL-6 and IL-10, a pro- and an anti-inflammatory cytokine, respectively, increased immediately after surgery. The plasma level of TNF-α could be inhibited by the high concentration of IL-10 up to 6 h post-surgery. An IL-10 reduction at baseline level, after 24 h post-surgery, could explain a rise of TNF-α plasma concentration. On the other hand, considering the dual role of IL-6 on inflammation acting both as an activator of inflammatory cascade or an anti-inflammatory agent, the increased IL-6 levels 24 h after surgery could be related to the negative feedback action on TNFα activity.
[Mh] Termos MeSH primário: Angina Estável/imunologia
Angina Instável/imunologia
Arritmias Cardíacas/imunologia
Ponte Cardiopulmonar
Infarto do Miocárdio/imunologia
Equilíbrio Th1-Th2/genética
[Mh] Termos MeSH secundário: Idoso
Angina Estável/sangue
Angina Estável/genética
Angina Estável/cirurgia
Angina Instável/sangue
Angina Instável/genética
Angina Instável/cirurgia
Arritmias Cardíacas/sangue
Arritmias Cardíacas/genética
Arritmias Cardíacas/cirurgia
Contagem de Células Sanguíneas
Glicemia/metabolismo
Procedimentos Cirúrgicos Eletivos/métodos
Feminino
Expressão Gênica
Perfilação da Expressão Gênica
Seres Humanos
Imunidade Inata
Interleucina-10/sangue
Interleucina-10/imunologia
Interleucina-6/sangue
Interleucina-6/imunologia
Interleucina-8/sangue
Interleucina-8/imunologia
Masculino
Meia-Idade
Infarto do Miocárdio/sangue
Infarto do Miocárdio/genética
Infarto do Miocárdio/cirurgia
Fator de Necrose Tumoral alfa/sangue
Fator de Necrose Tumoral alfa/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Blood Glucose); 0 (IL10 protein, human); 0 (IL6 protein, human); 0 (Interleukin-6); 0 (Interleukin-8); 0 (Tumor Necrosis Factor-alpha); 130068-27-8 (Interleukin-10)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


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[PMID]:29303238
[Au] Autor:Mansour BS; Wienecke G; Sadana N; Pouralifazel P; de Armendi A
[Ti] Título:Perioperative Management of a Parturient with Complex Regional Pain Syndrome for Elective C-Section.
[So] Source:J Okla State Med Assoc;110(4):202-4, 2017 04.
[Is] ISSN:0030-1876
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A 33 year-old female at 38 weeks gestation with a history of Complex Regional Pain Syndrome (CRPS) Type 1 of the upper extremities, diagnosed 13 years prior to this admission, was scheduled for an elective cesarean section (C-Section). She refused neuraxial anesthesia and requested general anesthesia. This abstract discusses the general anesthesia steps taken to pre-empt recurrence of CRPS symptoms.
[Mh] Termos MeSH primário: Anestesia Geral
Cesárea
Distrofia Simpática Reflexa/prevenção & controle
Prevenção Secundária
[Mh] Termos MeSH secundário: Adulto
Procedimentos Cirúrgicos Eletivos
Feminino
Seres Humanos
Gravidez
Distrofia Simpática Reflexa/complicações
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE



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