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Impact of bariatric surgery on control of type 2 diabetes : neuroendocrine mechanisms and clinical significance; O impacto da cirurgia barátrica no controlo da diabetes tipo 2 : mecanismos neuro-endócrinos e implicações clínicas

Eickhoff, Hans Christian August
Fonte: Universidade de Coimbra Publicador: Universidade de Coimbra
Tipo: Tese de Doutorado
ENG
Relevância na Pesquisa
36.31%
Background: Bariatric and metabolic surgery is an accepted treatment for obese patients with type 2 diabetes (T2D). However, the potential of gastrointestinal surgery regarding glycemic control in non-severely obese diabetic patients has yet to be defined. Along with weight loss itself, changes in gut hormone profiles after surgery play an important role in diabetes remission. Pathophysiology of T2D includes insulin resistance and insufficient insulin secretion, possibly modified by surgical procedures. Excessive or inadequate glucagon secretion promoting hepatic gluconeogenesis and glycogenolysis is also believed to contribute to hyperglycemia in diabetic patients. In the present experimental study, we explored the effect of established bariatric procedures, with and without duodenal exclusion, on glycemic control and pancreatic and gut hormone profile in Goto-Kakizaki (GK) rats, a lean animal model of T2D. Data obtained from our experimental model were supplemented by the results of a clinical study on the effects of sleeve gastrectomy (SG) on impaired fasting glucose (IFG) and T2D in obese patients. Methods: Forty 12- to 14-week-old GK rats were randomly assigned to four groups: control group (GKC), sham surgery (GKSS), sleeve gastrectomy (GKSG)...

Caracterização psicológica dos pacientes com obesidade severa, antes e depois da cirurgia bariatárica; Psychological characterisation of severely obese patients: pre- and post-bariatric surgery

Ferreira, André; Santos, Osvaldo; Raimundo, Graça; Pegacho, Margarida; Manuel, Carvalho
Fonte: Repositório Científico Lusófona Publicador: Repositório Científico Lusófona
Tipo: Artigo de Revista Científica
; POR
Relevância na Pesquisa
36.3%
Apesar de a prevalência de psicopatologia entre candidatos de cirurgia bariátrica ser superior à da população não obesa, sabe-se pouco sobre o impacto da cirurgia em termos psicopatológicos. O principal objectivo deste estudo foi caracterizar a evolução de morbilidade psicopatológica em doentes submetidos a cirurgia bariátrica. Estudo observacional longitudinal. Foram incluídos todos os doentes submetidos a cirurgia bariátrica entre Março 2008 e Junho 2010 num hospital geral da região sul de Portugal. A avaliação psicológica foi feita através de entrevista clínica estruturada, com aplicação do MCMI-III (mesmo protocolo antes e 12 meses após a cirurgia). Participaram 20 doentes (19 mulheres). Os síndromes de eixo 1 do DSM-IV mais prevalentes antes da cirurgia foram: ansiedade (40%), distimia (20%), perturbação somatoforme e perturbação delirante (15% cada). Depois da cirurgia, os mais prevalentes foram: ansiedade (40%), perturbação bipolar, distimia, e perturbação delirante (15% cada). A perturbação da personalidade mais prevalente (pré-cirurgia) foi a compulsiva (15%). Depois da cirurgia, foram: histriónica, compulsiva, e paranóide (10% cada). Em conclusão, a cirurgia bariátrica parece não ser eficaz...

Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: Does delayed surgery have an impact on outcome?

HABR-GAMA, Angelita; PEREZ, Rodrigo Oliva; PROSCURSHIM, Igor; SANTOS, Rafael Miyashiro Nunes dos; KISS, Desiderio; GAMA-RODRIGUES, Joaquin; CECCONELLO, Ivan
Fonte: ELSEVIER SCIENCE INC Publicador: ELSEVIER SCIENCE INC
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.29%
Background: The optimal interval between neoadjuvant chemoradiation therapy (CRT) and surgery in the treatment of patients with distal rectal cancer is controversial. The purpose of this study is to evaluate whether this interval has an impact on survival. Methods and Materials: Patients who underwent surgery after CRT were retrospectively reviewed. Patients with a sustained complete clinical response (cCR) 1 year after CRT were excluded from this study. Clinical and pathologic characteristics and overall and disease-free survival were compared between patients undergoing surgery 12 weeks or less from CRT and patients undergoing surgery longer than 12 weeks from CRT completion and between patients with a surgery delay caused by a suspected cCR and those with a delay for other reasons. Results: Two hundred fifty patients underwent surgery, and 48.4% had CRT-to-surgery intervals of 12 weeks or less. There were no statistical differences in overall survival (86% vs. 81.6%) or disease-free survival rates (56.5% and 58.9%) between patients according to interval (<= 12 vs. >1 2 weeks). Patients with intervals of 12 weeks or less had significantly higher rates of Stage III disease (34% vs. 20%; p = 0.009). The delay in surgery was caused by a suspected cCR in 23 patients (interval...

Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study

PAULITSCH, Felipe S.; SCHNEIDER, David; SOBEL, Burton E.; RACHED, Roberto; RAMIRES, Jose; JATENE, Fabio; STOLF, Noedir; HUEB, Whady; LOPES, Neuza H.
Fonte: LIPPINCOTT WILLIAMS & WILKINS Publicador: LIPPINCOTT WILLIAMS & WILKINS
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.31%
Objective To delineate the effects of extracorporeal bypass on biomarkers of hemostasis, fibrinolysis, and inflammation and clinical sequelae. Methods Patients were assigned prospectively and randomly to either on-pump (n=41) or off-pump (n=51) coronary bypass surgery. The concentrations of C-reactive protein, fibrinogen, D-dimer, and plasminogen activator inhibitor type-1 in blood were quantified before and after (1 and 24 h) surgery. Similar surgical and anesthetic procedures were used for both groups. Clinical events were assessed during initial hospitalization and at the end of I year. Results The concentrations of plasminogen activator inhibitor type-1 and D-dimer were greater compared with preoperative values 1 and 24 h after surgery in both groups, but their concentrations increased to a greater extent 24 h after surgery in the on-pump group (P<0.01). The concentration of C-reactive protein did not change appreciably immediately after surgery in either group but increased in a parallel manner 24 h after either on-pump or off-pump surgery (P<0.01). Bypass surgery in the on-pump group was associated with greater blood loss during surgery and more bleeding after surgery (P <= 0.01). The incidence of all other complications was similar in the two groups. Conclusion On-pump surgery was associated with biochemical evidence of a prothrombotic state early after surgery but no greater incidence of thrombotic events was observed. The prothrombotic state might be a consequence of extracorporeal bypass...

Rasmussen encephalitis: long-term outcome after surgery

TERRA-BUSTAMANTE, Vera C.; MACHADO, Helio R.; OLIVEIRA, Ricardo dos Santos; SERAFINI, Luciano N.; SOUZA-OLIVEIRA, Cecilia; ESCORSI-ROSSET, Sara; YACUBIAN, Elza Marcia Targas; NAFFAH-MAZZACORATTI, Maria da Graca; SCORZA, Carla A.; CAVALHEIRO, Esper A.; SCO
Fonte: SPRINGER Publicador: SPRINGER
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.32%
Rasmussen encephalitis (RE) is characterized by intractable epilepsy, progressive hemiparesis, and unilateral hemispheric atrophy. The progression of the symptoms to significant neurological impairment usually occurs within months to a few years. RE causes are unknown, although evidence of an autoimmune process has been extensively described in the literature. Antiepileptic drugs are usually not effective to control seizures or cerebral atrophy; despite data supporting a beneficial effect of early immunosuppressive and immunomodulatory interventions, for intractable seizures in RE patients with advanced disease, epilepsy surgery in the form of hemispheric disconnection has been considered the treatment of choice. This work describes the clinical and electrographic analyses, as well as the post-operative evolution of patients with RE. This work includes all the patients with RE evaluated from January 1995 to January 2008 by the RibeirA o pound Preto Epilepsy Surgery Program (CIREP), taking variables such as gender; age at epilepsy onset; seizure semiology; seizure frequency; interictal and ictal electroencephalographic (EEG) findings; age at surgery, when done; duration of epilepsy; surgery complications; follow-up duration; anatomo-pathological findings; post-surgery seizure; language and cognitive outcome; and anti-epileptic drug treatment after surgery into account. Twenty-five patients were evaluated; thirteen were female. Mean age of epilepsy onset was 4.4 +/- 2.0 years. There were no differences between patients with slow and fast evolution with respect to age of epilepsy onset (p = 0.79)...

"Avaliação do estado de ansiedade em pacientes submetidos a cirurgias eletivas sob regime ambulatorial ou sob regime de internação" ; Evaluation of anxiety state in patients submitted to elective surgery in an outpatient or hospitalization regime

Giuntini, Patricia Bodnar
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 27/04/2006 PT
Relevância na Pesquisa
36.31%
Introdução. A ansiedade é um sentimento normal que prepara o organismo para situações adversas. É difícil de ser quantificada, porém pode ser estimada por meio de escalas subjetivas como a analógica visual, a comportamental e a verbal ou de maneira objetiva indireta por meio de parâmetros hemodinâmicos ou quantificação de hormônios do estresse no plasma ou na saliva. Cirurgias realizadas sob regime ambulatorial acarretam menor custo e menor índice de infecção hospitalar. No entanto, não existem dados suficientes para afirmar que a não internação hospitalar provoca menor grau de ansiedade nos pacientes. Objetivo. Quantificar e comparar mediante a utilização de escalas, questionários e dosagem do cortisol salivar, o grau de ansiedade de pacientes submetidas a cirurgias sob regime ambulatorial ou sob regime de internação. Casuística e método – Foram constituídos dois grupos de 12 pacientes cada um: grupo RA no qual as pacientes foram operadas eletivamente sob regime ambulatorial e grupo RI no qual as pacientes foram operadas eletivamente sob regime de internação. Todas as pacientes foram avaliadas quanto ao estado de ansiedade na véspera e no dia da cirurgia por meio da aplicação das escalas de Spielberger (traço e estado)...

Alterações hemostáticas e clínicas em cirurgias de revascularização miocárdica com e sem circulação extracorpórea: estudo prospectivo randomizado; Hemostatic changes and clinical sequelae after on-pump compared with off-pump coronary artery bypass surgery: a prospective randomized study

Paulitsch, Felipe da Silva
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 07/01/2010 PT
Relevância na Pesquisa
36.32%
Introdução: a revascularização miocárdica (RM) sem circulação extracorpórea (CEC) tem sido associada a menores complicações quando comparadas à com CEC. Objetivos: determinar os efeitos da CEC em marcadores de hemostasia, fibrinólise, inflamação e correlacionar com eventos clínicos. Método: os pacientes foram incluídos de forma prospectiva e randomizada para cirurgia de RM com (n=41) ou sem CEC (n=51). As concentrações de proteína C reativa (PCR), fibrinogênio, dímero-D e inibidor do ativador do plasminogênio tipo 1 (PAI1) foram quantificadas antes e após (1 e 24 horas) a RM. As técnicas cirúrgicas e anestésicas foram padronizadas para ambos os grupos. Eventos clínicos foram avaliados durante a hospitalização inicial e após 1 ano de seguimento. Resultados: as concentrações de PAI1 e dímeros-d foram maiores quando comparados os valores pré-operatórios com os de 1 e 24 h, após a RM em ambos os grupos, porém as concentrações de PAI1 aumentadas estenderam-se por 24 h após a RM com CEC (p<0,01). A concentração de PCR teve um aumento de pequena magnitude imediatamente após a cirurgia em ambos os grupos e aumentou de modo similar 24h após a RM (p<0,01). A RM com CEC foi associada com maior perda sanguínea durante a cirurgia e mais sangramento pós-operatório (p<0...

Comportamento alimentar, ansiedade, depressão e imagem corporal em mulheres submetidas à cirurgia bariátrica; Eating Behavior, Anxiety, Depression and Body Image in Women Submitted to Bariatric Surgery

Mota, Diana Cândida Lacerda
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 13/04/2012 PT
Relevância na Pesquisa
36.29%
Segundo a Organização Mundial da Saúde (OMS), a obesidade tornou-se atualmente uma epidemia que se espalha em todo o mundo, sendo foco de inúmeros estudos que abordam sua prevenção e tratamento, tais como dietas, medicamentos e prática de atividade física. Em obesos mórbidos, a Cirurgia Bariátrica (CB) vem sendo considerada a terapia mais eficaz na redução do peso corporal destes indivíduos. Contudo, participantes submetidos a esse procedimento, podem apresentar complicações psicológicas e do comportamento alimentar, comprometendo o sucesso do tratamento, justificando assim a relevância da investigação destes fatores. O presente estudo avaliou o comportamento alimentar, sintomas de ansiedade e depressão e a imagem corporal em 50 mulheres obesas atendidas pelo serviço de cirurgia da obesidade do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto SP (HC/FMRP/USP). A pesquisa foi realizada em dois momentos: antes e quatro meses após o procedimento cirúrgico, sendo aplicados: Questionário Holandês do Comportamento Alimentar (QHCA), Inventários de Ansiedade (BAI) e de Depressão (BDI) de Beck e a Escala de Figuras de Silhuetas (EFS), aplicada após a cirurgia. Foi realizada a avaliação antropométrica de acordo com os parâmetros da Organização Mundial Da Saúde (1995) para obtenção do Índice de Massa Corporal (IMC). Foi realizada estatística descritiva...

O processo de tomada de decisão da mulher obesa pela cirurgia bariátrica: uma abordagem compreensiva; The decision-making process of obese women on the bariatric surgery: a comprehensive approach

Oliveira, Deíse Moura de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 22/04/2013 PT
Relevância na Pesquisa
36.3%
Introdução: a decisão pela cirurgia bariátrica pode envolver uma gama de situações que perpassam o cotidiano da mulher, razões que a conduzem a submeter-se a este procedimento cirúrgico, entendendo que os riscos nele envolvidos são consideravelmente menores do que aqueles inscritos na sua convivência com a obesidade. Objetivo: compreender o processo de tomada de decisão da mulher obesa pela cirurgia bariátrica. Método: pesquisa qualitativa fundamentada na Fenomenologia Social de Alfred Schütz. Participaram deste estudo 12 mulheres candidatas à cirurgia bariátrica cadastradas no Serviço de Controle de Hipertensão, Diabetes e Obesidade de Juiz de Fora, Minas Gerais, frequentadoras do grupo educativo do Programa Pró-obeso. Os depoimentos foram obtidos por meio de entrevista, no período de outubro a dezembro de 2012, a partir das seguintes questões norteadoras: o que fez você se decidir pela cirurgia bariátrica? Como está sendo para você se decidir pela cirurgia bariátrica? O que você espera para a sua vida ao decidir-se pela cirurgia bariátrica? Resultados: o processo de tomada de decisão da mulher pela cirurgia bariátrica fundamenta-se na inadequação dos seus hábitos alimentares, na sua aparência física incongruente com o padrão corporal da sociedade contemporânea...

Hip fracture in the elderly: does counting time from fracture to surgery or from hospital admission to surgery matter when studying in-hospital mortality?

Vidal, Edison Iglesias de Oliveira; Moreira-Filho, D. C.; Coeli, C. M.; Camargo, K. R.; Fukushima, F. B.; Blais, R.
Fonte: Springer London Ltd Publicador: Springer London Ltd
Tipo: Artigo de Revista Científica Formato: 723-729
ENG
Relevância na Pesquisa
36.32%
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq); Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP); This study aims to analyze whether the interval from hospital admission to surgery may be used as a surrogate of the actual gap from fracture to surgery when investigating in-hospital hip fracture mortality. After analyzing 3,754 hip fracture admissions, we concluded that those intervals might be used interchangeably without misinterpretation bias.The debate regarding the influence of time to surgery in hip fracture (HF) mortality is one of the most controversial issues in the HF medical literature. Most previous investigations actually analyzed the time from hospital admission to surgery as a surrogate of the less easily available gap from fracture to surgery. Notwithstanding, the assumption of equivalency between those intervals remains untested.We analyzed 3,754 hospital admissions of elderly patients due to HF in Quebec, Canada. We compared the performance as predictors of in-hospital mortality of the delay from admission to surgery and the actual gap from fracture to surgery using univariate and multiple logistic regression analysis.The mean times from fracture to surgery and from admission to surgery were 1.84 and 1.02 days (P < 0.001)...

Efeito dos antiinflamatórios tópicos acetato de prednisolona 1%, nepafenaco 0.1% e cetorolaco de trometamina 0.4% na manutenção da midríase intra-operatória em facectomias ; : estudo clnico aleatorizado; Effect of preopertaive use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery : a randomized trial

Fernando Roberte Zanetti
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 30/11/2011 PT
Relevância na Pesquisa
36.3%
Introdução: Os Antiinflamatórios tópicos são utilizados comumente no tratamento da inflamação ocular e do edema macular cistóide relacionado a cirurgia de catarata. Tem sido sugerido o uso de antiinflamatórios antes da cirurgia, para conseguir uma melhor midriase intraoperatória. Foi relatado que quando midriase e maior do que 6 mm, a incidência de ruptura da cápsula posterior e reduzido pela metade. O objetivo deste estudo original foi comparar o efeito do uso pré-operatório do acetato de prednisolona, do cetorolaco de trometamina, do nepafenaco e de um placebo, na manutenção da midriase intra-operatória da cirurgia de catarata. Objetivo: Comparar o efeito do uso pré-operatório dos antiinflamatórios tópicos acetato de prednisolona 1%, nepafenaco 0.1% e cetorolaco de trometamina 0.4%, alem de um placebo, na manutenção da midriase intraoperatoria durante a cirurgia de catarata. Desenho: Ensaio clinico aleatorizado, mascarado, realizado em um único centro. Métodos: E um estudo composto por 140 pacientes submetidos a cirurgia de facoemulsificação de catarata. Os pacientes (35 voluntários por grupo) foram aleatorizados para receber o placebo (carboximetilcelulose de sódio 0,5%), acetato de prednisolona 1%, cetorolaco de trometamina 0...

Robotic surgery in gynaecology and gynaecological oncology: Program initiation and operative outcomes at the Royal Adelaide Hospital

Oehler, M.
Fonte: Blackwell Publishing Asia Publicador: Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
36.31%
Background: Robotic surgery has become an integral part of gynaecological surgery in the USA. In Australia, however, robotic surgery has only been established in urologic and cardiac surgery. In 2008, the Royal Adelaide Hospital (RAH) was the first public hospital to initiate a robotic surgery program in gynaecology and gynaecological oncology in Australia. Aims: To evaluate the feasibility and outcome of the robotic surgery program in gynaecology and gynaecological oncology at the RAH. Methods: A prospective case series analysis of the first 71 patients operated by robotic surgery from August 2008 to May 2010 was performed. Results: All patients underwent a total or radical robotic hysterectomy with or without staging for gynaecological cancer, benign disease or genetic risk. No conversions to laparotomy were required. Sixty-seven patients (95%) were discharged the morning after surgery. Four patients (5%) required hospital stays of up to 3 days because of pre-existing medical conditions or logistical reasons. The only major postoperative complication was one vault dehiscence. Minor short-term problems in four patients were vaginal cuff cellulitis, vaginal vault granulation tissue and infected port sites. Conclusion: The RAH experience is that robotic surgery in gynaecology and gynaecological oncology is safe and feasible. Patient recovery is excellent...

Depression, anxiety and morbidity outcomes after cardiac surgery.

Tully, Phillip John
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2011
Relevância na Pesquisa
36.32%
Depression and heart disease are among the top ten causes of an estimated 56 million deaths throughout the world (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006). Projections by the World Health Organisation indicate that depression and cardiac disorders will indeed remain among the top ten leading causes of disease burden by the year 2020 (Lopez et al., 2006; Murray & Lopez, 1997). The extant literature describes a prognostic association between depressive symptoms and adverse coronary artery disease (CAD) outcomes (Barth, Schumacher, & Herrmann-Lingen, 2004; Rugulies, 2002; Suls & Bunde, 2005; Van der Kooy et al., 2007). These findings extend to persons having undergone cardiac revascularisation surgery (Connerney, Shapiro, McLaughlin, Bagiella, & Sloan, 2001) and have prompted various consensus panels to call for routine depression assessment among heart disease patients (Ballenger et al., 2001; Davidson et al., 2006; Lichtman et al., 2008). By comparison to depression, anxiety has attracted a smaller share of empirical investigation and consensus panel support with respect to heart disease morbidity outcomes. This is particularly the case with regard to heart disease patients who have undergone cardiac surgery. In fact, one unanswered question to date is whether or not anxiety is related to morbidity after cardiac surgery to the same degree as has been described for depression. Notwithstanding substantial interrelation...

Frontal sinus surgery: indications and outcomes in chronic rhinosinusitis.

Naidoo, Yuresh Sirkari
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2014
Relevância na Pesquisa
36.3%
The research described in this PhD thesis follows an extensive literature review of the role of the medical and surgical management of CRS. Despite the utilization of surgery to alleviate the symptoms of CRS refractory to medical therapy, there are clear deficiencies in our understanding of what type of surgery to perform, and how extensive this surgery should be so as to maximize long-term symptom alleviation and control. Particular controversy exists regarding addressing the frontal sinus with a wide variety of philosophies employed, but with limited scientific rationale to support such approaches. Chapter two describes a prospective study to validate a quality of life tool, the Adelaide Disease Severity Score. This study showed a simple 5 question tool directly related to sinus symptoms and visual analogue quality of life score correlated very highly with other more complex rhinological quality of life tools – the SNOT 20/22. It further correlated with radiological disease burden (Lund Mackay CT score) and endoscopic disease (Lund Kennedy endoscopic score) burden. This study validated our use of this tool to measure quality of life and symptom improvement in patients undergoing surgery. Chapter three describes a detailed retrospective study of the outcomes of primary frontal sinus surgery. This is the largest study in the literature of primary frontal surgery and forms the basis to support an approach where the diseased frontal sinus should be addressed surgically to optimize long-term outcomes. It also identified that certain anatomical factors such as a narrow frontal ostium seemed to play a role in persistence of symptoms. This raised questions as to whether these outcomes were as successful for revision and extended frontal sinus surgery. Were there identifiable risk factors for success and failure? The fourth chapter describes the outcomes of primary and revision standard frontal sinus surgery and investigates which patient...

All-cause 30-day postoperative mortality for older patients in highly developed countries having elective colorectal surgery: a systematic review

Sutherland, J.; Robertson-Malt, S.; Stern, C.J.; Engel, A.
Fonte: The Joanna Briggs Institute and The University of Adelaide Publicador: The Joanna Briggs Institute and The University of Adelaide
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
36.3%
Background: Death after surgery is an acknowledged outcome reflecting the safety of a procedure. Death rates after surgery are not often routinely collected, therefore mortality rates can be difficult to quantify. Colorectal surgery is increasingly offered to older patients. The likelihood of postoperative adverse outcomes (including death) may impact decision-making at individual, institutional or health care system levels. Objectives: The objective of this review was to provide an estimate of the prevalence of all-cause 30-day postoperative mortality for older patients in highly developed countries undergoing elective colorectal surgery. Inclusion criteria: Types of participants: This review considered studies and reports that included patients aged 65 years and over from highly developed countries undergoing elective colorectal surgical resection. Only studies from countries with a very high Human Development Index were included. Types of interventions: Studies and reports including patients having colorectal resection with or without anastamosis were included. Types of studies: This review considered experimental, analytical and descriptive epidemiological study designs, including randomized controlled trials, prospective and retrospective cohort studies...

Surgical trainees' attitudes to specialization in breast surgery

Kollias, J.; Rainsbury, R.
Fonte: Blackwell Science Asia Publicador: Blackwell Science Asia
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
Relevância na Pesquisa
36.33%
Background: Subspecialization in general surgery is being encouraged by various surgical societies. The aim of this study was to view attitudes of Royal Australasian College of Surgeons (RACS) trainees to subspecialization in surgery, in particular, breast ­surgery. Methods: A postal questionnaire survey of registered RACS basic and advanced surgical trainees was conducted in February 2002. Trainees were asked to nominate their preferred specialty and to indicate the level of support and interest for subspecialty training in breast surgery. Trainees indicating breast surgery as their preferred career choice were then asked to nominate their reasons for choosing breast surgery, preferred options for cross-specialty training and for vocation specifications such as a continuing ‘on-call’ responsibility. Results: Trainees returned 291 of 1049 (28%) completed questionnaires. One hundred and sixty-nine trainees felt that the concept of breast subspecialization in general surgery was reasonable (58%). For all respondents, the most popular specialty choices were plastic surgery (15.8%), orthopaedics (15.5%) and general surgery (15.4%). Breast surgery was chosen by 14 of 291 (4.8%) respondents as their first specialty preference and a further 25 respondents as their second specialty preference. Of 189 trainees who did not choose breast surgery as their preferred specialty...

Preconditioning shields against vascular events in surgery (SAVES), a multicentre feasibility trial of preconditioning against adverse events in major vascular surgery: study protocol for a randomised control trial

Healy, Donagh A; Clarke-Moloney, Mary; Gaughan, Brendan; O'Daly, Siobhan; Hausenloy, Derek; Sharif, Faisal; Newell, John; O'Donnell, Martin; Grace, Pierce; Forbes, John F; Cullen, Walter; Kavanagh, Eamon; Burke, Paul; Cross, Simon; Dowdall, Joseph; McMona
Fonte: BioMed Central Publicador: BioMed Central
Tipo: info:eu-repo/semantics/article; all_ul_research; ul_published_reviewed
ENG
Relevância na Pesquisa
36.31%
peer-reviewed; Background: Patients undergoing vascular surgery procedures constitute a 'high-risk' group. Fatal and disabling perioperative complications are common. Complications arise via multiple aetiological pathways. This mechanistic redundancy limits techniques to reduce complications that target individual mechanisms, for example, anti-platelet agents. Remote ischaemic preconditioning (RIPC) induces a protective phenotype in at-risk tissue, conferring protection against ischaemia-reperfusion injury regardless of the trigger. RIPC is induced by repeated periods of upper limb ischaemia-reperfusion produced using a blood pressure cuff. RIPC confers some protection against cardiac and renal injury during major vascular surgery in proof-of-concept trials. Similar trials suggest benefit during cardiac surgery. Several uncertainties remain in advance of a full-scale trial to evaluate clinical efficacy. We propose a feasibility trial to fully evaluate arm-induced RIPC's ability to confer protection in major vascular surgery, assess the incidence of a proposed composite primary efficacy endpoint and evaluate the intervention's acceptability to patients and staff.Methods/Design: Four hundred major vascular surgery patients in five Irish vascular centres will be randomised (stratified for centre and procedure) to undergo RIPC or not immediately before surgery. RIPC will be induced using a blood pressure cuff with four cycles of 5 minutes of ischaemia followed by 5 minutes of reperfusion immediately before the start of operations. There is no sham intervention. Participants will undergo serum troponin measurements preoperatively and 1...

Vivências de pacientes obesas mórbidas candidatas a cirurgia bariátrica : um estudo clínico-qualitativo = Experiences of patients morbidly obese candidates for bariatric surgery : a qualitative clinical study; Experiences of patients morbidly obese candidates for bariatric surgery : a qualitative clinical study

Anna Beatriz Ribeiro Ferreira Sampaio
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 12/07/2013 PT
Relevância na Pesquisa
36.31%
A obesidade vem crescendo, ano a ano, mundialmente, sendo vista pelas autoridades de saúde como um grave problema de saúde pública e um grande desafio para o século XXI. A consequência direta do aumento dessa população obesa e da falta de tratamentos adequados é a elevação do número de cirurgias bariátricas realizadas mundialmente. Essas cirurgias trazem consequências para o paciente operado, consequências essas que não são totalmente conhecidas. Metodologia: Utilizamos o Método Clínico-Qualitativo. A amostra foi intencional e fechada pelo critério de saturação, composta por sete mulheres candidatas à cirurgia bariátrica para tratamento de obesidade mórbida. A coleta de dados foi realizada por meio de entrevistas semidirigidas de questões abertas realizada pelo pesquisador gravadas, transcritas e analisadas em profundidade. Os dados foram submetidos à análise de conteúdo e validação externa pelos pares do Laboratório de Pesquisa Clínico-Qualitativa do Departamento de Psicologia Médica e Psiquiatria da Unicamp. Discussão e resultados: a Cirurgia Bariátrica traz a essas mulheres uma nova esperança de vida, mas as expectativas são irreais. Elas depositam todas as suas expectativas na cirurgia, acreditando que serão reinseridas no mercado de trabalho e na sociedade. Acreditam também que terão uma melhora de suas relações afetivas. Deixam de pensar nas dificuldades que irão enfrentar após a cirurgia. Nas falas dessas pacientes evidenciamos um forte mecanismo de negação quanto às dificuldades que decorrem da cirurgia...

Change in corneal aberrations after cataract surgery with 2 types of aspherical intraocular lenses

Marcos, Susana; Rosales, Patricia; Llorente, Lourdes; Jiménez-Alfaro, Ignacio
Fonte: Elsevier; American Society of Cataract & Refractive Surgery; American Society of Cataract & Refractive Surgery Publicador: Elsevier; American Society of Cataract & Refractive Surgery; American Society of Cataract & Refractive Surgery
Tipo: Artículo Formato: 579438 bytes; application/pdf
ENG
Relevância na Pesquisa
46.25%
10 pages, 6 figures.-- PMID: 17276261 [PubMed].; [Purpose] To study the effect of cataract surgery through 3.2 mm superior incisions on corneal aberrations with 2 types of monofocal intraocular lenses (IOLs) with an aspherical design.; [Setting] Instituto de Optica, Consejo Superior de Investigaciones Científicas, and Fundación Jiménez Díaz, Madrid, Spain.; [Methods] Corneal topography of 43 eyes was obtained before and after small corneal incision cataract surgery. Twenty-two eyes had implantation of a Tecnis Z9000 silicone IOL (Advanced Medical Optics) and 21 had implantation of an AcrySof IQ SN60WF acrylic IOL (Alcon Research Labs) using the recommended injector for each IOL type. The intended incision size (3.2 mm) was similar in the 2 groups. Corneal aberrations were estimated using custom-developed algorithms (based on ray tracing) for 10.0 mm and 5.0 mm pupils. Comparisons between preoperative and postoperative measurements and across the groups were made for individual Zernike terms and root-mean-square (RMS) wavefront error.; [Results] The RMS (excluding tilt and defocus) did not change in the AcrySof IQ group and increased significantly in the Tecnis group with the 10.0 mm and 5.0 mm pupil diameters. Spherical aberration and coma-like terms did not change significantly; however...

Are Changes in Ocular Aberrations With Age a Significant Problem for Refractive Surgery?

Marcos, Susana
Fonte: International Society of Refractive Surgery Publicador: International Society of Refractive Surgery
Tipo: Artículo Formato: 312352 bytes; application/pdf
ENG
Relevância na Pesquisa
46.23%
7 pages, 3 figures.-- PMID: 12361160 [PubMed].-- Presented at the 3rd International Congress of Wavefront Sensing and Aberration-free Refractive Correction, February 15-17, 2002, Interlaken, Switzerland.; We discuss current knowledge about the change of aberrations with aging, cataract surgery, and laser in situ keratomileusis (LASIK) for myopia. Based on this evidence, we speculate about the long-term expectations for postoperative LASIK eyes in terms of aberrations. Standard myopic LASIK surgery produces a significant increase in aberrations, particularly corneal spherical aberration, which changes to positive values. Aberrations increase with age, and in particular, the spherical aberration of the crystalline lens shifts toward positive values. Therefore, no compensatory effect is expected to occur with age after standard myopic LASIK, but rather the unusually high amount of aberrations in postoperative LASIK patients is expected to worsen with age. The amount of aberrations in patients after cataract surgery with implantation of standard intraocular lenses (IOLs) is higher than in normal young subjects. If an ideal customized ablation (not inducing aberrations and reducing naturally existing aberrations) is ever possible, the perfect correction will not last (due to the change of aberrations with age)...