scholarly journals A clinical investigation of the association between perioperative oral management and prognostic nutritional index in patients with digestive and urinary cancers

2020 ◽  
Vol 27 (5) ◽  
Author(s):  
H. Otagiri ◽  
S. Yamada ◽  
M. Hashidume ◽  
A. Sakurai ◽  
M. Morioka ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Medical Records ◽  
Clinical Investigation ◽  
Oral Intake ◽  
Prognostic Nutritional Index ◽  
Early Postoperative Period ◽  
Patients With Cancer ◽  
Positive Effects ◽  
Management Interventions ◽  
Nutritional Index

Background The prognostic nutritional index (pni) is a simple metric calculated using serum albumin and the peripheral lymphocyte count. It was reported that a low pni score is significantly associated with major postoperative complications and poor prognosis. The purpose of the present study was to investigate the effects of perioperative oral management (pom) on the perioperative pni profiles of patients with digestive system or urinary cancers. Study Design The medical records of 181 patients with cancer who underwent surgery and for whom a pni could be calculated were retrospectively reviewed. Results The intervention rate with pom was 34.8%. The median preoperative pni score was 48.25 in all patients with a pom intervention [25% to 75% interquartile range (iqr): 44.38–54.13] and 47.25 in those without an intervention (iqr: 42.0–53.5). Compared with patients not receiving pom, those who received pom had significantly higher pni scores from the early postoperative period (p < 0.05). Notably, of patients who could resume oral intake within 3 days after surgery, those who received pom intervention, compared with those who did not, had significantly higher pni scores from the early postoperative period (p < 0.05). Conclusions Perioperative oral management interventions might have positive effects on the postoperative pni scores of patients with cancer.

scholarly journals Long-term postoperative opioid prescription after cholecystectomy or gastric by-pass surgery: a retrospective observational study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Viktoria Larsson ◽  
Cecilia Nordenson ◽  
Pontus Karling
Keyword(s):  
Observational Study ◽  
Postoperative Period ◽  
Medical Records ◽  
Early Postoperative Period ◽  
Retrospective Observational Study ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Post Surgery ◽  
Gastric By Pass

Abstract Objectives Opioids are commonly prescribed post-surgery. We investigated the proportion of patients who were prescribed any opioids 6–12 months after two common surgeries – laparoscopic cholecystectomy and gastric by-pass (GBP) surgery. A secondary aim was to examine risk factors prior to surgery associated with the prescription of any opioids after surgery. Methods We performed a retrospective observational study on data from medical records from patients who underwent cholecystectomy (n=297) or GBP (n=93) in 2018 in the Region of Västerbotten, Sweden. Data on prescriptions for opioids and other drugs were collected from the patients` medical records. Results There were 109 patients (28%) who were prescribed opioids after discharge from surgery but only 20 patients (5%) who still received opioid prescriptions 6–12 months after surgery. All 20 of these patients had also been prescribed opioids within three months before surgery, most commonly for back and joint pain. Only 1 out of 56 patients who were prescribed opioids preoperatively due to gallbladder pain still received prescriptions for opioids 6–12 months after surgery. Although opioid use in the early postoperative period was more common among patients who underwent cholecystectomy, the patients who underwent GBP were more prone to be “long-term” users of opioids. In the patients who were prescribed opioids within three months prior to surgery, 8 out of 13 patients who underwent GBP and 12 of the 96 patients who underwent cholecystectomy were still prescribed opioids 6–12 months after surgery (OR 11.2; 95% CI 3.1–39.9, p=0,0002). Affective disorders were common among “long-term” users of opioids and prior benzodiazepine and amitriptyline use were significantly associated with “long-term” opioid use. Conclusions The proportion of patients that used opioids 6–12 months after cholecystectomy or GBP was low. Patients with preoperative opioid-use experienced a significantly higher risk of “long-term” opioid use when undergoing GBP compared to cholecystectomy. The indication for being prescribed opioids in the “long-term” were mostly unrelated to surgery. No patient who was naïve to opioids prior surgery was prescribed opioids 6–12 months after surgery. Although opioids are commonly prescribed in the preoperative and in the early postoperative period to patients with gallbladder disease, there is a low risk that these prescriptions will lead to long-term opioid use. The reasons for being prescribed opioids in the long-term are often due to causes not related to surgery.

Ultrasound imaging of biliodigestive anastomoses

10.12737/6673 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 0-0 ◽  
Author(s):  
Рязанцев ◽  
A. Ryazantsev ◽  
Благовестнов ◽  
D. Blagovestnov ◽  
Гончарова ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Postoperative Period ◽  
Medical Records ◽  
Postoperative Mortality ◽  
Magnetic Resonance Tomography ◽  
Abdominal Ultrasound ◽  
Early Postoperative Period ◽  
Ultra Sound ◽  
Reflux Cholangitis ◽  
Late Postoperative Period

The authors conducted a retrospective analysis of medical records of 71 patients operated on biliary obstruction with biliodigestive anastomoses. In the early postoperative period of 71 patients with various types of complications were observed in 14 (19,7%) patients of еarly postoperative mortality was 5,6% (4 patients) and 56 patients were observed from 1 year to 7 years after surgery. All patients in the postoperative period were performed trans-abdominal ultrasound imaging, tomography, magnetic resonance tomography, fistulography. The technique of improving ultrasonic visualization of the distal bile duct and area BDA and ultrasound semiotics state of biliodigestive anastomoses in the early and late postoperative period were developed. Ultra-sound criteria of insolvency biliodigestive anastomoses in the early postoperative period, and signs of scarring biliodigestive anastomoses and development of reflux cholangitis in the late postoperative period were carried out and systematized. High precision of data of ultrasonic imaging with a clinical diagnosis was noted. The sen-sitivity of ultrasound in detecting reflux cholangitis amounted to 100%; specificity – 83,7%; accuracy was 87,5%. The sensitivity of ultrasound in detecting scar stricture biliodigestive anastomoses amounted to 87,5%; the specificity was 93,8% of the respondents; the accuracy of 92,9%.

scholarly journals Effects of dual-task rehabilitative training in the early postoperative period after direct myocardial revascularization

2021 ◽  
Vol 10 (3) ◽  
pp. 15-25
Author(s):  
I. V. Tarasova ◽  
O. A. Trubnikova ◽  
I. N. Kuhareva ◽  
A. S. Sosnina ◽  
D. S. Kupriyanova ◽  
...  
Keyword(s):  
Cognitive Training ◽  
Postoperative Period ◽  
Dual Task ◽  
Myocardial Revascularization ◽  
Training Group ◽  
Early Postoperative Period ◽  
Cognitive State ◽  
Positive Effects ◽  
Task Training ◽  
Dual Task Training

Aim. To assess the effects of cognitive rehabilitation with dual-task training that involves a cognitive task combined with postural and walking control, as well as electroencephalogram indices in patients in the early postoperative period after direct myocardial revascularization.Methods. The study enrolled 48 patients scheduled for coronary artery bypass graft surgery. Subjects in this prospective, randomized study were randomized using envelopes to a postoperative cognitive training group (n = 23) and non-training group (n = 25). The cognitive training was carried out daily, starting 3-4 days after the procedure and until the discharge order. Dual tasks training (a cognitive task combined with postural and walking control) lasted 15-20 minutes. All patients were submitted to an extended neurophysiological assessment (psychometric tests and electroencephalogram study) and stabilography 3-5 days before and 8-11 days after coronary artery bypass grafting.Results. The patients who underwent cognitive training experienced postoperative cognitive dysfunction (POCD) in 39% cases in the early postoperative period after intervention, while the non-training group - in 64%. The relative risk of developing POCD in the non-training group was 2.77 (95% CI: 0.86-8.91, Z = 1.704, p = 0.08). The patients in cognitive training exhibited better cognitive state compared to the preoperative state (Z = 2.58; p = 0.01) in the absence of statistically significant differences in the non-training group. Moreover, type-1 theta power values increased in the non-training group in comparison to the preoperative values, while the cognitive training group did not have a statistically significant difference in theta power.Conclusion. Positive effects of dual task rehabilitation on the neurophysiological parameters of patients undergoing direct myocardial revascularization were demonstrated. Positive effects include lower frequency of POCD, improved cognitive state and less pronounced cortical dysfunction. The dual task training had proved a suitable training method for this category of patients. Additional studies are required to test the possibility of increasing the duration and intensity of dual task training for stronger recovery effect and improved cognitive and walking performance of patients in the postoperative period after direct myocardial revascularization.

Investigation of Optimal Time for Starting Betamethasone Using Fatigue Scores and Prognostic Nutritional Index in Terminally Ill Patients With Cancer-Related Fatigue

2016 ◽  
Vol 34 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Nanako Koyama ◽  
Chikako Matsumura ◽  
Hiroaki Morii ◽  
Chiaki Hasegawa ◽  
Daiki Hira ◽  
...  
Keyword(s):  
Survival Time ◽  
Terminally Ill ◽  
Prognostic Nutritional Index ◽  
Optimal Time ◽  
Clinical Validity ◽  
Patients With Cancer ◽  
Terminally Ill Patients ◽  
Cancer Related Fatigue ◽  
Nutritional Index ◽  
The Relationship

Background: Corticosteroids are frequently used to treat cancer-related fatigue (CRF), but it is yet to be established as standard care, and few reports have defined the appropriate time to start treatment. Objectives: We investigated the optimal time for starting betamethasone and evaluated the clinical validity of using the prognostic nutritional index (PNI) for this purpose. Methods: Data were retrospectively collected for patients with terminal cancer receiving betamethasone for palliative care. Fatigue strength was evaluated by the daily occurrence of fatigue, using proportion of adequate fatigue, AF(%), defined as the average of the daily score for all treatment days, AF(%)all, the initial 5 days, AF(%)initi5, or the last 5 days, AF(%)last5. We examined (1) the relationship between survival time and adequate fatigue for CRF and (2) the correlation between survival time and PNI (based on serum albumin and lymphocytes). Results: Data from 24 patients were included. The AF(%)all was approximately 50% at 42 days before death and gradually decreased as the survival time shortened ( R2 =.41, P <.001). There was a clear positive correlation between AF(%)all and AF(%)initi5 ( R2 =.84, P <.001). At 42 days before death, PNI was approximately 30 and significantly correlated with the survival time ( R2 = .873, P <.001). Conclusion: The adequate fatigue appears to be dependent on survival time, and PNI might be useful for identifying patients that will benefit from betamethasone use. It is hoped that these results will contribute to individualized pharmacotherapy of terminally ill patients with CRF.

scholarly journals Assessment of postoperative risk of complications on inguinal hernioplasty and its relation to risk factors

2020 ◽  
Vol 66 (5) ◽  
pp. 623-629
Author(s):  
Maurício Chibata ◽  
Oona Tomiê Daronch
Keyword(s):  
Postoperative Period ◽  
Medical Records ◽  
Early Postoperative Period ◽  
World Population ◽  
Inguinal Hernioplasty ◽  
Chronic Complications ◽  
Cross Sectional ◽  
Postoperative Risk ◽  
High Prevalence ◽  
The City

SUMMARY INTRODUCTION Abdominal wall hernias are a highly prevalent pathology, considering that 55 percent of the world population is affected by this disease at some point in their lives. As a large part of these patients present comorbidities, it is important to correlate the incidence of complications with the presence of previous pathologies. OBJECTIVES To evaluate whether the presence of comorbidities in patients submitted to inguinal hernioplasty increases the risk of acute and chronic complications in the postoperative period, as well as to explain which of these prior diseases present a greater association with the incidence of complications. METHODS This is a cross-sectional descriptive study carried out through the retrospective analysis of 313 medical records of patients submitted to open inguinal hernioplasty surgery between March and June 2017 at the General Surgery Service of the Cruz Vermelha Hospital - Paraná Branch, located in the City of Curitiba, state of Paraná, Brasil. RESULTS Of the 313 cases studied, the most prevalent comorbidities were: 107 patients with hypertension (34.19%), 52 smokers (16.61%), 30 cases with diabetes (9.58%), 14 with hypothyroidism (4,47%) and 10 with COPD (3.19%). Regarding the total of the sample evaluated, 130 patients (41.53%) did not present any comorbidity. When evaluating the complications, there were 49 cases (15.65%) of complications in the early postoperative period and 9 cases (2.88%) of chronic complications. The comorbidities that presented significant statistical influence (p <0.05) on the incidence of acute complications were hypertension (p = 0.02927) and smoking (p = 0.03196). CONCLUSION It is important to note the presence of acute postoperative complications of inguinal hernioplasty in patients who have hypertension or smoke, high prevalence diseases.

scholarly journals CARBOHYDRATE METABOLISM ABNORMALITIES IN PATIENTS WITH CANCER OF MAJOR DUODENAL PAPILLA BEFORE AND AFTER PANCREATICODUODENAL RESECTIONS

2012 ◽  
Vol 67 (4) ◽  
pp. 55-59
Author(s):  
A. N. Lebedeva ◽  
V. S. Demidova ◽  
A. G. Kriger
Keyword(s):  
Diabetes Mellitus ◽  
Carbohydrate Metabolism ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Duodenal Papilla ◽  
Moderate Severity ◽  
Patients With Cancer ◽  
Major Duodenal Papilla ◽  
Before And After

56 patients with cancer of major duodenal papilla were examined before and after pylorus-saving pancreaticoduodenal resection. Carbohydrate metabolism was estimated before and after the operation, impact of the operation on diabetes mellitus progression was detected. If there were no carbohydrate metabolism abnormalities in 75% before the operation, then there were 55% of such patients after the operation. After the pylorus-saving pancreaticoduodenal resection the impaired glucose tolerance was detected in 4 (7%) of patients whose carbohydrate metabolism had corresponded to norms before the operation. 7 (13%) Of 17 (31%) patients had diabetes mellitus of mild severity after the pylorus-saving pancreaticoduodenal resection, the rest 10 (18%) had diabetes mellitus of moderate severity. In 7 (13%) patients after the pylorus-saving pancreaticoduodenal resection the diabetes mellitus of moderate severity was detected for the first time, at that in 4 patients diabetes mellitus of mild severity was detected, and in 3 patients — diabetes mellitus of moderate severity (everyone received insulin therapy in the long-term postoperative period) was detected. Checking protocol of the patients’ carbohydrate metabolism in the perioperative period was described in detail. The possibility of prognostication of carbohydrate metabolism abnormalities in the long-term postoperative period by indications of carbohydrate metabolism before the operation and in early postoperative period was studied. Middle blood glucose level in early postoperative period is an informative indication for prognostication of carbohydrate metabolism state in the long-term postoperative period. An algorithm of patients’ examination with cancer of major duodenal papilla before the operation and after it was offered; also checking protocol of carbohydrate metabolism indices and correction of the detected abnormalities in the early postoperative period were offered. 

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