Is the disability of elderly patients related to increased blood transfusions after cardiac surgery?

Funding Acknowledgements Type of funding sources: None. Intorduction. Perioperative bleeding occurs in 2 to 15% of patients. Cardiac surgeries are associated with perioperative blood loss due to the invasive nature of the procedures, the need for high doses of anticoagulation and the need for extracorporeal circulation. Both transfusions and reoperations due to excessive postoperative bleeding are associated with adverse clinical outcomes and increased costs of care. In 2017, the common position of the European Association of Cardiac Cancer Surgeons (EACTS) and the European Association of Cardiac Cancer Surgical Anesthesiologists (EACTA) regarding the management of patient blood in order to maintain adequate perioperative homeostasis and minimizing bleeding, and thus reducing the amount of blood transfusions. Advanced age is one of the factors associated with an increased risk of perioperative bleeding, including the need for transfusion and reoperation. Purpose. Assessment of the relationship between preoperative disability and the amount of blood transfused in elderly patients after cardiac surgeries. Methods. The study included 100 patients ≥ 65 years of age (40 women and 60 men, mean age M ± SD =71.69 ± 4). A sociodemographic questionnaire and the Nagi scale for disability assessment were used to collect the research material. The Nagi scale assesses the limitations of the patient in seven activities. A significant disability is considered to be ≥ 3 points. The number of blood transfusions was assessed based on the analysis of medical records. The number of blood units transfused during hospitalization was taken into account. Statistically significant was assumed to be p < 0.05. Results. In the study group the mean score on the Nagi scale was M ± SD = 3.41 ± 1.83 points. Blood transfusions were required by 66% of the study participants. The number of transfused blood units ranged from 1 to 11. The mean number of transfused blood units was 1.41 ± 1.83 points: M ± SD = 1.56 ± 1.93. 28 patients required 1 blood unit, 11 blood units required 1 patient. There was a significant positive correlation between the values of the Nagi scale and the number of blood units transfused (r = 0.233, p = 0.019) . Moreover, the number of blood units transfused to patients with values of the Nagi scale ≥3 points turned out to be significantly higher than in patients with values of this scale <3 points (p = 0.015). Conclusions. 1) Patients with disability are qualified for cardiac surgeries. 2) Patients with disabilities require more blood units to be transfused.

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Background Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P = 0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P < 0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P < 0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P = 0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P = 0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation?

BackgroundSurgery may possibly be undermined by psychologic, psychiatric and psychosomatic problems, as long as these problems interfere with a patient’s capacity to cope with surgery adaptively. Recent studies have shown that interpersonal trauma, e.g. abuse or neglect, and its correlates are involved in the adaptation to surgery. This observation is heuristically coherent, given the respective traumatization is an interpersonal event occurring in a relationship. Notably, surgery inevitably leads to the violation of physical boundaries within a doctor-patient relationship. Based on the principles of psycho-traumatologic thinking, such a constellation is deemed qualified to activate posttraumatic symptoms in the traumatized.MethodThe present topical review summarizes the respective findings which point to a subgroup of patients undergoing surgery, in whom difficulty bearing tension and confiding in others may cause adaptive problems relevant to surgery. Although this theorizing is empirically substantiated primarily with respect to total knee arthroplasty (TKA), a pubmed-research reveals psychopathologic distress to occur prior to surgery beyond TKA. Likewise, posttraumatic distress occurs in large numbers in the context of several operations, including cardiac, cancer and hernia surgery.ConclusionAspects of psychological trauma may be linked to the outcomes of general surgery, as well, e.g. biliary, hernia or appendix surgery. The mechanisms possibly involved in this process are outlined in terms of a hierarchical organization of specific anxiety and negative affect as well as in terms of psychodynamics which imply the unconscious action of psychologic defenses at their core.ImplicationsNot least, we encourage the screening for trauma and its correlates including defenses prior to general surgery in order to identify surgical candidates at risk of, e.g. chronic postoperative pain, before the operation.

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications.Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups.Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P=0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P<0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P<0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P=0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P=0.016), compared to 99.6% in the AI group and 100% in the EI group.Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

Application infusion drugs based on sorbitol for normalization of aminotransferase activity blood cancer patients operated cardia of the stomach

Objective. To study the effect of intravenous infusions of Rheosorbilact on the activity of alanine aminotransferase and aspartate aminotransferase in the plasma of operated patients with gastric cardiac cancer after proximal gastrectomy. Materials and methods. Alanine aminotransferase and aspartate aminotransferase activity levels were studied in plasma of 40 operated patients with gastric cardiac cancer after proximal gastrectomy immediately after surgery, on the 1st, 2nd, 3rd, 5th day after intravenous infusions of the drug. The infusion of Rheosorbilact was administered intravenously, drip, for 5 days at a rate of 40 drops per minute. The daily dose of the drug was 1000.0 ml. Results. In patients with gastric cardiac cancer after proximal gastrectomy in the first days after surgery revealed changes in aminotransferases, which are accompanied by an increase in the activity of alanine aminotransferase and aspartate aminotransferase in blood plasma. To correct the activity of plasma aminotransferases in such patients, Rheosorbilact was administered intravenously immediately after surgery. After repeated intravenous infusions of Rheosorbilact for 5 days, a significant decrease in the activity of alanine aminotransferase and aspartate aminotransferase in blood plasma in the operated patients was revealed. Conclusions. In the first days after proximal gastrectomy in patients with gastric cardiac cancer, an increase in the activity of aminotransferases in blood plasma was revealed. Repeated intravenous infusions of Rheosorbilact normalize the activity of alanine aminotransferase and aspartate aminotransferase in the blood plasma of such patients in the early postoperative period. Infusion drug Rheosorbilact is recommended for widespread medical use in patients with cardiac gastric cancer after proximal gastrectomy, especially in the early postoperative period.

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications.Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups.Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P=0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P<0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P<0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P=0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P=0.016), compared to 99.6% in the AI group and 100% in the EI group.Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% ( P =0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively ( P <0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% ( P <0.001). The distant metastasis rate was 0.4%, 0% and 2.3% ( P =0.150). The five-year disease-specific survival rate in the BEI group was 96.6% ( P =0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

Analysis of the Value of Laparoscopy Combined with Right Thoracic Small Incision Ivor-Lewis in the Treatment of Cardia Cancer Under X-ray Biomedical Imaging

In order to explore the accuracy of image segmentation algorithm in the biological image segmentation of cardia cancer patients with X-ray barium meal imaging and the effect of laparoscopy combined with right thoracic small incision Ivor Lewis on the prognosis of patients with cardia cancer, 185 patients diagnosed with cardiac cancer in xxx hospital from June 2015 to December 2018 were taken as research objects. Based on X-ray barium meal images, the efficiency of manual segmentation and the proposed watershed based minimum error threshold algorithm for image segmentation was compared. Based on the segmentation results, 185 patients with cardiac cancer were divided into the control group (n = 105) and the test group (n = 80), and the control group received traditional Ivor Lewis surgery, while the test group received laparoscopic Ivor Lewis surgery combined with a small incision in the right chest. Postoperative comparison was made between the two groups of patients on the 3rd day after the operation in the number of lymph node dissection, the incidence of postoperative complications, and the pain score 24 h after the operation. The results showed that the minimum error threshold algorithm based on watershed presented in this study was significantly more accurate than manual segmentation in the segmentation of X-ray barium meal images of cardiac cancer patients. The intraoperative blood loss, postoperative out-of-bed activity time and hospitalization time of the experimental group were significantly lower than that of the control group, and the differences were statistically significant (P < 0.05). The complication rates of postoperative chest drainage volume, postoperative 24 h pain score, postoperative pulmonary infection, bleeding and anastomotic fistula in the 2 d test group were all lower than those in the control group, and the differences were statistically significant (P < 0.05), which indicated that the watershed based minimum error threshold algorithm proposed in this study can effectively achieve the segmentation of X-ray barium meal images of patients with cardiac cancer, while the laparoscopy combined with the right thoracic small incision Ivor Lewis can effectively improve the quality of life of patients.