[Experience in the dispensary service to children recovering from epidemic hepatitis].
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Adolescent↗
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Results for “HOSPITALS, CONVALESCENT”
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Basic design and equipment needed for a Coronary Care Unit.
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Cardiovascular Diseases↗
[Acute cholecystitis in videolaparoscopy].
The authors describe their experience in 15 cases of acute cholecystitis treated with laparoscopic cholecystectomy in emergency. Only in one patient, affected with an abscess of the upper right abdominal space, a laparotomy was performed. The results were excellent. The 14 patients treated with laparoscopic cholecystectomy were quickly discharged from the hospital (on an average 4 days after the surgical treatment) and the convalescence period was very short (range 10-15 days). In the patient treated with laparotomic cholecystectomy the postoperatory period was regular.
Acute Disease↗
[Prophylactic intraaortic balloon pumping preserves left ventricular systolic function in acute anterior myocardial infarction without cardiogenic shock].
OBJECTIVES: Left ventricular function and prognosis were evaluated in patients with acute myocardial infarction who underwent primary percutaneous coronary intervention supported by intraaortic balloon pumping. METHODS: Fifty-eight consecutive patients with first acute myocardial infarction were treated between July 1999 and April 2006. Twenty-five had cardiogenic shock on admission, whereas 33 did not. Patients with anterior acute myocardial infarction without cardiogenic shock were divided into the prophylactic intraaortic balloon pumping group (Group 1; n=17) and the rescue intraaortic balloon pumping group (Group 2; n=9). RESULTS: Thirty-day in-hospital mortality was 52% in cardiogenic shock patients, and 3% in non-shock patients. Baseline characteristics of non-shock anterior acute myocardial infarction were similar including Thrombolysis in Myocardial Infarction (TIMI) risk scores (5.1 and 5.0) in the two groups. However, average left ventricular ejection fraction in the convalescent stage was superior in Group 1 (48.7% vs. 37.8%, p = 0.03). Thirty-day in-hospital mortality was 0% in Group 1 and 11% in Group 2 (p = 0.34). Cox's hazard ratio in Group 2 to Group 1 was 2.38 (95% confidence intrerval; 0.84-11.1, p = 0.09) in terms of the subsequent major cardiac events. CONCLUSIONS: Prophylactic use of intraaortic balloon pumping starting prior to primary percutaneous coronary intervention preserves the convalescent left ventricular systolic function in patients with high risk for anticipated cardiac events after anterior acute myocardial infarction without cardiogenic shock.
Aged↗
[Endocrine surgery by hypnosis. From fiction to daily clinical application...].
Between April 1994 and March 1996, 108 thyroidectomies (97 partial or unilateral lobectomies and 11 bilateral lobectomies) and 13 cervical explorations for hyperparathyroidism were performed under hypnosedation (HS) technique combining hypnosis and light conscious sedation. Informed consent was obtained from each patient. None of these patients underwent preoperatively standard susceptibility test score or preparatory hypnotic session. Nevertheless, no patient required conversion to general anesthesia. Operative data and postoperative courses were compared to a well-matched population (n = 70) of patients operated on for thyroid diseases under general anesthesia (GA). Under HS, mortality was zero and surgical management was only complicated by unilateral definitive recurrent laryngeal nerve paralysis in one case (0.8%) and the need for neck reexploration for severe hematoma after parathyroidectomy in another case. Hyperparathyroidism was cured in all cases. The surgeons all reported better operating conditions, estimated by visual analog scale (VAS), for cervicotomy using HS (8.9 +/- 0.6 cm vs 8.0 +/- 1.2 cm in the GA group, p < 0.01). This is probably related to reduced bleeding in the operative field. All the patients reported a very pleasant experience and enjoyed having their surgery performed under HS (VAS of satisfaction: 9.35 +/- 0.99 vs 2.88 cm +/- 2.8 cm in the GA group, p < 0.001). Patients having HS had less postoperative pain (VAS of pain: 2.2 +/- 1.6 cm vs 3.2 +/- 2.0 cm in the GA group, p < 0.01), whereas antalgic consumption was significantly reduced in the HS group compared with the GA group (paracetamol on first postoperative day was, 932 +/- 519 mg vs 1437 +/- 622 mg in the GA group, p < 0.001). Hospital stay was also significantly lower (46.3 h +/- 14.6 vs 74.2 +/- 9.5 h in the GA group, p < 0.001), providing a substantial reduction of the costs of medical care. The postoperative fatigue syndrome and surgical convalescence were significantly improved after HS (VAS of fatigue: 2.05 +/- 2.01 cm vs 4.7 +/- 2.4 cm in the GA group, p < 0.001, hand grip test: 95.5% of preoperative muscular maximum force vs 89.9% in the GA group, p < 0.01). Full return to social or professional activity was usually accomplished after 10.3 +/- 10.2 days in the HS group vs 36 +/- 8 days in the GA group, p < 0.001). From this study, we concluded that HS is a very effective technique for providing relief of intra- and postoperative pain in endocrine surgery. This technique results in high patient satisfaction and better surgical convalescence. This technique therefore can be used in most motivated patients and reduces the socio-economic impact of hospitalization.
Activities of Daily Living↗
Psychological stress in wives of patients with myocardial infarction.
In a study of the psychological consequences of myocardial infarction on 65 wives of husbands admitted to a coronary care unit feelings of loss, depression, and guilt were common at the time of infarction. Many wives (38%) found the period of convalescence after discharge very stressful, attributing this to fears of a recurrent infarct and marital tension owing to their husbands' increased irritability and dependency. These anxieties and tensions gradually diminished and at one year after the initial illness only eight wives whose husbands had made a good physical recovery still showed considerable psychological disturbance. It is suggested that unnecessary emotional distress, particularly in the initial period after discharge from hospital, can be alleviated by increased help and support from the hospital and family doctor.
Adult↗
Relinquishing the sick role: convalescence and rehabilitation.
This paper examines the problems of patients who have been considered by their doctors to have received adequate rehabilitation and to be ready to relinquish the sick role. The sick role is discussed in its historical context and convalescence and rehabilitation are considered as alternative approaches to medical and nursing care. It is argued that many patients leaving hospital are frightened because they do not feel well and they will receive little if any follow-up or support after discharge. It is the author's belief that many patients need to convalesce because the very essence of their being is still ill.
Aftercare↗
Plasma and urine electrolyte concentrations and vasopressin levels in patients admitted to hospital for falciparum malaria.
Vasopressin levels, together with plasma and urinary electrolytes, were measured in the acute and convalescent stages of 17 patients with malaria and 11 patients with other febrile illnesses. There was a significantly lower serum sodium in the acute stages of both groups (p less than 0.01 and p less than 0.02). There was no significant difference between the malaria and control groups. There were no significant changes in the vasopressin levels, although one patient with malaria showed evidence of inappropriate vasopressin secretion which returned to normal after treatment. This study suggests the mild hyponatraemia sometimes seen in the acute stages of malaria is not related to inappropriate secretion of vasopressin, although this condition may be of importance in more severe cases of hyponatraemia.
Adolescent↗
End of an experiment: report from an inner city community hospital.
Community hospitals are associated with the provision of health care in rural rather than urban areas. However, the urban community hospital can reduce the pressure on acute hospitals and decrease the isolation of community health workers. In 1982 a community hospital was established in an inner London health district. This paper examines the role and function of this hospital over a oneyear period in 1986-87 and makes comparisons with the hospital's first two years of operation. The problems identified in the initial evaluation, such as low bed occupancy and the limited participation by general practitioners in the area, were still present. It was found that there had been a decrease in the number of patients treated for musculoskeletal, nervous system and respiratory problems but an increase in circulatory disorders and injuries or poisoning. There was also a marked decrease in the percentage of acute admissions but an increase in admissions for convalescence, rehabilitation and carer relief. Following a severe financial crisis in the health district the hospital was closed temporarily in November 1987.
Attitude of Health Personnel↗
[Ambulatory laparoscopic cholecystectomy. Feasibility and convalescence].
UNLABELLED: The purpose was to describe feasibility of and convalescence after laparoscopic cholecystectomy in a day case set up in this prospective, open, and descriptive study. Fifty consecutive patients referred for elective cholecystectomy participated. An overnight stay was planned for 13 patients, (12 because they lived alone, one because of pulmonary disease ASA III). The operation was in all cases performed under combined epidural-general anaesthesia. The primary issues were duration of hospital stay, reasons for delayed discharge, frequencies of nausea and vomiting, as well as duration of convalescence and reasons for postponement of return to work or recreational activities. Twenty-six patients (of 37 candidates for day case surgery) were discharged on the day of surgery and 16 on the first postoperative day. Eleven patients had nausea, and three vomited during the first three postoperative hours. Pain was the most common contributory reason for overnight stay (17 patients, eight of these being planned day-case patients who stayed overnight). The patients were recommended to resume work and recreational activities after 48 hours, but 35 patients did not observe this recommendation. The median number of days off work or recreational activity was four days (2-8), including the day of surgery. Pain was the most common contributory reason (19 patients). CONCLUSIONS: Laparoscopic cholecystectomy can be performed as an outpatient operation in more than half of all patients, in approximately 70% of patients not living alone, and with only 15% of the patients requiring more than one over-night stay. Postoperative pain is the primary reason for both delayed discharge and prolonged convalescence. Up to one week's duration of convalescence is recommended.
Adult↗
Multimedia article. Laparoscopic abdominoperineal resection for lower rectal cancers: how do we do it?
BACKGROUND: The appropriateness of the laparoscopic approach for the resection of rectal cancer has been controversial, although it is well established in colon cancer. This is a phase II study of laparoscopic abdominoperineal resection (APR) in the treatment of lower rectal cancers. METHODS: Patients with lower rectal adenocarcinoma located within 6 cm above the anal verge were recruited and subjected to laparoscopic APR. The surgical principle included en bloc resection with high ligation of inferior mesenteric vessels by no-touch isolation and total mesorectal excision. Details of the surgical procedures are presented in the video. The technical efficiency and outcome of this surgical approach were evaluated prospectively. This study was approved by the institutional review board of National Taiwan University Hospital (NTUH). RESULTS: A total of 22 patients were enrolled in the study from January 2003 to December 2004 under the ethical guidelines of clinical trials in NTUH. There were 12 females and 10 males, with an age distribution of 62.5 +/- 10.4 years. The body mass index was 24.8 +/- 4.0 kg/m2. Physical status (American Society of Anesthesiology classification) was class I in 12, class II in eight, and class III in two patients. Tumor size was 44.0 +/- 12.0 mm in diameter. Two patients were in pathologic TNM stage I, 14 in stage II, and six in stage III. The operation time was 214.0 +/- 28.4 min. Blood loss was 54.0 +/- 14.0 ml. Because the tumor specimen was retrieved from a perineal wound, the five 5 to 12 mm working ports constituted the abdominal wound. There were no major complications. However, wound infection of port sites was detected in one patient. The patients had a quick convalescence, as evaluated by the length of postoperative ileus (48.0 +/- 12.0 h), length of hospitalization (8.0 +/- 2.0 days), and degree of postoperative pain (3.5 +/- 0.5 visual analogue scale). Return to partial activity, full activity, and work was 2.0 +/- 0.5, 4.0 +/- 0.8, and 6.0 +/- 0.5 weeks, respectively. The number of cleared lymph nodes was 14.0 +/- 2.0. During follow-up (median, 18 months; range, 6-30), lung metastasis and local pelvic recurrence developed in one and two patients, respectively. Besides the expenses covered by the National Bureau of Health Insurance of Taiwan, the additional payment by patients undergoing laparoscopic procedures was NTD 24,000 +/- 3000 (1 U.S. dollar = 32 NTD). CONCLUSIONS: In our clinical setting, laparoscopic APR can be performed with good technical efficiency, quick functional recovery, and mild disability. The short-term oncologic results of laparoscopic APR seem to be acceptable, but further long-term follow-up for these patients is mandatory to define the oncologic outcomes of this approach.
Abdomen↗
Recovery from episodes during the course of affective disorder: a case-register study.
OBJECTIVE: The aim of the study was to investigate whether the duration of treated episodes changes during the course of unipolar and bipolar affective disorder. METHOD: The rate of recovery from successive hospitalized episodes was estimated with survival analyses in a case-register study including all hospital admissions with primary affective disorder in Denmark during the period 1971-1993. RESULTS: A total of 9174 patients with recurrent episodes were followed from their first admission. The rate of recovery from hospitalized episodes did not change with the number of episodes in unipolar or bipolar disorder. Furthermore, the rate of recovery was constant across episodes, regardless of the combination of age, gender and type of disorder. Initially in the course of the illness, the rate was a little faster for bipolar than for unipolar patients, but later in the course of the illness the rate of recovery was the same for the two disorders. CONCLUSION: It is concluded that, in modern treatment settings, the duration of affective episodes appears to be stable during the course of unipolar and bipolar disorder.
Adult↗
Patterns of hospitalization in elderly patients with asthma and chronic obstructive pulmonary disease.
The purpose of this study was to describe the impact of asthma and chronic obstructive pulmonary disease (COPD) in the elderly on health care utilization. The Health Care Financing Administration (HCFA) file for the year 1984 through 1991 involving beneficiaries < or = 65 yr were searched for the diagnoses of asthma and COPD by ICD-9 codes. The study groups were created by determining the first admission for an exacerbation of either disease during each year from 1984 through 1991. Patients were identified by their social security number. The 1984 cohort consisted of 56,692 patients with asthma exacerbation and 162,899 with COPD exacerbation. The 1991 cohort consisted of 67,758 patients with asthma exacerbation and 131,974 patients with COPD exacerbation. In addition, the 1984 cohort was tracked by social security number for evidence of rehospitalization for either asthma or COPD through 1991. Length of hospitalization increased as patients grew older. The discharge rate to an independent living facility diminished as age increased. The use of convalescent and nursing homes or home health care after discharge more than doubled from 1984 through 1991. The utilization of health care resources by elderly patients with asthma and COPD is immense, both during hospitalization and after discharge.
Age Factors↗
Laparoscopic nephrectomy, radical nephrectomy and adrenalectomy: Nagoya experience.
A total of 37 patients with various renal and adrenal diseases underwent laparoscopic nephrectomy, radical nephrectomy and adrenalectomy since July 1991. The underlying diseases included renal calculi, vesicoureteral reflux, ureteropelvic junction obstruction, ureteral stenosis, ectopic ureter, vascular disease, renal cell carcinoma and adrenal tumors. Twenty-nine kidneys (including 5 with renal cell carcinoma) and 5 adrenal glands were removed successfully. Three cases failed because of dense adhesion to the surrounding structures, hemorrhage from the renal vein and hemorrhage from the vena cava, respectively. Of the remaining 34 patients 3 required additional open laparotomy to control bleeding or remove lost calculi. Mean operating time was 265 minutes for nephrectomy, 383 minutes for radical nephrectomy and 199 minutes for adrenalectomy, and mean estimated blood loss was 455 ml., 430 ml. and 80 ml., respectively. Average hospital stay was 10 days for the 31 patients without open laparotomy and convalescence was completed by postoperative day 21. These results indicate that laparoscopic surgery for renal and adrenal disease is a feasible, minimally invasive procedure. In the case of laparoscopic radical nephrectomy, however, longterm followup is necessary to confirm the efficacy.
Adolescent↗
Laparoscopic ablation of symptomatic peripelvic renal cysts.
PURPOSE: We report our experience with laparoscopic ablation of symptomatic peripelvic renal cysts. PATIENTS AND METHODS: Two men and two women (mean age 58) with a peripelvic renal cyst associated with ipsilateral flank pain and obstruction were treated by transperitoneal laparoscopic ablation. One patient had an episode of pyelonephritis before detection of the cyst. Cyst size ranged from 4.5 to 6.5 cm (mean 5.5 cm). Dissection of the cyst was intricate because of the close proximity to the renal hilum and the compressed collecting system. Patients were followed with radiologic imaging at 6 and 12 months and once a year thereafter. RESULTS: In all cases, the laparoscopic procedure was successful. The operative time ranged from 120 to 190 minutes (mean 155 minutes), and the mean blood loss was <150 mL. The mean postoperative hospital stay was 2.7 days (range 2-5 days), and the time of convalescence was 14 days. Complications consisted of a subcutaneous hematoma. At a mean follow-up of 23 months, symptoms and collecting system obstruction had resolved in all patients. CONCLUSION: Although laparoscopic ablation of peripelvic renal cysts is technically challenging, it is a safe and efficacious procedure and offers a favorable minimally invasive alternative for the treatment of symptomatic cysts.
Adult↗
Oral refeeding in patients with mild acute pancreatitis: prevalence and risk factors of relapsing abdominal pain.
BACKGROUND AND AIM: In acute pancreatitis (AP), oral refeeding may stimulate pancreatic secretion, increasing the inflammation of the glandular tissue causing relapse of abdominal pain or even exacerbation of the disease. This study aimed to assess the prevalence and risk factors of abdominal pain relapse over oral refeeding in patients convalescing with AP as well as the impact of pain recurrence on the hospital stay. METHODS: Inclusion criteria were AP confirmed by biochemical and/or radiological data in the absence of severe disease or extensive necrosis. The same diet was offered to all patients during oral refeeding. Demographic, clinical, biochemical and radiological data were prospectively recorded and analyzed. RESULTS: A total of 130 patients were included. During the oral refeeding period, 32 (24.6%) patients had pain relapse, which was more common on days 1 (68.8%) and 2 (28.1%). Pain relapse was related to higher serum levels of lipase on the day before refeeding, higher serum levels of C-reactive protein on the fourth day, and presence of peripancreatic fluid collections (P < 0.01). Pain relapse significantly increased total hospital stay (P < 0.01). CONCLUSIONS: In patients with mild AP, pain relapse during oral refeeding was relatively high (24.6%), particularly on the first or second day. Their risk appeared be associated with more intense or persistent pancreatic inflammation on the day before refeeding, and presence of peripancreatic fluid collections. Pain relapse increased hospital stay, and likely overall costs on disease treatment.
Abdominal Pain↗
[Planning surgical treatment].
The following should be regarded as prerequisites for successful surgical treatment: careful assessment of the local problem and of the patient as a complete individual; a thorough understanding of the biomechanical implications of the disease and of the operations used in its management; a clear definition of the goals of surgery in both the patient's and the surgeon's minds; and very careful planning with regard to the timing and sequence of operations. Other factors of major importance, especially in multijoint reconstructive programmes, are careful patient selection, the early establishment of good doctor/patient rapport, the support of a highly skilled multidisciplinary team of health professionals, and impeccable supervision of the convalescence, especially at the particularly difficult period for the patient following discharge from hospital. Finally, the hospital team must be prepared to offer a permanent service as a readily available advice bureau for family doctors, patients, and their relatives.
Arthritis, Rheumatoid↗
Cerebrospinal fluid folate activity in patients with Plasmodium falciparum cerebral malaria.
Serum and CSF folate levels were determined simultaneously in 28 patients with P. falciparum cerebral malaria. Both mean values were found to be significantly lower than those of normal subjects reported earlier. Ten (35%) and nine (32%) patients showed low serum and CSF folate respectively. Altogether seven patients had low folate levels in both serum and CSF. After being treated in the hospital for one week, both serum and CSF folate levels increased in nine convalescent subjects. The CSF folate levels were statistically significantly higher than those of the acute malarial stage. These findings indicated that both serum and CSF folate levels were depressed in patients with cerebral malaria and increased after recovery.
Adolescent↗