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PubMed2004

[Incidence of oropharyngeal dysphagia associated with stroke in a regional hospital in São Paulo State - Brazil].

Cerebrovascular disease is recognized as to be associated with the highest mortality rate in Brazil. Dysphagia, speech and language disturbances are common consequences of the high incidence of stroke. Dysphagia is known to occur in at least 50% of the patients with acute stroke. The study is designed to establish the incidence of stroke in a reference hospital. One hundred and two consecutive patients admitted between January 2001 and January 2002 underwent a neurological examination with dysphagia specific analysis, performed by speech/dysphagia professionals as soon as they have clinical conditions. The localization of the lesions are determined by computer tomography or magnetic resonance image of the brain. Sixty one patients underwent videofluorscopic evaluation of swallowing. There was detected oropharyngeal dysphagia in 78 patients (76.5%) if the examination was limited to the clinical evaluation. Nevertheless, if complemented by videofluorscopic evaluation, the incidence grows to 90%. The explanation for the high incidence observed in this study could be pointed to the fact that dysphagia was registered on different times of the convalescence period. The data reinforces the importance of repeated evaluations made by different professionals of the staff involved in acute stroke attendance.

Adult↗
PubMed1999

[Care of persons with aphasia--a review of the literature].

What patients suffering from aphasia experience was examined by Helmbold et al. (1998). The course of the illness was described and divided into six stages. Other models of recovery processes do not take into account the fact that patients who have suffered a stroke are very often confronted with the problem of speech impairment which leads to a delay in recovery. If patients cannot talk to or interact with friends and relatives or professional carers they find it almost impossible to grasp their own clinical symptoms and ultimately to accept them. Nurses working in general hospitals rarely centre their attention on the individual needs of the patients, with the result that there is little or no interaction between patients with aphasia and their carers. This leads to isolation and depression. Interventions have shown that communication is possible even when there is serious speech impairment. In all attempts to encourage communication however the care and attention shown by nurses to aphasic patients is of decisive importance.

Aphasia↗
PubMed1988

Aeromedical transfer of burned patients: a review with special reference to European civilian practice.

Inter-hospital transfer of a patient with a burn injury can usually be undertaken with confidence, even for non-medical reasons, as long as it is undertaken with care. Transfer by air has many advantages for the seriously burned patient provided that all potential risk factors are taken into account. There is a need to consider infection, the respiratory condition and the cardiovascular status of the patient. The possibility of other injuries should also be borne in mind. Early transfer requires careful but urgent planning if it is to be achieved, as is desirable, by days 3 or 4 postburn. Transfer during or at the end of the resuscitation phase, or in the convalescent phase when skin cover is well established, poses least problems. Plenty of sterile paraffin gauze, wool and crêpe bandages will be needed. Appropriate monitoring equipment and full cardiovascular and respiratory resuscitation facilities should be carried. Care should be taken in the selection of the medical and nursing personnel to accompany the patient, who should whenever possible have experience of burns as well as aviation medicine.

Adult↗
PubMed1985

Doctor-patient communication in surgery.

The efficiency of communication between junior hospital doctors and 77 general surgical patients was assessed by using standardized questionnaires before and after the doctor/patient interview on both the patient and the house doctor. Patients were better informed about their illness than their surgery, and doctors wrongly estimated patients' knowledge in 41% of cases. Self-reported preoperative anxiety of patients was low and was estimated wrongly by house doctors in 58% of cases. In 52% of cases house doctors were considered by patients to be the most important source of information, but patients had little comprehension of the seniority of other doctors. Although 60% of patients were satisfied with the communication, the majority complained of lack of information concerning convalescence, postoperative pain and routine ward procedures.

Adolescent↗
PubMed2005

Prior abdominal surgery and radiation do not complicate the retroperitoneoscopic approach to the kidney or adrenal gland.

PURPOSE: Laparoscopic renal and adrenal surgery is an accepted standard of care. This can be accomplished by a transperitoneal or retroperitoneal approach. In patients with extensive prior intra-abdominal surgery with or without radiation the retroperitoneal laparoscopic approach may avoid bowel adhesions and potential operative complications. We compared clinical outcomes of the laparoscopic retroperitoneal approach in patients with prior open abdominal surgery with or without radiation to outcomes in those with no surgical history. MATERIALS AND METHODS: We evaluated clinical and functional parameters in 78 consecutive patients undergoing retroperitoneoscopic renal or adrenal surgery performed by a single surgeon in a 36-month period, including radical nephrectomy with or without ureterectomy in 50, nerve sparing surgery in 8, ablation in 16 and adrenalectomy in 4. All transperitoneal procedures during the same period were excluded from analysis. Patients were divided into 48 who underwent prior abdominal surgery with or without radiation (group 1) and 30 who did not (group 2). Prior abdominal surgeries in group 1 patients were open and they were major in 42 and/or minor in 39. An additional 6 patients in group 1 received prior abdominal radiation overlapping the planned surgical field. RESULTS: No statistically significant differences were noted between the groups in any parameter assessed, including operative time, blood loss, time to first oral intake, hospital stay or the complication rate (p >0.05). There were no enterotomies in either group. There were no open conversions in group 1, while there were 2 in group 2 (renal vein injury and splenorrhaphy secondary to lymphoma, respectively). Pathological findings showed malignancy in 57 cases (renal cell carcinoma, transitional cell carcinoma, carcinoid disease and metastases) and benign disease in 21 (oncocytoma, adenoma, pyelonephritis and complex cysts). All margins were negative except in 1 group patient with carcinoma in situ at the bladder cuff margin. CONCLUSIONS: The retroperitoneoscopic approach to the kidney and adrenal glands can be used in patients with extensive prior open abdominal surgery and/or radiation without significant increases in morbidity or convalescence.

Adrenal Gland Neoplasms↗
PubMed1997

Cost advantages of two-level anterior cervical fusion with rigid internal fixation for radiculopathy and degenerative disease.

BACKGROUND: Conventional anterior cervical discectomy with fusion is thought to require postoperative neck immobilization for the promotion of bony fusion. Rigid internal fixation with anterior cervical plates may decrease graft-related complications and provide immediate stability. This stability may obviate postoperative external immobilization. METHODS: This report reviews one surgeon's experience with the use of rigid internal fixation for two-level anterior cervical discectomy and fusion for radiculopathy to promote early mobilization without external bracing. It compares outcomes and costs with a similar population of patients treated with anterior cervical discectomy and fusion who did not undergo rigid internal fixation. We compared patients who underwent two-level allograft anterior cervical discectomy and fusion with or without rigid internal fixation between 1989 and 1994 performed by a single surgeon (FJP) to evaluate the cost advantages and outcome of each procedure. All patients had clinical evidence of cervical radiculopathy unresponsive to medical therapy with magnetic resonance imaging confirmation of the appropriate nerve root impingement. Thirty-nine patients underwent two-level Cloward allograft fusion using Synthes anterior cervical locking plates, 25 underwent identical fusion without plating. Follow-up was 6 months to 4 years (mean, 31 months). RESULTS: Twenty-three of 25 patients in the nonplated group and 36 of 39 patients in the plated group achieved excellent or good outcomes using the Odom criteria. There were six complications (two major and four minor) in each group. Patients who underwent plating returned to light activities (mean, 17 vs. 29 days), driving (28 vs. 57 days), and unrestricted work (66 vs. 136 days) sooner than non-plated patients (p < 0.05, paired t test). No patient with plates was given external immobilization. CONCLUSIONS: Two-level anterior cervical discectomy and fusion with anterior plating for radiculopathy is safe, effective, and seems to provide shorter convalescence compared with conventional anterior cervical discectomy and fusion. Patients returned to unrestricted work sooner, thus reducing short-term disability. Rigid internal fixation may provide cost advantages to patients and insurance disability providers. The authors conclude that the increased cost of treatment for rigid internal fixation is more than offset by the benefits of earlier mobilization.

Bone Plates↗
PubMed1998

[Functional urination disorders in patients recovering in an intensive care unit for more than 30 days].

Patients in rest-homes, intensive care units, long hospitalization and dialysis and whoever stays in a hospital continuously or occasionally for long periods of time may run into the well-known and typical complications of prolonged hospitalization. We have studied the urologic aspect in all the cases of the Medical- Surgical Emergency Institute in the Hospital of Ancona (seated in Torrette), over the period 1990-96, in patients hospitalized for at least 30 days. All the patients were followed and studied with the same method, though taking into account their different pathological conditions. They were treated by the same medical and paramedical staff. The same antibiotic therapy and the same checkup were adopted for all of them. We have noticed that out of 122 patients the most frequent pathologies have been urinary infections (19%); while sepsis with different pathogenesis was recorded in 4% of the patients. The method of study applied during and after the hospitalization was used also in rehabilitation centres and included: urologic examination, rectal touch (in men), direct X-ray of the abdomen, ultrasound of the urinary tract, X-ray urography, if required; moreover urodynamic examination, MRI of encephalon and spinal marrow in patients with neurological lesions. The catheter was removed in all the patients and none of the following conditions were observed: vesical lithiasis, abscesses, fistulae in penoscrotal angle, urethrostenosis, injuries to renal emunctory. In conclusion we believe that the functional symptoms of minction--be they of obstructive or irritable nature--are not existent and that the urologic prognosis in long term patients in excellent, provided that prophylaxis is carried on against hospital urinary infections as their occurrence is very frequent and therapy is expensive. It can also be stated the patient hospitalized in ICU will not present damages to the urinary tract, even if he/she has been hospitalized because of injuries to the urinary tract, provided that the urologic tutoring, together with the action of the physician handling the Emergency, follow the rules for asepsis, the best biocompatible materials are use, infections are monitored, the extensions of cerebrospinal injuries are examined and therapeutic axioms, such as barren and clean intermittent catheterism, are finally adopted.

Adolescent↗
PubMed2004

Gunshot wounds: bullet caliber is increasing, 1998-2003.

In 1999, Caruso reported data from the level 1 trauma center in Newark, New Jersey, documenting "...an ominous trend toward the use of larger caliber firearms in accidents, homicides and suicides." Those data were derived from measurements of bullets removed from our trauma patients and submitted to the Surgical Pathology laboratory from 1981 through 1997. We further document this trend with measurements of similar source bullets from 1998 through 2002. During the same time, we recorded mortality among gunshot wound victims treated at our trauma center. Bullets submitted to surgical pathology during the years 1998 through 2002 were measured with a millimeter rule to determine caliber or transverse diameter. A total of 367 bullets were studied in this 5-year period. Bullets deformed beyond measurability (approximately 22%) and shotgun pellets (< 5%) were excluded from our study. Bullet calibers were expressed in terms of mean plus or minus standard error (x +/- SE). Mortality figures were derived from analysis of medical records concerning the outcomes all victims of gunshot wounds (E 922, E 965) treated at our hospital during the years studied and expressed as percentages. Linear regression of mean bullet caliber over time was performed, and analysis of variance was used to assess statistical significance of apparent differences in mortality. Bullet caliber continued to increase from 8.47 +/- 0.22 to 9.16 +/- 0.15 mm during the 5-year observation period. Linear regression reveals R = 0.9649, P < 0.01. Mortality ranged from 4.7 per cent to 10.7 per cent but the differences were not significant (P > 0.20). These data support a continued trend toward the use of larger caliber firearms in accidents, homicides, and suicides. Mortality does not change during this time and presumably because of improvements in treatment, from resuscitation to definitive surgery and its convalescence.

Cause of Death↗
PubMed1991

Recurrent atrial arrhythmias following treatment for postoperative atrial fibrillation after coronary bypass operations.

Ambulatory Holter monitoring was performed in 58 patients during the early convalescence after myocardial revascularization in order to determine the incidence of recurrent atrial arrhythmias following treatment for postoperative atrial fibrillation. Fifteen patients who had undergone coronary bypass and had not developed spontaneous atrial fibrillation following operation served as the controls (group 1). The remaining patients developed spontaneous symptomatic atrial fibrillation after coronary bypass that required digitalization for rate control. Sixteen patients (group 2) continued taking digoxin for 8 weeks following operation, 13 patients (group 3) discontinued digoxin treatment 5 weeks following operation, and 14 patients (group 4) discontinued digoxin treatment 3 weeks following operation. Twenty-four-hour Holter monitoring indicated that asymptomatic atrial fibrillation was common in the treatment groups after digitalization just before discharge from hospital. Atrial fibrillation, however, rarely recurred following discharge from hospital and was never symptomatic. Our data indicate that patients who develop spontaneous postoperative atrial fibrillation should be treated with digoxin for 3 weeks following operation and then drug therapy may be discontinued indefinitely.

Atrial Fibrillation↗
PubMed1983

Urinary excretion of prostaglandins (PGE2 and PGF2 alpha) and kallikrein in acute glomerulonephritis.

We studied prostaglandins and kallikrein urinary excretion in 14 children with acute poststreptococcal glomerulonephritis within 48 hours of hospital admission (period A), and again, 4-6 weeks later, when they were clinically recovered (period B). Seventeen apparently healthy children were studied as controls. The results (mean +/- SEM) indicate that PGE2 urinary excretion (ng/kg/day) was diminished during both periods of study (control group = 2.06 +/- 0.43, patients = period A 0.91 +/- 0.28 [P less than 0.02], period B 0.92 +/- 0.21 [P less than 0.02]). PGF2 alpha urinary excretion (ng/kg/day) was also suppressed during period A, but not during period B when large individual variability existed (control group = 7.10 +/- 1.07, patients period A 3.56 +/- 0.66 [P less than 0.001], period B 10.51 +/- 5.01 [NS]). Kallikrein urinary excretion (EU/kg/day) was also depressed during the acute phase and remained low during convalescence (control group = 0.492 +/- 0.1, patients period A 0.143 +/- 0.044 [P less than 0.001], period B 0.265 +/- 0.093 [P less than 0.02]). There was no difference in PGE/PGF ratio between controls and patients in the periods of study (control 0.328 +/- 0.055, period A 0.395 +/- 0.144, period B 0.384 +/- 0.128). Urine volume (ml/day) was lower in period A (582 +/- 75.8) but comparable in period B (1020 +/- 140.2) and control children (1210 +/- 80.2). No correlation could be found between the urinary excretion of PGE2, PGF2 alpha and kallikrein with any of the following parameters: urinary or serum sodium and potassium, serum or urinary osmolality, Cosm, urine flow, plasma renin activity, plasma or urinary aldosterone, hypertension or fluid retention.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2002

The sagittal mandibular osteotomy under local anesthesia and intravenous sedation: four years of multicenter experience.

Today many surgical procedures involving head and neck areas can be performed under local anesthesia and intravenous sedation. The authors add to this list the sagittal osteotomies of the mandibular rami, thereby avoiding the need for general anesthesia and a hospital stay. The authors designed a protocol to be followed in a multicenter study (Milan and Barcelona) and applied it in 35 clinical cases with Class II malocclusion. The surgical procedure was performed with the Monitored Anesthesia Care technique, a combination of regional anesthesia and intravenous sedation. The results were good in all the clinical cases; skeletal correction of Class II was achieved in all patients and there were no intraoperative or postoperative complications. The major advantage of this technique is the functional control of the temporomandibular joint, which avoids displacements caused by gravity and the muscular relaxation commonly seen under general anesthesia. Furthermore, this protocol allows a reduction in costs, duration of surgery, and patient morbidity and convalescence. When this technique is accepted without hesitation, all Class II patients with only mandibular deficiency deformity may be treated in the most suitable way, thus providing the most satisfactory outcomes for the patient, orthodontist, and surgeon.

Adolescent↗
PubMed2002

Foodborne outbreak caused by a Norwalk-like virus in India.

An outbreak of acute gastroenteritis occurred in the nurses' hostel of a civil hospital in Delhi, after a farewell party involving 130 nurses and some of the housekeeping staff. All affected persons had eaten salad sandwiches at the party. Stool samples were collected from six of these patients on the second day of infection. All six samples, when tested for the presence of common bacteria, parasites, and rotavirus, were found to be negative. The clinical features of this outbreak matched the criteria set for outbreaks caused by Norwalk-like viruses (NLVs). Reverse transcription-polymerase chain reaction (RT-PCR) was carried out on these six samples, using primers from the RNA-dependent RNA polymerase (RdRp) gene of NLVs. Immunoelectron microscopy was carried out on two of the samples, using convalescent phase serum. All six samples were positive for genogroup (GG) II NLVs by RT-nested PCR. Aggregates of 32-nm viral particles were visualized by immunoelectron microscopy in one of the two samples. Sequencing of the RdRp gene was done on amplicons from three samples; phylogenetic analysis placed the isolates NDV/1999 in a Toronto virus cluster of GG II NLVs. This is the first report of a food-borne outbreak attributable to NLVs from India.

Acute Disease↗
PubMed1988

Tricuspid and mitral regurgitation detected by color flow Doppler in the acute phase of Kawasaki disease.

Valvular lesions in the acute phase of Kawasaki disease were studied in 19 children. The patients were intensively observed by color flow Doppler every day from the day of hospitalization up to 12 days after the onset of the disease and 2 or more times a week thereafter, for up to 28 days. Mitral regurgitation (MR) was found in 9 patients (47%) and tricuspid regurgitation (TR) in 10 (53%). MRs were of transient type and confirmed from 7.5 +/- 1.6 (mean +/- standard deviation) to 13.1 +/- 6.5 days after the onset of the disease. Both types of valvular regurgitation were mild. The direction of regurgitation was from the center of valvular coaptation toward the posterior wall of the atrium. Neither valvular prolapse nor valvular deformity was noted. In patients with MR, left ventricular ejection fraction on M-mode echocardiography was significantly lower in the acute phase than in the convalescent phase of the disease (p less than 0.05). Using gallium-67 scintigram, the positive uptake of the isotope was noted in 7 (88%) of 8 patients with MR, but not found at all in 8 patients free of MR. These results suggest that MR and TR are often transient in the acute phase of Kawasaki disease and could be attributed to myocarditis.

Acute Disease↗
PubMed2004

Initial experience with laparoscopic donor nephrectomies.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) is being adopted rapidly by transplant centres around the world as it offers less postoperative pain, quicker convalescence, and better cosmetic result when compared with the open approach. There may, however, be a steep learning curve with this technique. METHOD: A retrospective review was performed to evaluate the donor morbidity and graft outcome of 21 consecutive LDN performed at one centre between May 2002 and August 2003. RESULTS: Eighteen LDN were performed on the left and three on the right side. All left and one right LDN were done transperitoneally while the remaining two right side kidneys were removed by a retroperitoneal approach. The mean (+/-SD) operating time and warm ischemic time were, respectively, 236 minutes (+/- 46) and 4 minutes (+/- 1). The mean time for resuming oral intake was 23 hours (SD +/- 22.7). The median length of hospital stay was 5 days (range 3 to 18). One patient was reoperated for bleeding and required four units of packed cell transfusion. One recipient displayed delayed graft function requiring dialysis for 14 days. There were no graft losses. The mean creatinine of the recipients at the time of discharge was 1.15 mg/dL (+/- 0.21). CONCLUSIONS: There is undoubtedly a learning curve with LDN. Nevertheless, with prior skills in similar procedures such as laparoscopic radical nephrectomies, it is feasible to diminish the learning curve and morbidity of LDN to yield results consistent with those in the published literature.

Graft Survival↗
PubMed1976

[Physical work capacity in soldiers after treatment and leave of absence for acute pneumonia].

The physical activity capacity (W170) was twofold determined in 26 soldiers, aged about 20 by the method of three-stage loading (25,50 and 75 W) upon mechanic veloergometer and with the aid of regression extrapolation- at the release from the hospital after treatment for acute pneumonia and after 28+/-11 days of home sick leave. W170 was established not change significantly after the sick leave in spite of the favourable evolution towards further normalization of the remaining X-ray changes of the pneumonia and RES. The possible explanations are discussed for that W170 decrease after acute pneumonias and the conclusion is that further investigators in the field are necessary.

Acute Disease↗
PubMed2004

Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection.

OBJECTIVE: To determine the accuracy of differential diagnosis by team consultation of abortion in progression, low-lying implantation/cervicoisthmic pregnancy, and cervical pregnancy (CP) in patients referred for suspicion of abnormal implantation on the lower segment and cervix of the uterus and to determine the efficacy of endoscopic surgery with uterine artery blockade followed by cervical evacuation in the treatment of confirmed CP. DESIGN: Prospective observational study under multiple-clinic and multiple-hospital cooperation. SETTING: Tertiary clinical and academic medical center. PATIENT(S): Twenty-seven women with a tentative diagnosis of CP made at their primary gynecologists' offices from July 1999 to June 2003. INTERVENTION(S): Second-opinion ultrasound scanning with transabdominal and transvaginal approach and optional color Doppler use. For patients with confirmed CP, a new treatment modality with laparoscopy-assisted uterine artery ligation followed by hysteroscopic local endocervical resection to remove the ectopic pregnancy was employed. For patients with abortion in progression or low-lying implantation/cervicoisthmic pregnancy (non-CP) requiring termination, dilatation and curettage (D&C) was performed under transabdominal ultrasound guidance. MAIN OUTCOME MEASURE(S): Fulfillment of ultrasound-based diagnostic criteria and operative course, convalescence, and commencement of menstruation in those patients with confirmed CP. RESULT(S): Cervical pregnancy was diagnosed in six (22.2%) patients at <or=9-weeks' gestation, and they were all successfully treated without the need for adjuvant therapy. The mean operating time was 119 minutes, and the mean blood loss was 125 mL. Menstruation began a mean of 63 days after the treatment. Termination of non-CPs was achieved by a simple D&C. CONCLUSION(S): Team consultation minimizes false-positive ultrasound-based diagnosis of CP. A single-step combination endoscopic operation is an effective uterus-preserving alternative in the management of CP.

Abortion, Spontaneous↗
PubMed1999

Effects of attribution of responsibility for motor vehicle accidents on severity of PTSD symptoms, ways of coping, and recovery over six months.

In light of Delahanty et al.'s (1997) identification of attribution of responsibility for a motor vehicle accident (MVA) as a powerful determinant of initial level of distress from the trauma and of early remission of PTSD, we reexamined data from Blanchard and Hickling's (1997) prospective follow-up of 158 MVA survivors. Despite differences between the two samples (Delahanty sample recruited from hospitals 2-3 weeks post-MVA and predominantly male; our sample recruited from outpatient care 1-4 months post-MVA and predominantly female) we replicated Delahanty's findings: those with PTSD who blame themselves for the MVA are less symptomatic initially and recover more rapidly in the first 6 months than those with PTSD who blame another party for the accident.

Accidents, Traffic↗
PubMed1997

Recovery and quality of life one year after coronary artery bypass grafting.

In order to study recovery and quality of life after bypass surgery, both objective and subjective data were collected during structured interviews. A total of 56 patients participated in the study. Data were collected during hospital admission and during two home visits at 6 and 12 months after Coronary Artery Bypass Grafting (CABG). Patients reported improved state of health and quality of life. Most of the changes occurred within the first six months after discharge. However, for most patients life had more or less returned to normal one year after CABG. It was also found that few of the patients changed their risk behaviour after surgery.

Activities of Daily Living↗