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At least 199 records · Page 11Linked to original sources
PubMed1988

[Diabetic angiopathy and surgical consequences as a basis for rehabilitation].

Diabetes mellitus is a major risk factor for the development of arterial occlusive disease. 2 kinds of diabetic angiopathy with different sequelae can be found needing surgical therapy after failure of conservative treatment; quite often it is necessary to perform an amputation sooner or later. By sufficient walking exercises and exact preoperative workup it is possible to find a favourable level of amputation. Good operative technique and early postoperative mobilisation of the patient can lead to complete rehabilitation.

Amputation, Surgical↗
PubMed1987

Activity, air boots, and aspirin as thromboembolism prophylaxis in knee arthroplasty. A multiple regimen approach.

In this prospective study 90 patients underwent 100 total knee replacements. Each patient walked and practiced rehabilitation exercises one day preoperatively and the morning of surgery. The contralateral calf was intermittently pumped during surgery followed by bilateral pulsatile calf compression postoperatively. Aspirin was administered in the recovery room and continued 600 mg twice a day until discharge. Early activity and ambulation postoperatively were expected. Routine deep venous thrombosis screening tests were not performed. No physiologically significant postoperative venous thrombosis on any of these patients were observed. A Doppler test was performed on eight patients, venogram on two patients, and V/Q lung scan on two patients in whom a thromboembolic disease problem was clinically suspected. All of these tests were negative except for one V/Q scan.

Adult↗
PubMed1976

Metabolic considerations in reconstitution of the small intestine after jejunoileal bypass.

Intestinal bypass is a reversible procedure which has been used with success in the surgical treatment of morbid obesity. Nine patients with intestinal bypass were forced to undergo reconstitution of the gastrointestinal tract due to severe symptoms of short gut syndrome. Meticulous attention to detail must be exercised in the preoperative preparation of this type of patient. Parenteral hyperalimentation may be necessary to return the patient to adequate nutrition. No attempt at revision should be made until the patient is nutritionally and metabolically reconstituted.

Adult↗
PubMed1986

Value and limitation of biplane rest and exercise radionuclide angiography for assessing individual bypass grafts: a prospective study.

This prospective study evaluated the ability of serial biplane rest and exercise radionuclide angiography to predict the status of individual coronary bypass grafts in 20 patients 2 to 6 months after surgery. The preoperative coronary angiogram was used to assign vessels to 10 regions of distribution on the radionuclide angiogram. Predictions of graft adequacy for individual vessels were based on a detailed assessment of rest and exercise wall motion in their regions of supply. Of 59 grafts, 38 were judged adequate (patent with less than 75% stenosis) and 21 inadequate by postoperative catheterization. Radionuclide prediction of graft status was possible for 32 of the 59 grafts, including 19 of 24 left anterior descending, 7 of 19 circumflex and 6 of 16 right coronary artery grafts. The status of the remaining 27 grafts could not be assessed because of normal wall motion in their region of supply both pre- and postoperatively (22 vessels) or because a region of supply was not represented on the biplane radionuclide angiogram (5 vessels). Of the 32 predictions made, 25 (78%) were correct, including 13 (93%) of 14 predictions of graft adequacy and 12 (67%) of 18 predictions of graft inadequacy. The single incorrect prediction of graft adequacy resulted from improved exercise wall motion in a region supplied by a graft judged as having a 75% anastomotic stenosis. Most incorrect predictions of graft inadequacy were due to new septal or other rest wall motion abnormalities postoperatively. The comparison of pre- and postoperative studies was essential to maintain the predictive ability of the test. Thus, a detailed analysis of regional wall motion by rest and exercise radionuclide angiography can be used to predict the status of individual coronary artery bypass grafts. Reliable predictions can be made for most successful anterior descending grafts, and may permit cardiac catheterization to be deferred in certain cases. However, the method is limited by the need to perform preoperative exercise studies, by the low number of right and circumflex coronary artery grafts that can be evaluated and by the poor specificity of predictions of graft failure.

Adult↗
PubMed1984

Improvement in aerobic and hemodynamic responses to exercise following aorta-coronary bypass grafting.

Preoperative and postoperative hemodynamic studies were performed during exercise in 70 patients having aorta-coronary bypass grafting for the treatment of angina. There was significant symptomatic improvement with 88% of patients free of angina postoperatively. In patients with complete revascularization there was a marked improvement during exercise in maximal oxygen consumption, cardiac index, and maximal pressure-rate product. In addition, there was a fall in pulmonary arterial pressure postoperatively. In contrast, patients with incomplete revascularization showed a small but insignificant rise in maximal oxygen consumption and cardiac index. The major reason for the increase in cardiac index was a marked increase in heart rate rather than a change in stroke index. In patients with complete revascularization there was a significant increase in stroke work index at maximal exercise.

Adrenergic beta-Antagonists↗
PubMed1993

Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing.

Major surgery in the elderly continues to have a high mortality rate. Preoperative myocardial ischemia is a known risk factor. Cardiac failure is also a risk factor, but is difficult to quantify objectively. One hundred eighty-seven elderly surgical patients were evaluated for cardiac failure by cardiopulmonary exercise testing (CPX). The overall mortality in these patients was 7.5 percent. If three deaths secondary to surgical causes are excluded, mortality was 5.9 percent. There were 55 patients in whom the anaerobic threshold (AT) was less than 11 ml/min/kg; of these, 10 died, a mortality rate of 18 percent. There were 132 patients with an AT of greater than 11 ml/min/kg and of these, 1 patient died, giving a mortality rate of 0.8 percent (p < 0.001). A low AT associated with preoperative ischemia resulted in the death of 8 of 19 patients, a mortality rate of 42 percent. When the ischemia was associated with the higher AT, then 1 patient out of 25 died, a mortality rate of 4 percent (p < 0.01). Both preoperative ischemia and preoperative cardiac failure are independent risk factors for perioperative mortality in the elderly.

Aged↗
PubMed1989

Cardiac performance in children with pectus excavatum.

Fourteen children with pectus excavatum and 14 normal control patients underwent graded exercise testing using a cycle ergometer and the James protocol. All the subjects were preoperative. The children were exercised to exhaustion during the test. The pectus and control groups were broken down into subgroups consisting of subjects less than or equal to 10 years of age and subjects greater than or equal to 11 years of age (pectus and controls less than or equal to 10 years old, PI and CI, respectively; pectus and controls greater than or equal to 11 years old, PII and CII, respectively). Maximal workload, oxygen consumption, cardiac output, and stroke volume were not significantly different when comparing the total groups or when each of the respective subgroups were compared. However, maximal diastolic BP was significantly elevated when the entire pectus and control groups were compared. When the subgroups were compared, maximal diastolic BP was elevated only in the older pectus patients (PII) and remained so until five minutes after exercise. Additionally, left ventricular systolic time intervals were measured immediately after exercise in all the children. The ratio of preejection period to left ventricular ejection time (P/L) was significantly shortened in the total pectus group. When the subgroups were compared, the P/L ratio was significantly decreased only in the older patients. Also, the preejection period (PEP) was significantly shortened in the older pectus patients. It appears that children with pectus excavatum have a normal exercise tolerance and oxygen transport. However, older pectus children develop an increased diastolic BP and a shortened P/L and PEP in response to exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Lung scanning and exercise testing for the prediction of postoperative performance in lung resection candidates at increased risk for complications.

OBJECTIVE: To analyze the value of preoperative lung scanning and exercise testing for the prediction of postoperative complications and of the short- as well as long-term performance in lung resection candidates at increased risk for complications. DESIGN: Prospective clinical trial. SETTING: Clinical pulmonary function laboratory in a university teaching hospital. PATIENTS: Twenty-five (mean age, 63 years; 17 men) of 84 consecutive lung resection candidates were considered at increased risk for postoperative complications due to impaired pulmonary function (FEV1 < 2 L or diffusion of carbon monoxide [DCO] < 50% predicted, or FEV1 and DCO < or = 80% predicted combined with New York Heart Association dyspnea index > or = 2). INTERVENTIONS: Candidates underwent radionuclide ventilation/perfusion scans and exercise testing to predict postoperative (= ppo) values for FEV1, DCO, and maximal O2 uptake (VO2max). They all underwent thoracotomy for neoplastic lesions; 7 had pneumonectomies, 18 lobectomies. Six patients had postoperative complications (within 30 days), of whom three died. Three and 6 months postoperatively, pulmonary function tests and VO2max were repeated. MEASUREMENTS AND RESULTS: In the 22 survivors, the observed values were then compared with the predicted values. At 3 months, there were excellent correlations (absolute/predicted values): for FEV1 r = 0.78 and 0.81; for DCO, r = 0.77 and 0.74; and for VO2max, r = 0.71 and 0.83. The means of FEV1 and VO2max did not differ from the predicted values, whereas the predicted DCO was lower than the observed value (mL/min/mm Hg: 15.1 vs 17.9; percent predicted: 59.6 vs 70.9) (p < 0.05). At 6 months, correlations remained very good for FEV1 (r = 0.81 and 0.84) and for DCO (r = 0.76 and 0.74), but had decreased for VO2max to 0.56 and 0.65, respectively. All means were higher than predicted (p < 0.05) owing to recovery in the lobectomy group. Patients with postoperative complications (group B) had a lower preoperative VO2max in percent predicted (62.8 +/- 7.5% vs 84.6 +/- 19.7%) (p < 0.01) and also a lower VO2max-ppo (10.6 +/- 3.6 vs 14.8 +/- 3.5 mL/kg/min and 44.3 +/- 13.5 vs 68.0 +/- 20.7% predicted) (p < 0.05) than patients without complications (group A). A VO2max-ppo < 10 mL/kg/min was associated with a 100% mortality. Although FEV1-ppo and DCO-ppo were lower in group B, the difference did not reach significance. CONCLUSIONS: Radionuclide-based calculations of postoperative VO2max are predictive of operative morbidity and mortality: a VO2max-ppo of < 10 mL/kg/min may indicate inoperability. Further, short-term postoperative performance is accurately predicted by FEV1-ppo and VO2max-ppo, but long-term function is underestimated after lobectomy.

Aged↗
PubMed2002

Cardiopulmonary exercise parameters in children with atrial septal defect and increased pulmonary blood flow: short-term effects of defect closure.

UNLABELLED: Markedly increased pulmonary blood flow because of a relevant atrial septal defect (ASD) leads to impaired cardiopulmonary function during maximum exercise in adults. No comparative preoperative and postoperative data are available on the short-term effects of shunt closure on cardiorespiratory function at peak exercise in children. Pulmonary function testing at rest and cardiopulmonary exercise testing together with haemodynamic assessment was done prospectively in children with an ASD preoperatively and again after full recovery at 3-4 mo postoperatively and compared with a matched normal population. Sixteen children, aged 6.8-16.1 y, with a defect of 8-23 mm (median 15 mm) and a pulmonary/systemic flow ratio of 1.5-3.5 (median 2.2) were tested and compared with 15 healthy children. Preoperatively, baseline pulmonary function parameters and exercise capacity were no different from normals. At peak exercise, patients with a shunt had increased pulmonary resistance, especially of the distal airways (p = 0.04), with a significantly larger proportion of children having a paradoxical increase in total airway resistance during exercise (p < 0.05). Maximum serum lactate at peak exercise was elevated (p < 0.05) in patients. In patients, maximum oxygen uptake was impaired (p = 0.03) and remained so at repeat evaluation postoperatively. The same observation was made for chronotropic response to exercise. CONCLUSION: Cardiopulmonary exercise parameters in patients with ASD differed only slightly from those in normal children. The most important deviations were a lower maximum oxygen uptake and an increase in airway resistance at maximum exercise.

Adolescent↗
PubMedDate not supplied

Pre- and postoperative exercise testing of the child with coarctation of the aorta.

Exercise studies in patients with coarctation of the aorta (CoA) are reviewed. A brief survey of the natural history of unoperated CoA, the pioneers who reported the first operative repair, and comments on blood pressure measurements are provided. Preoperative and postoperative (postop) exercise studies of patients with CoA are also reviewed. The various etiological factors which may contribute to hypertension found in some post-op CoA patients are discussed.

Aortic Coarctation↗
PubMed1989

Preoperative assessment as a predictor of mortality and morbidity after lung resection.

To refine the functional guidelines for operability for lung resection, we prospectively studied 55 consecutive patients with suspected lung malignancy thought to be surgically resectable. Lung function and exercise capacity were measured preoperatively and at 3 and 12 months postoperatively. Preoperative pulmonary scintigraphy was used to calculate the contribution to overall function by the affected lung or lobe and to predict postoperative lung function. Pneumonectomy was performed in 18 patients, lobectomy in 29, and thoracotomy without resection in six. No surgery was attempted in two patients who were considered functionally inoperable. Cardiopulmonary complications developed in 16 patients within 30 days of surgery, including three deaths. The predictions of postoperative function correlated well with the measured values at 3 months. For FEV1, r = 0.51 in pneumonectomy (p less than 0.05) and 0.89 in lobectomy (p less than 0.001). Predicted postoperative FEV1 (FEV1-ppo), diffusing capacity (DLCO), predicted postoperative DLCO (DLCO-ppo) and exercise-induced arterial O2 desaturation (delta SaO2) were predictive of postoperative complications including death and respiratory failure. In patients who underwent pneumonectomy, the best predictor of death was FEV1-ppo. The predictions were enhanced by expressing the value as a percentage of the predicted normal value (% pred) rather than in absolute units. For the entire surgical group a FEV1-ppo greater than or equal to 40% pred was associated with no postoperative mortality (n = 47), whereas a value less than 40% pred was associated with a 50% mortality (n = 6), suggesting that resection is feasible when FEV1-ppo is greater than or equal to 40% pred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Lobar occlusion in the preoperative assessment of patients with lung cancer.

Bronchial occlusion during exercise was used to predict the functional effects of subsequent pulmonary resection in six high risk patients with lung cancer and severe airflow obstruction. Each patient underwent transnasal fibreoptic bronchoscopy whilst cycling in steady state at a load which had been selected as equivalent to walking at a brisk pace for that patient. The effects on minute ventilation and oxygen uptake were observed during occlusion of the bronchus to the diseased lobe. If the patient was able to continue cycling and maintain the same work load during occlusion this was regarded as indicating that he would withstand resection of the occluded lung tissue. In five of the patients, postoperative studies were performed. All were able to maintain the same level of steady state exercise postoperatively as that maintained during bronchial occlusion preoperatively. Resection resulted in a decrease in static lung volumes. Other routine whole lung function tests, walking capacity and incremental exercise indices, however, were largely unchanged.

Aged↗
PubMed1990

[Effects of coronary revascularization on infarcted myocardial regions--evaluation on postoperative left ventricular regional wall motion during exercise].

In order to determine the effects of coronary revascularization for infarcted regions on postoperative left ventricular function and regional wall motion, we studied first-pass radionuclide angiography at rest and during exercise before and after operation in 18 patients with previous myocardial infarction. Preoperative mean value of left ventricular ejection fraction (LVEF) was significantly decreased during exercise from 56.8 +/- 14.1% to 46.1 +/- 15.5% (p less than 0.01). Postoperatively, there was no change of the values between at rest and during exercise: 53.6 +/- 14.1% versus 51.9 +/- 15.7%. Postoperative mean LVEF during exercise was significantly higher, compared with that of preoperative LVEF (p less than 0.05). Mean regional ejection fraction of infarcted regions was significantly decreased during exercise from 66.0 +/- 15.0% to 56.1 +/- 15.8% (p less than 0.01) before operation. However, there was no significant change in values between at rest and during exercise after operation: 65.4 +/- 13.9% versus 61.8 +/- 14.5%. Mean postoperative regional ejection fraction during exercise was significantly higher, compared with preoperative regional ejection fraction after operation (p less than 0.05). These results might be indicated that regional wall motion of the infarcted regions with ischemia enhanced by exercise preoperatively can be definitely improved by coronary revascularization.

Adult↗
PubMed1979

Reversal of exertional hypotension after coronary bypass grafting.

A decrease in systolic blood pressure that occurs with treadmill exercise testing may be a sign of reversible ischemic left ventricular dysfunction. To test this hypothesis, we examined retrospectively the postoperative treadmill responses of 37 patients who had exertional hypotension (end exercise systolic blood pressure less than or equal to initial preexercise levels) before coronary arterial bypass grafting. This group of 37 patients was characterized preoperatively by an abnormal exercise electrocardiogram (36 patients), multiple vessel occlusive disease (36 patients) and a normal ejection fraction at rest (32 patients). Postoperative exercise tests showed improvement in hemodynamic and electrocardiographic changes with reversal of exertional hypotension (33 patients), and conversion to a normal exercise electrocardiogram (29 patients). Coronary bypass surgery can be expected to reverse exertional hypotension in patients with symptomatic angina pectoris and evidence of ischemia in the exercise electrocardiogram.

Adult↗
PubMed1997

Atrial septal defect in adults: cardiopulmonary exercise capacity before and 4 months and 10 years after defect closure.

OBJECTIVES: The purpose of the study was to evaluate the cardiopulmonary exercise capacity and ventilatory function in adults with atrial septal defect (ASD) preoperatively and 4 months and 10 years postoperatively. BACKGROUND: Only few data are available on cardiopulmonary exercise tolerance after ASD closure, but detailed knowledge might be helpful for indication for defect closure in certain patients. METHODS: The study was performed in adult patients (mean [+/-SD] age at operation 39.9 +/- 11.5 years; left-right shunt 9.6 +/- 5.6 liters/min; pulmonary/systemic flow ratio 2.8 +/- 1.2; mean pulmonary artery pressure 18.2 +/- 6.2 mm Hg). Cardiopulmonary exercise testing was performed with a bicycle ergometer. We determined peak oxygen uptake, anaerobic threshold, performance at anaerobic threshold and maximal performance in relation to these variables in a normal group. Ventilatory function at rest was expressed by vital capacity, maximal voluntary ventilation and forced expiratory volume in 1 s. RESULTS: Preoperatively, ventilatory function at rest was only moderately reduced to approximately 75% to 85%. Four months postoperatively we found no significant improvement, but 10 years postoperatively ventilatory function at rest was normalized. Preoperative cardiopulmonary exercise capacity was markedly reduced to 50% to 60%; early postoperatively it was only slightly higher, but late postoperatively exercise capacity significantly improved and was completely normalized. CONCLUSIONS: Although preoperative cardiopulmonary capacity in adult patients with nonrestrictive ASD was significantly decreased, some improvement was seen at 4 months postoperatively, with complete restitution to normal at 10 years after shunt closure.

Adult↗
PubMed1984

Improved regional ventricular function after successful surgical revascularization.

Left ventricular segments with reversible asynergy at rest demonstrate reversible myocardial perfusion defects on exercise thallium-201 scintigrams. To determine if improved perfusion eliminates asynergy at rest, 23 patients with angina (stable in 21, unstable in 2) were studied before and after coronary artery bypass surgery. All patients underwent exercise myocardial perfusion scintigraphy, contrast ventriculography and coronary arteriography before and after surgery. Selective graft angiography was performed during the postoperative catheterization to determine graft patency. Segmental ventricular function was quantitated by a regional fraction method. The scintigrams were divided into five regions and compared with the corresponding regions of the ventriculogram. Seventy-one of a possible 142 ventricular segments exhibited exercise-induced perfusion deficits. Preoperative regional ejection fraction was normal in 42 of these segments and abnormal in 29. Postoperatively, in 19 of the abnormal segments, function improved or normalized. All these segments had improved perfusion during exercise after surgery and were supplied by a patent bypass graft. Nine of the 10 segments in which abnormal wall motion persisted postoperatively continued to have exercise-induced perfusion deficits, and 9 of the 10 segments were supplied by an occluded or stenotic graft or one with poor run off. Of the 42 segments with normal wall motion preoperatively, 30 had improved perfusion after surgery and 35 maintained normal function. This study indicates that asynergy at rest is permanently reversed after coronary bypass surgery if improved myocardial perfusion can be documented. These findings are consistent with but do not prove the concept that reversible rest asynergy may reflect chronic ischemia or a prolonged effect from previous ischemic episodes.

Angina Pectoris↗
PubMed2005

Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: a randomized study.

BACKGROUND & AIMS: The aim of this study was to investigate whether specialized supportive enteral and parenteral feeding have superior effects compared to oral nutrition on recovery during long-term postoperative treatment of cancer patients with preoperative weight loss and reduced maximum exercise capacity. METHODS: One hundred twenty-six patients referred for resection of the esophagus (n = 48), stomach (n = 28), or pancreas (n = 50) were considered to be included before operation. Included patients (n = 80) received supportive enteral or parenteral nutrition postoperatively at home corresponding to 1000 kcal/d until the patients did not wish to continue with artificial nutrition for any reason. Patients randomized to oral nutrition only served as control subjects. Caloric intake, body composition (dual-energy x-ray absorptiometry), and respiratory gas exchanges at rest and during exercise were measured including health-related quality of life. RESULTS: Survival and hospital stay did not differ among the groups, whereas overall complications were higher on artificial nutrition (P < .05). Changes in resting energy expenditure and biochemical tests did not differ during follow-up among the groups. Body weight and whole body fat declined similarly over time in all groups (P < .005), whereas lean body mass was unchanged during follow-up compared to preoperative values. Maximum exercise capacity and maximum oxygen consumption were normalized within 6 months postoperatively in all groups. There was no difference in recovery of food intake among the groups. Parenteral feeding was associated with the highest rate of nutrition-related complications, whereas enteral feeding reduced quality of life most extensively. CONCLUSION: After major surgery, specialized supportive enteral and parenteral nutrition are not superior to oral nutrition only when guided by a dietitian.

Body Composition↗