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At least 451 records · Page 25Linked to original sources
PubMed1995

Atrial ectopic activity and atrial fibrillation/flutter after coronary artery bypass surgery. A case-base study controlling for confounding from age, beta-blocker treatment, and time distance from operation.

To evaluate the impact of ectopic atrial activity and cardiac autonomic function for development of atrial fibrillation or flutter we studied 128 consecutive patients undergoing elective coronary artery bypass grafting. The patients were Holter monitored during a 96-h postoperative period. Autonomic balance was estimated by heart rate variability measurement. Thirty-eight (30%) patients developed sustained atrial fibrillation or flutter. Holter recordings were analyzed in a case-base design matching for age, beta-blocker treatment, and time elapsed after the operation. The number of supraventricular ectopic beats/h was increased (P < 0.01) in the case group during each of the last 7 h before onset of atrial fibrillation or flutter. Episodes of supraventricular tachycardia 62% vs. 26%; cases vs. controls (P = 0.007), episodes of non-sustained atrial fibrillation 29% vs. 0% (P = 0.0009), and episodes of non-sustained atrial flutter 15% vs. 0% (P = 0.05) were significant predictors of atrial fibrillation or flutter. Mean heart rate/h was increased in each of the 24 h preceding the arrhythmia. However, indexes of autonomic heart function did not differ significantly between groups. Patients developing atrial fibrillation or flutter after coronary artery bypass surgery present 'warning' atrial arrhythmias: numerous supraventricular ectopic beats, paroxysmal supraventricular tachycardia, and episodes of nonsustained atrial fibrillation and flutter.

Adrenergic beta-Antagonists↗
PubMed2000

Autonomic nervous system activity associated with postural disturbances in patients with perilymphatic fistula: sympathetic or vagal origin?

The study focused on patients suffering from perilymphatic fistula (PLF), whether they had undergone surgery or not. Vestibular disturbances can be harmless but are associated with varying symptoms, demonstrating disorders within the autonomic nervous system (ANS). The aim was to test whether the orthosympathetic is involved as the vagal part is often suspected of eliciting a feeling of sickness. Non-invasive and uninterrupted recording of ANS activity represents an objectivation technique to evidence such disturbances. Electrodermal activity, thermovascular variables, instantaneous cardiac rate and blood pressure were recorded. Discomfort was triggered experimentally by applying various stimulations successively to the intact ear then to the PLF (or operated) side. Twelve subjects took part in the experiment. Two types of ANS activity were distinguished: (1) phasic responses during stimulation and (2) tonic evolution thereafter. Results show strong activation in orthosympathetic variables when the PLF side was stimulated. No further significant difference between the two sides was to be observed following surgery. After stimulation, a sudden increase in skin resistance was observed, associated with slight bradycardia. No vagal signs having been evidenced, actual nausea may result from brief inhibition of sympathetic activation resulting, in turn from primary over-activation of this system.

Adult↗
PubMed2006

[The quality of life after rectal cancer surgery].

Surgery is a definite treatment for rectal cancer by resecting the tumor. Surgeon not only aims to cure the patient but aims to relieve distressing symptoms as well. Unfortunately, patients may suffer adverse consequences from such surgery. The operative dissection of the rectum may damage the pelvic autonomic nerves disturbing bladder and sexual function. The construction of a permanent colostomy following an abdominoperineal resection may be associated with one or more physical problems as well as clinically significant psychosocial problems as well. The advances in knowledge of tumor biology and the improvements of surgical techniques and devices result in an increasing number of sphincter saving procedures such as low anterior resection. Although avoiding permanent stoma is generally regarded as a favorable outcome measure, patients undergoing sphincter-saving surgery may develop a number of unpleasant symptoms, typically fecal soiling and urgency, especially with low anastomosis. It is evident that the consequences of rectal surgery have an important bearing on quality of life. Although differences in definition exist, quality of life may be regarded as representing an individual's ability to carry out daily activities, as well as satisfaction with personal performance and with balance between disease control and adverse effects of treatment. In addition to traditional endpoints, such as survival and disease recurrences, assessing quality of life is necessary to provide a proper, comprehensive understanding of the outcome of surgery and other forms of treatment.

Digestive System Surgical Procedures↗
PubMed2005

Urinary and sexual function after total mesorectal excision.

The autonomous pelvic nerves are in close contact to the visceral pelvic fascia that surrounds the mesorectum. The concept of total mesorectal excsion (TME) in rectal cancer treatment has led to a substantial improvement of autonomous pelvic nerve preservation. Consecutively, this highly precise and sharp dissection technique under direct vision reduces the problem of accidental bladder denervation from 50-60% with conventional rectal cancer surgery to less than 20% with TME and the problem of postoperative impotence from 70-100% to less than 30%. The learning curve in this technically demanding procedure plays a major role with regard to a satisfying nerve preservation. The laparoscopic approach for TME allows to obtain similarly favorable results with regard to postoperative urogenital function, at least for tumors situated in the middle and upper third of the rectum, compared with open surgery. The present paper describes and depictures in detail the anatomy and the pathophysiology of autonomic pelvic nerves, the surgical technique for nerve preservation and gives a short overview of the results in the literature including own data.

Autonomic Nervous System↗
PubMed1994

QT dispersion and autonomic function in diabetic and non-diabetic patients with renal failure.

We have studied 13 patients with diabetic nephropathy and 13 patients with uraemia of other origin undergoing renal transplantation, and 12 control patients undergoing general surgery. QTc dispersion and maximum QTc interval were calculated from the 12-lead ECG, and cardiovascular autonomic function tests were performed. QTc dispersion was significantly greater in diabetic (mean 100 (SD 37) ms) and non-diabetic (51 (17) ms) uraemic patients than in control patients (29 (10) ms), and it differentiated the groups better than maximum QTc. In diabetic patients, severe autonomic neuropathy was common. In other uraemic patients less severe disturbances in autonomic function were found. In diabetic uraemic patients, increased QTc dispersion and severe autonomic neuropathy may indicate high risk for cardiac arrhythmias. In our opinion, QTc dispersion and autonomic function tests may give valuable information on perioperative risks.

Adult↗
PubMedDate not supplied

[FastTrack approach to major colorectal surgery].

Intensive rehabilitation programs after major abdominal, thoracic and vascular surgery have been published over the last few years, showing early recovery, fewer complications and a quicker discharge. The aim of the study was to evaluate the feasibility and efficacy of a multimodal intensive rehabilitation program (FastTrack) after major colorectal surgery, according to the experience of Dr. H. Kehlet of Hvidovre University Hospital, Copenhagen. The study design was of the prospective, randomized, controlled type. Forty patients undergoing elective colonic surgery were randomly selected and assigned to two groups well matched for age, weight, ASA and type of resection. The FastTrack group underwent a multimodal rehabilitation program with epidural analgesia, short laparotomy, early feeding and mobilisation. The control group had the usual postoperative treatment with a pain control program. The FastTrack group exhibited a shorter need for assisted ventilation, a lower sedation level and lower opioid consumption over the first 24 hours. We also observed a statistically significant earlier onset of peristalsis (0.5 vs 2.7 days), gastrointestinal function (defecation) (2.8 vs 5.8 days), regular feeding (3.1 vs 7.2 days) and autonomous ambulation (3.3 vs 6.9). The multimodal rehabilitation approach to colon surgery permits an earlier postoperative recovery, better postoperative performance and quicker functional autonomy. These results may have important implications for the management of patients after major colorectal surgery.

Aged↗
PubMed1996

Contact laser sphincterotomy: further experience and longer follow-up.

I report here the use of a crystal chisel contact tip firing Nd:YAG laser for transurethral sphincterotomy in 76 consecutive spinal cord injury patients. Their mean age was 53 years (range 26 to 77 years). Fifty-four (72%) were complete motor (Frankel A and B) and 21(28%) were incomplete lesions (Frankel C and D) They were evaluated with multichannel urodynamic equipment and 89% of the patients showed detrusor sphincter dyssynergia and 11% showed detrusor areflexia. Forty-three patients (56%) had previous electrocautery sphincterotomy and were not voiding well. A cystoscopic examination showed that 32% had an associated enlarged prostate and/or bladder-neck stenosis and 32% had associated wide-body strictures in the bulbous urethra. The crystal chisel contact tip firing Nd:YAG laser almost mimicked a hot diathermy knife to create an intraurethral incision as well as vaporizing the tissues. For sphincterotomy, a 12 o'clock incision was used from the verumontanum to the bulbous urethra. In patients with an associated enlarged prostate or bulging lateral lobes, 3 and 9 o'clock incisions were also made from the bladder-neck to the verumontanum and also vaporized the bulging prostate tissue. We used 25 to 40 watts for cutting, and vaporization of tissue and 15-25 watts to stop bleeding. The blood loss was less than 50 ml at surgery in 97.4% patients. None of the patients were transfused. An indwelling Foley catheter was usually left in situ for about 24 h and the majority of the patients were discharged the next day. All patients have been followed up at least every 6 months for a mean period of 27 months (range 16 to 41 months). The durability of surgery has been checked with linear array transrectal sonography and by urodynamic evaluation. Sixty-nine patients (92%) had adequate voiding, minimal to absent autonomic dysreflexia and no significant symptomatic urinary tract infection. There were seven patients who required repeat laser surgery within 2 to 5 months. All subsequent patients are voiding well with wide open bladder-neck and posterior urethra as shown on a voiding cystourethrogram.

Adult↗
PubMed2003

The first dental college: emergence of dentistry as an autonomous profession.

Old as the ills of mankind, dentistry has been practiced as a specialty of surgery by physicians, surgeons, and artisans, at various times with titles such as barber surgeon, toothdrawer, operator for the teeth, and surgeon dentist. There being universal need for dental services, and lacking enforceable standards of practice and qualification, the profession was invaded by dubiously prepared pretenders at practice. The unconscionable consequence remained largely unremedied until realization of a philosophically sound basis of professional literature, organization, and education incident to the institution of the first dental college and the American system of dental education that elevated dentistry to the status of a recognized autonomous profession.

Baltimore↗
PubMed2007

Safety and efficacy of surgical management of hyperthyroidism: 15-year experience from a tertiary care center in a developing country.

BACKGROUND: Ideal management of toxic goiter still remains elusive. Though surgical management of toxic multinodular goiter (MNG) is well accepted, surgical treatment of Graves' disease (GD) is still controversial in view of the presumed increased incidence of complications. In this paper, we discuss the experience of the surgical management of hyperthyroidism at a specialized tertiary care endocrine center in a developing country, highlighting the minimal morbidity and satisfactory outcome in experienced hands. MATERIALS AND METHODS: We retrospectively reviewed 325 consecutive patients with hyperthyroidism managed surgically from 1990 to 2005. The etiologic diagnoses were Graves' disease (185), toxic MNG (105), and autonomously functioning thyroid nodules (AFTN) (n = 35). The indications for surgery in Graves' patients were large goiter, relapse after antithyroid drug therapy (ATD), Graves' ophthalmopathy, and presence of nodule. The indications for surgery in toxic MNG were retrosternal extension (n = 15), compressive symptoms (n = 20), and large size (grade II). Among the AFTN nodule size, those greater than 4 cm (85%) formed the major indication for surgery. Subjects with GD and toxic MNG were subjected to subtotal thyroidectomy (n = 93 prior to 1995) or total thyroidectomy (n = 205 post-1995). Hemithyroidectomy was the procedure of choice in patients with AFTN. RESULTS: Patients with Graves' disease were younger in age, with shorter mean duration of goiter when compared with the other 2 groups. Eight percent of patients with Graves' disease without a clinically palpable nodule and 25% of those with nodules had associated differentiated carcinoma, including papillary, follicular, and medullary thyroid cancer. Four percent of patients with toxic MNG had malignancy. Complications included temporary hypocalcemia (24%), permanent hypocalcemia (3%), and permanent vocal-cord palsy (1%). CONCLUSIONS: Surgery for hyperthyroidism has negligible mortality and acceptable morbidity in experienced hands. It is a definite option in selected cases. Immediate and permanent cure of hyperthyroidism is achieved, with no recurrences, after total thyroidectomy. The cosmetic outcome is good, with excellent patient satisfaction and acceptance.

Adult↗
PubMed1975

Impaired cardiovascular responsiveness in liver disease.

Cardiovascular responsiveness to reflex impaired in patients with cirrhosis compared with control subjects. Peripheral vascular responses to exogenous noradrenaline were also impaired in cirrhotic patients, but peripheral vascular responses to infused adrenaline and to angiotensin II were similar in both groups. Impaired cardiovascular reactivity in patients with chronic liver disease could predispose them to circulatory failure after haemorrhage or surgery and should be considered when prescribing drugs which affect autonomic activity.

Angiotensin II↗
PubMedDate not supplied

Spectral analysis of sudden bradycardia during intrathecal meperidine anesthesia.

BACKGROUND AND OBJECTIVES: Severe bradycardia occurring suddenly during spinal anesthesia, although rare, is potentially fatal. Bradycardias are more common after intrathecal meperidine. We report two such episodes occurring in elderly male patients undergoing transurethral surgery. METHODS: Subarachnoid block was provided using 50 mg meperidine. Autonomic function was assessed by measuring heart rate (HR) variability using R-R intervals from standard electrocardiographic recordings. Frequency-domain spectra were constructed from 512 heartbeats, and an autoregressive method was used to calculate spectral power. RESULTS: In both patients, bradycardia (HR <50 beats/min) occurred after about 10 minutes and was associated with severe hypotension and a 10- to 100-fold increase in spectral density in both the low (0.04-0.15 Hz), mainly sympathetic, and the high (0.15-0.40 Hz), mainly parasympathetic, frequency bands. These spectral increases were subsequently attenuated by intravenous atropine. Heart rate slowing was noted to be periodic, or oscillatory, in one patient. CONCLUSION: Sudden increases in vagal, or parasympathetic, activity probably accounted for bradycardia.

Adjuvants, Anesthesia↗
PubMed2006

Subclinical Cushings disease with amelioration of metabolic comorbidities after removal of pituitary tumor.

A 49-year-old woman with hypertension, obesity and impaired glucose tolerance (IGT) was admitted for evaluation of pituitary incidentaloma. Although she presented no Cushingoid feature, endocrine examination of hypothalamo-pituitary-adrenal (HPA) axis showed elevated basal plasma ACTH and cortisol levels, their lack of circadian rhythm, non-suppressibility to low-dose (1 mg) dexamethasone, and responsiveness to CRH, suggesting autonomous ACTH secretion from a pituitary tumor. She underwent transsphenoidal surgery, and was diagnosed as chromophobe adenoma with positive ACTH immunoreactivity. Postoperatively, her abnormal HPA axis was resolved, along with improvement of hypertension, obesity and IGT. Thus, her metabolic comorbidities are likely due to subclinical Cushings disease.

Female↗
PubMed2000

Endoscopic subureteral glutaraldehyde cross-linked collagen injection for the treatment of secondary vesicoureteral reflux: comparison with primary vesicoureteral reflux in adults.

PURPOSE: We assessed the effectiveness of endoscopic subureteral glutaraldehyde cross-linked collagen injection for treating vesicoureteral reflux in patients with vesicoureteral disorders. MATERIALS AND METHODS: All 51 ureters studied had grade II or greater vesicoureteral reflux. We treated 18 patients (24 refluxing ureters) with secondary and 17 adults (27 refluxing ureters) with primary vesicoureteral reflux. The primary group served as controls to establish normal urination. A total of 14 patients with secondary vesicoureteral reflux had a low compliant autonomous bladder, including 11 with myelodysplasia and 3 after pelvic surgery and radiotherapy. One patient had an unstable bladder due to cerebral palsy and 3 had anatomical abnormalities of the urinary tract. We evaluated the estimated reflux-free rate in the secondary and adult primary vesicoureteral reflux groups. RESULTS: Repeat injection was required in 24 ureters because of recurrent reflux. Average injected volume in the secondary and primary groups was 2.72 and 2.88 ml. per refluxing unit, respectively. The estimated reflux-free rate after the initial injection decreased gradually to about 35% in each group, while 12 and 24 months after the last injection it remained constant at 70% in the secondary group but decreased from 84.7% to 62.1% in the primary group. The percent of late recurrence was higher in the primary group. CONCLUSIONS: Long-term efficacy of the endoscopic correction of vesicoureteral reflux in the secondary group was similar to that in the primary group. Thus, endoscopic subureteral glutaraldehyde cross-linked collagen injection is useful for treating complicated secondary vesicoureteral reflux as a minimally invasive procedure. It is considered optional treatment of primary vesicoureteral reflux to avoid long-term prophylactic treatment.

Absorbable Implants↗