[Use of respiratory physiotherapy in surgical patients. II. In thoracic surgical patients].
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Breathing Exercises↗
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Results for “Preoperative Exercise”
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Physiotherapy--essentials of chest care.
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Breathing Exercises↗
[Value and significance of the effort electrocardiogram in patients operated on for aortocoronary bypass].
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Coronary Artery Bypass↗
[Functional recovery in pulmonary tuberculosis].
At first Authors explain the stages of tubercular disease in which a programme of functional respiratory rehabilitation can be advised. Then they deal with the main aspects of rehabilitating treatment in some tubercular manifestations, as sero-fibrinous pleural effusion, tubercular empyema, parenchymal fibrosis and surgical reliquates. With regard to surgical reliquates, we mostly consider pulmonary resections and pleural skinning. At last Authors recall the indications to physical exercise training, that are constituted by some reliquates of tubercular pathology, and they resume the accomplishment modalities of such a programme in order to allow every patient wide possibilities of social reintroduction.
Breathing Exercises↗
[Physiokinesitherapy in thoracic surgery].
The importance of physiokinesitherapy in the prevention and cure of postoperative complications is emphasised. Thoracic as well as general and other specialised surgery is shown to benefit from physiokinesitherapy exercises. The postoperative complications most likely to benefit from physiokinesitherapy are listed, the techniques most often used in thoracic cases are described and two routine pre- and postoperative programmes are outlined. In conclusion a more widespread systematic use of physiokinesitherapy after thoracic surgery is recommended.
Exercise Therapy↗
[Surgical treatment of rheumatoid lesions of the ankle joint in children].
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Adolescent↗
[Ambulatory monitoring of left ventricular function in patients with ischemic heart disease: effects of coronary revascularization].
The aim of this study was to assess the efficacy of coronary artery bypass using an ambulatory radionuclide monitoring system of left ventricular function (VEST) during daily activities in patients with previous myocardial infarction and coronary artery disease. Ten patients with previous myocardial infarction, clinical evidence of residual angina and angiocardiographically proven coronary artery disease of at least two epicardial vessels were studied by VEST 8 +/- 2 days before and 15 +/- 3 days after surgical myocardial revascularization. VEST allows to monitor both left ventricular function and 2 ECG leads. During the radionuclide monitoring (at least 60 min) all patients underwent handgrip test (compression of a dynamometer for 2 min at the 75% of maximal capacity), a mental stress (arithmetic operation consisting in subtracting 17 from 17,000 for 4 min), walking (140 yards) and climbing stairs (8 flights). No significant changes in left ventricular function during mental stress and handgrip both before and after the surgical procedure were observed. In the preoperative evaluation, walking induced a significantly increase in heart rate from rest to peak exercise (73 +/- 13 versus 79 +/- 11 b/min, respectively; p < 0.01). After coronary artery bypass, heart rate (rest: 92 +/- 18 b/min, effort: 98 +/- 19 b/min; p < 0.01), ejection fraction (rest: 47 +/- 8%, effort: 53 +/- 10%; p < 0.01), cardiac output (rest: 43 +/- 8 edv/min, effort: 51 +/- 11 edv/min, p < 0.01), and stroke volume (rest: 47 +/- 9%, effort: 53 +/- 9%; p < 0.01) increased at maximal effort compared to the control conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Influence of isosorbide dinitrate (ISDN) on compliance of the pulmonary venous system.
Irreversible poor pulmonary venous compliance can worsen the natural course of patients with high pulmonary capillary wedge pressure, especially those with mitral stenosis, but nitrates (isosorbide dinitrate--ISDN), which have venodilatory properties, could increase this compliance in most patients. The aim of this study was to assess the hemodynamic effects of ISDN in patients with mitral stenosis, with special emphasis on the pulmonary venous compliance. Pulmonary venous compliance was estimated according to the Hirakawa equation (dV/dp = 0.4 x k2 x sV/(v-d)) in 39 patients with mitral stenosis during preoperative right heart catheterization with Vygon 5155-180 thermodilution catheters at rest and during exercise (25 W) in the supine position. This procedure was repeated after the application of 3.75 mg of Iso-Mack spray. Overall, ISDN increased pulmonary venous compliance significantly both at rest and during exercise (6.0 to 7.5 ml/mmHg and 6.0 to 7.6 ml/mmHg, respectively). The patients were divided into two groups according to their level of ISDN response; those with a good response of an increase of 15% or more in pulmonary venous compliance (Group I), and those with an increase of less than 15% (Group II). There were significant differences between these two groups in stroke volume index and heart rate. In Group I, while the mean right atrial pressure, mean pulmonary artery pressure and mean pulmonary wedge pressure all decreased significantly, there was a simultaneous insignificant decrease in the stroke volume index and an also insignificant increase in the heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)
Atrial Function, Right↗
Difficulties in judging effects of rehabilitation.
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Breathing Exercises↗
The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery.
A prospective study of the use of transcutaneous neural stimulation (TNS) in 90 arthroscopic knee surgery patients was performed to determine: if TNS is as effective as traditional pain medication in treating postoperative knee pain; and if patients that had received TNS regain preoperative motion and strength quicker than the control population. The patients were divided into three equal groups. Group I consisted of patients with no TNS unit, Group II had a "placebo" unit, and Group III had a "live" unit. Preoperatively, each patient received an isokinetic muscle examination, orientation to the TNS unit, leg circumference measurements, and exercise instruction. An isokinetic muscle examination and leg circumference measurements were repeated at 1, 3, and 7 weeks postoperatively. Additionally, the amount of pain and medication required was analyzed. The results of the study indicated that the use of a TNS unit is an effective adjunct in decreasing postoperative pain in 93% of patients. The amount of pain and total pain medication required was greatest in the control group, less in the placebo, and markedly reduced in the TNS group. A comparison among the three groups revealed that the TNS group regained the following preoperative values 1 month sooner than the other two groups (3 as opposed to seven weeks postoperatively): isokinetic power in flexion and extension (P less than 0.05), range of motion (P less than 0.02), and leg volume (P less than 0.05). There was no correlation between the pain and irregular wave forms on the isokinetic graph. The only complication noted was skin irritation at the electrode sites.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Effects of vestibulo-ocular reflex exercises on vestibular compensation after vestibular schwannoma surgery.
OBJECTIVE: To assess vestibular function in a large group of vestibular schwannoma patients so that we could determine whether simple vestibular exercises speed vestibular dysfunction recovery after tumor removal surgery. STUDY DESIGN: A prospective investigation of the vestibular dysfunction experienced by patients in the first 12 weeks after surgery. SETTING: Vestibular investigation unit at a tertiary referral institution. PATIENTS: Sixty-five patients with identified vestibular schwannoma referred for preoperative vestibular investigations. Thirty-two men and 33 women, with a mean age 51 years (range, 24-77 yr). INTERVENTIONS: There were 27 control patients, 30 exercise patients, and 8 patients that had balance physiotherapy. Exercise patients began simple vestibulo-ocular reflex gaze stabilization exercises 3 days after surgery. MAIN OUTCOME MEASURES: Postoperative vestibular function testing was performed at 2 to 3, 6 to 7, and 10 to 12 weeks after surgery. Objective measurements of vestibular compensation status were as follows: spontaneous nystagmus and sinusoidal harmonic acceleration asymmetry and gain values. Dizziness Handicap Inventory questionnaires were used to assess subjective perceptions. RESULTS: The main findings were reduced dispersion in vestibulo-ocular reflex asymmetry at 2 to 3 weeks, reduced mean in asymmetry at 6 to 7 weeks, less dizziness/imbalance according to the Dizziness Handicap Inventory questionnaire, and that preoperative caloric tests did not predict postoperative severity of vestibular systems. CONCLUSION: This large study provided unique evidence that a program of simple vestibular exercises and education can speed the rate of compensation after vestibular schwannoma surgery.
Adolescent↗
The intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence in the female.
The aim was to evaluate the intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence. Fifty-four unselected patients, aged from 26 to 79 years, mainly with mixed incontinence symptoms, underwent this procedure. It works by tightening the suburethral vagina ('hammock'), and by creating an artificial pubourethral neoligament. Where indicated, repair of uterine prolapse (24 cases), or infracoccygeal sacropexy (17 cases) was also performed. Almost all patients were discharged on the day of, or day after surgery, without requirement for postoperative catheterization, and returned to fairly normal activities, including jobs, within 7 to 14 days. At a mean follow-up time of 15 months, the cure rates for preoperative symptoms were, frequency 88%, nocturia 77%, urge incontinence 89%, stress incontinence (SI) 85%, symptoms of abnormal emptying, 77%, and reduction of mean residual urine from 67.5 mL to 32 mL. The objective cure rate (exercise pad testing) for stress incontinence was 88.6%; taking the group as a whole, urine loss was reduced from a mean of 11.6 g preoperatively to a mean of 0.5 g postoperatively. Urodynamically diagnosed detrusor instability was not a predictor of surgical failure in this study. According to the concepts presented here, symptoms of urinary dysfunction are mainly symptomatic manifestations of abnormal laxity in the vagina or its supporting ligaments. The surgical methods used to correct these defects are fairly simple, safe and easily learnt by an practising gynaecologist.
Adult↗
[Results of heart valve replacement. Prognosis--occupational and general disability--occupational rehabilitation].
The success of valve surgery has led to a marked improvement in prognosis, quality of life and exercise tolerance in patients with symptomatic valvular heart disease. The degree of subjective and objective improvement depends on multiple preoperative factors like NYHA status, left ventricular function, valve lesion and type of valve replaced as well as peri- and postoperative factors like the occurrence of a perioperative myocardial infarction, the degree of intraoperative myocardial damage, the type of valve replaced and the speed and degree of postoperative regression of left ventricular hypertrophy and dilatation. The postoperative exercise tolerance is a major determinant for postoperative vocational rehabilitation. Therefore the individual functional assessment of patients postoperatively is of major importance.
Aortic Valve↗
Postoperative atelectasis and pneumonia.
Postoperative pulmonary complications, specifically atelectasis and pneumonia, are the leading cause of postoperative morbidity and death. It is crucial that the clinician have a thorough understanding of the pathophysiology, risk factors, and scientific basis for currently used respiratory interventions to tailor the patient's care in the preoperative, intraoperative, and postoperative settings. Given the changing healthcare environment and increasing economic constraints, all respiratory interventions must be reevaluated for use in patient care, keeping in mind the factors of scientific basis, patient needs, appropriate utilization, and quality patient outcomes.
Breathing Exercises↗
Evidence-based preoperative evaluation of candidates for thoracotomy.
All patients considered for thoracotomy should have preoperative spirometry. Patients meeting the criteria outlined below should also have quantitative radionuclide perfusion scanning. Patients felt to be at high risk on the basis of predicted postoperative FEV1 should be considered for exercise assessment. If exercise assessment is performed, an MVO2 of < 10-15 mL/kg/min or a predicted postoperative MVO2 < 10 mL/kg/min identifies a patient at very high risk for complications and mortality. Limited available data support the use of preoperative risk indices to identify patients at high risk (See Table 4). Lung volume reduction surgery may provide new approaches in selected patients with significant obstructive lung disease and concomitant lung cancer.
Evidence-Based Medicine↗
Prophylactic digitalization preoperatively of patients with arteriosclerotic heart disease.
This study was undertaken to investigate the hemodynamic effect of prophylactic digitalization before major surgical procedures. Sixteen patients, all admitted for an elective vascular operation for arteriosclerotic disease and all with impaired left ventricular function, were investigated. In half of the patients, digitalis was given before the operation, the other half of the patients served as the control study. The measured parameters were pulmonary artery mean pressure, pulmonary capillary wedge pressure, central venous pressure, mean arterial blood pressure, heart rate, cardiac output, blood volume and arterial, as well as venous, oxygen content. Preoperatively, before digitalization, no significant differences were noted between the two groups at rest and during exercise. Before anesthesia and postoperatively, those given digitalis had improved cardiac function. Those in both groups, however, had a normal hemodynamic response to the surgical trauma. In this study, a definite answer is not provided concerning the usefulness of prophylactic digitalization but an increase in the ability of the digitalized heart to withstand the imposition of a pressure load postoperatively is suggested.
Aged↗
The role of pelvic floor exercises on post-prostatectomy incontinence.
PURPOSE: Post-radical prostatectomy incontinence occurs in 0.5% to 87% of patients. This condition may be attributable to intrinsic sphincteric deficiency, and/or detrusor abnormalities. Previous studies of pelvic floor exercise (PFE) for improving post-prostatectomy incontinence have shown mixed results. We determined whether preoperative and early postoperative biofeedback enhanced PFE with a dedicated physical therapist would improve the early return of urinary incontinence. MATERIALS AND METHODS: A total of 38 consecutive patients undergoing radical prostatectomy from November 1998 to June 1999 were randomly assigned to a control or a treatment group. The treatment group of 19 patients was referred to physical therapy and underwent PFE sessions before and after surgery. Patients were also given instructions to continue PFE at home twice daily after surgery. The control group of 19 men underwent surgery without formal PFE instructions. All patients completed postoperative urinary incontinence questionnaires at 6, 12, 16, 20, 28 and 52 weeks. Incontinence was measured by the number of pads used with 0 or 1 daily defined as continence. RESULTS: Overall 66% of the patients were continent at 16 weeks. A greater fraction of the treatment group regained urinary continence earlier compared with the control group at 12 weeks (p <0.05). Three control and 2 treatment group patients had severe incontinence (greater than 3 pads daily) at 16 and 52 weeks. Of all patients 82% regained continence by 52 weeks. CONCLUSIONS: PFE therapy instituted prior to radical prostatectomy aids in the earlier achievement of urinary incontinence. However, PFE has limited benefit in patients with severe urinary incontinence 16 weeks after surgery. There is a minimal long-term benefit of PFE training since continence rates at 1 year were similar in the 2 groups.
Biofeedback, Psychology↗
Functional recovery of hibernating myocardium after coronary bypass surgery: does it coincide with improvement in perfusion?
To determine the relationship between functional recovery and improvement in perfusion after coronary artery bypass graft surgery (CABG), 49 patients were studied. Radionuclide angiography was performed before, 1 month after, and 6 to 12 months after CABG to evaluate regional wall motion. Exercise thallium-201 myocardial perfusion imaging was done before and 1 month after CABG to assess regional perfusion. Preoperative asynergy was observed in 108 segments, and 74 of them showed an improvement in wall motion 1 month after CABG (segment A). Sixty-six of these segments (89%) were associated with an improvement in perfusion. Eight segments that had not improved 1 month after CABG demonstrated a delayed recovery of wall motion 6 to 12 months after CABG (segment B). However, seven of eight segments (88%) already showed an improvement in perfusion 1 month after CABG. A total of 82 segments exhibited functional recovery after CABG and were considered hibernating segments. In the preoperative study segment B more frequently had areas of akinesis or dyskinesis than segment A (75% vs 34%, p less than 0.05). The mean percent thallium-201 uptake in segment B was lower than that in segment A (74% +/- 9% vs 83% +/- 8%, p less than 0.05). Functional recovery of hibernating myocardium usually coincided with an improvement in perfusion. However, delayed functional recovery after reperfusion was observed in some instances. Severe asynergy and severe thallium-201 defects were more frequently observed in these segments with delayed recovery. Hibernating myocardium might remain stunned during those recovery periods.
Coronary Artery Bypass↗