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PubMedDate not supplied

Spiral CT with 3D reconstruction in children requiring reoperation for failure of chest wall growth after pectus excavatum surgery. Preliminary observations.

Pectus excavatum is the most common congenital chest wall deformity. Extensive corrective surgery prior to age 3 may disturb chest wall growth and result in a constricted thorax. We describe our surgical and radiologic experience with eight such cases, paying particular attention to the role of spiral computed tomography (CT) with 3D reconstruction in patient management. Spiral CT was performed on children who had developed restrictive chest walls following pectus excavatum surgery. These children then underwent a unique operation to elevate the sternum and attempt to correct their restrictive chest wall defects. In several cases, postoperative spiral CT was performed. Spiral CT with 3D reconstruction defined the orientation of the ribs and costal cartilages and their relationship to the sternum, allowing exact preoperative measurement of the bony rib cage and guiding individualized operative correction. Computed thoracic volumes in select cases correlated well with subjective patient reports of increased exercise capacity. Repair of pectus excavatum defects prior to age 3 may result in constrictive thoracic abnormalities. Surgical correction can increase thoracic volume and improve prospects for normal thoracic function. Three-dimensional reconstruction of spiral CT data is useful in both preoperative and postoperative evaluation.

Adolescent↗

PubMed1989

[Prevention of thromboembolic complications after surgical treatment of cancer of the stomach].

It was established that in patients with local spread of carcinoma of the stomach the hemostasis system makes danger of thrombogenesis due to lowered reserved possibilities of fibrinolysis and aggregation activity of the vessel wall. The state of danger of thrombogenesis under such conditions realizes itself in thrombi of profound veins of lower extremities detected by the method of radioisotope phlebography at the preoperative stage of treatment in 32.5% of the patients. Radioindication with fibrinogen125 has shown that the progressing development of preoperative thromboses is observed in the postoperative period. Complex medicamentous treatment (heparin, rheopolyglucin, nicotinic acid, aspirin) in combination with the graded physical exercise of the lower extremity muscles in the postoperative period eliminates the danger of thrombogenesis and prevents the development of venous thrombotic complications.

Blood Coagulation↗

PubMed1985

Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly.

Although chest physical therapy (PT) immediately after surgery lowers the risk of postoperative pulmonary complications, several reports indicate preoperative chest PT results in further improvement. This study compares the effects of initiating chest PT either before and/or after chest surgery in patients over age 65. We studied two groups: 130 patients (the PRE group) undergoing both pre- and postoperative therapy and 150 patients (the POST group) undergoing only postoperative therapy, dividing them into four surgical subgroups: lung, cardiac and other thoracic surgery, upper abdominal, and lower abdominal (considered low risk compared with the other three). Overall complication rates and atelectasis rates were significantly lower in the PRE high-risk subgroups. PRE and POST pneumonia rates, however, were statistically equivalent in all surgical subgroups. Since the low rate of pulmonary complications for PRE-group patients undergoing thoracic or upper abdominal procedures is comparable to that for PRE-group therapy in much younger populations, advanced age alone does not appear to be a significant risk factor. The lack of effect on incidence of pneumonia indicates that preoperative chest PT only counters the altered pulmonary mechanics responsible for atelectasis, but has no effect on pulmonary complications due to infection.

Abdomen↗

PubMed1998

[Prospective study on evaluation of the ischemic heart disease for preoperative patients with lung cancer].

One hundred twenty-four patients with lung cancer undergoing operation in our hospital were prospectively studied on evaluation of the ischemic heart disease before operation. They performed master double electrocardiogram and exercised T1 scintigram before operation. The patient with positive master double electrocardiogram and/or exercised T1 scintigram was taken into high risk group. All patients in high risk group performed coronary angiography. This high risk group consisted of 37 patients (29.8%), including 6 single vessel disease (4.8%), 2 double vessel disease (1.6%), and 1 triple vessel disease (0.8%). Preoperative revascularization was done 8 patients (6.5%). These revascularization patients had uneventful course during and after lung operation. However 2 cases of vasospastic angina (VSA) occurred in non-risk group during operation. It was impossible to anticipate VSA before lung operation in our series. Therefore our preoperative evaluation and care of organic ischemic heart disease was effective in preventing cardiac complications.

Adult↗

PubMed1998

Disability from vestibular symptoms after acoustic neuroma resection.

OBJECTIVE: This study aimed to evaluate the recovery of balance function after acoustic neuroma resection. STUDY DESIGN: This study was a retrospective case review with patient survey. SETTING: The surgery was conducted at a tertiary referral center. PATIENTS: Patients who underwent surgical resection of acoustic neuroma and had preoperative vestibular function testing were eligible for entering the study. INTERVENTIONS: All patients received surgical resection of acoustic neuroma. Patients treated since 1990 received postoperative vestibular habituation exercises. MAIN OUTCOME MEASURES: These included postoperative symptom and disability scores, dizziness handicap inventory (DHI) total and subset scores, time after surgery at which patients were able to walk independently, whether patients returned to their usual professional responsibility, and time to return to full activities at work. RESULTS: Significant correlation was found between several preoperative symptoms and vestibular testing results and the resulting postoperative disability from dizziness. CONCLUSIONS: This information may be helpful in counseling patients before surgery with respect to the degree of postoperative dysequilibrium and may suggest that the clinician should initiate more aggressive vestibular rehabilitation exercises in patients who may be at greater risk of having persistent dysequilibrium develop after surgery.

Adolescent↗

PubMed1989

Preoperative cardiac consultations in a teaching hospital.

Perioperative consultations may play a major role in the care of surgical patients in an era of prospective payments. Since insurance reimbursement policy favors limitations in the number of consultants on a case, general medicine ("holistic") consultation services may become preferred perioperative consultants in the future. To focus curriculum planning for perioperative consultants, we reviewed the content of 60 consecutive perioperative consultations by noncardiac surgery services to a university cardiology consultation team. Clinical descriptions of the patients' exercise tolerance showed that 95% of the patients belonged in functional classes I and II. One fourth of the requests were for routine preoperative clearance. The most frequent cardiac conditions for evaluation were congestive heart failure, old myocardial infarctions, murmurs, abnormal electrocardiograms, angina, and previous histories of coronary artery bypass surgery. Few patients needed management of arrhythmias. Physicians involved in perioperative care should assess their abilities in managing these cardiac conditions.

Adult↗

PubMed1998

Relation between preoperative inspiratory lung resistance and the outcome of lung-volume-reduction surgery for emphysema.

BACKGROUND: Surgery to reduce lung volume has recently been reintroduced to alleviate dyspnea and improve exercise tolerance in selected patients with emphysema. A reliable means of identifying patients who are likely to benefit from this surgery is needed. METHODS: We measured lung resistance during inspiration, static recoil pressure at total lung capacity, static lung compliance, expiratory flow rates, and lung volumes in 29 patients with chronic obstructive lung disease before lung-volume-reduction surgery. The changes in the forced expiratory volume in one second (FEV1) six months after surgery were related to the preoperatively determined physiologic measures. A response to surgery was defined as an increase in the FEV1 of at least 0.2 liter and of at least 12 percent above base-line values. RESULTS: Of the 29 patients, 23 had some improvement in FEV1 including 15 who met the criteria for a response to surgery. Among the variables considered, only preoperative lung resistance during inspiration predicted changes in expiratory flow rates after surgery. Inspiratory lung resistance correlated significantly and inversely with improvement in FEV1 after surgery (r=-0.63, P<0.001). A preoperative criterion of an inspiratory resistance of 10 cm of water per liter per second had a sensitivity of 88 percent (14 of 16 patients) and a specificity of 92 percent (12 of 13 patients) in identifying patients who were likely to have a response to surgery. CONCLUSIONS: Preoperative lung resistance during inspiration appears to be a useful measure for selecting patients with emphysema for lung-volume-reduction surgery.

Adult↗

PubMed2005

Little effect of physical training on body composition and nutritional intake following colorectal surgery--a randomised placebo-controlled trial.

OBJECTIVE: Postoperatively patients have a reduction in nutritional intake and body weight. We studied the effect of postoperative physical training on nutritional intake and body composition. METHODS: Patients > or =60 y admitted for elective colorectal surgery were randomised to train muscular strength (group A) or to nonstrengthening exercises (group B) for 3 months. Fat mass (FM) and lean body mass (LBM) were assessed with bioimpedance preoperatively, 7, 30, and 90 days postoperatively. Nutritional intake was registered in a subpopulation. RESULTS: Of 119 included patients, 60 were randomised to group A and 59 to B. The changes in LBM at postoperative day 7 were a mean (s.d.) of 0.4 (2.1) kg in group A compared to -0.7 (2.0) kg in B. The difference between groups of 1.2 (0.5) kg at day 7 was statistically significant (P=0.03). At no other time was observed difference between groups in weight, LBM, or FM. The energy and protein intake rose during postoperative day 1-7 and rose further after discharge. At no time were differences between groups. CONCLUSION: Physical training had little effect on body composition following abdominal surgery. The nutritional intake in well-nourished patients did not increase by training.

Aged↗

PubMed1989

[Reversibility of left ventricular functional damage after valve replacement in patients with chronic aortic valve insufficiency].

The authors study retrospectively some preoperative echocardiographic findings and their importance as predictors of reversible myocardial dysfunction. The functional status of 57 survivors after isolated aortic valve replacement was evaluated with exercise testing and on this ground the patients, were divided into three groups: A (28 pts) greater than 60%; C (10 pts) less than 40%; B (19 pts) from 40% to 60%. The authors conclude that the postoperative improvement in functional status is strictly correlated with some preoperative echocardiographic indexes (end-diastolic dimension, end-systolic dimension, shortening fraction, mean end-systolic radius/thickness ratio, end-systolic wall stress, myocardial mass, ejection fraction) with are also predictive of operative mortality. The authors consider the principal values of beginning left ventricular impairment: a) end-systolic dimension greater than or equal to 5.5 cm; b) shortening fraction less than 27%; c) mean end-systolic radius/thickness ratio greater than 2.5; d) end-systolic wall stress greater than 240 mmHg.

Aortic Valve Insufficiency↗

PubMed2001

Effect of restoration of AV synchrony on stroke volume, exercise capacity, and quality-of-life: can we predict the beneficial effect of a pacemaker upgrade?

The aim of this study was to assess to what extent patients with VVIR pacemakers and without overt symptoms of a pacemaker syndrome benefit from a pacemaker upgrade, and if a preoperative noninvasive measurement of the change in stroke volume (SV) could predict the effect of a pacemaker upgrade. The study group consisted of 20 (12 women, 8 men) VVIR patients with a mean age of 60 years. The indication for the first implantation was AV block in 13 patients and SSS in 7. The mean time of a ventricular pacing was 77 months. The objective (echocardiography, an exercise capacity) and the subjective (the quality-of-life) parameters investigated in patients during ventricular pacing were compared to results obtained 2 months and 1 year after a pacemaker upgrade. To assess preoperatively a change in a SV expected after upgrading, attempts were made to restore AV synchronization by the use of a transesophageal pacemaker. An increase in SV (from 5% to > 35%) during temporary AV resynchronization was observed in each patient. Values of SV increase correlated with those obtained 2 months (r = 0.65; P < 0.01) and 1 year (r = 0.66; P < 0.01) after an upgrade. Superior hemodynamics was associated with a significant improvement of an exercise capacity in both subgroups of patients. The most significant improvement in the quality-of-life was observed in patients with SSS. We did not find correlations between SV and the quality-of-life assessed 2 months (r = 0.043; NS) or 1 year (r = 0.02; NS) after an upgrade. In conclusion, a pacemaker upgrade performed after a long-term ventricular pacing resulted almost consistently in the improvement of hemodynamics and was associated with an increase of exercise capacity. In patients with SSS it was followed by the significant improvement of their quality-of-life. Such a relation was not observed in patients with AV block as some of them (especially those with VVIR pacemakers) felt quite well during ventricular pacing. The proposed preoperative echocardiographic evaluation may precisely predict the degree of hemodynamic improvement expected after a pacemaker upgrade.

Adult↗

PubMedDate not supplied

Cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease.

Severe chronic obstructive pulmonary disease is characterized by limited exercise capacity as a result of changes in pulmonary mechanics, abnormal gas exchange, altered cardiac function, respiratory muscle dysfunction, nutritional factors, and dyspnea. Cardiopulmonary exercise testing is a safe, effective method for objectively studying exercise performance and may be carried out using simple walk tests or more complicated treadmill or cycle-ergometry testing. Indications in patients with chronic obstructive pulmonary disease include defining the etiology of dyspnea, evaluating work disability or impairment, and assessing the response to therapy or the need for supplemental oxygen. It is also indicated in preoperative evaluation and as part of a pulmonary rehabilitation program.

Exercise Test↗

PubMed1981

[Preoperative treatment of severe coronary stenosis with the balloon catheter in patients with operable carcinomas (author's transl)].

Two patients with severe angina pectoris during minimal physical exercise and angiologically proven severe coronary stenosis also had a surgically operable carcinoma of the bronchus and stomach, respectively. Extensive operation for carcinoma would have been a serious cardiological risk. A preceding aortocoronary bypass operation would have been an additional stress as well as a delay of surgery by several weeks. Using percutaneous transluminal coronary dilatation it was possible to remove severe and isolated coronary stenoses rapidly and with little effort. Both survived carcinoma operations a few days later without trouble.

Angina Pectoris↗

PubMed1984

Low-level exercise testing before and after coronary artery bypass surgery.

Heart rate and blood pressure responses to low-level exercise tests in patients immediately before and after coronary artery bypass graft surgery lack sufficient documentation. This study documents heart rate, blood pressure, electrocardiographic responses and symptoms during low-level treadmill tests (LLTT) of 19 patients in two subgroups (A and B) before surgery, and again the day before hospital discharge. Preoperatively, the most common reason for stopping the treadmill test early was onset of angina. Postoperatively, patients stopped due to fatigue (4), dyspnea (6), and dizziness (2). Mean resting heart rate responses increased 37% in group A (n = 9) and 40% in group B (n = 10) from the preoperative to postoperative test. Mean postoperative resting pressure rate product responses increased 16% in group A and 38% in group B compared to preoperative values. Mean resting systolic blood pressure responses were 15% lower postoperatively for group A. This LLTT proved to be a clinically feasible tool which provided objective information about the patient's readiness for discharge and exercise prescription.

Blood Pressure↗

PubMed1990

Exercise cardiorespiratory function in adolescents with pectus excavatum. Observations before and after operation.

We studied 12 children with pectus excavatum (mean age, 13.8 years) using pulmonary function and exercise testing. Eight patients had surgical repair and were studied before and after repair. Four patients did not have repair and were tested twice. The degree of chest wall deformity in the two groups was similar. All patients reached 86% or more of their maximal predicted heart rate with exercise. Total lung capacity decreased 8% (p less than 0.01) after operation. In the nonoperated control group, total lung capacity was similar during both studies. The ratio of ventilation at maximal exercise to maximal voluntary ventilation was 68% +/- 12% before and 66% +/- 9% after operation in the operated group and 69% +/- 18% and 79% +/- 30% at two studies in the nonoperated group (nonsignificant changes). Maximal oxygen uptake was 36.1 +/- 4.4 ml/kg/min preoperatively and 38.1 +/- 8.1 postoperatively and 41.2 +/- 7.3 ml/kg/min and 43.0 +/- 6.9 on two studies in the nonoperated group (nonsignificant changes). Cardiac output and stroke volume increased appropriately with exercise both before and after operation. Operation had no physiologically significant effect on the cardiorespiratory response to exercise. Slight changes in cardiorespiratory function occurred in both operated and nonoperated subjects. These results emphasize the importance of studying patients before and after operation and of using a control group.

Adolescent↗

PubMed1990

The treatment of nonunions and pseudarthroses of the humeral shaft.

In summary, if one follows the AO/ASIF principles of open reduction and stable internal fixation of nonunions and pseudarthroses of the humerus, mostly with plate fixation supplemented by shingling or petaling, cement for loose screws when necessary, and bone grafting of defects or atrophic nonunions, then successful healing with one operative procedure can be achieved in over 95%, with almost full correction of preoperative deformity. Return of useful function and range of motion can also be achieved in 75% to 90% by early active exercises, physiotherapy, and occasional continuous passive motion, supported by hinged braces or cast braces in the postoperative period until union occurs. Union was achieved in an average of 6.6 months after the operative procedure.

Adult↗

PubMed2006

The use of autologous blood to improve exercise capacity after total hip arthroplasty: a preliminary report.

BACKGROUND: Venesection of red blood cells in healthy well-trained subjects decreased the maximum oxygen uptake parallel with the reduction in hemoglobin (Hb) level. Based on the large Hb decrease that is seen after total joint surgery, one could expect a decrease in performance as well. The purpose of this study was to investigate whether autologous blood enhanced performance on a bicycle ergometer in patients after total hip arthroplasty. STUDY DESIGN AND METHODS: Nine patients scheduled for elective total hip arthroplasty in an accelerated stay program participated in a preoperative autologous blood donation (PABD) program. Weeks before the scheduled surgery, patients donated 4 units of blood and received standard erythropoietin treatment. Physical fitness was assessed during exercise test on a bicycle ergometer. Each patient was matched with three previously tested patients. RESULTS: Patients in both groups were 69.0 years old (range, 66-74 years vs. 61-77 years). None of the patients had relevant cardiovascular abnormalities. On average patients received 3.3 units of blood because 3 units were not transfused. The PABD group showed a Hb decrease of 0.5 g per dL (4%) on the fourth postoperative day versus 4.4 g per dL (31%) in the control group. The decline in power output on Day 4 was significantly less in the PABD group compared with the control group (t test, p = 0.026). CONCLUSION: From this pilot study it can be concluded that correction of the postoperative Hb decrease was associated with a lower decrease in maximum power output, compared to the control group. On Days 23 and 39, however, the difference in performance between the PABD group and control group had disappeared.

Aged↗

PubMed1993

Current practice in the preoperative evaluation of patients undergoing major vascular surgery: a survey of cardiovascular anesthesiologists.

Various cardiovascular testing modalities have been proposed as a means of reducing perioperative risk in patients undergoing vascular surgery. It is currently unknown with what frequency and under what conditions these tests are used in clinical practice. In an attempt to determine the spectrum of current clinical practice, the authors surveyed anesthesiologists who attended the 1992 Society of Cardiovascular Anesthesiologists Annual Meeting. A total of 77 of 100 surveys were returned, representing 58 institutions in the United States: 26 university hospitals, 29 private hospitals, 2 Veterans Administration hospitals, and 1 military hospital. The incidence of preoperative testing was not significantly different between private and university institutions, and ranged from a mean of 54% of patients undergoing lower extremity procedures to 73% of patients undergoing aortic surgery, with a wide disparity among institutions. Dipyridamole or exercise thallium imaging was the most common test used, and Holter monitoring was the least common. The testing led to revascularization in 52% of university and 72% of private hospitals. Testing was thought to result in modification of perioperative monitoring in 85% of the institutions and in modification of other aspects of care in a significant percentage of institutions. In conclusion, in this random population, preoperative testing was reported to be used in a significant percentage of patients, and similar practices were found between university and private institutions. The practices at the individual institutions and types of tests ordered varied greatly, and suggest the need for further research to determine optimal preoperative strategies.

Anesthesiology↗

PubMed1998

Effects of exercise on Achilles tendon healing in a rat model.

The effects of motion, or lack of it, on Achilles tendon healing are not well defined. We have recently shown that immobilization has a detrimental effect on tendon healing in a rat model. The aim of this experiment was to determine whether enforced exercise had an additional beneficial effect on the mechanical and functional recovery of divided Achilles tendons in rats. Male Sprague-Dawley rats were randomly allocated into a nonexercise and an exercise group (N = 10 for each group). In both groups the right Achilles tendon was surgically transected. The left, uninjured lower limb served as an internal control. Both groups of animals were housed under identical conditions with the exception that the exercise group swam for 15 minutes per day. Functional performance was determined from the measurement of hindpaw prints of walking rats preoperatively and on alternate postoperative days. On day 15, the animals were killed and weighed, and biomechanical evaluations were performed on both the injured and uninjured Achilles tendon constructs. There were no differences in weight at time of death. All animals had an initial functional deficit that returned to near-normal by day 15. There were significant differences in the morphological and the mechanical properties of the healing Achilles tendon constructs at day 15 when comparing the injured with the uninjured Achilles tendon constructs. Supplemental exercise, however, had no effect on the functional or mechanical recovery of injured or uninjured Achilles tendons in the rat model.

Achilles Tendon↗