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At least 1,063 records · Page 59Linked to original sources
PubMed1996

[Functional results of surgical lung volume reduction in severe pulmonary edema].

BASIC PROBLEM AND OBJECTIVE OF THE STUDY: Lung volume reduction (LVR) is a new surgical approach designed to relieve shortness of breath and improve exercise tolerance in patients with severe lung emphysema. The aim of this study was to analyse changes of lung function, gas exchange, exercise tolerance and degree of dyspnoea one and 3 months after LVR. PATIENTS AND METHODS: Seventeen patients (15 men and two women; mean age 53 [38-68] years) with severe emphysema (six with alpha 1-PI deficiency) underwent unilateral (n = 14) or bilateral (n = 3) LVR surgery. One week before and one and 3 months after surgery pulmonary function tests, arterial blood gas analysis at rest breathing room air, 6-minute walking distance and dyspnoea score (Medical Research Council Scale) were determined. RESULTS: There was a significant increase in forced expiratory vital capacity after one second (FEV1, P < 0.001), and a significant decrease in total lung capacity (TLC, P < 0.0001) and residual volume (RV, P < 0.0001). The mean increase in FEV1 was 39% and in PaO2 9%. The mean decrease in TLC was 20%, in RV 26% (P < 0.001; both comparisons), and in paCO2 4% (not significant). The mean 6-minute walking distance increased by 96% from 229 to 405 meters (P < 0.0001). The mean dyspnoea score on a five point scale (0-4 points) decreased by 52% from 3.4 to 1.6. With the exception of the improved inspiratory vital capacity the postoperative results at one and 3 months after LVR did not differ significantly. All patients were alive 3 months postoperatively. CONCLUSIONS: In patients with severe emphysema surgical LVR shows significantly improved pulmonary function, gas exchange, dyspnoea and walking distance as assessed one and three months postoperatively. The early mortality seems to be low.

Acute Disease↗
PubMedDate not supplied

Feasibility and efficacy of home exercise training before lung volume reduction.

BACKGROUND: Exercise training is recommended before lung volume reduction surgery (LVRS) in patients with emphysema. Unfortunately, many of these patients are referred from remote areas where there is no available rehabilitation program. The authors evaluated the feasibility and efficacy of a minimally supervised home-based exercise training program. METHODS: Twenty-three emphysematous patients (age 61 +/- 6, forced expiratory volume in 1 second = 29 +/- 7% predicted [mean +/- SD]) were recruited from our LVRS program. Measurements of pulmonary function, maximal and submaximal exercise capacity, 6-minute walking distance (6-MWD), muscle strength, and quality of life with the Chronic Respiratory Questionnaire were obtained before and after training. Home-based exercise training program included muscle exercises and aerobic training, and started with detailed teaching while the follow-up was ensured through weekly phone calls and a diary filled by each patient. RESULTS: Significant increases in 6-MWD (P < 0.001), quality of life (P < 0.005), peak work rate (P < 0.05), peak oxygen consumption (P < 0.05), endurance time (P < 0.005), and muscle strength were observed in the home-based exercise training program. CONCLUSIONS: Home-based exercise training for patients in preparation for LVRS was feasible, and induced significant improvement in exercise tolerance and quality of life.

Exercise↗
PubMed2005

Short-term intensive treatment for donors with hepatic steatosis in living-donor liver transplantation.

BACKGROUND: The use of steatotic livers is associated with increased primary nonfunction in liver transplantation. To reduce the risk of liver injury, we applied a short-term combination therapy of diet, exercise and drugs for 11 living-donor liver transplantation (LDLT) candidates with steatosis. METHODS: Subjects were treated with a protein-rich (1000 kcal/day) diet, exercise (600 kcal/day), and bezafibrate (400 mg/day) for 2-8 weeks. RESULTS: The treatment significantly improved macrovesicular steatosis (30+/-4% vs. 12+/-2% [mean +/- SEM], P = 0.0028). Body weight and BMI were significantly reduced (73.7 +/- 3.2 kg vs. 66.9 +/- 2.9 kg, P = 0.0033, 26.4 +/- 0.7 kg/m vs. 24.1 +/- 0.8 kg/m, P = 0.0033). The treatment completely normalized liver function tests and lipid metabolism. Seven treated liver grafts (left lobe) were transplanted to the recipients. We compared transplanted graft function and resected liver function of donors using parameters such as peak total bilirubin, prothrombin time at postoperative day 3, and peak alanine aminotransferase between treated liver (n = 7) and donor liver without hepatic steotosis (n = 37). The transplanted grafts showed good liver functions, and there was no difference between them with respect to functional parameters. The treated donors also showed good liver functions, and no significant differences in functional parameters. CONCLUSIONS: The results of this study indicate that our short-term treatment effectively reduced steatosis and contributed to safer LDLT. Our findings also suggest that even severely steatotic livers can be used for LDLT grafting subsequent to our short-term treatment regimen.

Adult↗
PubMedDate not supplied

Pre-operative short-term pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery.

The role of pre-operative short-term pulmonary rehabilitation in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass graft surgery has been assessed for the first time prospectively. Forty-five patients posted for coronary artery bypass graft surgery were randomised to receive either short-term pulmonary rehabilitation (group I) or no such programme (group II). Patients of both the groups were evenly matched with respect to age, sex, body surface area, duration and severity of chronic obstructive pulmonary disease and coronary artery disease. Normal individuals who evenly matched with the study group were assessed for normal respiratory function parameters. Pre-operative and post-operative peak expiratory flow rate, inspiratory capacity, post-operative ventilation time, post-operative pulmonary complication and hospital stay were determined in both the groups. Peak expiratory flow rate (220.0 +/- 12.9 and 324.3 +/- 84.3 in group I, 218.0 +/- 16.4 and 260.5 +/- 35.2 in group II) and inspiratory capacity (844.0 +/- 147.4 and 1100.0 +/- 158.1 in group I, 830.0 +/- 117.4 and 1090 +/- 137 in group II) were significantly lower before and after surgery respectively in both groups compared to normal values. Even though both groups showed a significant rise in post-operative peak expiratory flow rate and inspiratory capacity after surgery, the post-operative peak expiratory flow rate and inspiratory capacity in group I was significantly higher than in group II. In group I, the post-operative ventilation time (24.5 +/- 6.00 hours), post-operative complications (n = 4) and hospital stay (12.4 +/- 3.6 days) were significantly lower than in group II (35.2 +/- 22.3 hours, n = 11, 18.8 +/- 6.6 days respectively). These data suggest that short-term pulmonary rehabilitation is feasible and effective in improving pulmonary functions before and after surgery and in reducing surgical morbidity and cost of medical care significantly.

Breathing Exercises↗
PubMed2004

[Experience with the use of autoarterial conduits in coronary surgery].

Between September 1999 and until the present time 14 direct myocardial revascularization using arterial conduits were performed at the Department of Vascular Surgery and Surgical Treatment of CAD, V. Vakhidov Scientific Center of Surgery, RU Ministry of Public Health. The internal mammary artery was used in all the cases, right gastroomental artery in 2 cases. Revascularization of one coronary artery was accomplished in 2 patients, of two arteries in 8 and of three coronary arteries in 4 patients. In 12 cases, direct myocardial revascularization was realized on the working heart and in 2 cases, under cardiopulmonary bypass. Ischemic changes on the ECG at rest, recorded in the preoperative period, disappeared following operation. In all the patients, myocardial contractility (EF) after operation rose by 6-8% on an average as compared to the initial level. Physical exercise tolerance was measured by BEM in 6 (42.9%) patients. Angina of effort, FC II, was diagnosed only in 2 patients. All the patients were discharged in a satisfactory condition. Only patients with unstable angina were recommended to take long-acting nitrates whereas the remaining subjects were advised to take the antiaggregation doses of aspirin.

Anastomosis, Surgical↗
PubMedDate not supplied

Continuous high thoracic epidural administration of bupivacaine with sufentanil or nicomorphine for postoperative pain relief after thoracic surgery.

In a prospective study, 40 patients who had undergone thoracotomy for lung resection were investigated. During operation, all patients received intravenous anesthesics, halothane and an initial dose of bupivacaine 0.5% with epinephrine 5 micrograms.ml-1 (5 to 10 ml) by thoracic epidural catheter. One hour after the initial dose of bupivacaine 0.5% with epinephrine, patients were divided in two groups for analgesia, the sufentanil group (50 micrograms sufentanil in 60 ml bupivacaine 0.125%) or the nicomorphine group (3 mg nicomorphine in 60 ml bupivacaine 0.125%) by a continuous epidural infusion (5 to 10 ml.h-1) for three days. Cardiovascular differences between the sufentanil group and the nicomorphine group were not statistically significant per- or postoperatively. The minimum respiratory frequency on either Day 1, 2, or 3 was 12 breaths.min-1 in the sufentanil group, corresponding to a PaCO2 of 32 mmHg, and 11 breaths.min-1, corresponding to a PaCO2 of 41 mmHg in the nicomorphine group. On Day 1, the PaCO2 in the sufentanil group was significantly lower (p less than 0.01), but in both groups the PaCO2 on Day 1 was significantly higher than the preoperative value. An inverse visual analogue pain scale (0 to 10 IVAS) showed mean scores above 7.5 for all patients during the three days. Scoring pain relief during exercise showed a significant difference in favor of the sufentanil group on Days 1, 2, and 3 (p less than 0.0008). The mean plasma bupivacaine level doubled every day, 138 ng.ml-1 on Day 1, 290 ng.ml-1 on Day 2, and 596 ng.ml-1 on Day 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Noninvasive cardiac output monitoring during exercise before and after coronary artery bypass surgery.

A computerized continuous wave Doppler instrument was used to monitor changes in cardiac output and stroke volume during supine symptom limited graded bicycle exercise in 30 subjects. Eight patients were studied before and after coronary artery bypass graft (CABG) and were found to have patent grafts (group 1). Six patients were symptomatic after CABG and had at least one graft occluded (group 2). Sixteen age matched asymptomatic subjects served as controls (group 3). In group 1 patients before CABG, the duration of exercise was 5 +/- 2 mins (mean +/- standard deviation), the double product was 162 +/- 25, the percentage change in cardiac output with exercise was 33 +/- 7 and the percentage change in stroke volume was 1 +/- 5. Following CABG in group 1 patients, the duration of exercise increased to 9 +/- 2 mins, the double product to 186 +/- 16, the percentage change in cardiac output to 74 +/- 14 and the stroke volume to 13 +/- 12% (P less than 0.05). These results were not significantly different from those obtained in the group 3 patients (controls) in whom the duration of exercise was 10 +/- 3 mins, double product 211 +/- 24, percentage change in cardiac output 95 +/- 30 and the percentage change in stroke volume was 13 +/- 5.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMedDate not supplied

The role of nursing in a support group for heart transplantation recipients and their families.

Heart transplantation, an increasingly accepted intervention to prolong life, involves specific nursing interventions, not only in the area of patient physical care but also in areas of health teaching and psychosocial assessment. This study discusses data collected from a support group created in September 1984 for heart transplant recipients and their families. The major concerns of patients and families were identified and translated into implications for nursing care. Fourteen sessions were voice-recorded and analyzed, identifying common, recurring topics. A total of 24 potential candidates for transplantation and recipients, ranging in age from 19 to 52 years, and eight wives participated in at least one of the weekly sessions. The average attendance per session was eight patients and three wives. The major areas of concern related to; health maintenance, role-relationships, self perception/self concept, values/beliefs regarding health, and coping/stress tolerance. Preoperative patients had greater concern for health maintenance, whereas patients in the post-transplant period were more concerned about role-relationships, sexual function and activity-exercise patterns. Nursing implications in these areas included in-depth health teaching about procedures, medications and their side effects, self-care regarding signs and symptoms of infection or rejection, and dietary requirements and limitations. Other aspects involved psychosocial adjustments following discharge from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1994

Effects of conservative treatment in patients who later will be candidates for TMJ surgery.

In an attempt to evaluate the effect of conservative treatment in 33 patients with longstanding symptoms from the joint and later subjected to temporomandibular joint surgery, a retrospective study was made based on careful case records and personal follow-up. The treatment period varied widely between the patients but was on average 2.5 years. The result of the conservative treatment in these patients was, however, very slight and limited to a minor increase in mouth-opening capacity. All TMJ-patients, including those with the diagnosis ADD and suspected ankylosis, ought to have a strict treatment and follow-up programme in order to reduce doctor's delay if and when surgical intervention should be necessary. Efforts should be focused on development of diagnostic methods to support the selection of patients for TMJ surgery earlier so as to avoid prolonged unsuccessful conservative treatment.

Adolescent↗
PubMed1978

Results of aortocoronary bypass operations. Follow-up in 343 patients.

Three hundred and forty-three patients who had aortocoronary bypass graft operations for disabling angina were followed up for from 6 months to 5 years (average 2 years). 80 per cent had multiple grafts and 20 per cent had additional endarterectomy. The overall mortality within one month of operation was 5 per cent, and in those who had vein graft procedures only was 4 per cent. 11 per cent had a postoperative myocardial infarction (6% perioperative) and there were 3 per cent late deaths. At 3 years 90 per cent are surviving. 80 per cent are asymptomatic without treatment. The mean angina grade was 0.3 at the latest follow-up, compared with 2.5 before operation; maximum exercise tolerance was also significantly improved (P less than 0.001). When angina recurred, it did so in 80 per cent of the cases within 12 months of operation and was usually attributable to inadequate revascularisation. Ventricular function as assessed by preoperative ventriculography was the factor most clearly related to survival rate and the early excellent results of coronary bypass operations seem to be maintained up to 5 years. It is, therefore, reasonable to continue to advise operation if only for relief of angina.

Adult↗