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PubMed1975

[Pulmonary function tests and spiroergometric parameters during rehabilitation of patients with idiopathic scoliosis (fusion of the spine with Harrington rod and training) (author's transl)].

11 female patients with idiopathic scoliosis underwent spinal fusion surgery after Harrington. Additionally the patients were exercised before and after surgery by a special program. During the period of rehabilitation the usual spirographic measurements were carried out and some spiroergometric parameters were measured at standardized ergometric work loads. The diminished vital capacity and the practically normal forced vital capacity were not changed significantly, but the maximum voluntary ventilation was enhanced distinctly. The resting heart rate, primarily far above normal level, decreased significantly at the end of the exercise period and approached normal range. Maximum heart rate corresponded always to the mean values of normal subjects. Instead of a nearly constant increased minute volume of respiration, respiratory frequency and specific ventilation (respiratory equivalent) the maximum 0-2 uptake and maximum 0-2 puls increased significantly. These changes can be explained by an improvement of the uneven distribution of perfusion and ventilation, due to the combined surgical and exercise treatment.

Adolescent↗
PubMed2006

Physical activity in women planning sacrocolpopexy.

This study describes preoperative physical activity in 314 stress-continent women with prolapse planning sacrocolpopexy. Seventy-six percent reported that they engaged in mild, 60% in moderate, and 26% in strenuous exercise (counts are not mutually exclusive). Activity frequencies did not generally differ by prolapse stage. Prolapse substantially interfered with exercise or recreation in 27% of women, household work or yard work in 19%, and work outside the home in 8%. Compared to women with less symptom distress, more women with greater symptom distress reported that prolapse interfered with household/yard work (43 vs 5%, p<0.0001), working outside the home (29 vs 8%, p<0.005), and recreation/exercise (51 vs 10%, p<0.0001). Prolapse stage was not associated with interference with household/yard work (p=0.28) or work outside home (p=0.89). Although prolapse stage is associated with interference with recreation (p=0.02), this association is not consistently positive : stage II, 42%; stage III, 22%; and stage IV, 32%.

Adult↗
PubMed1984

Mean systolic ejection rate after aortocoronary bypass graft surgery.

In 62 patients with coronary artery disease who underwent aortocoronary bypass graft surgery, we measured the mean systolic ejection rate invasively at rest and during upright exercise before and several months after operation. After bypass surgery, mean systolic ejection rate did not show any change at either supine or sitting rest and at submaximal exercise levels of walking on a treadmill. At maximal exercise, only patients with complete revascularization showed a significant increase in heart rate from 105 to 147 (+40%) and mean systolic ejection rate from 339 ml/sec to 404 ml/sec (+19%, P less than 0.001). Patients with incomplete revascularization did not show a substantial change in these variables. Beta-blocker withdrawal did not affect the result significantly.

Adrenergic beta-Antagonists↗
PubMed2004

Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review.

A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

Arthroplasty, Replacement↗
PubMed1999

Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure.

BACKGROUND: Elevated left ventricular filling pressures present a major target of therapy for symptomatic heart failure but are difficult to assess directly. Because the relationship of left- and right-sided pressures remains ill defined in chronic heart failure, this study compared 3 right-sided measurements (right atrial [RA] pressure, pulmonary artery systolic [PAS] pressure, and severity of tricuspid regurgitation [TR]) to the pulmonary capillary wedge (PCW) pressure. METHODS: Hemodynamic measurements and echocardiography were available from 1000 patients undergoing transplant evaluation. Right atrial and PAS pressure, and TR severity were compared to PCW pressure. For 754 patients undergoing repeat measurements, changes in RA and PAS pressures were compared to PCW changes. RESULTS: Right atrial pressure correlated with PCW pressure (r = 0.64), regardless of etiology or TR severity. Right atrial pressure changes correlated with PCW changes (r = 0.62). Discordance was defined as either RA > or = 10 mm Hg despite PCW < 22 mm Hg (6%) or RA < 10 mm Hg despite PCW > or = 22 mm Hg (15%). For detection of PCW > or = 22 mm Hg, positive predictive values were 88% for RA > or = 10 mm Hg, 95% for PAS > or = 60 mm Hg, and 79% for > or = moderate TR. Pulmonary artery systolic pressure correlated very closely with PCW (r = 0.79), and could be estimated as 2 x PCW. Reduction in PAS pressure during therapy was strongly determined by PCW pressure reduction (r = 0.67). CONCLUSIONS: Accurate estimation of RA pressure can potentially guide therapy of left ventricular filling pressures in approximately 80% of chronic heart failure patients without obvious non-cardiac disease. In this population, elevated PAS pressures are largely determined by elevated left-sided filling pressures.

Diuretics↗
PubMed1999

Long-term quality of life in patients after total gastrectomy.

This study used a questionnaire survey to evaluate the long-term quality of life (QOL) in 51 patients who underwent total gastrectomy. Activities of daily living (ADL) were good in 20, relatively good in 9, relatively poor in 13, and poor in 6 patients. The other 3 patients were treated on an inpatient basis. Of 38 patients who had been employed before surgery, 18 (47%) resumed working. Physically, body weight increased or showed no changes in 38 patients (74%), but decreased in the other 13 patients, of whom 3 showed a 15% or more decrease. Dumping symptoms developed in 13 patients (26%), 2 of whom had a severe condition. Clear decreases in physical strength and mental strength (spiritual energy) were reported by 10 and 8 patients, respectively. Comprehensive QOL was good in 20, slightly poor in 17, and poor in 14 patients. Quality of life was poor in 12 (41%) of the 29 patients with good ADL. The following were suggested as necessary for patients and their families: sufficient preoperative explanation about pathophysiology and nutritional management after total gastrectomy; execution of a continued patient education program until after discharge; and explanations in specific terms about cooking methods, nutritional management, exercise therapy, periodic medical checks, and patients' associations using pamphlets and food models to describe daily living of the patients after discharge.

Activities of Daily Living↗
PubMed2006

Exercise testing in asymptomatic aortic stenosis.

AIMS: To determine the safety of exercise testing (ET) in patients with moderate or severe asymptomatic aortic stenosis (AAS) and its accuracy to predict the need for surgery and mortality. METHODS: 106 consecutive patients with AAS performed a maximal ET. RESULTS: Follow-up [10.7 (4.9-19.4) months (percentile 25-75)] was completed in 102 patients (96.2%), 63.9 years (+/-15.1), 65 (61.3%) male, peak gradient 82.8 mm Hg (+/-25.4), mean gradient 50.5 mm Hg (+/-16.6), valve area 0.67 cm(2) (+/-0.16); 67 patients (65.7%) had abnormal ET. Among the 35 patients with normal ET, there were no deaths and 10 aortic valve replacements (AVR) (28.5%) were performed. Among the 67 patients with abnormal ET, 37 (55.2%) had events (35 AVR and 2 died) (p <0.0001). There were no complications with ET. CONCLUSION: ET may be performed safely in patients with AAS. ET gives additional information to an AVR decision.

Aged↗
PubMedDate not supplied

Congenital malformations of the gallbladder and cystic duct diagnosed by laparoscopy: high surgical risk.

Congenital anomalies of the gallbladder are rare and can be accompanied by other malformations of the biliary or vascular tree. Being difficult to diagnose during routine preoperative studies, these anomalies can provide surgeons with an unusual surprise during laparoscopic surgery. The presence of any congenital anomaly or the mere suspicion of its existence demands that we exercise surgical prudence, limit the use of electrocoagulation, and ensure that no structure be divided until a clear picture of the bile ducts and blood vessels is obtained. If necessary, perform intraoperative cholangiography to further define the biliary system. However, if the case remains unclear, or if laparoscopy does not provide enough information, open surgery should be considered before undesirable complications occur.

Adult↗
PubMed1976

[Work load hemodynamics before and after aortocoronary bypass].

Left ventricular enddiastolic pressure (LVEDP) was studied during exercise in 22 patients pre- and postoperatively under an identical work load. 13 patients showed improvement of LVEDP (normalization in 5), LVEDP was unchanged in 5 (w.n.l. in 2), and had deteriorated in 4. These results suggest that improvement or normalization of LVEDP under exercise following aortocoronary bypass surgery can be assumed if there is complete revascularization, if all grafts are functioning well, if there is no progression of the underlying disease, and if preoperative LV angiography is normal or shows only ischemic (reversible) hypokinesis.

Angina Pectoris↗
PubMed1994

[Long-term results of arthroscopic meniscectomy].

The long-term results after partial arthroscopic meniscectomy were evaluated in follow-up examinations on 77 patients performed according to identical criteria after post-operative periods of two (6-36 months) and seven years (66-96 months). The subjective results after up to more than seven years showed a stable course and were unrelated to the radiological signs of osteoarthritis. The objective clinical results, assessed in the Lysholm score, showed a significant deterioration as compared to the two-year follow-up (p < 0.0002). In particular, an obvious increase of pain and an increased tendency for swelling were observed, while the results in the Lachman test showed a significant reduction of anterior instability (p < 0.0015) as an obvious result of a marked improvement of muscle strength. These results also correlated with a significant increase of sporting and exercise capacity as compared to the results obtained in the two-year follow-up. While osteoarthritis rates seen in the first follow-up were similar to the preoperative findings, a massive increase of osteoarthritis could be seen at the second follow-up after a further five years with only 22 of 77 patients (28.6%) showing no radiographic signs of osteoarthritis. In 31 patients (40.25%) with negative preoperative findings slight to moderate signs of osteoarthritis were seen in the seven-year follow-up. Regardless of the type of meniscal tear the osteoarthritic changes seen were related to the age of the patient and the stability of the joint and were significantly different from those in the non-operated, contralateral joint.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

[Early and late physiological effects of balloon mitral valvuloplasty].

PURPOSE: To evaluate the early and late cardiorespiratory responses after balloon mitral valvuloplasty. METHODS: Nine female patients aged 35 +/- 9 years with mitral stenosis, in class II or III (NYHA) underwent up-right ergoespirometric test, resting electrocardiogram and echocardiogram before, 3 to 5 days (early evaluation) and 8 to 12 months (late evaluation) after mitral valvuloplasty. All patients were treated with digitalis and diuretics. RESULTS: During late evaluation, 44% patients were in class II and 56% were in class I (NYHA). The resting heart rate decreased (87 +/- 11 bpm vs 85 +/- 7 bpm vs 75 +/- 9 bpm) and the number of steps increased (4 +/- 1 steps vs 5 +/- 2 steps vs 6 +/- 1 steps); the peak oxygen uptake improved only in the late evaluation (16 +/- 3 mL/kg/min vs 18 +/- 4 mL/kg/min vs 22 +/- 7 mL/kg/min). The anaerobic threshold, minute ventilation (VE) and ventilatory equivalent for oxygen showed no change. The heart rate (1st step: 124 +/- 18 bpm vs 112 +/- 13 bpm vs 87 +/- 15 bpm), O2 uptake (1st step: 10 +/- 2 mL/ kg/min vs 8 +/- 2 mL/kg/min vs 8 +/- 2 mL/kg/min) and VE decreased during submaximal exercise in early and late phases. The mitral valve area decreased in the late evaluation (0.94 cm2 vs 1.66 cm2 vs 1.20 cm2). CONCLUSION: Although partial restenosis tended to occur in these patients, they improved the functional class and cardiorespiratory performance and cardiocirculatory load during submaximal exercise.

Adult↗
PubMed1993

Antiobesity Surgery: Is a Structured Support Group Desirable? Preliminary.

The relevance of a post-gastroplasty physician-and dietitian-supervised support group for weight loss, dietary habits, dietary knowledge, and exercise has been assessed. Two post vertical banded gastroplasty groups were compared: those who did (n = 10) and those who did not (n = 11) attend a monthly post-gastroplasty support session. A 55-point questionnaire plus a 24-hour dietary recall and food frequency analysis were employed. Addressed were dietary and exercise history, eating habits, and factual dietary knowledge. At the time following surgery of this study (support: mean 29.7 vs no support: mean 34.9 months, NS), there was no difference in weight loss between the two groups. There was no difference in the two groups between preoperative, length of time from surgery to interview or weight at Interview. Those who attended the support group consumed significantly fewer calories (1559 +/- 320 vs 2278 +/- 271, p </= 0.5), total grams of fat a day (57 +/- 19 vs lie +/- 17, p </= 0.5), fat as percentage of total diet (26 +/- 4 vs 44 +/- 2, p </= 0.0005, and saturated fat as percentage of total diet 8 +/- 1 vs 17 +/- 2, p </= 0.0005). Attendees were more physically active than those who did not attend (236+/-49 vs 115+/-46 minutes exercise per week, p </= 0.05). Of those attending the seven monthly group session, 80% stated that it was easy to determine the fat content of food from the food label, compared to 36% in the non-support group (p </= 0.05). This suggests that to the postoperative period studied, weight loss is determined by the operation itself. However, we show that those who do attend are better informed, make wiser food choices, and are more physically active. To determine whether the difference in dietary habits and nutritional knowledge will result in an improved long-term weight loss, requires a more prolonged follow-up.

Journal Article↗
PubMed2006

Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control?

OBJECTIVES: The purpose of this study was to assess the value of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate (HR) control scheduled for major vascular surgery. BACKGROUND: Treatment guidelines of the American College of Cardiology/American Heart Association recommend cardiac testing in these patients to identify subjects at increased risk. This policy delays surgery, even though test results might be redundant and beta-blockers with tight HR control provide sufficient myocardial protection. Furthermore, the benefit of revascularization in high-risk patients is ill-defined. METHODS: All 1,476 screened patients were stratified into low-risk (0 risk factors), intermediate-risk (1 to 2 risk factors), and high-risk (> or =3 risk factors). All patients received beta-blockers. The 770 intermediate-risk patients were randomly assigned to cardiac stress-testing (n = 386) or no testing. Test results influenced management. In patients with ischemia, physicians aimed to control HR below the ischemic threshold. Those with extensive stress-induced ischemia were considered for revascularization. The primary end point was cardiac death or myocardial infarction at 30-days after surgery. RESULTS: Testing showed no ischemia in 287 patients (74%); limited ischemia in 65 patients (17%), and extensive ischemia in 34 patients (8.8%). Of 34 patients with extensive ischemia, revascularization before surgery was feasible in 12 patients (35%). Patients assigned to no testing had similar incidence of the primary end point as those assigned to testing (1.8% vs. 2.3%; odds ratio [OR] 0.78; 95% confidence interval [CI] 0.28 to 2.1; p = 0.62). The strategy of no testing brought surgery almost 3 weeks forward. Regardless of allocated strategy, patients with a HR <65 beats/min had lower risk than the remaining patients (1.3% vs. 5.2%; OR 0.24; 95% CI 0.09 to 0.66; p = 0.003). CONCLUSIONS: Cardiac testing can safely be omitted in intermediate-risk patients, provided that beta-blockers aiming at tight HR control are prescribed.

Adrenergic beta-Antagonists↗
PubMed2003

Bronchoscopic lung volume reduction.

AIM: Because traditional lung volume reduction involves major surgery in unfit patients, resource implications are formidable. Many patients are too ill for consideration and overall survival rates have lead to questions about its continuation. We report on a new method of lung volume reduction, through a bronchoscopic approach. Patients with severe dyspnoea with end stage emphysema were recruited. Target areas for collapse therapy were upper lobes or segments with severe destruction, occupying a large volume, with surrounding lung compression and little perfusion. These were delineated radiologically and with ventilation-perfusion scanning. Endobronchial bloc-kade was initially with detachable, silicone balloons and later with especially designed and hospital manufactured stainless steel wire stents containing bio-compatible sponge. METHODS: Five males and 3 females with preoperative breathlessness at rest and muscle wasting were treated. Operative time was a mean of 67.5 min. Rehabilitation began immediately and 7 patients left hospital the following day. RESULTS: Five patients had improvements in well-being, dyspnoea, exercise tolerance, lifestyles and medication requirements. One patient survived at least 2 years and 2 are still alive 4(1/2) years later. Endoscopic balloon replacement with wire and sponge devices was required in 5 patients. Complications were related to intraoperative oxygenation problems in 2 patients and late infections in 4. CONCLUSIONS: Bronchoscopic lung volume reduction for the treatment of end-stage emphysema subjectively improved the majority of patients. The use of stents was promising: balloons were disappointing.

Aged↗