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At least 1,135 records · Page 63Linked to original sources
PubMed1993

Preoperative prediction of pulmonary complications following thoracic surgery.

The ability of preoperative quality-of-life and physiologic variables to predict postoperative complications was tested in 117 consecutive patients undergoing thoracotomy for possible or definite lung cancer. Preoperatively, quality of life was globally assessed by the QLI and Sickness Impact Profile. Dyspnea was assessed by the Clinical Dyspnea Index and a modified Pneumoconiosis Research Unit question. Spirometry and maximal exercise testing were carried out in 115 and 46 subjects, respectively. Thirty-seven percent experienced at least one respiratory complication (eg, pneumonia, atelectasis prompting bronchoscopy, pulmonary embolism). Twofold or greater increases in respiratory complications were associated with current smoking (p < 0.05), cancer as the final pathologic condition (p < 0.10), at least moderate dyspnea (p < 0.10), FEV 1 < 60 percent of predicted (p < 0.05), ventilatory reserve < 25 L (p < 0.05), and VO2max < 1.25 L (p < 0.05). Twofold increases in the incidence of any complication (respiratory, cardiac, etc) were associated with age > or = 75 years (p < 0.05) and cancer as the final pathologic condition (p < 0.05). We conclude that simple historic information (age, smoking status, cancer status, dyspnea) indicates the risk of postoperative morbidity. General quality-of-life measures were not good predictors of morbidity. Our findings corroborate the few studies supporting the value of VO2max and suggest that the usefulness of the ventilatory reserve deserves further attention.

Activities of Daily Living↗
PubMed1986

Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study.

To determine the potential benefit of incentive spirometry, which has been advocated to prevent pulmonary complications after upper-abdominal surgery, we compared a group of patients receiving incentive spirometry to another group receiving no specialized postoperative respiratory care. Forty patients in the American Society of Anesthesiologists' class 1 and 2 who were undergoing cholecystectomy (through right subcostal incision) were included in the study and were randomly allocated to one of the two groups. Patients receiving incentive spirometry were encouraged by a specialized respiratory physiotherapist to breathe deeply for five minutes hourly, 12 times daily, for three postoperative days. No statistically significant difference between the two groups was found in the radiologic evidence of postoperative pulmonary complications, arterial oxygen pressure, spirometric measurement, and clinical evaluation at the second or fourth postoperative day (or both). In particular, deterioration on the chest x-ray film at the fourth postoperative day was observed in eight of 20 patients in the group receiving incentive spirometry and in six of 20 in the control group. Our study confirms the postoperative deterioration of respiratory function after upper-abdominal surgery and demonstrates the lack of therapeutic values of incentive spirometry in these patients at low risk for pulmonary complications.

Adult↗
PubMed2000

Comparative analysis of left ventricular hemodynamics and hypertrophy after aortic valve replacement with homografts or mechanical valves.

BACKGROUND AND AIM OF THE STUDY: The study aim was to examine comparatively the effects of prosthetic and homograft valves in the aortic position on ventricular hemodynamics and structure. METHODS: Hemodynamic evaluations were performed at rest and during exercise in 38 patients who had undergone aortic valve replacement (AVR) with either a homograft (n = 19) or prosthetic valve (19-23 mm; n = 19). Using echocardiographic, electrocardiographic and hematologic methods, the pressure gradient (PG); aortic valve area; diameters of left anterior wall, posterior wall (PW) and interventricular septum (IVS); ejection fraction (EF); left ventricular mass (LVM) and mass index (LVMI); electrocardiographic data of LV hypertrophy; hemoglobin; hematocrit and lactate dehydrogenase (LDH) levels were measured. RESULTS: LVM and LVMI decreased significantly after surgery in both groups (p<0.001), but the decrease was significantly greater in the homograft group (p<0.05). The IVS and PW diameters in the homograft group decreased significantly postoperatively (p<0.05); the inter-group difference was also significant (p<0.01). In the homograft group there was a significant improvement in EF (p<0.05), and the exercise PG was significantly less. Both groups showed improved LV hypertrophy and correlation between V1S >24 mm criteria and LVMI measurements. Postoperative LDH levels in the homograft group were significantly lower than preoperative levels (p<0.05); the intergroup difference was also significant (p<0.001). CONCLUSIONS: Our data suggest that homografts, as compared to mechanical prostheses, provide significantly better hemodynamics in the aortic position.

Adult↗
PubMed1991

[Reversion of eye position after surgical correction of exotropia].

The authors analysed the reversion of eye position in 62 postoperative patients of concomitant exotropia. The results indicated the presence of a correlation with the preoperative condition of binocular vision, the type of strabismus, and the age of patient. The authors opened that the amplitude of surgical correction should depend on these factors, and prudence should be exercised in recommending surgical intervention for mild intermittent exotropia in children.

Adolescent↗
PubMed1989

Management of the patient with rheumatoid arthritis. The role of the hand therapist.

The treatment of patients with rheumatoid arthritis requires a team approach, with the patient as the key player. These patients have a chronic disease that necessitates monitoring by physicians, nurses, social workers, therapists, and vocational counselors. The hand therapist provides individual exercise and activities programs, hand splinting, and instruction in joint protection and energy conservation techniques. When a patient requires surgery, the hand therapist works in conjunction with the surgeon in both the preoperative phase of patient evaluation and education, and in the postoperative management. The team working together helps the patient receive maximum benefits from treatment and to live more comfortably with his disease.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Rehabilitative treatment in endoprosthesis of the elbow joint].

A technique of rehabilitation treatment was suggested and tested on 25 patients with an elbow joint endoprosthesis. The postoperative rehabilitation involved three periods: absolute immobilization, relative immobilization and postimmobilization. Therapeutic measures should be adjusted to each specific stage and imply different physiotherapeutic modalities according to clinical features and duration of the postoperative period: position treatment; passive, light active dynamic exercise, isometric training, underwater exercise; electrostimulation; manual and mechanical massage; occupational therapy. Positive response after adequate postoperative rehabilitation was registered in 20 patients.

Adult↗
PubMed1988

[Decrease in left ventricular stroke performance following bypass of a significant main coronary artery stenoses].

Hemodynamic parameters and left ventricular function were assessed 14 +/- 4 (means +/- SEM) days preoperatively and 101 +/- 5 days after aortocoronary bypass surgery in eight men (51-65 years of age) with left main coronary stenosis (greater than or equal to 75%). Working capacity on bicycle exercise stress test increased from 43 +/- 7 to 68 +/- 7% of age-, and body-surface matched normals; at the same time cardiac output (thermodilution) decreased from 5.7 +/- 0.5 to 4.7 +/- 2 l/min (p less than 0.05), stroke volume decreased from 78 +/- 6 to 63 +/- 3 ml (p less than 0.01), stroke work from 1.16 +/- 0.10 to 0.89 +/- 0.07 Joule (p less than 0.001), and stroke power from 4.0 +/- 0.3 to 3.4 +/- 0.2 Joule/s (p less than 0.01) postoperatively. Left ventricular volumes decreased postoperatively but not significantly, ejection fraction remained unchanged (57 +/- 13/59 +/- 13%). A control group (PTCA of LAD) showed no significant changes of these parameters. As all patients had a good postoperative result, decrease of stroke work after aortocoronary bypass surgery is not necessarily an expression of postoperative deterioration, since it can coincide with good left ventricular function, angiographically successful revascularization, and an increase in working capacity.

Adult↗
PubMed1976

The influence of hypertrophy on myocardial function.

In patients with hypertrophy from long-standing left ventricle pressure (PL) and volume overload (VL) as well as in a group of controls basal left ventricular contractility was assessed by peak measured isovolumic velocity of shortening (Vpm), mean velocity of circumferential fiber shortening (mean VCF) and mean normalized systolic ejection rate (MNSER). The angiographically determined left ventricular muscle mass was elevated to a similar extent in PL and VL. As compared to the control group both hypertrophy had decreased contractile indexes. No significant differences of contractility existed between the groups with PL and VL. Hence it appears that in chronic mechanical overloading the extent of hypertrophy is probably more important for the decrease of contractility than the nature of the stimulis to hypertrophy. In 15 patients with aortic stenosis left ventricular muscle mass and isovolumic and ejection phase contractile indexes were determined preoperatively and 13.5 months after successful valve replacement by a tilting disc prosthesis. Postoperatively there was a significant (P less than 0.001) decrease of muscle mass from 182 to 114 g/m2. Mean VCF increased from 1.07 to 1.52 circ/sec (P less than 0.01); MNSER from 1.92 to 2.59 enddiastolic volumes/sec (P less than 0.01); Vpm from 1.17 to 1.60 ML/sec (P less than 0.001) and total pressure Vmax from 1.61 to 2.09 ML/sec (P less than 0.01). In 9 of 13 patients an abnormal or pathologic response to handgrip at the preoperative study became normal postoperatively. It is concluded that in aortic stenosis removal of the chronic pressure burden leads to regression of left ventricular hypertrophy associated with an improvement of resting and exercise contractile function. Pressure-deprived contractile indexes; ejection phase contractile indexes; chronic pressure load; chronic volume load; aortic valve replacement; postoperative hemodynamics.

Cardiomyopathy, Hypertrophic↗
PubMed2003

Preoperative evaluation of patients undergoing lung resection surgery.

Lung cancer continues to be the leading case of cancer deaths in the United States. In patients with resectable non-small cell lung cancer, surgical resection is the treatment of choice. An accurate preoperative general and pulmonary-specific evaluation is essential as postoperative complications and morbidity of lung resection surgery are significant. After confirming anatomic resectability, patients must undergo a thorough evaluation to determine their ability to withstand the surgery and the loss of the resected lung. The measurement of spirometric indexes (ie, FEV(1)) and diffusing capacity of the lung for carbon monoxide (DLCO) should be performed first. If FEV(1) and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection, including pneumonectomy, without further testing. However, if FEV(1) and DLCO are < 60% of predicted, further evaluation by means of a quantitative lung scan is required. If lung scan reveals a predicted postoperative (ppo) values for FEV(1) and DLCO of > 40%, the patient can undergo lung resection. If the ppo FEV(1) and ppo DLCO are < 40%, exercise testing is necessary. If this reveals a maximal oxygen uptake (O(2)max) of > 15 mL/kg, surgery can be undertaken. If the O(2)max is < 15 mL/kg, surgery is not an option. This review discusses the existing modalities for preoperative evaluation prior to lung resection surgery.

Female↗
PubMed1985

Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983: impact of preoperative left ventricular function.

Recent studies suggest that preoperative left ventricular function may no longer be an important determinant of survival or functional results after operation for aortic regurgitation because of improved operative techniques. To assess the effect of left ventricular function on prognosis in the current surgical era, we performed echocardiographic and radionuclide angiographic studies in 80 consecutive patients undergoing valve replacement from 1976 to 1983. No patient had associated coronary artery disease. For all patients, 5 year survival was 83 +/- 5%, significantly better than the 62 +/- 9% 5 year survival in our patients operated on from 1972 to 1976. Preoperative resting left ventricular ejection fraction (p less than .001), fractional shortening (p less than .001), and end-systolic dimension (p less than .01) were the most significant predictors of survival (univariate life-table analysis). Five year survival was 63 +/- 12% in patients with subnormal ejection fraction (n = 50) compared with 96 +/- 3% in those with normal ejection fraction (n = 30). Patients with subnormal left ventricular ejection fraction and poor exercise tolerance or prolonged duration of left ventricular dysfunction (greater than 18 months) comprised the high-risk subgroup (5 year survival 52 +/- 11%). Patients in this subgroup also had persistent left ventricular dysfunction after operation, with greater left ventricular end-diastolic dimensions and reduced ejection fraction (both p less than .001) compared with patients with normal preoperative left ventricular ejection fraction or a brief duration of left ventricular dysfunction (less than 14 months). Cold hyperkalemic cardioplegia was used for myocardial preservation in 46 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed2005

Preoperative assessment for lung cancer surgery.

PURPOSE OF REVIEW: Pulmonary resection remains the only curative treatment option for lung cancer surgery. This review summarizes recent advances in the preoperative functional evaluation of the patient with lung cancer. RECENT FINDINGS: The workup of patients with bronchogenic carcinoma covers three areas: tumor type, tumor extent, and patient cardiopulmonary reserves. Significant advances have been made in the latter two areas. Traditionally lobectomy was regarded as the minimum resection for lung cancer; new studies are challenging this view and suggesting that segmentectomy is acceptable for stage Ia cancers < or =20 mm. An important change relating to cardiopulmonary reserves of the patient is the shift in emphasis toward early exercise testing and, in particular, the use of stair climbing as a surrogate marker of maximal oxygen consumption. New studies confirm the benefit of combined lung volume reduction surgery and lung cancer surgery in certain patients who might otherwise be excluded from surgery because of poor lung function. SUMMARY: Advances in the preoperative workup of lung cancer patients and in surgical techniques are permitting resections in previously inoperable patients. A new, simplified algorithm for the preoperative workup of lung cancer patients assessing the value of stair climbing as a surrogate marker of maximal oxygen consumption is proposed.

Age Factors↗
PubMed1996

Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery.

OBJECTIVES: This study evaluated the prognostic value of abnormal test results with pharmacologic stress with regard to perioperative and long-term outcomes in a large population of candidates for vascular surgery. BACKGROUND: Although numerous studies have demonstrated the prognostic value of dipyridamole-thallium-201 myocardial perfusion and dobutamine echocardiography in vascular surgery candidates, a synopsis of predictive estimates is difficult because of individual study variability in pretest clinical risk, sample size and study design. METHODS: A systematic review of published reports on preoperative pharmacologic stress risk stratification from the MEDLINE data base (1985 to 1994) identified 10 reports on dipyridamole-thallium-201 myocardial perfusion (1,994 patients) and 5 on dobutamine stress echocardiography (446 patients). Random effects models were used to calculate summary odds ratios and 95% confidence intervals. RESULTS: Summary odds ratios for death or myocardial infarction and secondary cardiac end points were greater for dobutamine echocardiographic dyssynergy (14- to 27-fold) than for dipyridamole-thallium-201 redistribution (4-fold); wider confidence intervals were noted with dobutamine echocardiography. Pretest coronary disease probability was correlated with the positive predictive value of a reversible thallium-201 defect (r=0.70), increasing sixfold from low to high risk patient subsets. Cardiac event rates were low in patients without a history of coronary artery disease (1% in 176 patients) compared with patients with coronary disease and a normal or fixed-defect pattern (4.8% in 83 patients) and one or more thallium-201 redistribution abnormality (18.6% in 97 patients, p=0.0001). CONCLUSIONS: Meta-analysis of 15 studies demonstrated that the prognostic value of noninvasive stress imaging abnormalities for perioperative ischemic events is comparable between available techniques but that the accuracy varies with coronary artery disease prevalence.

Adrenergic beta-Agonists↗
PubMed1983

Prospective assessment of regional myocardial perfusion before and after coronary revascularization surgery by quantitative thallium-201 scintigraphy.

Because thallium-201 uptake relates directly to the amount of viable myocardium and nutrient blood flow, the potential for exercise scintigraphy to predict response to coronary revascularization surgery was investigated in 47 consecutive patients. All patients underwent thallium-201 scintigraphy and coronary angiography at a mean (+/- standard deviation) of 4.3 +/- 3.1 weeks before and 7.5 +/- 1.6 weeks after surgery. Thallium uptake and washout were computer-quantified and each of six segments was defined as normal, showing total or partial redistribution or a persistent defect. Persistent defects were further classified according to the percent reduction in regional thallium activity; PD25-50 denoted a 25 to 50% constant reduction in relative thallium activity and PD greater than 50 denoted a greater than 50% reduction. Of 82 segments with total redistribution before surgery, 76 (93%) showed normal thallium uptake and washout postoperatively, versus only 16 (73%) of 22 with partial redistribution (probability [p] = 0.01). Preoperative ventriculography revealed that 95% of the segments with total redistribution had preserved wall motion, versus only 74% of those with partial redistribution (p = 0.01). Of 42 persistent defects thought to represent myocardial scar before surgery, 19 (45%) demonstrated normal perfusion postoperatively. Of the persistent defects that showed improved thallium perfusion postoperatively, 75% had normal or hypokinetic wall motion before surgery, versus only 14% of those without improvement (p less than 0.001). Whereas 57% of the persistent defects that showed a 25 to 50% decrease in myocardial activity demonstrated normal thallium uptake and washout postoperatively, only 21% of the persistent defects with a decrease in myocardial activity greater than 50% demonstrated improved perfusion after surgery (p = 0.02). Thus, preoperative quantitative thallium-201 scintigraphy appears useful in predicting response to revascularization surgery, and some persistent defects may revert to normal thallium uptake after surgery. Importantly, the preoperative distinction between viable and nonviable myocardium can be reasonably established by quantitating the amount of persistent reduction in thallium uptake and correlating this with preoperative wall motion.

Coronary Artery Bypass↗
PubMed2000

Mini-maze suffices as adjunct to mitral valve surgery in patients with preoperative atrial fibrillation.

INTRODUCTION: After mitral valve (MV) surgery, preoperative atrial fibrillation (AF) often recurs while cardioversion therapy generally fails. Additional Cox maze surgery improves postoperative arrhythmia outcome, but the extensive nature of such an approach limits general appliance. We investigated the clinical outcome of a simplified, less extensive Cox maze procedure ("mini-maze") as adjunct to MV surgery. METHODS AND RESULTS: Thirteen patients with MV disease and preoperative AF were treated with combined surgery (group 1). Nine control patients without previous AF underwent isolated MV surgery (group 2). We retrospectively compared the results to findings in 23 patients with preoperative AF who had undergone isolated MV surgery (group 3). In group 1, mini-maze took an additional 46 minutes of perfusion time. One 75-year-old patient died of postoperative multiple organ failure. Seven patients showed spontaneously converting (within 2 months) postoperative AF. After 1 year, 82% were in sinus rhythm (SR). No sinus node dysfunction was observed. In group 2, all patients were in SR after 1 year. In group 3, only 53% were in SR after 1 year, despite serial cardioversion and antiarrhythmic drug therapy. Exercise tolerance and heart rate were comparable for groups 1 and 2. Left atrial function was present in all but one patient in group 1 and in all patients in group 2 (after MV reconstruction). CONCLUSION: Adding a relatively simple mini-maze to MV surgery improves arrhythmia outcome in patients with preoperative AF without introducing sinus node dysfunction or persistent absence of left atrial function. The results of this type of combined surgery are encouraging and deserve further attention.

Aged↗
PubMed2002

Myocardial hibernation in coronary artery disease.

Coronary artery disease (CAD) is very prevalent in Western societies and is a leading cause of mortality and morbidity. Despite decreases in mortality rates from CAD over the past 30 years, ischemic heart failure remains an important problem because people with CAD are now living longer. Hibernating myocardium may be defined as reversible left ventricular dysfunction due to chronic CAD that shows improvement in function after revascularization. Many patients with ischemic cardiomyopathy have areas of hibernating myocardium, and thus can potentially show improvement in left ventricular regional and global function if they are revascularized. Whether hibernating myocardium represents an adaptive response to hypoperfusion in the face of chronic ischemia or whether it is a degenerative process is not entirely clear. Clearly, ultrastructural changes of de-differentiation are seen, and include loss of sarcomeres and the appearance of small mitochondria and glycogen accumulation. Although the mechanisms underlying the changes in morphology and depressed contractility, and the factors governing recovery of function are not clear, changes in adrenergic receptor density, cytokine upregulation, and the degree of fibrosis may all play a role. Identification of viability is commonly performed with dobutamine echocardiography or nuclear imaging. Because patients with extensive CAD and poor left ventricular systolic function are high-risk candidates for coronary bypass surgery, the preoperative identification of viability provides important prognostic information. Patients with viable myocardium who are treated with revascularization rather than medical therapy have better outcomes in terms of survival, left ventricular function, symptoms, and exercise capacity.

Chronic Disease↗