RESUMEN
BACKGROUND: Catastrophic loss of the penis following post-circumcision necrosis is a rare and devastating complication. Treatment options are limited, and the process is highly challenging. This study aims to report the successful application of our combined treatment approach for a 6-year-old patient who experienced total penile loss due to progressive necrosis 1 year after circumcision. METHODS & RESULTS: Following penile degloving, proximal penile mobilisation and separation and reshaping of the corpora were performed. The penile shaft was covered with a tunnelled composite anterior-lateral inguinal skin flap. Glanuloplasty was performed using a left buccal mucosal graft, followed by 10 sessions of hyperbaric oxygen therapy. At 1.5 months postoperatively, urethral dilation was performed once because of minor voiding difficulties. At 10 months postoperatively, the patient had excellent voiding function and no additional complaints. The patient expressed high satisfaction with the outcome and is still under close follow up. CONCLUSIONS: A standard treatment for serious complications such as necrosis and total penile loss has not been established yet. Although scrotal skin flap is a straightforward technique, it was not preferred in our case because of fibrosis following scrotal necrosis and potential risk of hair growth. The developed approach could be an effective alternative to other techniques.
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Circuncisión Masculina , Oxigenoterapia Hiperbárica , Mucosa Bucal , Pene , Colgajos Quirúrgicos , Humanos , Masculino , Pene/cirugía , Mucosa Bucal/trasplante , Niño , Circuncisión Masculina/efectos adversos , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/etiología , Necrosis/etiología , Terapia CombinadaRESUMEN
The management of noninfectious complications in kidney transplant recipients includes a broad spectrum of conditions, including metabolic issues, cardiovascular diseases, and malignancies, each presenting unique challenges for nephrologists managing these patients. Unlike infectious complications, these noninfectious issues require nuanced, multidisciplinary approaches for prevention, diagnosis, and management, emphasizing the need for personalized care plans. Cardiovascular disease is particularly significant, standing as the primary cause of death post-transplantation, with recent data indicating an overtaking of cancer death rates over infections among kidney transplant recipients. The intricacies of managing these patients, influenced by the burden of kidney disease and immunosuppression, highlight the importance of a collaborative care model. Although nephrologists may not directly treat all these conditions, their understanding of the unique aspects of transplant recipients is crucial. They play a pivotal role in coordinating care with specialists such as cardiologists, endocrinologists, hematologists, and oncologists, ensuring comprehensive management that addresses these specific post-transplant complications. This review discusses the epidemiology, underlying mechanisms, clinical manifestations, and management strategies of various noninfectious complications post-kidney transplant, with a focus on cardiovascular, metabolic, oncologic, and hematologic complications.
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Enfermedades Cardiovasculares , Trasplante de Riñón , Complicaciones Posoperatorias , Humanos , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/epidemiología , Neoplasias/terapia , Enfermedades Hematológicas/terapia , Enfermedades Metabólicas/etiología , Enfermedades Metabólicas/terapiaRESUMEN
Postoperative delirium (POD) is a prevalent perioperative complication among elderly individuals and is a cause of significant detrimental consequences for both individuals and society. Pharmacological and nonpharmacological prevention methods/therapies have been proposed to mitigate the risk of POD. Nevertheless, the efficacy of pharmacological interventions is controversial, and some of them cause side effects. Therefore, numerous studies have explored the effectiveness of nonpharmacological interventions in mitigating POD and have recommended the use of nonpharmacological multicomponent interventions by an interdisciplinary team as primary interventions. However, dedicated units aimed at promoting comanagement are rare and are only present in academic hospitals. Therefore, there is increasing interest in nonpharmacological mono-component interventions for preventing POD, which offer advantages such as easy application, cost-effectiveness, patient acceptability and noninvasiveness. These interventions are divided into cognitive training and noncognitive interventions. The former is aimed at increasing cognitive reserve, thus decreasing the incidence rate of POD. Noncognitive interventions, including sensory stimuli (music therapy, odor enrichment), improving sleep disturbances, physical activity, acupuncture and transcranial magnetic/direct current stimulation, are aimed at decreasing the risk factors for POD. This review provides a comprehensive overview of recently reported nonpharmacological mono-component interventions for preventing POD and briefly describes their clinical value.
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Delirio , Complicaciones Posoperatorias , Humanos , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapia , Delirio/prevención & control , Delirio/etiología , Delirio/terapiaRESUMEN
Dysphagia after anterior cervical spine surgery has a 5% to 15% incidence beyond 1-year postsurgery, often attributed to mechanical factors such as pharyngeal thickening and epiglottis inversion. Despite normal neurological examination and electromyography, nerve distortion related to stretching also remains a possibility in these patients and may cause allodynia resulting in odynophagia and dysphagia. Current treatment options for dysphagia after anterior cervical discectomy and fusion are limited to local intraoperative steroid injections and tracheal traction exercises. In our patient, a glossopharyngeal nerve block was effectively used to manage the glossopharyngeal allodynia, thereby reducing the odynophagia and dysphagia, ultimately enhancing oral tolerance.
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Vértebras Cervicales , Trastornos de Deglución , Discectomía , Bloqueo Nervioso , Fusión Vertebral , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Vértebras Cervicales/cirugía , Bloqueo Nervioso/métodos , Nervio Glosofaríngeo , Masculino , Persona de Mediana Edad , Femenino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapiaRESUMEN
Due to an increase in the worldwide prevalence of obesity and the efficiency of bariatric surgery, this procedure is more often performed. Besides its benefits, it has also disadvantages and may be the cause of nutritional deficiencies. Thiamin deficiency is particularly important to diagnose and to treat early as it can lead to major sequelae and even to death. Wernicke's encephalopathy is the most frequent presentation associating confusion, ataxia, ophtalmoplegia and nystagmus. The full triad is not usually observed, which may lead to sub-diagnosis of this affection. The diagnosis is clinical, biological and radiologic thanks to the brain MRI. Intravenous thiamin supplementation therapy must be administered as fast as possible in order to avoid long-term damages. In the ophthalmological field, the potential sequelae are ophthalmoplegia, nystagmus and optic neuropathy. Therapeutics for nystagmus are pharmacological, surgical and/or optical. We illustrate this condition with a case report of an 18-year-old man developing Wernicke's encephalopathy as early as six weeks after a sleeve gastrectomy.
Suite à une augmentation de la prévalence de l'obésité dans le monde et à l'efficacité de la chirurgie bariatrique, cette technique est pratiquée de plus en plus fréquemment. Malgré ses avantages, elle n'est pas sans risque et peut être responsable de déficits nutritionnels multiples. Le déficit en vitamine B1 ou thiamine est particulièrement important à connaître et, à rapidement diagnostiquer en raison des nombreuses séquelles invalidantes, voire le décès du patient, dont il peut être responsable. Le tableau classique est l'encéphalopathie de Gayet-Wernicke associant confusion, ataxie et troubles oculomoteurs. Néanmoins, il n'est pas toujours complet, ce qui participe au sous-diagnostic de cette pathologie. Le diagnostic est clinique, biologique et/ou radiologique grâce à l'IRM cérébrale. La supplémentation vitaminique intraveineuse doit être instaurée le plus rapidement possible afin d'éviter des séquelles à long terme. D'un point de vue ophtalmologique, les séquelles potentielles sont les ophtalmoplégies, les nystagmus et les neuropathies optiques. Les thérapies envisageables du nystagmus, outre la supplémentation en thiamine en aigu, sont pharmacologiques, chirurgicales et/ou optiques. Nous illustrons cette pathologie par un cas clinique d'encéphalopathie de Gayet-Wernicke dès la 6ème semaine post-opératoire d'une chirurgie bariatrique de type «sleeve¼ chez un patient de 18 ans.
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Cirugía Bariátrica , Encefalopatía de Wernicke , Humanos , Encefalopatía de Wernicke/etiología , Encefalopatía de Wernicke/diagnóstico , Encefalopatía de Wernicke/terapia , Masculino , Cirugía Bariátrica/efectos adversos , Adolescente , Tiamina/uso terapéutico , Tiamina/administración & dosificación , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapiaRESUMEN
BACKGROUND: Immunosuppressive therapy is essential for to prevent graft rejection in renal transplant patients; however, it is associated with elevating the risk of several pathologies in these patients particularly infectious and neoplastic conditions. In this study, we explore the diagnosis and treatment of skin lesions in renal transplant patients. METHODS: A retrospective chart review of 12 renal transplant recipients referred to plastic and reconstructive surgery with skin lesions from 2000 to 2020 was performed. RESULTS: The mean age of the 12 patients was 49.6 years. Time to plastic surgery after renal transplantation ranged between 1 and 16 years. Nine cases of basal cell carcinoma, 2 cases of squamous cell carcinoma, and 1 case of skin and soft tissue infection of the lower extremity and cutaneous extranodal NK/T-cell lymphoma, nasal type was observed. Flaps, skin grafts, and artificial dermis grafts constitute the main reconstructive methods. There were no postoperative infections or wound dehiscence. CONCLUSIONS: Cutaneous infections and skin malignancy account for most of the skin lesions developing after renal transplantation. Posttransplant lymphoproliferative disorder warrants equal attention and should not be disregarded. Early diagnosis and treatment significantly improve prognosis as patients with longer duration of transplant were found to have more aggressive tumors. Plastic and reconstructive surgery offers a safe therapeutic method of treatment in these cases.
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Trasplante de Riñón , Humanos , Trasplante de Riñón/efectos adversos , Estudios Retrospectivos , Persona de Mediana Edad , Masculino , Femenino , Adulto , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Procedimientos de Cirugía Plástica/métodos , Anciano , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/etiología , Enfermedades de la Piel/cirugíaRESUMEN
BACKGROUND: Perioperative neurocognitive disorder (PND) is a critical concern for older patients undergoing cardiac surgery, impacting cognitive function and quality of life. Electroacupuncture and transcutaneous electrical acupoint stimulation (TEAS) hold promise for mitigating PND. This protocol outlines a systematic review and meta-analysis to thoroughly assess the efficacy of electroacupuncture and TEAS in older patients undergoing cardiac surgery with PND, providing up-to-date evidence for PND prevention and treatment. OBJECTIVE: This study aimed to thoroughly assess the efficacy of electroacupuncture and TEAS in older patients undergoing cardiac surgery with PND, providing up-to-date evidence for PND prevention and treatment. METHODS: A comprehensive and systematic approach will be used to identify eligible studies from a diverse range of electronic databases, including 9 major sources such as PubMed (NLM) and Cochrane (Wiley), as well as 2 clinical trial registration websites. These studies will focus on investigating the effects of electroacupuncture and TEAS on PND in older patients undergoing cardiac surgery. The study selection will adhere to the criteria outlined in the patient, intervention, comparison, outcome, and studies (PICOS) format. Data extraction will be carried out by 2 independent researchers (YP and LS), using established tools to evaluate the risk of bias. The primary outcome will be PND incidence, with secondary outcomes including Mini Mental State Examination scores, neuron-specific enolase, S100ß, interleukin-1ß, interleukin-6, tumor necrosis factor-α, time to first flatus, first defecation, bowel sound recovery, and hospitalization duration to be selectively reported. Adverse events linked to acupuncture, such as bleeding, needle site pain, and local reactions, rather than serious adverse events, will also be considered. Meta-analysis will be performed using appropriate statistical methods to assess the overall effect of electroacupuncture and TEAS on PND prevention, treatment, or other relevant outcomes. The Cochrane Collaboration Risk of Bias tool will be used for assessment, and data synthesis will be executed using the RevMan 5.4 software (Cochrane). RESULTS: We plan to summarize the eligible studies through the use of a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart. The findings will be showcased in the form of a summary table of evidence. Figures and forest plots will be used to illustrate the outcomes of the meta-analysis. CONCLUSIONS: The impacts of electroacupuncture and TEAS interventions on PND in older patients undergoing cardiac surgery have not yet been established. This protocol addresses a critical gap by thoroughly assessing electroacupuncture and TEAS for PND in older patients undergoing cardiac surgery, enhancing understanding of nonpharmacological interventions, and guiding future research and clinical practices in this field. Its strength lies in rigorous methodology, including comprehensive search strategies, independent review processes, and thorough assessments of the risk of bias. TRIAL REGISTRATION: PROSPERO CRD42023411927; https://tinyurl.com/39xdz6jb. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55996.
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Procedimientos Quirúrgicos Cardíacos , Electroacupuntura , Estimulación Eléctrica Transcutánea del Nervio , Anciano , Humanos , Puntos de Acupuntura , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Electroacupuntura/métodos , Metaanálisis como Asunto , Trastornos Neurocognitivos/etiología , Trastornos Neurocognitivos/prevención & control , Trastornos Neurocognitivos/terapia , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Revisiones Sistemáticas como Asunto , Estimulación Eléctrica Transcutánea del Nervio/métodosAsunto(s)
Paquetes de Atención al Paciente , Humanos , Paquetes de Atención al Paciente/métodos , Paquetes de Atención al Paciente/normas , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Delirio/prevención & control , Delirio/etiología , Delirio del Despertar/prevención & control , Delirio del Despertar/etiologíaRESUMEN
OBJECTIVE: To summarize current knowledge regarding management of hypergranulation in the context of gender-affirming vaginoplasty. SOURCES OF INFORMATION: There have been no studies to date examining hypergranulation treatment options following vaginoplasty. Evidence from the literature on this complication in other settings and the opinions of authorities and experts in this area were used to inform this review. MAIN MESSAGE: Hypergranulation is a common complication of vaginoplasty, but many care providers may not know how to identify or treat it. This short report will review hypergranulation after vaginoplasty, including risk factors, identification, and treatment options such as douching, silver nitrate, and topical steroids. CONCLUSION: By increasing clinicians' knowledge of this pervasive complication, patients' postsurgical care and outcomes can be improved.
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Vagina , Humanos , Femenino , Masculino , Vagina/cirugía , Cirugía de Reasignación de Sexo/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/terapia , Pene/cirugía , Factores de RiesgoRESUMEN
BACKGROUND: Incontinence is not rare after rectal cancer surgery. Platelet-rich plasma may promote tissue repair and generation but has never been tested for the treatment of anal incontinence. This study evaluated the impact of platelet-rich plasma injection on the severity of incontinence and quality of life after low rectal cancer surgery. METHODS: This is a prospective cohort proof of concept study in a colorectal cancer institution. Patients had undergone low anterior or intersphincteric resection for low rectal cancer and had a Wexner score > 4. Ten milliliters of platelet-rich plasma were injected into the internal and external sphincters under endoanal ultrasound (EAUS) guidance. Primary outcome measure was > 2 point improvement in Wexner score (improved group). The patients were assessed with endo-anal ultrasound examination, manometry, the Wexner Questionnaire and SF-36 Health Surveys, and patients were asked whether they used pads and antidiarrheal medications before and 6 months after PRP injection. RESULTS: Of 20 patients included in the study, 14 (70%) were men, and the average age was 56.8 (SD = 9.5) years. No statistically significant difference was found in Wexner scores before and after PRP injection (p = 0.66). Seven (35%) patients experienced a > 2 point improvement in Wexner score. Rectal manometry demonstrated improved squeezing pressure (p = 0.0096). Furthermore, physical functioning scoring (p = 0.023), role limitation (p = 0.016), emotional well-being (p = 0.0057) and social functioning (p = 0.043) domains on the SF-36 questionnaire improved. One (5%) and three (15%) patients stopped using pads and antidiarrheal medications. CONCLUSION: Platelet-rich plasma injection does not restore Wexner scores, but more than one-third of patients may benefit from this application with an improvement of > 2 points in their scores. Platelet-rich plasma injection may improve squeezing pressure and certain life quality measures for incontinent patients after rectal cancer surgery.
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Canal Anal , Incontinencia Fecal , Manometría , Plasma Rico en Plaquetas , Calidad de Vida , Neoplasias del Recto , Humanos , Neoplasias del Recto/cirugía , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Incontinencia Fecal/etiología , Incontinencia Fecal/terapia , Canal Anal/cirugía , Anciano , Resultado del Tratamiento , Endosonografía/métodos , Encuestas y Cuestionarios , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Proctectomía/métodos , Proctectomía/efectos adversos , Adulto , InyeccionesRESUMEN
OBJECTIVE: Hematomas of the liver graft, that is, postintervention, subcapsular or intrahepatic are rare yet potentially fatal complications following liver transplantation (LT), necessitating immediate diagnosis and management to avert devastating outcomes. This study was aimed to introduce our approach to manage graft hematoma subsequent to LT. METHODS: Among 131 orthotopic liver transplantations (OLT) conducted at our institution between January 2017 and May 2023, 3 cases of intrahepatic (n = 2) and extrahepatic (n = 1) hematoma were confirmed through computed tomography (CT) within 10 days after LT. The clinical outcomes of various treatment modalities for these three cases were analyzed. RESULTS: Three out of 131 (2.3%) LT recipients developed graft hematoma. Patient 1 developed a spontaneous intrahepatic hematoma, without evident predisposing factors, while patient 2 developed an intrahepatic hematoma following endoscopic retrograde cholangiopancreatography (ERCP). The third case that is extrahepatic hematoma was speculated to be a result of minor hepatic parenchymal injury stemming from compressive and volume-reducing manipulation of a large graft, or secondary to focal ischemic necrosis of the liver. Our management protocol was summarized as follows: (1). Immediate ultrasound and CT, particularly enhanced CT; (2). Puncture and percutaneous drainage (PD) of the hematoma; (3). Arterial embolization if the origin could be identified as a ruptured vessel; (4). Surgical evacuation of the hematoma in the presence of bile leakage, to avoid a compartment respectably secondary infection. All three patients responded favorably to treatment and remained alive to date. CONCLUSION: Prompt diagnosis and sequential individualized management can successfully deal with intra-/extrahepatic graft hematoma after LT. Our results underscored that an individualized management considering potential future complications into account.
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Hematoma , Trasplante de Hígado , Humanos , Trasplante de Hígado/efectos adversos , Hematoma/etiología , Hematoma/terapia , Masculino , Persona de Mediana Edad , Femenino , Tomografía Computarizada por Rayos X , Complicaciones Posoperatorias/terapia , Adulto , Hepatopatías/cirugía , Embolización TerapéuticaRESUMEN
ABSTRACT: Venovenous (VV) ECMO is rarely used during decompensated circulatory states. Although VA ECMO is the routine option, VV ECMO may be an option in selected patients. We present a case of pulmonary edema due to acute heart failure in a patient 4- and 12-year post-lung transplantation who received VV ECMO. Using a thoughtful cannulation strategy, VV ECMO, and aggressive ultrafiltration, the patient was successfully decannulated, extubated, and discharged from the hospital. In cardiogenic pulmonary edema, VV ECMO represents an additional, and likely under-utilized tool, especially in patients who are at high risk for ventilator-associated lung injury. Cannula location and size should be given additional consideration to potentially transition to V-AV ECMO configuration if necessary.
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Oxigenación por Membrana Extracorpórea , Insuficiencia Cardíaca , Trasplante de Pulmón , Humanos , Oxigenación por Membrana Extracorpórea/métodos , Insuficiencia Cardíaca/cirugía , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/complicaciones , Masculino , Edema Pulmonar/etiología , Edema Pulmonar/terapia , Persona de Mediana Edad , Enfermedad Aguda , Enfermedad Crónica , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/etiologíaRESUMEN
ABSTRACT: An electrical storm (ES) refers to multiple occurrences of ventricular arrhythmias within a short time. Catheter ablation is a treatment option for ES but can be challenging in unstable cardiovascular patients. We present the case of a 50-year-old patient with poor left ventricular function who experienced ES after emergency coronary artery bypass grafting (CABG). Despite maximal antiarrhythmic therapy, the patient had recurrent ventricular tachycardia and fibrillation (VT/VF), hindering catheter ablation. Elective venoarterial extracorporeal membrane oxygenation (ECMO) support was established, allowing a successful second catheter ablation attempt without complications. The patient was weaned off ECMO the following day and remained in normal sinus rhythm.
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Ablación por Catéter , Puente de Arteria Coronaria , Oxigenación por Membrana Extracorpórea , Taquicardia Ventricular , Humanos , Oxigenación por Membrana Extracorpórea/métodos , Persona de Mediana Edad , Ablación por Catéter/métodos , Taquicardia Ventricular/terapia , Masculino , Puente de Arteria Coronaria/métodos , Fibrilación Ventricular/terapia , Fibrilación Ventricular/etiología , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/prevención & controlRESUMEN
With improvements in initial care for patients with congenital diaphragmatic hernia (CDH), the number of CDH patients with severe disease who are surviving to discharge has increased. This growing population of patients faces a unique set of long-term challenges, multisystem adverse outcomes, and post-intervention complications requiring specialized multidisciplinary follow-up. Early identification and intervention are essential to mitigate the potential morbidity associated with these challenges. This manuscript outlines a general framework for long-term follow-up for the CDH patient, including cardiopulmonary, gastrointestinal, neurodevelopmental, surgical, and quality of life outcomes.
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Hernias Diafragmáticas Congénitas , Humanos , Hernias Diafragmáticas Congénitas/terapia , Hernias Diafragmáticas Congénitas/cirugía , Hernias Diafragmáticas Congénitas/diagnóstico , Calidad de Vida , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/diagnóstico , Estudios de Seguimiento , Recién NacidoRESUMEN
BACKGROUND: Evidence is limited regarding the effectiveness of leadless pacemaker implantation for conduction disturbance following transcatheter aortic valve replacement (TAVR). OBJECTIVES: This study sought to examine the national trends in the use of leadless pacemaker implantation following TAVR and compare its performance with transvenous pacemakers. METHODS: Medicare fee-for-service beneficiaries aged ≥65 years who underwent leadless or transvenous pacemakers following TAVR between 2017 and 2020 were included. Outcomes included in-hospital overall complications as well as midterm (up to 2 years) all-cause death, heart failure hospitalization, infective endocarditis, and device-related complications. Propensity score overlap weighting analysis was used. RESULTS: A total of 10,338 patients (730 leadless vs 9,608 transvenous) were included. Between 2017 and 2020, there was a 3.5-fold increase in the proportion of leadless pacemakers implanted following TAVR. Leadless pacemaker recipients had more comorbidities, including atrial fibrillation and end-stage renal disease. After adjusting for potential confounders, patients with leadless pacemakers experienced a lower rate of in-hospital overall complications compared with patients who received transvenous pacemakers (7.2% vs 10.1%; P = 0.014). In the midterm, we found no significant differences in all-cause death (adjusted HR: 1.13; 95% CI: 0.96-1.32; P = 0.15), heart failure hospitalization (subdistribution HR: 0.89; 95% CI: 0.74-1.08; P = 0.24), or infective endocarditis (subdistribution HR: 0.98; 95% CI: 0.44-2.17; P = 0.95) between the 2 groups, but leadless pacemakers were associated with a lower risk of device-related complications (subdistribution HR: 0.37; 95% CI: 0.21-0.64; P < 0.001). CONCLUSIONS: Leadless pacemakers are increasingly being used for conduction disturbance following TAVR and were associated with a lower rate of in-hospital complications and midterm device-related complications compared to transvenous pacemakers without a difference in midterm mortality.
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Arritmias Cardíacas , Estimulación Cardíaca Artificial , Medicare , Marcapaso Artificial , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Masculino , Anciano , Femenino , Anciano de 80 o más Años , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Resultado del Tratamiento , Factores de Riesgo , Factores de Tiempo , Estimulación Cardíaca Artificial/efectos adversos , Estados Unidos , Arritmias Cardíacas/terapia , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiología , Medición de Riesgo , Estudios Retrospectivos , Diseño de Equipo , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Válvula Aórtica/fisiopatología , Válvula Aórtica/diagnóstico por imagen , Bases de Datos Factuales , Planes de Aranceles por Servicios , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/mortalidadAsunto(s)
Útero , Humanos , Femenino , Incidencia , Útero/trasplante , Útero/cirugía , Constricción Patológica , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Vagina/cirugía , Trasplante de Órganos/efectos adversos , Resultado del TratamientoRESUMEN
AIM: Sacral neuromodulation (SNM) has become a standard surgical treatment for faecal incontinence (FI). Prior studies have reported various adverse events of SNM, including suboptimal therapeutic response, infection, pain, haematoma, and potential need for redo SNM. The aim of this study was to identify the risk factors associated with long-term complications of SNM. METHOD: This retrospective cohort reviewed patients who underwent two-stage SNM for FI at our institution between 2011-2021. Preoperative baseline characteristics and follow-up were obtained from the medical record and/or by telephone interview. Management and outcome of each postoperative event were evaluated by univariate and multivariate regression analyses. RESULTS: A total of 291 patients (85.2% female) were included in this study. Postoperative complications were recorded in 219 (75.2%) patients and 154 (52.9%) patients required surgical intervention to treat complications. The most common postoperative event was loss of efficacy (46.4%). Other common adverse events were problems at the implant site (pain, infection, etc.) in 16.5% and pain during stimulation in 11.7%. Previous vaginal delivery (OR 2.74, p = 0.003) and anal surgery (OR = 2.46, p = 0.039) were independent predictors for complications. Previous colorectal (OR = 2.04, p = 0.026) and anal (OR = 1.98, p = 0.022) surgery and history of irritable bowel syndrome (IBS) (OR = 3.49, p = 0.003) were independent predictors for loss of efficacy. CONCLUSION: Postoperative adverse events are frequently recorded after SNM. Loss of efficacy is the most common. Previous colorectal or anal surgery, vaginal delivery, and IBS are independent risk factors for complications.
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Terapia por Estimulación Eléctrica , Incontinencia Fecal , Complicaciones Posoperatorias , Humanos , Incontinencia Fecal/terapia , Incontinencia Fecal/etiología , Femenino , Estudios Retrospectivos , Factores de Riesgo , Persona de Mediana Edad , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Estudios de Seguimiento , Terapia por Estimulación Eléctrica/métodos , Terapia por Estimulación Eléctrica/efectos adversos , Anciano , Adulto , Plexo Lumbosacro , Resultado del Tratamiento , Sacro/inervaciónRESUMEN
INTRODUCTION: Postoperative ileus (POI) is a postoperative complication that can cause lingering recovery after colorectal resection and a heavy healthcare system burden. Acupuncture aims to prevent postoperative complications, reduce the duration of POI, help recovery and shorten hospital stays. We hypothesise that preoperative electroacupuncture (EA) can promote POI recovery under the enhanced recovery after surgery protocol after laparoscopic surgery in patients with POI. METHODS AND ANALYSIS: This is a multicentre, randomised, sham-controlled trial. A total of 80 patients will be enrolled and randomly assigned to the EA or sham electroacupuncture (SA) group. The eligible patients will receive EA or SA for one session per day with treatment frequency starting on preoperative day 1 for four consecutive days. The primary outcome is the time to first defecation. The secondary outcomes include the time to first flatus, length of postoperative hospital stay, time to tolerability of semiliquid and solid food, postoperative nausea, vomiting, pain and extent of abdominal distention, time to first ambulation, preoperative anxiety, 30-day readmission rate, the usage of anaesthetics and analgesics during operation, length of postanaesthesia care unit stay. A mechanistic study by single-cell RNA sequencing in which postintervention normal intestinal tissue samples will be collected. The results of this study will provide evidence of the effects of acupuncture on POI and promote good clinical decision to millions of patients globally every year. ETHICS AND DISSEMINATION: This study has been approved by the ethical application of Beijing University of Chinese Medicine (2022BZYLL0401), Beijing Friendship Hospital Affiliated to Capital Medical University(2022-P2-368-02), Cancer Hospital Chinese Academy of Medical Science (23/175-3917), Huanxing Cancer Hospital (2023-002-02). The results will be published in a medical journal. In addition, we plan to present them at scientific conferences. TRIAL REGISTRATION NUMBER: ChiCTR2300077633.
Asunto(s)
Neoplasias Colorrectales , Electroacupuntura , Ileus , Laparoscopía , Complicaciones Posoperatorias , Humanos , Electroacupuntura/métodos , Laparoscopía/efectos adversos , Ileus/etiología , Ileus/terapia , Neoplasias Colorrectales/cirugía , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/etiología , China , Tiempo de Internación/estadística & datos numéricos , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Cuidados Preoperatorios/métodos , Femenino , Adulto , MasculinoRESUMEN
Postcardiotomy shock in the cardiac surgical patient is a highly morbid condition characterized by profound myocardial impairment and decreased systemic perfusion inadequate to meet end-organ metabolic demand. Postcardiotomy shock is associated with significant morbidity and mortality. Poor outcomes motivate the increased use of mechanical circulatory support (MCS) to restore perfusion in an effort to prevent multiorgan injury and improve patient survival. Despite growing acceptance and adoption of MCS for postcardiotomy shock, criteria for initiation, clinical management, and future areas of clinical investigation remain a topic of ongoing debate. This article seeks to (1) define critical cardiac dysfunction in the patient after cardiotomy, (2) provide an overview of commonly used MCS devices, and (3) summarize the relevant clinical experience for various MCS devices available in the literature, with additional recognition for the role of MCS as a part of a modified approach to the cardiac arrest algorithm in the cardiac surgical patient.