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OBJECTIVE: Phyllodes tumors in the breast are exceptionally uncommon fibroepithelial tumors. In the literature, they are typically categorized as benign phyllodes tumor, borderline phyllodes tumor, and malignant phyllodes tumor. This study aims to assess and present the clinical and surgical outcomes of patients diagnosed with phyllodes tumor. METHODS: The outcomes of patients aged 18 years and above diagnosed with phyllodes tumor between 2006 and 2023 were retrospectively reviewed. Patients were grouped as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared by clinical and surgical results. RESULTS: Of all 57 patients with phyllodes tumor, 64.9% (n=37) were benign phyllodes tumor and 35.1% (n=20) were borderline/malignant phyllodes tumor [22.8% (n=13) borderline phyllodes tumor and 12.3% (n=7) malignant phyllodes tumor]. When the patients were divided into two groups as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared, our cumulative (total) recurrence rate was 14.0%, with final surgical margin width between groups [(0

Asunto(s)

Neoplasias de la Mama , Márgenes de Escisión , Recurrencia Local de Neoplasia , Tumor Filoide , Centros de Atención Terciaria , Humanos , Tumor Filoide/cirugía , Tumor Filoide/patología , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Adulto Joven , Resultado del Tratamiento , Periodo Posoperatorio , Mastectomía/métodos , Anciano , Adolescente

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OBJECTIVES: to develop and validate the content, appearance, and semantics of a prototype application for monitoring patients in the postoperative period of cardiac surgery. METHODS: this is a technological development study based on Contextualized Instructional Design. The content and appearance evaluation was conducted by a committee of specialists, and semantic validation was carried out by patients from a cardiac surgery outpatient clinic. RESULTS: the application prototype consisted of 43 screens, validated by 17 health specialists, with content validity ratio and appearance validity index results of 0.86 and 0.99, respectively. For semantic validation, 10 patients participated in data collection, with a total content validity index of 0.978. CONCLUSIONS: the prototype of the "VivaCor PósOp" application demonstrated evidence of content, appearance, and semantic validity, with the potential to stimulate self-care in patients in the postoperative period of cardiac surgery.

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Procedimientos Quirúrgicos Cardíacos , Aplicaciones Móviles , Humanos , Aplicaciones Móviles/normas , Aplicaciones Móviles/tendencias , Aplicaciones Móviles/estadística & datos numéricos , Procedimientos Quirúrgicos Cardíacos/métodos , Femenino , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Reproducibilidad de los Resultados , Anciano , Adulto

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Introducción. Etimológicamente la palabra íleo proviene del griego eileos que significa rodando o girando; es descrito como el retraso temporal de la motilidad gastrointestinal. Mundialmente es reconocido que el íleo postoperatorio es una de las principales complicaciones después de cirugía y representa un problema importante por su elevado costo sanitario. Se ha investigado respecto al uso preventivo de medidas físicas y farmacológicas, como los procinéticos, para el manejo del íleo postoperatorio. Métodos. Investigación clínico-terapéutica, comparativa, de corte longitudinal prospectivo de seguimiento, con muestreo no probabilístico por conveniencia, conformado por cuatro grupos con 25 pacientes cada uno, atendidos en el Servicio de Cirugía General entre mayo y agosto de 2021. Resultados. Los pacientes presentaron una media de edad de 49,4 ± 19,6 años y el 53 % fueron hombres. El 86 % de los pacientes presentaron ruidos intestinales antes de 24 horas posteriores a la operación. La primera evacuación en los pacientes que ingirieron café tipo espresso fue a las 42,6 horas y para aquellos en el grupo de café americano fue a las 43,4 horas en comparación con 89,4 horas en el grupo control (p < 0,001). Conclusión. Se recomienda el uso del café como una medida segura y económica para el inicio de la dieta, como una alternativa al esquema tradicional, constituyéndose en una opción para el manejo del íleo postoperatorio

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Introduction. Etymologically the word ileus comes from the Greek eileos, which means rolling or turning. It is described as the temporary delay of gastrointestinal motility. It is recognized worldwide that postoperative ileus is one of the main complications after surgery and represents an important problem due to its high healthcare cost. Research has been done regarding the preventive use of physical and pharmacological measures, such as prokinetics, for the management of postoperative ileus.Methods. Clinical-therapeutic, comparative, prospective longitudinal follow-up research, with non-probabilistic convenience sampling, made up of four groups with 25 patients each, treated in the General Surgery Service between May and August 2021. Results. The patients had a mean age of 49.4 ± 19.6 years and 53% were male; 86% of patients had bowel sounds within 24 hours after the operation. The first bowel movement in patients who ingested espresso coffee was 42.6 hours and for those in the American coffee group it was at 43.4 hours compared to 89.4 hours in the control group (p < 0.001). Conclusion. The use of coffee is recommended as a safe and economical measure to start the diet as an alternative to the traditional fashion, becoming an option for the management of postoperative ileus.

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Humanos , Periodo Posoperatorio , Café , Ileus , Dieta , Nutrición, Alimentación y Dieta , Motilidad Gastrointestinal

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PURPOSE: To evaluate the effect of upper eyelid ptosis repairwith Muller muscle-conjunctival resection on meibomian gland function and ocular surface parameters. METHODS: Thirty-eight patients who underwent ptosis repair with Muller muscle-conjunctival resection were retrospectively reviewed. Meibomian gland loss, Ocular Surface Disease Index OXFORD score, meiboscore, and noninvasive keratograph break-up time were measured preoperatively and at 1st, 3rd, and 6th months postoperatively. RESULTS: Noninvasive keratograph break-up time values decreased significantly at 1st and 3rd months postoperatively compared to the preoperative level, but were similar to the preoperative level at 6th months postoperatively (p<0.001 and p=0.628, respectively). Ocular surface disease index, OXFORD score, meibomian gland loss, and meiboscore values increased significantly in the 1st and 3rd postoperative months compared to the preoperative period, but these values decreased to preoperative levels in the 6th postoperative month (p<0.001 and p>0.05, respectively). CONCLUSION: There is a transient deterioration in meibography findings and OSDI score in the early postoperative period afterMuller muscle-conjunctival resection. Patients undergoing Muller muscle-conjunctival resection may require topical lubricants, especially in the first 3 postoperative months.

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Blefaroptosis , Glándulas Tarsales , Humanos , Femenino , Glándulas Tarsales/diagnóstico por imagen , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Blefaroptosis/cirugía , Adulto , Periodo Posoperatorio , Resultado del Tratamiento , Anciano , Factores de Tiempo , Conjuntiva/cirugía , Conjuntiva/diagnóstico por imagen , Disfunción de la Glándula de Meibomio/diagnóstico por imagen , Periodo Preoperatorio , Músculos Oculomotores/cirugía , Músculos Oculomotores/diagnóstico por imagen

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OBJECTIVES: to validate the content of a guidance guide on self-care in the postoperative period of breast surgery for breast cancer. METHODS: a methodological study with content validity, carried out with 15 expert nurses and physiotherapists, between May and July 2022. Recruitment took place from the Lattes Platform, using snowball sampling. The level of relevance and representativeness for each item was verified using the Content Validity Index (CVI). It was considered valid when CVI was equal to or greater than 78% (0.78). RESULTS: from the initial total of 37 items, two were excluded, as they had insufficient practical relevance and theoretical relevance, and another five items which, although presenting a CVI lower than the established cut-off, were suggested to be rewritten and grouped with other similar items. CONCLUSIONS: thirty items were considered valid and demonstrated important and significant characteristics, constituting suitable material for application in clinical practice.

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Neoplasias de la Mama , Autocuidado , Humanos , Neoplasias de la Mama/cirugía , Femenino , Autocuidado/métodos , Encuestas y Cuestionarios , Reproducibilidad de los Resultados , Periodo Posoperatorio , Adulto , Persona de Mediana Edad

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Cardiac surgery causes a series of disturbances in human physiology. The correction of systemic hemodynamic variables is frequently ineffective in improving microcirculatory perfusion and delivering oxygen to the tissues. We present the case of a 52-year-old male submitted to mitral valve replacement (metallic valve) and subaortic membrane resection. Sublingual microcirculatory density and perfusion were evaluated using a handheld CytoCam camera before surgery and in the early postoperative period. In this case, systemic hemodynamic variables were compromised despite an actual improvement in the microcirculatory parameters in comparison to the preoperative evaluation, possibly due to the correction of the structural cardiac defects.

Asunto(s)

Microcirculación , Humanos , Masculino , Persona de Mediana Edad , Microcirculación/fisiología , Hemodinámica/fisiología , Implantación de Prótesis de Válvulas Cardíacas , Suelo de la Boca/irrigación sanguínea , Suelo de la Boca/cirugía , Periodo Posoperatorio , Procedimientos Quirúrgicos Cardíacos/métodos , Válvula Mitral/cirugía

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INTRODUCTION: The effect of pump flow type on perfusion in coronary surgery using cardiopulmonary bypass (CPB) is discussed. We aimed to evaluate the effect of pump flow type on cognitive functions with neurocognitive function tests. METHODS: One hundred patients who underwent isolated coronary artery bypass surgery between November 2020 and July 2021 were divided into two equa groups. Groups were formed according to pump flow type pulsatile (Group 1) and non-pulsatile (Group 2). Clock drawing test (CDT) and standardized mini mental test (SMMT) were performed on the patients in both groups in the preoperative period, on the 1st preoperative day, and on the day before discharge. Neurocognitive effects were compared with all follow-up parameters. RESULTS: There was no difference between the groups in terms of demographic data and in terms of neurocognitive tests performed before the operation. SMMT on postoperative day 1 (Group I: 27.64 ± 1.05; Group II: 24.44 ± 1.64; P=0.001) and CDT (Group I: 5.4 ± 0.54; Group II: 4 .66 ± 0.52; P=0.001), and SMMT on the day before discharge (Group I: 27.92 ± 1.16; Group II: 24.66 ± 1.22; P=0.001) and CDT (Group I: 5 It was calculated as .66 ± 0.48; Group II: 5.44 ± 0.5; P=0.001). The duration of intensive care and hospitalization were higher in the non-pulsatile group. CONCLUSION: We think that the type of pump flow used in coronary artery bypass surgery using CPB is effective in terms of neurocognitive functions and that pulsatile flow makes positive contributions to this issue.

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Puente Cardiopulmonar , Puente de Arteria Coronaria , Flujo Pulsátil , Humanos , Masculino , Femenino , Puente de Arteria Coronaria/efectos adversos , Persona de Mediana Edad , Puente Cardiopulmonar/efectos adversos , Flujo Pulsátil/fisiología , Anciano , Pruebas Neuropsicológicas , Cognición/fisiología , Periodo Posoperatorio , Complicaciones Posoperatorias

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PURPOSE: This prospective, randomized, unmasked, clinical trial aimed to report the visual outcomes of cataract surgery on both eyes versus cataract surgery on one eye in Brazilian patients. METHODS: This study included patients with bilateral cataracts and binocular visual acuity worse than or equal to 0.3 logarithm of the minimum angle of resolution. The patients were randomly assigned to undergo surgery on one (Control Group) or both eyes (one eye at a time; Intervention Group). Postoperatively, self-reported visual function using Catquest-9SF (primary outcome measure), binocular visual acuity, stereopsis, and ocular dominance (secondary outcome measures) were compared. RESULTS: A total of 151 patients (77 and 148 eyes in the Control and Intervention Groups, respectively) completed the follow-up. Patients who underwent surgery on both eyes exhibited significantly better self-reported visual function (p=0.036) and stereopsis (p=0.026) than those who underwent surgery on one eye. Binocular visual acuity and ocular dominance did not affect the group comparisons. CONCLUSIONS: Surgery on both eyes resulted in significantly better self-reported visual function and stereopsis than surgery on one eye.

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Extracción de Catarata , Percepción de Profundidad , Visión Binocular , Agudeza Visual , Humanos , Visión Binocular/fisiología , Agudeza Visual/fisiología , Masculino , Femenino , Anciano , Percepción de Profundidad/fisiología , Extracción de Catarata/métodos , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Predominio Ocular/fisiología , Encuestas y Cuestionarios , Catarata/fisiopatología , Periodo Posoperatorio

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BACKGROUND: Lower limb coronal alignment was thought to be a predictive factor for Unicompartmental Knee Arthroplasty (UKA) result. The tibial bony resection and implant position lead to joint line change postoperatively. Analysis was done to find out the correlation between these factors. METHODS: From 2019 to 2021, 90 medial Oxford UKA were implanted by a single surgeon. Hip Knee Ankle Angle (HKAA), Lateral Distal Femoral Angle (LDFA), Medial Proximal Tibial Angle (MPTA), and intraoperative bony resection thickness were measured. The medial joint line change was calculated. The correlation between joint line change and alignment change was evaluated. RESULTS: The mean tibial resection thickness was 4.3 mm. The mean tibial joint line was elevated by 2.3 mm, while the mean femoral joint line proximalized by 0.8 mm. HKAA changed from 8.4° varus preoperatively to 3.6° varus postoperatively. LDFA changed from 89.0° to 86.7°. MPTA changed from 85.6° to 86.6°. Preoperative HKAA showed a strong correlation with postoperative HKAA (p < 0.001), and preoperative MPTA showed a positive correlation with postoperative HKAA (p < 0.001). While preoperative LDFA had a negative correlation with postoperative HKAA (p < 0.001). The femoral joint line change and LDFA change had a significant correlation with HKAA change (p < 0.05). CONCLUSION: The change of joint line had no correlation with postoperative HKAA in Oxford UKA. Preoperative HKAA strongly correlated with postoperative HKAA; while preoperative smaller LDFA and larger MPTA had a moderate correlation with postoperative HKAA. The femoral joint line change and LDFA change had a weak to moderate correlation with HKAA change.

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Artroplastia de Reemplazo de Rodilla , Articulación de la Rodilla , Humanos , Artroplastia de Reemplazo de Rodilla/métodos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Articulación de la Rodilla/cirugía , Tibia/cirugía , Estudios Retrospectivos , Fémur/cirugía , Prótesis de la Rodilla , Periodo Posoperatorio , Resultado del Tratamiento , Anciano de 80 o más Años , Osteoartritis de la Rodilla/cirugía

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OBJECTIVE: This study aims to evaluate the role of TUSG in the postoperative period and the detection of early complications after surgical treatment, pulmonary resection, or decortication for infectious and inflammatory thoracic diseases, comparing with the standard method (Chest Radiography ‒ CXR). METHODS: Prospective non-randomized self-controlled study. Twenty-one patients over 16 years of age have undergone surgical treatment of inflammatory and infectious lung diseases. These patients were followed up with CXR and TUSG (performed on the 1st and 3rd postoperative days and/or after the chest tube removal). RESULTS: Both exams demonstrated similar results regarding their ability to safely predict the adequate moment for chest drain removal. TUSG allowed chest drain removal in 30% of cases and CXR in 34%. Statistical analysis demonstrates that both exams have similar capabilities in detecting postoperative changes in the pleural space. However, the authors report that TUSG is statistically more accurate in detecting subcutaneous emphysema than CXR (p = 0.037, Kappa [κ = 0.3068]). The analysis of other parameters showed no statistical difference. CONCLUSION: The authors conclude that TUSG in trained hands is equivalent to CXR in searching for postoperative complications regarding the surgical treatment of infectious and inflammatory thoracic diseases and can be used as a complement, and not a substitute, to CXR, when CCT is not feasible, or a more urgent diagnosis is needed.

Asunto(s)

Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Periodo Posoperatorio , Adulto , Anciano , Ultrasonografía/métodos , Adulto Joven , Radiografía Torácica , Enfermedades Pulmonares/cirugía , Enfermedades Pulmonares/diagnóstico por imagen , Drenaje/métodos , Factores de Tiempo , Tubos Torácicos , Reproducibilidad de los Resultados

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Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48 h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.

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Antifibrinolíticos , Pérdida de Sangre Quirúrgica , Escoliosis , Fusión Vertebral , Ácido Tranexámico , Humanos , Ácido Tranexámico/uso terapéutico , Escoliosis/cirugía , Femenino , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Masculino , Antifibrinolíticos/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Adolescente , Estudios Prospectivos , Adulto , Transfusión Sanguínea/estadística & datos numéricos , Resultado del Tratamiento , Periodo Posoperatorio , Tiempo de Internación , Adulto Joven , Hemorragia Posoperatoria/epidemiología

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PURPOSE: To compare inferomedial wall orbital decompression to balanced medial plus lateral wall orbital decompression in patients with Graves' orbitopathy in the inactive phase with regard to exophthalmos reduction and the effects on quality of life. METHODS: Forty-two patients with inactive Graves' orbitopathy were randomly divided into two groups and submitted to one of two orbital decompression techniques: inferomedial wall orbital decompression or medial plus lateral wall orbital decompression. Preoperative and postoperative assessments included Hertel's exophthalmometry and a validated Graves' orbitopathy quality of life questionnaire. The results of the two groups were compared. RESULTS: Compared to preoperative measurement, exophthalmos reduction was statistically significant in both groups (p<0.001) but more so in patients undergoing medial plus lateral wall orbital decompression (p=0.010). Neither orbital decompression techniques increased the visual functioning subscale score on the Graves' orbitopathy quality of life questionnaire (inferomedial wall orbital decompression p=0.362 and medial plus lateral wall orbital decompression p=0.727), but a statistically significant difference was observed in the score of the appearance subscale in patients submitted to medial plus lateral wall orbital decompression (p=0.006). CONCLUSIONS: Inferomedial wall orbital decompression is a good alternative for patients who do not require large exophthalmos reduction. However, medial plus lateral wall orbital decompression offers greater exophthalmos reduction and greater improvement in appearance (higher Graves' orbitopathy quality of life questionnaire scores), making it a suitable option for esthetic-functional rehabilitation.

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Descompresión Quirúrgica , Exoftalmia , Oftalmopatía de Graves , Calidad de Vida , Humanos , Descompresión Quirúrgica/métodos , Oftalmopatía de Graves/cirugía , Oftalmopatía de Graves/psicología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Exoftalmia/cirugía , Resultado del Tratamiento , Encuestas y Cuestionarios , Órbita/cirugía , Periodo Posoperatorio

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PURPOSE: To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up. METHODS: This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed. RESULTS: Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information. CONCLUSION: Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis.

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Enfermedades de la Córnea , Microscopía Acústica , Prótesis e Implantes , Agudeza Visual , Humanos , Microscopía Acústica/métodos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Enfermedades de la Córnea/cirugía , Enfermedades de la Córnea/diagnóstico por imagen , Resultado del Tratamiento , Anciano , Complicaciones Posoperatorias/diagnóstico por imagen , Trasplante de Córnea/métodos , Periodo Posoperatorio , Implantación de Prótesis/métodos , Córnea/diagnóstico por imagen , Córnea/cirugía , Adulto Joven , Órganos Artificiales , Adolescente

RESUMEN

PURPOSE: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and "slow cook" transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. METHODS: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). RESULTS: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was -0.10 ± 0.35 and -0.074 ± 0.16 in the micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and "slow cook" transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the "slow cook" and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the "slow cook" transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and "slow cook" transscleral cyclophotocoagulation, respectively (p<0.001). CONCLUSION: Both techniques reduced intraocular pressure effectively.

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Glaucoma de Ángulo Abierto , Presión Intraocular , Coagulación con Láser , Láseres de Semiconductores , Esclerótica , Humanos , Glaucoma de Ángulo Abierto/cirugía , Glaucoma de Ángulo Abierto/fisiopatología , Presión Intraocular/fisiología , Femenino , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Coagulación con Láser/métodos , Anciano , Láseres de Semiconductores/uso terapéutico , Esclerótica/cirugía , Agudeza Visual , Adulto , Estudios de Seguimiento , Periodo Posoperatorio , Cuerpo Ciliar/cirugía , Factores de Tiempo

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INTRODUCTION: The postoperative (PO) period after cardiac surgery is associated with the occurrence of respiratory complications. Noninvasive positive pressure ventilation (NIPPV) is largely used as a ventilatory support strategy after the interruption of invasive mechanical ventilation. However, the variables associated with NIPPV prescription are unclear. OBJECTIVE: To describe the literature on predictors of NIPPV prescription in patients during the PO period of cardiac surgery. MATERIALS AND METHODS: This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform in December 2021 (CRD42021291973). Bibliographic searches were performed in February 2022 using the PubMed, Lilacs, Embase and PEDro databases, with no year or language restrictions. The Predictors for the prescription of NIPPV were considered among patients who achieved curative NIPPV. RESULTS: A total of 349 articles were identified, of which four were deemed eligible and were included in this review. Three studies were retrospective studies, and one was a prospective safety pilot study. The total sample size in each study ranged from 109 to 1657 subjects, with a total of 3456 participants, of whom 283 realized NIPPV. Curative NIPPV was the only form of NIPPV in 75% of the studies, which presented this form of prescription in 5-9% of the total sample size, with men around 65 years old being the majority of the participants receiving curative NIPPV. The main indication for curative NIPPV was acute respiratory failure. Only one study realized prophylactic NIPPV (28% of 32 participants). The main predictors for the prescription of curative NIPPV in the PO period of cardiac surgery observed in this study were elevated body mass index (BMI), hypercapnia, PO lung injury, cardiogenic oedema and pneumonia. CONCLUSIONS: BMI and lung alterations related to gas exchange disturbances are major predictors for NIPPV prescription in patients during the PO period of cardiac surgery. The identification of these predictors can benefit clinical decision-making regarding the prescription of NIPPV and help conserve human and material resources, thereby preventing the indiscriminate use of NIPPV.

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Procedimientos Quirúrgicos Cardíacos , Ventilación no Invasiva , Humanos , Ventilación no Invasiva/métodos , Ventilación no Invasiva/estadística & datos numéricos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Periodo Posoperatorio , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/etiología , Respiración con Presión Positiva/métodos , Masculino

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INTRODUCTION: A year ago, in a sample of 113 patients, our research group found that a high number of lymphocytes in the immediate postoperative period was correlated to a poor prognosis in cardiovascular surgeries. This study is an expansion of the initial study in order to confirm this finding. METHODS: We analyzed the data of 338 consecutive patients submitted to cardiovascular surgeries with cardiopulmonary bypass performed at Hospital Universitário Ciências Médicas (Belo Horizonte/Brazil) from 2015 to 2017. We analyzed 39 variables with the outcomes death, hospital stay, and intensive care unit stay. RESULTS: The value of lymphocytes in the immediate postoperative period > 2175.0/mm³ was an indicator of poor prognosis in this sample (P<0.001). The variables female sex, age, high level of European System for Cardiac Operative Risk Evaluation II, increased stay in the intensive care unit and in the ward, elevation of creatinine in the preoperative period and at intensive care unit discharge, elevation of the percentage of immediate postoperative period segmented neutrophils, high immediate postoperative period neutrophil/lymphocyte ratio, fasting hyperglycemia, preoperative critical condition, reintubation, mild or transient acute renal failure, surgical infection, cardiopulmonary bypass, and aortic cross-clamping and mechanical ventilation durations also had an impact on the mortality outcome. CONCLUSION: The value of lymphocytes in the immediate postoperative period > 2175.0/mm3 was an indicator of poor prognosis in cardiovascular surgery with cardiopulmonary bypass.

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Puente Cardiopulmonar , Tiempo de Internación , Humanos , Puente Cardiopulmonar/mortalidad , Puente Cardiopulmonar/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Recuento de Linfocitos , Pronóstico , Linfocitos , Periodo Posoperatorio , Factores de Riesgo , Procedimientos Quirúrgicos Cardiovasculares/mortalidad , Estudios Retrospectivos , Complicaciones Posoperatorias/mortalidad , Adulto , Unidades de Cuidados Intensivos/estadística & datos numéricos

RESUMEN

BACKGROUND: Pulmonary valve regurgitation is a significant long-term complication in patients with tetralogy of Fallot (TOF). OBJECTIVE: This study aims to investigate the effects of pulmonary valve implantation (PVI) on the anatomy and function of the right ventricle (RV) and the long-term evolution of the implanted prosthesis in the pulmonary position. METHODS: A single-center retrospective cohort analysis was performed in 56 consecutive patients with TOF who underwent PVI. The study included patients of both sexes, aged ≥ 12 years, and involved assessing clinical and surgical data, pre- and post-operative cardiovascular magnetic resonance imaging, and echocardiogram data more than 1 year after PVI. RESULTS: After PVI, there was a significant decrease in RV end-systolic volume indexed by body surface area (BSA), from 89 mL/BSA to 69 mL/BSA (p < 0.001) and indexed RV end-diastolic volume, from 157 mL/BSA to 116 mL/BSA (p < 0.001). Moreover, there was an increase in corrected RV ejection fraction [ RVEFC = net pulmonary flow (pulmonary forward flow - regurgitant flow) / R V end-diastolic volume ] from 23% to 35% (p < 0.001) and left ventricular ejection fraction from 58% to 60% (p = 0.008). However, a progressive increase in the peak pulmonary valve gradient was observed over time, with 25% of patients experiencing a gradient exceeding 60 mmHg. Smaller prostheses (sizes 19 to 23) were associated with a 4.3-fold higher risk of a gradient > 60 mmHg compared to larger prostheses (sizes 25 to 27; p = 0.029; confidence interval: 1.18 to 17.8). CONCLUSION: As expected, PVI demonstrated improvements in RV volumes and function. Long-term follow-up and surveillance are crucial for assessing the durability of the prosthesis and detecting potential complications. Proper sizing of prostheses is essential for improved prosthesis longevity.

Asunto(s)

Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Pulmonar , Válvula Pulmonar , Tetralogía de Fallot , Humanos , Tetralogía de Fallot/cirugía , Tetralogía de Fallot/fisiopatología , Tetralogía de Fallot/diagnóstico por imagen , Masculino , Femenino , Estudios Retrospectivos , Insuficiencia de la Válvula Pulmonar/cirugía , Insuficiencia de la Válvula Pulmonar/fisiopatología , Insuficiencia de la Válvula Pulmonar/diagnóstico por imagen , Insuficiencia de la Válvula Pulmonar/etiología , Válvula Pulmonar/cirugía , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/fisiopatología , Resultado del Tratamiento , Adulto , Adolescente , Adulto Joven , Factores de Tiempo , Niño , Ecocardiografía , Función Ventricular Derecha/fisiología , Volumen Sistólico/fisiología , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Imagen por Resonancia Magnética , Periodo Posoperatorio

RESUMEN

OBJECTIVES: to map available evidence on telenursing use in the postoperative period and its impact on patient outcomes. METHODS: a scoping review, conducted according to the JBI model and the PRISMA-ScR checklist. The search was carried out in the CINAHL, Embase, LILACS, PubMed, Web of Science, SciELO, Scopus and Cochrane Library databases. RESULTS: twelve studies were included, published between 2011 and 2023, 66.6% of which were in developed countries. Of the positive outcomes, we highlight improved levels of disability, autonomy and quality of life, lower rates of post-operative complications, pain and reduced costs. Telephone monitoring was the most widely used modality, but there were few studies in the pediatric context and in Brazil. CONCLUSIONS: of the studies, 11 (91.6%) identified at least one positive outcome in telenursing use and none showed negative aspects in the postoperative period. The role of nurses in digital health needs further study.

Asunto(s)

Teleenfermería , Humanos , Periodo Posoperatorio , Teleenfermería/métodos , Teleenfermería/tendencias , Brasil , Calidad de Vida/psicología

RESUMEN

Although Down syndrome (DS) is considered a risk factor for hemodynamic instabilities (mainly pulmonary hypertension-PH) following surgery for congenital cardiac communications, many DS patients do surprising well postoperatively. We prospectively analyzed perioperative factors for a possible correlation with post-cardiopulmonary bypass (CPB) inflammatory reaction and postoperative PH in pediatric subjects. Sixty patients were enrolled (age 3 to 35 months), 39 of them with DS. Clinical and echocardiographic parameters (anatomical and hemodynamic) were computed preoperatively. Pulmonary and systemic mean arterial pressures (PAP and SAP) were assessed invasively intra and postoperatively. Immediate postoperative PAP/SAP ratio (PAP/SAPIPO) and the behavior of pressure curves were selected as primary outcome. Serum levels of 36 inflammatory proteins were measured by chemiluminescence preoperatively and 4 h post CPB. Of all factors analyzed, peripheral oxygen saturation (O2Sat, bedside assessment) was the only preoperative predictor of PAP/SAPIPO at multivariate analysis (p = 0.007). Respective values in non-DS, DS/O2Sat ≥ 95% and DS/O2Sat < 95% subgroups were 0.34 (0.017), 0.40 (0.027) and 0.45 (0.026), mean (SE), p = 0.004. The difference between non-DS and DS groups regarding postoperative PAP curves (upward shift in DS patients, p = 0.015) became nonsignificant (p = 0.114) after adjustment for preoperative O2Sat. Post-CPB levels of at least 5 cytokines were higher in patients with O2Sat < 95% versus those at or above this level, even within the DS group (p < 0.05). Thus, a baseline O2Sat < 95% representing pathophysiological phenomena in the airways and the distal lung, rather than DS in a broad sense, seems to be associated with post-CPB inflammation and postoperative PH in these patients.

Asunto(s)

Síndrome de Down , Cardiopatías Congénitas , Hemodinámica , Humanos , Femenino , Masculino , Lactante , Síndrome de Down/fisiopatología , Preescolar , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/fisiopatología , Periodo Posoperatorio , Estudios Prospectivos , Puente Cardiopulmonar/efectos adversos , Complicaciones Posoperatorias/etiología , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Factores de Riesgo

RESUMEN

Photobiomodulation is a safe option for controlling pain, edema, and trismus when applied postoperatively in third molar surgery. However, administration prior to surgery has been under-explored. This study aims to explore the effectiveness of pre-emptive photobiomodulation in reducing postoperative edema in impacted lower third molar extractions. Two groups of healthy individuals undergoing tooth extraction will be randomly assigned: Control group receiving pre-emptive corticosteroid and simulated photobiomodulation, and Photobiomodulation Group receiving intraoral low-intensity laser and extraoral LED cluster application. The primary outcome will be postoperative edema after 48 h. The secondary outcomes will be pain, trismus dysphagia, and analgesic intake (paracetamol). These outcomes will be assessed at baseline as well as two and seven days after surgery. Adverse effects will be recorded. Data will be presented as means ± SD and a p-value < 0.05 will be indicative of statistical significance.

Asunto(s)

Terapia por Luz de Baja Intensidad , Tercer Molar , Dolor Postoperatorio , Extracción Dental , Diente Impactado , Humanos , Tercer Molar/cirugía , Extracción Dental/efectos adversos , Extracción Dental/métodos , Terapia por Luz de Baja Intensidad/métodos , Diente Impactado/cirugía , Método Doble Ciego , Dolor Postoperatorio/prevención & control , Edema/prevención & control , Edema/etiología , Femenino , Masculino , Periodo Posoperatorio , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Adulto