scholarly journals The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xin You Li ◽  
Ming Tian ◽  
Ai Zhi Li ◽  
Chun Lei Han ◽  
Ke Zhong Li
Keyword(s):  
Laparoscopic Surgery ◽  
Shoulder Pain ◽  
Prospective Observational Study ◽  
Conditional Logistic Regression ◽  
Specific Treatment ◽  
Clinical Problem ◽  
Pain Visual Analogue Scale ◽  
Risk Patients ◽  
Treatment Plans ◽  
Common Clinical Problem

AbstractPostlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.

scholarly journals Caracterización del dolor perineal postparto en puérperas

2016 ◽  
Vol 18 (3) ◽  
pp. 556
Author(s):  
Paula Andrea Medina Piedrahita ◽  
Crystian Borrero Cortés ◽  
Pedro José Herrera Gómez ◽  
Juan Manuel Ospina Díaz
Keyword(s):  
Birth Weight ◽  
Observational Study ◽  
Epidural Analgesia ◽  
Medical Records ◽  
Prospective Observational Study ◽  
Clinical Problem ◽  
Analog Scale ◽  
Factors Associated ◽  
Las Mujeres ◽  
Common Clinical Problem

Introducción: El dolor perineal posparto es un problema clínico frecuente, no abordado en profundidad en Colombia. Objetivo: Determinar la prevalencia, severidad y posibles factores asociados con el dolor perineal postparto en una muestra de mujeres en el Hospital La Victoria-Instituto Materno Infantil de Bogotá.  Materiales y métodos: Estudio observacional prospectivo. Se evaluó el grado de dolor perineal percibido en 133 pacientes en posparto, mediante la escala análoga numérica de dolor, estando acostada, sentada, caminando y yendo al baño (micción y/o defecación), a las 12 y 48 horas postparto. Datos demográficos, del parto y recién nacido fueron tomados directamente de las historias clínicas. Resultados: Prevalencia global del dolor perineal moderado a severo 36-39,5% dependiendo de la actividad a las 12 horas del parto y entre 28-31,6% a las 48 horas. El dolor perineal se encontró asociado, en cualquiera de las actividades valoradas, con el uso de analgesia epidural durante el trabajo de parto, desgarro grado II o mayor, peso y perímetro cefálico del recién nacido. Se registra mejor efecto analgésico con dosis de acetaminofén de 3 g diarios o más.  Conclusiones: El dolor perineal moderado a severo afecta a menos del 50% de las mujeres postparto vaginal; se asocia con la frecuencia y magnitud del trauma perineal. Los resultados sugieren la necesidad de profundizar en el estudio del manejo analgésico más adecuado para estas pacientes.Abstract Introduction: Postpartum perineum pain is a common clinical problem, which is not addressed in detail in Colombia. Objective: To assess prevalence, magnitude and possible factors associated with postpartum perineum pain in a sample of women in the Hospital “La Victoria-Instituto Materno Infantil”, in Bogotá. Materials and methods: A prospective observational study was performed where the degree of perineum pain perceived by 133 postpartum patients was evaluated by using numerical analog scale of pain when they were sitting down, lying, walking and going to the bathroom (urination and/or defecation), at 12 and 48 hours of postpartum . Demographic, birth and newborn data were taken directly from the medical records. Results: Overall prevalence of moderate to severe perineum pain 36 to 39.5% depending on the activity at 12 hours of delivery, and since 28 to 31.6% at 48 hours after it. Perineum pain was associated, during any of the activities assessed, with the use of epidural analgesia during labor, laceration of degree II or greater, birth weight and head circumference of the newborn. Better analgesic effect of acetaminophen doses as 3 g per day or more was registered. Conclusions: Moderate to severe perineum pain affects less than 50 % of women with vaginal postpartum. It is associated with the frequency and degree of perineum trauma. The results suggest the need for further study of the most appropriate analgesic doses for these patients.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

Chronic pain following elective inguinal hernia repair—is it a common clinical problem?

2007 ◽  
Vol 32 (Suppl. 1) ◽  
pp. 174
Author(s):  
Z. M. Kirkor ◽  
T. N. Evans ◽  
H. Mathew ◽  
C. Swart ◽  
C. Morris ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Clinical Problem ◽  
Common Clinical Problem

Homeopathic Treatment of Subclinical Hypothyroidism—A Series of 19 Cases

Homeopathy ◽  
2021 ◽  
Author(s):  
Luiz Carlos Esteves Grelle ◽  
Luiz Antonio Bastos Camacho
Keyword(s):  
Subclinical Hypothyroidism ◽  
Clinical Importance ◽  
Clinical Problem ◽  
Thyroid Stimulating Hormone ◽  
Exclusion Criteria ◽  
The Mean ◽  
Common Clinical Problem ◽  
Prompt Diagnosis ◽  
Serum Tsh ◽  
Tsh Levels

Abstract Background Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. Aim The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. Methods This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. Results Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. Conclusion The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5–5.0 mIU/L).

scholarly journals Treating Postlaparoscopic Surgery Shoulder Pain with Acupuncture

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Gur Kreindler ◽  
Samuel Attias ◽  
Anna Kreindler ◽  
Haim Hen ◽  
Bassel Haj ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Chinese Medicine ◽  
Side Effects ◽  
Traditional Chinese Medicine ◽  
Visual Analogue Scale ◽  
Shoulder Pain ◽  
Analogue Scale ◽  
Acupuncture Treatment ◽  
Common Side Effect ◽  
Analgesic Treatment

Objective.The purpose of this study was to examine the effect of acupuncture on postlaparoscopic shoulder pain (PLSP) which is a common side effect in patients undergoing abdominal laparoscopic surgery.Methods.Patients with moderate to severe PLSP in spite of analgesic treatment, which were referred by the medical staff to the Complementary-Integrative Surgery Service (CISS) at our institution, were provided with acupuncture treatment. The severity of PLSP and of general pain was assessed using a Visual Analogue Scale (VAS) from 0 to 10. Pain assessment was conducted prior to and two hours following acupuncture treatment. Acupuncture treatment was individualized based on traditional Chinese medicine diagnosis.Results.A total of 25 patients were evaluated during a 14-month period, from March 2011 to May 2012. A significant reduction in PLSP (mean reduction of6.4±2.3  P<0.0001) and general pain (mean reduction6.4±2.1  P<0.0001) were observed, and no significant side effects were reported.Conclusion.Individualized acupuncture treatments according to traditional Chinese medicine principles may improve postlaparoscopic shoulder pain and general pain when used in conjunction with conventional therapy. The primary findings of this study warrant verification in controlled studies.

Evaluation of the patient with a bleeding tendency

2010 ◽  
pp. 4498-4506
Author(s):  
Trevor Baglin
Keyword(s):  
Clinical Problem ◽  
Bleeding Tendency ◽  
Common Clinical Problem

An apparent bleeding tendency is a common clinical problem, with presentation varying from acute unexpected bleeding during or immediately after surgery, to spontaneous unusual or excessive bruising, purpura, epistaxis, or a chronic haemorrhagic tendency. The following are important aspects of the assessment of the patient....

Clinical Applications

2016 ◽  
pp. 236-252
Author(s):  
Elson L. So
Keyword(s):  
Intensive Care Unit ◽  
Central Nervous System ◽  
Nervous System ◽  
Specific Treatment ◽  
Clinical Problem ◽  
Clinical Applications ◽  
Neural Function ◽  
Central Nervous System Disorders ◽  
Progression Of Disease ◽  
The Central Nervous System

Many electrophysiological assessment and techniques of clinical neurophysiology can be used in the assessment of patients with suspected disease of the central nervous system. Each of the techniques is applied either to assist clinicians in assessing disease of the central nervous system or, less commonly, to monitor changes in neural function. These techniques can be used to monitor neural function in observing progression of disease, such as the frequency of seizures, or improvement in a patient’s condition with specific treatment. They are also used in the intensive care unit and operating room to identify progressive neural damage. The clinical neurophysiological testing technique that is most appropriate for a patient depends on the clinical problem, and, often, some combination of techniques best provides the necessary data. This chapter focuses on the application of clinical neurophysiological techniques in assessing patients with suspected central nervous system disorders.

scholarly journals Hematological Diseases and Osteoporosis

2020 ◽  
Vol 21 (10) ◽  
pp. 3538 ◽  
Author(s):  
Agostino Gaudio ◽  
Anastasia Xourafa ◽  
Rosario Rapisarda ◽  
Luca Zanoli ◽  
Salvatore Santo Signorelli ◽  
...  
Keyword(s):  
Systemic Mastocytosis ◽  
Integrated Approach ◽  
Clinical Problem ◽  
Secondary Osteoporosis ◽  
Fracture Rate ◽  
Hematological Diseases ◽  
Increase Fracture Risk ◽  
Male Subjects ◽  
Common Clinical Problem

Secondary osteoporosis is a common clinical problem faced by bone specialists, with a higher frequency in men than in women. One of several causes of secondary osteoporosis is hematological disease. There are numerous hematological diseases that can have a deleterious impact on bone health. In the literature, there is an abundance of evidence of bone involvement in patients affected by multiple myeloma, systemic mastocytosis, thalassemia, and hemophilia; some skeletal disorders are also reported in sickle cell disease. Recently, monoclonal gammopathy of undetermined significance appears to increase fracture risk, predominantly in male subjects. The pathogenetic mechanisms responsible for these bone loss effects have not yet been completely clarified. Many soluble factors, in particular cytokines that regulate bone metabolism, appear to play an important role. An integrated approach to these hematological diseases, with the help of a bone specialist, could reduce the bone fracture rate and improve the quality of life of these patients.

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