Relation between Perioperative Hypertension and Intracranial Hemorrhage after Craniotomy

2000 ◽  
Vol 93 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Ayman Basali ◽  
Edward J. Mascha ◽  
Iain Kalfas ◽  
Armin Schubert
Keyword(s):  
Blood Pressure ◽  
Hospital Stay ◽  
Intracranial Hemorrhage ◽  
Systemic Hypertension ◽  
Control Group ◽  
Inclusion Criteria ◽  
Control Groups ◽  
Retrospective Case ◽  
Blood Pressure Elevation ◽  
Prolonged Hospital

Background Previous data suggest that systemic hypertension (HTN) is a risk factor for postcraniotomy intracranial hemorrhage (ICH). The authors examined the relation between perioperative blood pressure elevation and postoperative ICH using a retrospective case control design. Methods The hospital's database of all patients undergoing craniotomy from 1976 to 1992 was screened. Coagulopathic and unmatchable patients were excluded. There were 69 evaluable patients who developed ICH postoperatively (n = 69). A 2-to-1 matched (by age, date of surgery, pathologic diagnosis, surgical procedure, and surgeon) control group without postoperative ICH was assembled (n = 138). Preoperative, intraoperative, and postoperative blood pressure records (up to 12 h) were examined. Incidence of perioperative HTN (blood pressure > or = 160/90 mmHg) and odds ratios for ICH were determined. Results Of the 11,214 craniotomy patients, 86 (0.77%) suffered ICH, and 69 fulfilled inclusion criteria. The incidence of preoperative HTN was similar in the ICH (34%) and the control (24%) groups. ICH occurred 21 h (median) postoperatively, with an interquartile range of 4-52 h. Sixty-two percent of ICH patients had intraoperative HTN, compared with only 34% of controls (P < 0.001). Sixty-two percent of the ICH patients had prehemorrhage HTN in the initial 12 postoperative hours versus 25% of controls (P < 0.001), with an odds ratio of 4.6 (P < 0.001) for postoperative ICH. Hospital stay (median, 24.5 vs. 11.0 days), and mortality (18.2 vs. 1.6%) were significantly greater in the ICH than in the control groups. Conclusions ICH after craniotomy is associated with severely prolonged hospital stay and mortality. Acute blood pressure elevations occur frequently prior to postcraniotomy ICH. Patients who develop postcraniotomy ICH are more likely to be hypertensive in the intraoperative and early postoperative periods.

scholarly journals Efficacy of Operculectomy in the Treatment of 145 Cases with Unerupted Second Molars: A Retrospective Case–Control Study

2020 ◽  
Vol 8 (3) ◽  
pp. 65 ◽  
Author(s):  
Andrea Abate ◽  
Davide Cavagnetto ◽  
Andrea Fama ◽  
Marco Matarese ◽  
Francesca Bellincioni ◽  
...  
Keyword(s):  
Control Group ◽  
Case Group ◽  
Inclusion Criteria ◽  
Control Groups ◽  
Retrospective Case ◽  
Second Molar ◽  
One Year ◽  
And Control ◽  
Lower Arch ◽  
Control Study

The aim of this study is to assess whether operculectomy in patients with retained second molars eases spontaneous tooth eruption in respect to untreated controls. Two hundred and twenty-two patients with delayed eruption of at least one second molar were selected from the archives of the Department of Orthodontics, Milan, Italy. Eighty-eight patients, 40 males and 48 females (mean age 14.8 ± 1.3 years), met the inclusion criteria. Records were then divided into case and control groups. The case group consisted of patients that underwent removal of the overlaying mucosa over second molars (i.e., operculectomy) and the control group consisted of subjects who retained their operculum over an unerupted second molar and were followed for one year without performing any treatment. A total of 145 impacted second molars were considered (75 cases, 70 controls). A risk ratio with 95% confidence interval was used to compare the prevalence of eruption in the two groups. Spontaneous eruption occurred in 93.3% of cases in the operculectomy group (70/75), while in the control group, 10% teeth erupted spontaneously (7/70). Spontaneous eruption in the upper arch occurred in 95.2% of cases among treated patients (40 out of 42), while in the lower arch, spontaneous eruption occurred in 90.9% of cases (30 out of 33). Spontaneous eruption of the upper second molars in the control group occurred in 8.5% of cases (3 out of 35), while in the lower arch, it occurred in 8.5% (3 out of 35). Operculectomy can ease the spontaneous eruption of retained second molars and reduce the chances of inclusion.

Uncomplicated adult inguinal hernia repair under local anaesthesia and spinal anaesthesia

2020 ◽  
Vol 11 (3) ◽  
pp. 3212-3221
Author(s):  
Naniwadekar R G
Keyword(s):  
Inguinal Hernia ◽  
Hospital Stay ◽  
Spinal Anaesthesia ◽  
Local Anaesthesia ◽  
Control Group ◽  
Early Ambulation ◽  
Inguinal Hernias ◽  
Hernia Inguinal ◽  
The Subject ◽  
Prolonged Hospital

Multiple researchers have given numerous guidelines in the clinical management of this disorder in the late nineteenth and twentieth centuries, after comprehensive works on the subject. As a result, a very wide variety of surgical procedures are now available to the surgeon to suit the requirement. There have been numerous advances in the management of inguinal hernia. Inguinal hernias can conveniently be repaired under all kinds of anaesthesia, namely general, spinal and local. Whereas the general anaesthesia requires the services of an experienced anaesthetist and new devices and spinal anaesthesia requires postoperative impairment while local anaesthesia is safe to prescribe, easy and efficient and does not cause postoperative complications. This work consisted of a study group of twenty-five adult patients of uncomplicated inguinal hernias, who after repair of hernias, which after repair of hernias were allowed early ambulation and had a short hospital, stay of one day post operatively. The second control group consisted of similar twenty-five patients who are subjected to conventional delayed ambulation and prolonged hospital stay. The results of repair in the two groups were compared; the available literature on the subject was reviewed. The implementation of ”shortstay surgery” not only relieves the waiting list in hospitals but also offers an economic boost and provides the patient with some social advantages.

Hypoxic moderation of systemic hypertension in the spontaneously hypertensive rat

1987 ◽  
Vol 252 (3) ◽  
pp. R554-R561 ◽  
Author(s):  
W. N. Henley ◽  
A. Tucker
Keyword(s):  
Blood Pressure ◽  
Spontaneously Hypertensive Rat ◽  
Metabolic Adaptation ◽  
Systemic Hypertension ◽  
Thyroid Status ◽  
Blood Pressure Elevation ◽  
Spontaneously Hypertensive ◽  
Moderate Hypobaric Hypoxia ◽  
Hypertensive Rat ◽  
Wistar Kyoto

The mechanism by which chronic, moderate, hypobaric hypoxia attenuates systemic systolic blood pressure (SBP) in the spontaneously hypertensive rat (SHR) was investigated in a three-part study. In experiment 1, 10 wk of hypoxia (3,658 m altitude) commencing in 7-wk-old rats was partially effective in preventing the rise in SBP [hypoxic SHR (SHR-H) 154 mmHg vs. normoxic SHR (SHR-N) 180 mmHg; P less than 0.01]. When hypoxia was initiated in 5-wk-old SHR (experiments 2 and 3), protection against hypertension was nearly complete (experiment 2: SHR-H 122 mmHg vs. SHR-N 175 mmHg; P less than 0.001; experiment 3: 135 vs. 152 mmHg, respectively; P less than 0.05). Elevations in O2 consumption (VO2) and rectal temperature (Tre) in SHR vs. normotensive [Wistar-Kyoto (WKY)] rats provided evidence that the SHR is a hypermetabolic animal. Thyroid hormonal indices suggested that SHR changed from a low to high thyroid status at a time that rapid blood pressure elevation occurred; however, hypoxia did not influence thyroid status. Acute, significant decrements in VO2 and Tre in SHR-H (experiments 2 and 3) accompanied the attenuation of SBP by hypoxia, whereas large decrements in VO2 and SBP did not occur in hypoxic WKY. Timely administration of moderate hypoxia protects against the development of hypertension in the SHR. This protection may relate to a metabolic adaptation made by the hypoxic SHR.

scholarly journals Variability in Opioid Prescription Following Primary Single-Level Lumbar Microdiscectomy

2020 ◽  
pp. 219256822095067
Author(s):  
Hai Le ◽  
Eileen Phan ◽  
Lauren Agatstein ◽  
Joshua Barber ◽  
Eric Klineberg ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Case Series ◽  
Postoperative Pain Management ◽  
Prolonged Hospital Stay ◽  
Inclusion Criteria ◽  
Retrospective Case ◽  
Opioid Prescription ◽  
Single Level ◽  
Lumbar Microdiscectomy ◽  
Prolonged Hospital

Study Design: Retrospective case series. Objectives: To evaluate the variability in opioid prescription following primary single-level lumbar microdiscectomy. Methods: We retrospectively reviewed consecutive patients who underwent primary single-level lumbar microdiscectomy. Only opioid-naïve patients ≥18 years old were included. Patients who had revision microdiscectomy, multilevel decompression, and/or any complication requiring prolonged hospital stay (>2 days) were excluded. The primary outcomes were the maximum daily dosage of opioids prescribed in morphine milligram equivalents (MME) and the number of pills prescribed (equivalent to 5 mg hydrocodone). Results: Between 2014 and 2019, 169 patients (90 men, 79 women) met inclusion criteria, with a mean age of 46.9 years. Surgery resulted in a statistically significant improvement in VAS (Visual Analogue Scale) score (6.4 to 2.5, P < .01). At discharge, 8 patients (4.7%) did not receive any opioid prescription. Of the remaining 161 patients, 1 patient (0.01%) received hydromorphone, 30 (18.6%) Percocet, 43 (26.7%) oxycodone, and 87 Norco (54.0%). The length of opioid prescription was 6.7 days. The maximum daily dosage of opioids prescribed was 70.4 MME (SD 32.1). The total number of pills prescribed was 89.4 (SD 54.7). Twenty-five patients (15.5%) received a refill prescription. Multivariate analysis demonstrated the operating service, prescriber, and hospital admission were statistically significant predictors of maximum daily MME. The prescriber and hospital admission were statistically significant predictors of total number of pills prescribed. Conclusions: We found significant variability in opioid prescription following primary single-level lumbar microdiscectomy. For standard spinal procedures like lumbar microdiscectomy, opioid-prescribing guidelines should be established to standardize postoperative pain management.

scholarly journals Investigation of the effect of the virtual reality application on experimental pain severity in healthy

2019 ◽  
Vol 65 (3) ◽  
pp. 446-451
Author(s):  
Dilek Karaman ◽  
Funda Erol ◽  
Dilek Yılmaz ◽  
Yurdanur Dikmen
Keyword(s):  
Blood Pressure ◽  
Virtual Reality ◽  
Control Group ◽  
Control Groups ◽  
Adult Type ◽  
Significant Difference ◽  
The Mean ◽  
And Control ◽  
Experimental Group ◽  
Virtual Reality Application

SUMMARY OBJECTIVE: This study aimed to investigate the effect of virtual reality application on experimental ischemic pain created with a blood pressure instrument in healthy volunteers. METHODS: The research sample consisted of 172 volunteer adult students who conformed to the inclusion criteria. These individuals were assigned into an experimental (n=86) and a control group (n=86) by a simple randomization method. All individuals in the experimental and control groups wereexperimentally subjected to pain for two minutes by applying 260 mmHg of pressure 3-4 cm above the antecubital region of the left arm with an aneroid adult-type blood pressure instrument. During the procedure, the volunteers in the experimental group watched virtual reality images, while those in the control group received no intervention. Immediately after the procedure, the pain levels of the individuals in both groups were assessed with a Visual Analog Scale (VAS). RESULTS: We found that the mean pain score of the individuals in the experimental group was 2.62±1.82, and that of individuals in the control group was 5.75±1.65. Results of the statistical analysis showed a statistically significant difference between the mean pain scores of the individuals in the experimental and control groups (p<0.001). CONCLUSION: This study found that the use of virtual reality was effective in reducing the level of pain in healthy individuals. This method used a smartphone with widespread availability and ease of transportation, which can be used by health professionals as a non-pharmacological method in the management of pain.

Evidence for Peripheral Vascular Involvement in Mild Elevation of Blood Pressure in Man

1976 ◽  
Vol 51 (s3) ◽  
pp. 65s-68s
Author(s):  
R. Sivertsson ◽  
R. Sannerstedt ◽  
Y. Lundgren
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Index ◽  
Structural Changes ◽  
Vascular Involvement ◽  
Control Group ◽  
Study Group ◽  
Blood Pressure Elevation ◽  
Pressure Elevation ◽  
Arterial Blood

1. Cardiac output at rest, intra-arterial blood pressure and hand blood flow at maximal vasodilatation were studied in two groups of 18–25-year-old men: forty-four with mild blood pressure elevation were referred from a military enlistment centre, and twenty-nine normotensive volunteers were mainly recruited from the same enlistment centre. 2. The study group was characterized by a significantly higher cardiac index at rest, and a significantly higher blood flow resistance in the hand at maximal vasodilatation than the control group, indicating the presence of structural modifications in the resistance vessels of patients with mild blood pressure elevation. 3. The tendency to increased vascular resistance in the blood vessels of the hand at maximal vasodilatation was more pronounced in patients with a normal cardiac index than in those with a high index. This suggests inclusion in the study group of tense, anxious individuals with an elevated cardiac index but otherwise normal circulation, but does not exclude the possibility that these patients may develop structural changes later on.

scholarly journals A Comparative Study of Relationship between Micronutrients and Gestational Diabetes

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Farideh Akhlaghi ◽  
Seyyed Majid Bagheri ◽  
Omid Rajabi
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Gestational Age ◽  
Control Group ◽  
Study Group ◽  
Inclusion Criteria ◽  
Control Groups ◽  
Significant Difference ◽  
Micronutrient Concentration ◽  
And Control

In this paper, we studied the relation between the micronutrient and gestational diabetes. Therefore, we measured micronutrient concentration including Ni, Al, Cr, Mg, Fe, Zn, Cu, and Se in serum of women with gestational diabetes between 24 and 28 weeks of gestational age (study group) who had inclusion criteria and comparison with micronutrient levels in normal pregnant women with same gestational age (control group). Results showed that there was no significant difference between the serum micronutrient level (Ni, Al, Cr, Mg, Zn, Cu, Se) in study and control groups except serum level of iron which in serum of gestational diabetic women was lower than normal pregnant women and difference was significant.

scholarly journals Operative delivery rates following induction of labour for obstetric cholestasis

2011 ◽  
Vol 4 (2) ◽  
pp. 66-69 ◽  
Author(s):  
Jessica R Webster ◽  
Lucy Chappell ◽  
Floria Cheng ◽  
Andrew C G Breeze ◽  
Nuala Lucas ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Operative Delivery ◽  
Control Groups ◽  
Retrospective Case ◽  
Assisted Delivery ◽  
Gestational Week ◽  
Control Study ◽  
Singleton Pregnancies

The aim of this study was to determine whether women induced for obstetric cholestasis (OC) have increased rates of operative delivery compared with women without OC who are induced. This retrospective case-control study included 64 women with OC (singleton pregnancies), who had labour induced compared with two control groups (matched for parity and gestational week at delivery). The majority of women were induced at 37 weeks. We found no significant increase in the rate of operative or assisted delivery in OC cases compared with either control group. Women with OC who are induced between 36 and 40 weeks gestation do not have increased rates of assisted or operative delivery compared with induced controls.

scholarly journals Hypothalamus-Related Resting Brain Network Underlying Short-Term Acupuncture Treatment in Primary Hypertension

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Hongyan Chen ◽  
Jianping Dai ◽  
Xiaozhe Zhang ◽  
Kai Wang ◽  
Shuhua Huang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular System ◽  
Acupuncture Treatment ◽  
Bodily Pain ◽  
Brain Network ◽  
Control Group ◽  
Control Groups ◽  
Short Term ◽  
Sf 36 ◽  
And Control

The present study attempted to explore modulated hypothalamus-seeded resting brain network underlying the cardiovascular system in primary hypertensive patients after short-term acupuncture treatment. Thirty right-handed patients (14 male) were divided randomly into acupuncture and control groups. The acupuncture group received a continuous five-day acupuncture treatment and undertook three resting-state fMRI scans and 24-hour ambulatory blood pressure monitoring (ABPM) as well as SF-36 questionnaires before, after, and one month after acupuncture treatment. The control group undertook fMRI scans and 24-hour ABPM. For verum acupuncture, average blood pressure (BP) and heart rate (HR) decreased after treatment but showed no statistical differences. There were no significant differences in BP and HR between the acupuncture and control groups. Notably, SF-36 indicated that bodily pain (P= 0.005) decreased and vitality (P= 0.036) increased after acupuncture compared to the baseline. The hypothalamus-related brain network showed increased functional connectivity with the medulla, brainstem, cerebellum, limbic system, thalamus, and frontal lobes. In conclusion, short-term acupuncture did not decrease BP significantly but appeared to improve body pain and vitality. Acupuncture may regulate the cardiovascular system through a complicated brain network from the cortical level, the hypothalamus, and the brainstem.

scholarly journals Risk Factors for Prolonged Hospital Stay and In-Hospital Mortality in Hip Fracture Patients Aged Over 65 Years: A Composite Endpoint Analysis

2020 ◽  
Author(s):  
Jorge Salvador Marín ◽  
Francisco Javier Ferrández Martínez ◽  
Jose Miguel Seguí Ripoll ◽  
José Antoio Quesada Rico ◽  
Domingo Orozco Beltrán ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hip Fracture ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
High Blood Pressure ◽  
Composite Endpoint ◽  
Medical Complications ◽  
Prolonged Hospital Stay ◽  
The Mean ◽  
Prolonged Hospital

Abstract Objectives : This study aimed to determine the risk factors that increase the risk of in-hospital mortality and/or prolonged hospital stay in hip fracture patients aged over 65 years. Methods : We conducted a retrospective study of patients aged over 65 years who underwent hip fracture surgery in the period from January 2015 to December 2017. Our analysis included 54 variables related to medical, psychological, functional and laboratory comorbidities present at admission; treatment, complications and laboratory follow-up during the hospital stay; and functional status and destination on discharge. We performed a bivariate analysis and a multivariate analysis with a composite endpoint combining in-hospital mortality and hospital stay lasting more than 10 days. Results : We included 360 patients with an average age of 84 years. Women accounted for 75% of the sample, and 53.5% of all patients had a pertrochanteric fracture. The mean number of comorbidities per patient was 2.72, and the most common comorbidities were high blood pressure, dementia and diabetes. The rate of in-hospital mortality was 3.6% (n 13) and the mean length of hospital stay was 8.48 days, with 16.4% of patients staying in hospital for more than 10 days. Medical complications, lower hemoglobin on admission, high blood pressure, obesity and Parkinson’s disease were significantly associated with our endpoint in the multivariate analysis Conclusions : Patients who suffer medical complications during hospitalization, and those with lower hemoglobin on admission, high blood pressure, obesity or Parkinson’s disease, have an increased risk of in-hospital mortality or prolonged hospital stay

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