scholarly journals Thoracic surgery in the COVID-19 era: an Italian university hospital experience

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Riccardo Taje ◽  
Stefano Elia ◽  
Benedetto Cristino ◽  
Federico Tacconi ◽  
Gianluca Natali ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Surgical Care ◽  
Primary Outcome Measure ◽  
University Hospital ◽  
Mortality And Morbidity ◽  
Number Of Patients ◽  
Study Results ◽  
Group A ◽  
Advanced Stages ◽  
Free Rate

Abstract Background Aims of this study were to assess the results of anti-COVID19 measures applied to maintain thoracic surgery activity at an Italian University institution through a 12-month period and to assess the results as compared with an equivalent non-pandemic time span. Methods Data and results of 646 patients operated on at the department of Thoracic Surgery of the Tor Vergata University Policlinic in Rome between February 2019 and March 2021 were retrospectively analyzed. Patients were divided in 2 groups: one operated on during the COVID-19 pandemic (pandemic group) and another during the previous non-pandemic 12 months (non-pandemic group). Primary outcome measure was COVID-19 infection-free rate. Results Three patients developed mild COVID-19 infection early after surgery resulting in an estimated COVID-19 infection-free rate of 98%. At intergroup comparisons (non-pandemic vs. pandemic group), a greater number of patients was operated before the pandemic (352 vs. 294, p = 0.0013). In addition, a significant greater thoracoscopy/thoracotomy procedures rate was found in the pandemic group (97/151 vs. 82/81, p = 0.02) and the total number of chest drainages (104 vs. 131, p = 0.0001) was higher in the same group. At surgery, tumor size was larger (19.5 ± 13 vs. 28.2 ± 21; p < 0.001) and T3-T4/T1-T2 ratio was higher (16/97 vs. 30/56; p < 0.001) during the pandemic with no difference in mortality and morbidity. In addition, the number of patients lost before treatment was higher in the pandemic group (8 vs. 15; p = 0.01). Finally, in 7 patients admitted for COVID-19 pneumonia, incidental lung (N = 5) or mediastinal (N = 2) tumors were discovered at the chest computed tomography. Conclusions Estimated COVID-19 infection free rate was 98% in the COVID-19 pandemic group; there were less surgical procedures, and operated lung tumors had larger size and more advanced stages than in the non-pandemic group. Nonetheless, hospital stay was reduced with comparable mortality and morbidity. Our study results may help implement efficacy of the everyday surgical care.

Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Antonella Pino ◽  
◽  
Lorenzo Gasco ◽  
Daqi Zhang ◽  
Paolo Carcoforo ◽  
...  
Keyword(s):  
Body Dysmorphic Disorder ◽  
The Body ◽  
University Hospital ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Scar Assessment ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

Thoracic surgery mortality and morbidity in a university hospital

2012 ◽  
Vol 20 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Sirilak Suksompong ◽  
Sarawut Thamtanavit ◽  
Benno von Bormann ◽  
Punnaruk Thongcharoen
Keyword(s):  
Thoracic Surgery ◽  
University Hospital ◽  
Mortality And Morbidity ◽  
Surgery Mortality

Further Analysis on Solution Treatment for Diabetes of Patients at Hospitals in Vietnam

2021 ◽  
Vol 19 (8) ◽  
pp. 88-93
Author(s):  
Vu Thanh Binh ◽  
Dinh Tran Ngoc Huy
Keyword(s):  
Blood Pressure ◽  
Sugar Content ◽  
Solution Treatment ◽  
Policy Implications ◽  
University Hospital ◽  
Masked Hypertension ◽  
Blood Pressure Monitor ◽  
Number Of Patients ◽  
Study Results

In recent years in Vietnam, preventing and treatment for diabetes of patients in hospitals has been rising as hot issues because the number of patients with diabetes tend to increase much. Our study uses mainly statistics and qualitative analysis synthesis and inductive methods, together with quantitative analysis with data and statistics. Vu Thanh Binh et al (2021) said that Monitoring blood pressure with a continuous blood pressure monitor to carry around to detect masked hypertension (MH) in type 2 diabetes patients who are on outpatient treatment at Thai Binh Medical University Hospital, Thai Binh, Vietnam. Our study results indicated that diabetes including type 1 and type 2 and can be identified at early stages and have prevention treatment solutions such as physical exercises, eating food with lipid, and Reduce the amount of foods with high starch and sugar content. Lat but not least, Strengthening knowledge and skills of nurses and doctors and quality of human resources operating in the field of diabetes. Finally, our paper will propose policy implications and recommendations.

scholarly journals Ten years incidence of intracranial complications of chronic suppurative otitis media

2020 ◽  
Vol 3 (6) ◽  
pp. 996-1001
Author(s):  
Khaled Mohamed Mokbel Khalefa
Keyword(s):  
Brain Abscess ◽  
Otitis Media ◽  
Sinus Thrombosis ◽  
University Hospital ◽  
Chronic Suppurative Otitis Media ◽  
Lateral Sinus ◽  
Suppurative Otitis Media ◽  
Mortality And Morbidity ◽  
Number Of Patients ◽  
Intracranial Complications

Background: complications of chronic Suppurative Otitis Media have mortality and morbidity risks which are caused by Reluctance in its management with late presentation. The aim of this study was to investigate, the frequency, mortality and morbidity of intracranial complications of chronic suppurative otitis media admitted at our tertiary University Hospital in ten years from 2006 -2016. Result: The total number of patients reported with intracranial complication due to chronic suppurative otitis media was 64 patients. Brain abscess and Meningitis were present in 24 (37.5%) and 22 cases (34.4%). In 14 cases (21.8%) extradural abscess was found while 4 (6.3%) had lateral sinus thrombosis. Conclusion: Brain abscess is the most common and dangerous complication in chronic suppurative otitis media in our region.

scholarly journals National Thoracic Surgery Standards Implementation: Barriers, Enablers, and Opportunities

2021 ◽  
Vol 28 (1) ◽  
pp. 405-416
Author(s):  
Angel Arnaout ◽  
Anubha Prashad ◽  
Nadine Dunk ◽  
Jess Rogers ◽  
Annemarie Edwards ◽  
...  
Keyword(s):  
Focus Group ◽  
Thoracic Surgery ◽  
Patient Outcomes ◽  
Surgical Care ◽  
Treatment Decision ◽  
Audit And Feedback ◽  
Pathology Report ◽  
Implementation Barriers ◽  
Standards Implementation ◽  
Study Results

Background: Diagnosis and surgical treatment decision making for thoracic cancers is complex. Moreover, there is demonstrated variability in how each province in Canada delivers cancer care, resulting in disparities in patient outcomes. Recently, the Canadian Partnership Against Cancer (CPAC) published pan-Canadian evidence-based standards for the care of thoracic surgery cancer patients. This study was undertaken to assess the degree to which these standards were currently met in practice and to further understand the determinants to their implementation nationally. Methods: This study was undertaken in two parts: (1) a national survey of thoracic surgeons to assess the perceived extent of implementation of these standards in their institution and province; and (2) formation of a focus group with a representative sample of thoracic surgeons across Canada in a qualitative study to understand the determinants of successful standards implementation. Results: 37 surgeons (33% response rate) participated in the survey; 78% were from academic hospitals. The top categories of standards that were under-implemented included (a) quality assurance processes, data collection and clinician audit and feedback, and (b) ongoing regional planning and workload assessments for thoracic surgeons, and (c) pathology turnaround time target of two weeks and the use of a standardized synoptic pathology report format. Enablers, barriers, and opportunities for standards implementation contextualized the discussion within the focus group. Conclusion: Study results demonstrated variation in the implementation of surgery standards across Canada and identified the determinants to the delivery of high quality surgical care. Future work will need to include the promotion and development of quality improvement strategies and effective resource allocation that is aligned with the implementation of thoracic cancer surgery standards in order to improve patient outcomes.

scholarly journals Hartmann’s Procedure for Complicated Diverticulitis: A Critical Reappraisal

2019 ◽  
Vol 13 (1) ◽  
pp. 121-131
Author(s):  
Raffaele Costantini
Keyword(s):  
Hospital Setting ◽  
Hemodynamic Instability ◽  
Complicated Diverticulitis ◽  
Hartmann’S Procedure ◽  
Mortality And Morbidity ◽  
Hartmann's Procedure ◽  
Number Of Patients ◽  
Advanced Stages ◽  
Alternative Procedures ◽  
Critical Patients

Background: Complicated diverticulitis in advanced stages (Hinchey III, IV) is an important surgical emergency for which Hartmann’s Procedure (HP) has traditionally represented the gold standard treatment. HP, however, has high mortality and morbidity and a low percentage of reanastomosis rate. Increasing efforts have therefore been made in recent years to propose alternatives. Objective: To critically review studies on the outcome of HP vs. alternative procedures for complicated diverticulitis Resection-Anastomosis without [RA] or with [RAS] protective stomia, Laparoscopic Lavage [LL]. Methods: Literature search in PubMed for original and review papers in the past 20 years (up to July 2019) with keywords: Hartmann’s procedure, complicated diverticulitis. Results: Comparative studies on HP vs. RA/RAS overall reveal better outcomes of RA/RAS, i.e., reduced mortality, morbidity and healthcare costs. However, most studies have limitations due to lack of randomization, limited number of patients and significant impact of surgeons’ specialization and hospital setting/organization in the decision of the type of surgery to perform. These factors might induce preferential allocation of the most critical patients (advanced age, hemodynamic instability, numerous comorbidities) to HP rather than RA/RAS. LL shows promising results but has been tested in a too small number of trials vs. HP to draw definite conclusions. Conclusion: Though valid alternatives to HP are being increasingly employed, consensus on the best approach to complicated diverticulitis has not yet been reached. HP is still far from representing an obsolete intervention, rather it appears to be the preferred choice in the most critical patients.

scholarly journals Implementation of an ERAS program in patients undergoing thoracic surgery at a third-level university hospital. An ambispective cohort study

2020 ◽  
Author(s):  
Soledad Bellas-Cotán ◽  
Rubén Casans-Francés ◽  
Cristina Ibáñez ◽  
Ignacio Muguruza ◽  
Luis E. Muñoz-Alameda
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Thoracic Surgery ◽  
Surgical Complications ◽  
Readmission Rate ◽  
University Hospital ◽  
Secondary Outcome ◽  
Logistic Analysis ◽  
Number Of Patients ◽  
Eras Protocol

ABSTRACTObjetiveTo analyze the effects of the implementation of an ERAS program in patients undergoing pulmonary resection in a tertiary university hospital on the rates of complications and readmission and the length of stay.Methodsambispective cohort study, with a prospective arm of patients undergoing thoracic surgery within an ERAS program versus a retrospective arm of patients before the implementation of the protocol. We recluited 50 patients per arm. The primary outcome was the number of patients with 30-day surgical complications. Secondary outcome included ERAS adherence, no-surgical complications, mortality, readmission, reintervention rates, pain and hospital lenght of stay. We performed a multivariate logistic analysis to study the association of coutcomes with ERAS adherence.ResultsWe found no difference between the two groups in surgical complications [Standard 18 (36%) vs 12 (24%], p =0.19]. ERAS group was significantly lower only in its readmission rate [Standard 15 (30%) vs 6 (12%], p =0.03]. In multivariate analyses, ERAS adherence was the only factor associated with a reduction in surgical complications [OR (95%CI) = 0.02 (0.00, 0.59), p = 0.03] and length of stay [HR (95%CI) = 18.5 (4.39, 78.4), p < 0.001].ConclusionsERAS program was able to decrease the readmission rate at our centre significantly. The adherence to the ERAS protocol influenced the reduction of surgical complications and length of stay.

Analysis of Deliberate Self-Wrist-Cutting Episodes Presenting to the Emergency Department

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Jin Kim ◽  
Han Joon Kim ◽  
Soo Hyun Kim ◽  
Sang Hoon Oh ◽  
Kyu Nam Park
Keyword(s):  
Emergency Department ◽  
Medical Records ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Psychiatric Interview ◽  
Clinical Variables ◽  
Completed Suicide ◽  
Number Of Patients ◽  
Group A ◽  
Efficacy Of Treatment

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.

Paradoxical Hypotension during Dobutamine Infusion for Myocardial Perfusion Scintigraphy

1998 ◽  
Vol 37 (08) ◽  
pp. 268-271
Author(s):  
B. Caner ◽  
E. Atalar ◽  
A. Karanfil ◽  
L. Tokgözoğlu ◽  
E. L. Ergün
Keyword(s):  
Blood Pressure ◽  
Myocardial Perfusion ◽  
Systolic Blood Pressure ◽  
Myocardial Perfusion Scintigraphy ◽  
Stress Test ◽  
Dobutamine Infusion ◽  
Perfusion Scintigraphy ◽  
Tilt Table ◽  
Study Results ◽  
Group A

Summary Aim: Dobutamine as a predominant beta-1 agonist increases heart rate and myocardial contractility and at sufficient high doses, it also increases systolic blood pressure. This study was undertaken to describe instances of paradoxical hypotension during dobutamine infusion for TI-201 myocardial perfusion SPECT study and the relationship between scintigraphic findings and hypotension occurred during dobutamine infusion. Methods: In 201 consecutive patients unable to perform adequate exercise, dobutamine TI-201 myocardial SPECT was performed. Dobutamine was infused starting from 10 μg/kg/min increasing to 40 μg/kg/min. Paradoxical hypotension was defined as a decrease in systolic blood pressure ≥ 20 mmHg compared with baseline study. Results: Paradoxical hypotension was observed in 40 patients (Group A) out of 201 (19.9%) while no significant change in systolic blood pressure was detected in the remaining 161 patients (Group B). Mean maximum fall in systolic blood pressure was 39 ± 18 mmHg (range: 20-90). In 33 of 40 patients (83%) with paradoxical hypotension, scintigraphy was normal compared to 131 (81%) of the remaining 161 patients. In patients of Group A, angiography, echocardiography and tilt table tests were performed in 13, 11 and 6 patients respectively. Nine of 13 angiographic evaluations (69%), 10 of 11 echocardiographic evaluations (91%), all of the tilt table tests were normal. Additionally, all of the patients of Group A were clinically followed up at least 6 months after the myocardial perfusion scintigraphy. None of the patients had a cardiac event except one patient during the follow-up period. Conclusion: Paradoxical hypotension during dobutamine infusion for myocardial scintigraphy is not an uncommon finding and up to 19.9% patients may develop such hypotension. To maximize test safety, precautions should be taken during dobutamine myocardial stress test, since remarkable decrease in systolic blood pressure may occur. Unlike hypotension occurring with exercise test, hypotension response to dobutamine is not always a marker for coronary artery disease.

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

Sign in / Sign up

Export Citation Format

Share Document