Posztoperatív vertigo vizsgálata stapedotomián és                     stapedectomián átesett betegeknél

Abstract: Introduction and aim: The reason of gradually developing conductive hearing loss in otosclerotic patients is the ossification of the stapes footplate to the surrounding bony structures and the therapy of stapes fixation is mainly surgical. In stapedotomy the footplate of the stapes is fenestrated with laser and microdrill in a diameter of 0.8 mm, whereas in stapedectomy there is complete removal of the footplate followed by the reconstruction of the ossicular chain. In the early postoperative period, temporary vertigo is frequently recorded which significantly influences the recovery. Method: In the Department of Otorhinolaryngology, University of Pécs both stapedectomy and stapedotomy were performed on a daily basis between 01.02.2010 and 15.03.2012. Our study focused on comparing the degree of postoperative vertigo after the two types of surgery. We hypothesized that the smaller fenestration of the stapes footplate during stapedotomy limits exposure to the inner ear reducing the severity of dizziness. Vertigo was evaluated subjectively with a retrospective questionnaire and objectively with static posturography. Results: On the 1st postoperative day, significantly fewer patients reported vertigo in the stapedotomy group and with significantly lower intensity. Results of the questionnaire regarding the later postoperative period showed no significant differences between the groups. Based on the analysis of the posturography test results, no significant difference was detected between the postoperative stability of the two groups. Results of the questionnaire and the posturography showed no correlation. Posturography test results did not confirm the presence of subjective vertigo. Conclusion: Many factors may play a role in the development of vertigo after stapes surgery, but the type of intervention does not influence it. Orv Hetil. 2017; 158(38): 1503–1511.

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Does mitral valve repair matter in infants with ventricular septal defect combined with mitral regurgitation?

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2018-11-2-85-92 ◽

2018 ◽

Vol 11 (2) ◽

pp. 85-92

Author(s):

Yuriy Yu Kulyabin ◽

Ilya A Soynov ◽

Alexey V Zubritskiy ◽

Alexey V Voitov ◽

Nataliya R Nichay ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Ventricular Septal Defect ◽

Postoperative Period ◽

Septal Defect ◽

Early Postoperative Period ◽

Valve Repair ◽

Significant Difference

OBJECTIVES: This study aimed to assess mitral valve function after repair of ventricular septal defect (VSD) combined with mitral regurgitation (MR) in the mid-term follow-up period, to evaluate the clinical utility of simultaneous mitral valve repair (MVR). METHODS: From June 2005 to March 2014, 60 patients with VSD and MR underwent surgical treatment. After performing propensity score analysis (1:1) for the entire sample, 46 patients were selected and divided into 2 groups: those with VSD closure and MVR - 23 patients and those with VSD closure without mitral valve intervention - 23 patients. The follow-up period - 32 (28;40) months. RESULTS: There was no postoperative mortality in either group. There was no significant difference in the duration of the postoperative period between groups. Mean cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the 'VSD + MVR' group (cardiopulmonary bypass, P=0.023; aortic cross-clamp, P< 0.001). There was no significant difference in regurgitation area (P=0.30) and MR grade (P= 0.76) between groups postoperatively. There was no significant difference in freedom from MR ≥ 2+ between groups (log-rank test, P= 0.28). The only significant risk factor for recurrent MR ≥ 2+ during the follow-up period was mild residual MR in the early postoperative period ( P=0.037). CONCLUSIONS: In infants with VSD combined with MR, simultaneous MVR has no benefits simultaneous MVR provided no advantage over that of isolated VSD closure. We found that the presence of mild residual MR in the early postoperative period predisposes the development of MR ≥ 2+ in follow-up period.

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Development of Pharyngocutaneous Fistula after Total Laryngectomy: The Predictive Value of C-reactive Protein/Albumin Ratio

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2020.58 ◽

2020 ◽

Vol 63 (4) ◽

pp. 159-163

Author(s):

Abitter Yücel ◽

Hilal Yücel ◽

Fuat Aydemir ◽

Mert Mutaf ◽

Mehmet Akif Eryılmaz ◽

...

Keyword(s):

Postoperative Period ◽

Total Laryngectomy ◽

Linear Regression Analysis ◽

Multiple Linear Regression Analysis ◽

Early Postoperative Period ◽

Pharyngocutaneous Fistula ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein ◽

Significant Difference

Background: We aimed to evaluate whether C-reactive protein(CRP)/ Albumin ratio (CAR) performed in the early postoperative period after total laryngectomy could be a predictive factor for the development of pharyngocutaneous fistula (PCF). Methods: The files of patients with laryngeal squamous cell carcinoma who underwent total laryngectomy between January 2005 and January 2019 were retrospectively reviewed. Patients were divided into two groups: patients with PCF (PCF group) and without (Non-PCF group). CAR values and risk factors were compared between groups. Results: The overall incidence of PCF was 23.2%. There was a statistically significant difference between the two groups in terms of CRP and CAR levels (p = 0.001). The CAR value of 27.05 (sensitivity = 75.0% , specificity 68.2%, area under curve (AUC) = 0.742, 95% confidence interval 0.616–0.868) was determined as a cutoff value to describe the development of fistula in the early postoperative period. In multiple linear regression analysis, there was an independent relationship between presence of PCF and previous RT and CAR value. Conclusions: CAR, performed in the early postoperative period, may be a new and useful marker for predicting PCF after total laryngectomy.

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Non-Conservative Therapy in the Prevention of Subepithelial Fibroplasia after LASEK Hypermetropia Correction

Ophthalmology in Russia ◽

10.18008/1816-5095-2018-2-200-206 ◽

2018 ◽

Vol 15 (2) ◽

pp. 200-206

Author(s):

S. A. Korotkikh ◽

A. E. Bogachev ◽

A. S. Shamkin

Keyword(s):

Dry Eye ◽

Postoperative Period ◽

Sodium Hyaluronate ◽

Early Postoperative Period ◽

Diagnostic Methods ◽

Dry Eye Syndrome ◽

Control Group ◽

Study Group ◽

Postoperative Therapy ◽

Significant Difference

The results of observation of patients who underwent vision eximerlaser correction by the LASEK method regarding medium degree of hyperopia were analyzed.Purpose:to investigate the severity of the «dry eye» syndrome and corneal subepithelial fibroplasia in patients after laser correction of hyperopia by the LASEK method, and their prevention by reducing the preservative action on the eye surface.Patients and methods.The study included 40 patients (76 eyes), aged 21–46 years (32.98 ± 1.79) who underwent LASEK surgery for moderate hyperopia (4.03 ± 0.38 D). Patients were divided into two groups: 1) control group (20 patients, 37 eyes) — postoperative therapy included the corneoprotector “Stilavit®” and the preparation of hyaluronic acid “Oksial®”, containing preservatives; 2) the study group (20 patients, 39 eyes) — postoperative therapy included the corneoprotector “Hilozar-comod®” and the artificial tear preparation “Hilo-comod®”, which did not contain reservatives. Ophthalmic examination included, in addition to standard diagnostic methods, the Norn test, the Schirmer test, the staining of the eye surface with lissamine green. In addition, a questionnaire was conducted on a modified OSDI questionnaire; there a section characterizing the quality of vision (section B) was removed.Results.The analysis of the obtained data showed that in the study group there was less pronounced “dry eye” syndrome at 3,6,12 months after the operation. The maximum difference in the indicators of the “dry eye” syndrome between the groups was at 3 and 6 months of the postoperative period. When evaluating corneal subepithelial fibroplasia, maximum attention was paid to the frequency and the intensity index. It was shown a significant difference in the intensity of the haze between the study group and the control group by 26.1 % at 3 months, by 62.2 % at 6 months and by 65.3 % 12 months after the operation. Conclusion.Nonconservative therapy with sodium hyaluronate and dexapanthenol in the early postoperative period and only sodium hydrolurate allows to reduce the severity of the dry eye syndrome after laser correction of hypermetropia and, as a result, to reduce the intensity of haze development by 65.3 %, and its frequency on 11,5 %.

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Sublingual microcirculatory alterations during the immediate and early postoperative period: A systematic review and meta-analysis

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211214 ◽

2021 ◽

pp. 1-13

Author(s):

Athanasios Chalkias ◽

Nikolaos Papagiannakis ◽

Georgios Mavrovounis ◽

Konstantina Kolonia ◽

Maria Mermiri ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Period ◽

English Literature ◽

Meta Analysis ◽

Early Postoperative Period ◽

Vessel Density ◽

Flow Index ◽

Randomized Controlled ◽

Microcirculatory Flow ◽

Significant Difference

BACKGROUND: The incidence of postoperative microcirculatory flow alterations and their effect on outcome have not been studied extensively. OBJECTIVE: This systematic review and meta-analysis was designed to investigate the presence of sublingual microcirculatory flow alterations during the immediate and early postoperative period and their correlation with complications and survival. METHODS: A systematic search of PubMed, Scopus, Embase, PubMed Central, and Google Scholar was conducted for relevant articles from January 2000 to March 2021. Eligibility criteria were randomized controlled and non-randomized trials. Case reports, case series, review papers, animal studies and non-English literature were excluded. The primary outcome was the assessment of sublingual microcirculatory alterations during the immediate and early postoperative period in adult patients undergoing surgery. Risk of bias was assessed with the Ottawa-Newcastle scale. Standard meta-analysis methods (random-effects models) were used to assess the difference in microcirculation variables. RESULTS: Thirteen studies were included. No statistically significant difference was found between preoperative and postoperative total vessel density (p = 0.084; Standardized Mean Difference (SMD): –0.029; 95%CI: –0.31 to 0.26; I2 = 22.55%). Perfused vessel density significantly decreased postoperatively (p = 0.035; SMD: 0.344; 95%CI: 0.02 to 0.66; I2 = 65.66%), while perfused boundary region significantly increased postoperatively (p = 0.031; SMD: –0.415; 95%CI: –0.79 to –0.03; I2 = 37.21%). Microvascular flow index significantly decreased postoperatively (p = 0.028; SMD: 0.587; 95%CI: 0.06 to 1.11; I2 = 86.09%), while no statistically significant difference was found between preoperative and postoperative proportion of perfused vessels (p = 0.089; SMD: 0.53; 95%CI: –0.08 to 1.14; I2 = 70.71%). The results of the non-cardiac surgery post-hoc analysis were comparable except that no statistically significant difference in perfused vessel density was found (p = 0.69; SMD: 0.07; 95%CI: –0.26 to 0.39; I2 = 0%). LIMITATIONS: The included studies investigate heterogeneous groups of surgical patients. There were no randomized controlled trials. CONCLUSIONS: Significant sublingual microcirculatory flow alterations are present during the immediate and early postoperative period. Further research is required to estimate the correlation of sublingual microcirculatory flow impairment with complications and survival.

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Comparative Efficacy of Ondansetron Versus Granisetron to Prevent Perioperative Nausea and Vomiting in Patients undergoing Gynaecological Surgery under Spinal Anaesthesia

International Journal of Medical and Dental Sciences ◽

10.18311/ijmds/2017/18792 ◽

2017 ◽

Vol 6 (1) ◽

pp. 1371

Author(s):

Robina Makker ◽

Amit Bhardwaj ◽

Arwinder Pal Singh ◽

Asha Anand

Keyword(s):

Spinal Anaesthesia ◽

Postoperative Period ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Study Groups ◽

Early Postoperative Period ◽

Nausea And Vomiting ◽

Gynaecological Surgery ◽

Significant Difference ◽

Late Postoperative Period

Background: Posotoprative nausea and vomiting remains a persistent and distressing problem inspite of many advances on perioperative care and anti-emetic drugs. A newer antiemetic drug Granisetron has not been studied in patients undergoing gynaecological surgery under spinal anaesthesia.Objective: A randomized double blind study was conducted to compare Ondansetron and Granisetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery under spinal anaesthesia.Material and methods: 60 consecutive patients, age between 20-65 years, ASA grade I and II undergoing gynaeacologicla surgery under spinal anaesthesia were randomized into two goups of 30 each. One group received intravenous Ondansetron 4.0 mg and the second received intravenous Granisetron 2.0 mg 5 minutes before induction of anaesthesia. For the first 24 hours postoperatively all episodes of nausea and vomiting were recorded. A complete response to the drug was considered if there was no nausea or vomiting and no need for rescue anti-emetic. The observations were tabulated and analysed.Results: During early postoperative period (0-3 hrs) there was statistically no significant difference in the study groups. Statistically significant difference was found in the study groups in the late postoperative period (3-24 hrs).Conclusion: In the early postoperative period both Ondansetron and Granisetron are equally effective in preventing postoperative nausea and vomiting in patients undergoing gynaecological surgery under spinal anaesthesia. Granisetron is better than Ondansetron in the late postoperative period of upto 24 hrs.

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Tear Film Osmolarity of the Eye after Cataract Surgery. Summary of the Doctoral Thesis

10.25143/prom-rsu_2021-17_dts ◽

2021 ◽

Author(s):

◽

Ēriks Elksnis ◽

Keyword(s):

Cataract Surgery ◽

Postoperative Period ◽

Ocular Surface ◽

Tear Film ◽

Visual Outcome ◽

Early Postoperative Period ◽

University Hospital ◽

Control Group ◽

Study Group ◽

Significant Difference

Almost every cataract surgeon has encountered a situation during the postoperative period when, even though, the primary goal – improvement of visual acuity – has been achieved, yet the patient felt frustrated because of subjective discomfort in the operated eye. Sometimes this issue is more disturbing for the patient than the hope for a perfect visual outcome. Although it has been established that the ocular surface is affected during the postoperative period, there is still no generally accepted opinion about the changes in tear osmolarity after cataract surgery despite several studies dedicated to evaluation of these changes. The present study was designed to elucidate the effect of cataract surgery on the characteristic feature of ocular surface homeostasis – tear film osmolarity in the early postoperative period. Aim. The aim of the study was to evaluate the changes in tear film osmolarity after a cataract surgery in a healthy ocular surface. Methods. For this purpose two examination groups were formed. The study group included voluntary patients undergoing cataract surgery not having any complaints about subjective symptoms typical of dry eye disease. In order to correspond to the criteria of healthy ocular surface, the study group excludes the following types of patients and conditions: contact lens wearers, patients with diabetes, pseudoexfoliation, pterygia and eye drop users. The eye that has not undergone the surgery was classified as the control group. This single–center, prospective study was held at Ophthalmology department of Pauls Stradins Clinical university hospital. All cataract surgeries were done by the same surgeon. The tear osmolarity tests were evaluated with TearLab Osmolarity System (TearLab Corporation, San Diego, CA, the USA) before surgery, in the next morning, one week and one month after the surgery. Results. No statistically significant difference was observed between the groups before operation when comparing the mean tear osmolarity – in the study group it was 296.87 mOsm/L, and in the control group it was 297.27 mOsm/L (p = 0.84). The tear osmolarity results changed significantly during early postoperative period in the study group (p < 0.001), while in non–operated eye no significant tear film osmolarity changes were observed (p = 0.86). Significant changes were recognized on the next day after the surgery – the tears became hypoosmolar (< 275 mOsm/L). One week later the tear osmolarity increased significantly, and the tears became hyperosmolar (312.64 mOsm/L). Over the course of one month, the test values for the study and control groups equalized (297.87 in the study group and 298.93 in the control group (p = 0.66)), when compared to preoperative tear osmolarity results. Conclusion. The results achieved lead towards a more detailed understanding of the changes in the ocular surface homeostasis after a cataract surgery. The obtained data indicate that tear osmolarity changes considerably during the first postoperative month after a cataract surgery. Also, there is a huge difference in measurements between operated and non–operated eye on the next day and one week after the surgery. One month after the surgery tear osmolarity returns to preoperative test results, and there is no difference determined between the eyes.

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100 ROBOTIC-ASSISTED OPERATIONS IN COLORECTAL CANCER (FIRST OUTCOMES)

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2015-174-6-80-84 ◽

2015 ◽

Vol 174 (6) ◽

pp. 80-84 ◽

Cited By ~ 1

Author(s):

D. V. Gladyshev ◽

S. A. Kovalenko ◽

M. E. Moiseev ◽

S. S. Gnedash ◽

A. M. Karachun ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Hospital Stay ◽

Postoperative Period ◽

Early Postoperative Period ◽

Treatment Results ◽

Robotic Assisted ◽

Significant Difference ◽

First Results

This article analyzed the immediate treatment results of 210 patients, underwent endovideosurgical operative treatment concerning colorectal cancer (106 laparoscopic and 104 robotic-assisted operations). According to the first results, there was no significant difference between two methods in such medical indices as the volume of intraoperative hemorrhage, terms of hospital stay and peristalsis recovery, the rate of conversion and complications in early postoperative period, quantity of removed lymph nodes, quality of TME. The application of robotics allowed performance of precision work in conditions of limited space of the small pelvis.

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Local Anesthesia and Conscious Sedation Does Not Affect Patient's Mood and Anxiety Levels during Percutaneous Endoscopic Lumbar Diskectomy: A Prospective Study

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1739203 ◽

2021 ◽

Author(s):

H. Yener Erken ◽

Oguz Karaeminogullari ◽

Onur Yilmaz ◽

Kerem Mirel ◽

R. Ozgur Ozer

Keyword(s):

Prospective Study ◽

Operating Room ◽

Local Anesthesia ◽

Postoperative Period ◽

Conscious Sedation ◽

Early Postoperative Period ◽

Preoperative Period ◽

Significant Difference ◽

Anxiety Levels ◽

A Prospective Study

Abstract Background and Study Aims Undergoing a surgical procedure can be very stressful for patients and can lead to high anxiety levels during both the preoperative and the postoperative period. Levels of anxiety and fear may depend on multiple factors including the type of anesthesia to be used. The objective of this study is to evaluate whether patient's awareness of the surgical environment in the operating room under local anesthesia and conscious sedation (LACS) affects their mood and anxiety levels. Methods We performed a prospective study for a series of consecutive patients who underwent transforaminal percutaneous endoscopic lumbar diskectomy (PELD) for the treatment of lumbar disk herniation. The patients completed Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) forms in the preoperative period and in the early postoperative period. We divided the patients into two groups according to the type of anesthesia applied during surgery: LACS and general anesthesia (GA) groups. We compared the preoperative and postoperative POMS and STAI scores between groups and the change of these scores between the preoperative and postoperative periods in each group. Results In this study, we included 30 patients who underwent PELD between May and December 2019 and met the inclusion criteria. The GA group consisted of 16 patients and the LACS group consisted of 14 patients. In each group, POMS and STAI scores decreased in the early postoperative period compared with the preoperative period. We found no significant difference in percentage of POMS and STAI TX-1 score changes between the LACS and GA groups. Conclusion The results of our study show that patients' awareness of the surgical environment in the operating room under LACS does not significantly affect their mood and anxiety levels and patients do not seem to endure increased emotional stress during the PELD operation, as compared with PELD operation under GA.

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Value of Tourniquet Use in Anterior Ankle Arthroscopy: A Randomized Controlled Trial

Foot & Ankle International ◽

10.1177/1071100717702461 ◽

2017 ◽

Vol 38 (7) ◽

pp. 716-722 ◽

Cited By ~ 5

Author(s):

Damjan Dimnjaković ◽

Pero Hrabač ◽

Ivan Bojanić

Keyword(s):

Randomized Controlled Trial ◽

Postoperative Pain ◽

Postoperative Period ◽

Controlled Trial ◽

Early Postoperative Period ◽

Ankle Arthroscopy ◽

Consecutive Series ◽

Randomized Controlled ◽

Significant Difference ◽

Functional Scores

Background: A tourniquet is usually used during anterior ankle arthroscopy to allow for improved visibility and reduced operation time. However, this has not been demonstrated to be true in clinical studies on knee arthroscopy, while limited tourniquet time has been described as a possible factor to lower the complication rate of ankle arthroscopy. The purpose of this randomized controlled trial was to examine the effect of tourniquet use on arthroscopic visualization, operative time, postoperative intra-articular bleeding, postoperative pain scores, and outcome of anterior ankle arthroscopy. Methods: A consecutive series of 50 patients who were scheduled for anterior ankle arthroscopy were randomized to have the surgery done either without the tourniquet inflated (25 patients) or with the tourniquet inflated (25 patients). The patients were evaluated by the course of the surgery, postoperative intra-articular bleeding, and pain during the early postoperative period, and subjective and objective functional scores were used to evaluate the condition of the ankle before and 3 and 6 months after the surgery. Forty-nine patients were present at the final follow-up, 6 months after the surgery. Results: The results between the groups were comparable regarding the duration of the operative procedure, consumption of sterile saline, visualization, and functional scores. A notable difference between the groups in favor of the nontourniquet group was present regarding postoperative bleeding but was not statistically significant. A statistically significant difference in favor of the nontourniquet group was found regarding postoperative pain during several days in the early postoperative period. Conclusion: Our study showed that anterior ankle arthroscopy was performed adequately without the use of a tourniquet and that it had the same operative course as cases in which the tourniquet was used and functional outcomes that were not worse than cases in which the tourniquet was used. Level of Evidence: Level I, prospective randomized controlled trial

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Potentialities of Diffusion Weighted MRI in the Assessment of the Degree of Adjacent Intervertebral Disc Degeneration: Rigid Lumbosacral Stabilization and Total Intervertebral Disc Arthroplasty

N N Priorov Journal of Traumatology and Orthopedics ◽

10.32414/0869-8678-2017-4-18-24 ◽

2017 ◽

pp. 18-24

Author(s):

V. A. Byval’tsev ◽

I. A. Stepanov ◽

Yu. Ya. Pestryakov

Keyword(s):

Intervertebral Disc ◽

Postoperative Period ◽

Intervertebral Discs ◽

Early Postoperative Period ◽

Diffusion Weighted Mri ◽

Diffusion Weighted ◽

Total Arthroplasty ◽

Significant Difference ◽

Apparent Diffusion ◽

Adc Values

Purpose: to evaluate the condition of adjacent intervertebral discs (IVD) after single level rigid lumbosacral stabilization and total arthroplasty by calculating IVD height index and apparent diffusion coefficient (ADC).Patients and methods. The study included 117 patients (64 women and 53 men) after rigid lumbosacral stabilization or total arthroplasty of the degenerative IVD at L5–S1 level. Values of ADC and height of the adjacent IVD were assessed prior to surgery, at discharge and in 6, 12, 24 and 36 months after surgical intervention.Results. The value of the height of the adjacent IVD in patients after rigid stabilization in the early postoperative period averaged 0.58±0.046, in 6 months – 0.58±0.044 and 0.52±0.037 in 36 months after surgery. In patients after total arthroplasty it made up 0.59±0.041, 0.60±0.038 and 0.56±0.02, respectively. Comparison of the adjacent IVD height indices showed significant difference starting from the 12th observation months (p<0.05). In group of patients after rigid stabilization the value of ADC made up 1547.7±231.4 mm2/s in the early postoperative period, 1314.5±117.9 mm2/s in 6 months and 1189.3±117.9 mm2/s in 36 months after surgery. In patients after total arthroplasty it was 1539.7±228.9 mm2/s, 1477.3±245.1 mm2/s and 1334.5±217.6 mm2/s, respectively. Statistically significant difference in ADC values between 2 groups of patients was noted in 6 months after surgery and later (p<0.05).Conclusion. Diffusion weighted MRI with ADC calculation is a modern noninvasive diagnostic method for early stages of adjacent IVD degeneration. In contrast to rigid lumbosacral stabilization, total IVD arthroplasty enables to delay slightly the degeneration of segments adjacent to the operated level.

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