scholarly journals Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction

2017 ◽  
Vol 44 (6) ◽  
pp. 574-581 ◽  
Author(s):  
Dimas André Milcheski ◽  
Rogério Rafael da Silva Mendes ◽  
Fernando Ramos de Freitas ◽  
Guilherme Zaninetti ◽  
Araldo Ayres Moneiro Júnior ◽  
...  
Keyword(s):  
Outpatient Care ◽  
Wound Dehiscence ◽  
Surgical Wound ◽  
Surgical Wound Dehiscence ◽  
Complex Wound ◽  
One Stage Reconstruction ◽  
New Surgery ◽  
Selection Of Patients ◽  
Selection Of

ABSTRACT Objective: to evaluate a brief hospitalization protocol for the treatment of pressure ulcers, proposed by the Complex Wound Group of Clinical Hospital of University of Sao Paulo Medical School, particularly in regard to selection of patients, hospitalization time, cutaneous covering, complications and sore recurrence. Methods: retrospective cohort of 20 consecutive patients with 25 pressure lesions Grade IV. All patients were ambulatorily prepared and were hospitalized for surgical one time procedure for pressure lesion closing. Results: in total, 27 flaps were performed to close 25 wounds. Three patients showed minor dehiscence (11.1%). There was no recurrence during the post-surgical follow-up period. No patient suffered a new surgery and no flap showed partial or total necrosis. Median time of hospitalization was 3.6 days (2-6 days) and median follow-up was 91 months (2-28 months). All patients maintained their lesions closed, and there was no recurrence during follow-up. Conclusion: the brief hospitalization protocol was considered adequate for the resolution of pressure wounds, showing an average time of hospitalization of 3.6 days and rate of minor surgical wound dehiscence of 11.1%.

scholarly journals Active surveillance in patients with a PSA >10 ng/mL

2014 ◽  
Vol 8 (9-10) ◽  
pp. 702 ◽  
Author(s):  
Paul Toren ◽  
Lih-Ming Wong ◽  
Narhari Timilshina ◽  
Shabbir Alibhai ◽  
John Trachtenberg ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Specific Antigen ◽  
Sufficient Evidence ◽  
Hazard Ratios ◽  
Diagnostic Biopsy ◽  
Selection Of Patients ◽  
Baseline Psa ◽  
Selection Of

Introduction: The use of prostate-specific antigen (PSA) in active surveillance (AS) for prostate cancer is controversial. Some consider it an unreliable marker and others as sufficient evidence to exclude patients from AS. We analyzed our cohort of AS patients with a PSA over 10 ng/mL.Methods: We included patients who had clinical T1c–T2a Gleason ≤6 disease, and ≤3 positive cores with ≤50% core involvement at diagnostic biopsy and ≥2 total biopsies. Patients were divided into 3 groups: (1) those with baseline PSA >10 ng/mL, (2) those with a PSA rise >10 ng/mL during follow-up; and (3) those with a PSA <10 ng/mL throughout AS. Adverse histology was defined as biopsy parameters exceeding the entry criteria limits. We further compared this cohort to a concurrent institutional cohort with equal biopsy parameters treated with immediate radical prostatectomy.Results: Our cohort included 698 patients with a median follow-up of 46.2 months. In total, 82 patients had a baseline PSA >10 ng/mL and 157 had a PSA rise >10 ng/mL during surveillance. No difference in adverse histology incidence was detected between groups (p = 0.3). Patients with a PSA greater than 10 were older and had higher prostate volumes. Hazard ratios for groups with a PSA >10 were protective against adverse histology. Larger prostate volume and minimal core involvement appear as factors related to this successful selection of patients to be treated with AS.Conclusion: These results suggest that a strict cut-off PSA value for all AS patients is unwarranted and may result in overtreatment. Though lacking long-term data and validation, AS appears safe in select patients with a PSA >10 ng/mL and low volume Gleason 6 disease.

scholarly journals Management of surgical wound dehiscence by oxygen-ozone therapy in a FIV-positive cat – a case report

2020 ◽  
Vol 89 (2) ◽  
pp. 189-194
Author(s):  
Călin Cosmin Repciuc ◽  
Corina Gina Toma ◽  
Ciprian Andrei Ober ◽  
Liviu Ioan Oana
Keyword(s):  
Case Report ◽  
Wound Dehiscence ◽  
Complete Healing ◽  
Limb Amputation ◽  
X Rays ◽  
Surgical Wound ◽  
Ozone Therapy ◽  
Contraction Phase ◽  
Surgical Wound Dehiscence ◽  
Low Efficiency

Patients infected with the feline immunodeficiency virus (FIV) are frequently victims of postoperative wound dehiscence due to low efficiency of the immune system that predisposes to delayed scaring and epithelization processes. This case report aimed to describe the successful use of medical ozone in the treatment of a dehisced wound in a feline patient that presented this type of FIV-associated complication. Here we present a case of a 12-year-old, mixed-breed, male, FIV-positive cat with purulent arthritis affecting the shoulder, elbow, and the carpal joints with subsequent periostitis and arthrogryposis affecting the right forelimb. After a thorough investigation (clinical examination, X-rays) it was decided that limb amputation would be the proper choice. The surgical wound did not tend to heal, followed by rejection of the suture material, skin necrosis, and wound dehiscence. After 13 days following the surgery with allopathic treatment and no improvement, oxygen-ozone-therapy was started. Clinically, oxygen-ozone therapy showed significant results after the first session: borders of the wound got into the contraction phase, got attached to the underlying tissues, and exudates were significantly diminished. The therapy continued every 2 days showing improved blood perfusion of the affected area and a visible advancement of the contraction phase daily with complete healing in 1.5 months.

Surgical Wound Dehiscence Treatment With Low-Level Laser Therapy and Barbatimão: A Case Report

2021 ◽  
Vol 67 (10) ◽  
pp. 18-22
Author(s):  
Jessica Breder ◽  
Daniela Tsukumo ◽  
Eliana Pereira ◽  
Maria Lima
Keyword(s):  
Case Report ◽  
Laser Therapy ◽  
Wound Dehiscence ◽  
Low Level Laser Therapy ◽  
Surgical Wound ◽  
Low Level ◽  
Low Level Laser ◽  
Surgical Wound Dehiscence ◽  
Level Laser

BACKGROUND: Low-level laser therapy (LLLT) and a gel containing an extract of Barbatimão, a native Brazilian tree, have shown promising results in both preclinical and clinical wound healing studies. PURPOSE: To describe the treatment of surgical wound dehiscence with LLLT and Barbatimão gel. CASE STUDY: A 54-year-old woman without comorbidities underwent abdominoplasty at another health facility. Three (3) weeks later she presented to the authors’ clinic after an episode of syncope, abrupt dyspnea, purulent exudate, and necrotic tissue in the surgical incision. She reported that wound redness, warmth, and swelling started 8 days postoperatively. The patient was admitted; on day 3 of that hospital stay, her condition improved and surgical debridement was performed. Follow-up care of wound dehiscence was provided in the outpatient clinic. The treatment involved daily application of Barbatimão gel and weekly application of LLLT. The wound healed after 84 days. CONCLUSION: This case report suggests that LLLT may be a beneficial adjunctive therapy, together with Barbatimão gel, for the treatment of surgical wound dehiscence.

Upfront cytoreductive surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer in Indian patients

2021 ◽  
Author(s):  
Mukur Dipi Ray ◽  
Suryanarayana S.V. Deo ◽  
Lalit Kumar ◽  
Manish Kumar Gaur
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Ovarian Carcinoma ◽  
Cytoreductive Surgery ◽  
Advanced Ovarian Cancer ◽  
Advanced Stages ◽  
Selection For ◽  
Selection Of Patients ◽  
Selection Of

In cases of ovarian carcinoma, primary cytoreductive surgery (CRS) is the standard treatment up to stage IIIB, but patient selection for neoadjuvant chemotherapy (NACT) in selected cases is controversial. A total of 200 patients with advanced ovarian cancer were analyzed retrospectively, according to specific selection criteria. Primary CRS was performed in 95 patients (47.5%) and interval CRS after 3–6 cycles of NACT was performed in 105 patients (52.5%). After median follow-up of 35 months, 5-year overall survival was 53.7% in the upfront CRS group and 42.2% in the NACT group. Primary CRS is the standard in advanced stages of ovarian carcinoma, but in certain subset of patients, NACT is preferred. Identifying that group is challenging but feasible. Proper selection of patients is key to successful outcomes.

Selection of patients with breast cancer for routine follow-up bone scans

1990 ◽  
Vol 2 (6) ◽  
pp. 328-332 ◽  
Author(s):  
R.E. Coleman ◽  
I. Fogelman ◽  
F. Habibollahi ◽  
W.R.S. North ◽  
R.D. Rubens
Keyword(s):  
Breast Cancer ◽  
Bone Scans ◽  
Selection Of Patients ◽  
Selection Of

The Perth Surgical Wound Dehiscence Risk Assessment Tool (PSWDRAT): development and prospective validation in the clinical setting

2019 ◽  
Vol 28 (6) ◽  
pp. 332-344 ◽  
Author(s):  
Kylie Sandy-Hodgetts ◽  
Keryln Carville ◽  
Nick Santamaria ◽  
Richard Parsons ◽  
Gavin D. Leslie
Keyword(s):  
Risk Assessment ◽  
Predictive Power ◽  
Assessment Tool ◽  
Wound Dehiscence ◽  
Risk Assessment Tool ◽  
Anatomical Location ◽  
Surgical Wound ◽  
Previous Surgery ◽  
Postoperative Wound ◽  
Surgical Wound Dehiscence

Objective:The worldwide volume of surgery today is considerable and postoperative wound healing plays a significant part in facilitating a patient's recovery and rehabilitation. While contemporary surgical procedures are relatively safe, complications such as surgical wound dehiscence (SWD) or breakdown of the incision site may occur despite advances in surgical techniques, infection control practices and wound care. SWD impacts on patient mortality and morbidity and significantly contributes to prolonged hospital stay. Preoperative identification of patients at risk of SWD may be valuable in reducing the risk of postoperative wound complications.Method:A three-phase study was undertaken to determine risk factors associated with SWD, develop a preoperative patient risk assessment tool and to prospectively validate the tool in a clinical setting. Phases 1 and 2 were retrospective case control studies. Phase 1 determined variables associated with SWD and these informed the development of a risk assessment tool. Univariate analysis and multiple logistic regression were applied to identify predictors of surgical risk. Phase 2 used the receiver operator curve statistic to determine the predictive power of the tool. Phase 3 involved a prospective consecutive case series validation to test the inter-rater reliability and predictive power of the tool.Results:In addition to those already identified in the literature, one independent risk predictor for SWD was identified: previous surgery in the same anatomical location (p<0.001, odds ratio [OR] 4). Multiple combined factors were integrated into the tool and included: age (p<0.019, OR 3), diabetes (p<0.624, OR 2), obesity (p<0.94, OR 1.4), smoking (p<0.387, OR 2), cardiovascular disease (p<0.381 OR 3) and peripheral arterial disease (p<0.501, OR 3). The predictive power of the tool yielded 71% in a combined data sample.Conclusion:Patients with previous surgery in the same anatomical location were four times more likely to incur a dehiscence. Identification of at-risk patients for complications postoperatively is integral to reducing SWD occurrence and improving health-related outcomes following surgery.

Endoscopic Treatment of Subglottic and Tracheal Stenosis by Radial Laser Incision and Dilation

1987 ◽  
Vol 96 (6) ◽  
pp. 661-664 ◽  
Author(s):  
Stanley M. Shapshay ◽  
Roger L. Hybels ◽  
John F. Beamis ◽  
R. Kirk Bohigian
Keyword(s):  
Carbon Dioxide ◽  
Tracheal Stenosis ◽  
Endoscopic Treatment ◽  
Mechanical Trauma ◽  
Careful Selection ◽  
Tracheal Collapse ◽  
Laser Incision ◽  
Selection Of Patients ◽  
Selection Of

Five patients with severe fibrous subglottic and tracheal stenosis were treated by endoscopic radial laser incision and dilation using both carbon dioxide and neodymium:yttrium aluminum garnet lasers. Good results were noted without complications in all patients in a follow-up period of at least 1 year. Careful selection of patients, excluding those with tracheal collapse or tracheomalacia, and preservation of tracheal epithelium with minimal heat and mechanical trauma are considered essential for good results.

Six-Months, Fixed-Term, Once Weekly Psychotherapy: A Report on 20 Cases with Follow-ups

1972 ◽  
Vol 121 (563) ◽  
pp. 425-435 ◽  
Author(s):  
Harold Stewart
Keyword(s):  
Mode Of Action ◽  
Brief Psychotherapy ◽  
Maximum Period ◽  
Therapeutic Results ◽  
Psychotherapeutic Techniques ◽  
Selection Of Patients ◽  
Selection Of

The difficulties in providing adequate psychotherapy facilities in the N.H.S. are well known, and various psychotherapeutic techniques have been used to try to cope with them. Of these the most important have been variants of group and brief psychotherapy, and it is with the latter that this paper is concerned. The technique I have used in this series is to offer patients once-weekly psychotherapy for a maximum period of 6 months and then to terminate no matter what progress has been made, the patient having been informed of these conditions from the start. In this paper I shall consider the criteria used in the selection of patients, the technique and probable mode of action, a brief account of the cases with the therapeutic results obtained, and the follow-up on these cases.

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