scholarly journals Preoperative assessment and preparation of patients with neurologic disorders

2011 ◽  
Vol 58 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Ivan Palibrk ◽  
Nevena Kalezic ◽  
Cedomir Vucetic ◽  
Ivan Dimitrijevic ◽  
Vladimir Arsenijevic ◽  
...  
Keyword(s):  
Significant Contribution ◽  
Disease Duration ◽  
Surgical Intervention ◽  
Neurological Diseases ◽  
Preoperative Assessment ◽  
Postoperative Recovery ◽  
Patient History ◽  
Patient Medication ◽  
Neurologic Disorders ◽  
Undiagnosed Diseases

Ageing of population world wide has significant contribution as one of the major risk factor for neurodegenerative disorders. The patients with neurodegenerative as well as other neuological diseases presented the population with possible great need either of small or big surgical intervention. There are several important issues in patients with neurological diseases: the nature, disease duration, therapy, the patient?s ability to live without assistance. Neurological disease may become worst by general and regional anesthesia. Stopping therapy may lead to worsening of neurological diseases. One of the main common threat is the risk of significant cardiorespiratory complications, which is important in assessing operational risk, in preoperative preparation and in terms of postoperative recovery and outcomes of surgical treatment. This has resulted in greater preoperative care by detailed patient history evaluation and examination, patient information and informed consent. Besides the effect of the anaesthetic technique upon the course of the disease, there is also the interaction of drugs administered during anaesthesia and patient medication. Several undiagnosed diseases may be disclosed following a surgical/anaesthetic intervention.

Preoperative Predictors and Costs of 30-Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States

2021 ◽  
pp. 019459982098070
Author(s):  
Habib Khoury ◽  
Shaghauyegh S. Azar ◽  
Hannah Boutros ◽  
Nina L. Shapiro
Keyword(s):  
Health Care ◽  
Financial Burden ◽  
Preoperative Assessment ◽  
Health Care Expenditures ◽  
The United States ◽  
Postoperative Hemorrhage ◽  
International Classification Of Disease ◽  
Neurologic Disorders ◽  
Common Causes ◽  
National Trends

Objectives To understand national trends in 30-day postoperative readmission following inpatient pediatric tonsillectomy and adenoidectomy. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Methods We used the Nationwide Readmissions Database to identify and analyze 30-day readmissions following inpatient tonsillectomy from 2010 to 2015. Using the International Classification of Disease codes, we identified 66,652 patients and analyzed the incidence, causes, risk factors, and costs of 30-day readmission. Results Of 66,652 patients who underwent inpatient tonsillectomy, 2660 (4.0%) experienced a readmission. Readmitted patients were more commonly aged <2 years (23.4 vs 10.6%, P = .01) and had a greater burden of comorbidities, including preoperative anemia (3.9 vs 1.3%, P < .001), coagulopathy (3.5 vs 1.4%, P < .001), and neurologic disorders (19.1 vs 6.6%, P < .001). Readmitted patients experienced higher rates of postoperative complications (17.4 vs 9.0%, P < .001) and had a longer length of stay (4.5 vs 2.2 days, P < .001). Index cost of hospitalization was higher among readmitted patients ($14,129 vs $7307, P < .001), and each readmission cost an additional $7576. Postoperative hemorrhage (21.3%) and dehydration (17.7%) were the 2 most common causes for readmission. Independent predictors of readmission included age <3 years, multiple comorbidities, and postoperative neurologic complications. The incidences of tonsillectomies and readmissions declined during the study period, most notably between 2010 and 2012. Conclusion Readmission after inpatient tonsillectomy and adenoidectomy places a substantial financial burden on the health care system. Targeted strategies to improve preoperative assessment and optimize postoperative care may prevent readmission, reduce unnecessary health care expenditures, and improve patient outcomes.

scholarly journals Neurosurgical procedures in pregnancy

2003 ◽  
Vol 18 (1) ◽  
pp. 01-13 ◽  
Author(s):  
Bayram Cirak ◽  
Nejmi Kiymaz ◽  
Memduh Kerman ◽  
Kadir Tahta
Keyword(s):  
Surgical Intervention ◽  
Neurosurgical Procedures ◽  
Low Back ◽  
Intracranial Tumors ◽  
The Past ◽  
Neurologic Disorders ◽  
Neurologically Intact ◽  
Neurosurgical Intervention ◽  
In Pregnancy

PURPOSE: Over the past few decades maternal mortality has progressively declined because of improved management of the major obstetric problems of hemorrhage, infection, and toxemia. As a result, the relative incidence of deaths resulting from non obstetric causes has increased. Chief among nonobstetric causes are neurologic disorders. Those most common during pregnancy are low back pain, intracranial tumors, subarachnoid hemorrhage, and neurotrauma. The management of the neurosurgical pathologies during pregnancy needs some specifications for both the mother and the fetus. METHODS: We performed a retrospective study evaluating the clinical, radiological, and surgical characteristics of 9 patients who have cranial neuropathologies and have undergone neurosurgical intervention. RESULTS: Most of the patients in this study had vaginal delivery. Prominent neurosurgical disease related to cerebral damage. Every patient underwent a laboratory and radiological evaluation. All except one survived the neurosurgical pathology. Neither baby nor mother had significant problem during delivery and neurosurgical intervention. CONCLUSION: Pregnant women may face to every kind of neurosurgical pathology that nonpregnant women have faced. In addition, pregnancy itself, gives rise some metabolic changes in the women and those changes may cause some neurologic pathologies to be symptomatic or to aggravate the present symptomatology. Because of those reasons, close neurologic follow up of a pregnant woman is of vital importance. At the end of a pregnancy having experienced some neurologic interventions including diagnostic evaluation or surgical intervention does not necessitates the cesarean section for a neurologically intact infant and mother.

scholarly journals Detecting and Monitoring Brain Disorders Using Smartphones and Machine Learning

2020 ◽  
Author(s):  
Rich Colbaugh ◽  
Kristin Glass ◽  
Volv Global
Keyword(s):  
Machine Learning ◽  
Neurological Diseases ◽  
Disease Status ◽  
Sensor Data ◽  
Care Seeking ◽  
Brain Disorders ◽  
Real Patient ◽  
Data Collection And Analysis ◽  
Interpretable Models ◽  
Undiagnosed Diseases

AbstractThe ubiquity of smartphones in modern life suggests the possibility to use them to continuously monitor patients, for instance to detect undiagnosed diseases or track treatment progress. Such data collection and analysis may be especially beneficial to patients with i.) mental disorders, as these individuals can experience intermittent symptoms and impaired decision-making, which may impede diagnosis and care-seeking, and ii.) progressive neurological diseases, as real-time monitoring could facilitate earlier diagnosis and more effective treatment. This paper presents a new method of leveraging passively-collected smartphone data and machine learning to detect and monitor brain disorders such as depression and Parkinson’s disease. Crucially, the algorithm is able learn accurate, interpretable models from small numbers of labeled examples (i.e., smartphone users for whom sensor data has been gathered and disease status has been determined). Predictive modeling is achieved by learning from both real patient data and ‘synthetic’ patients constructed via adversarial learning. The proposed approach is shown to outperform state-of-the-art techniques in experiments involving disparate brain disorders and multiple patient datasets.

scholarly journals Multimodal anesthesia and analgesia at the stages of the perioperative period in children with abdominal surgical pathology

2021 ◽  
Vol 24 (1) ◽  
pp. 27-31
Author(s):  
Elmira A. Satvaldieva ◽  
Otabek Ya. Fayziev ◽  
Anvar S. Yusupov
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Postoperative Recovery ◽  
Surgical Pathology ◽  
Abdominal Organ ◽  
Epidural Blockade ◽  
Abdominal Operations

Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children. Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine. Results. According to surgical intervention, the arrangement of perioperative analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic, promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid postoperative recovery.

scholarly journals Esophagoplasty in patients with burn strictures of the esophagus

2011 ◽  
Vol 4 (1) ◽  
pp. 57-62
Author(s):  
Yury Vladimirovich Cikini ◽  
Evgeny Aleksandrovich Drobyazgin ◽  
Anton Vadimovich Kutepov ◽  
Inessa Viktorovna Berkasova
Keyword(s):  
Quality Of Life ◽  
Disease Duration ◽  
Surgical Intervention ◽  
Long Term Results ◽  
Stomach Tube ◽  
Left Half

Esophagoplasty in cicatricial narrowing of the esophagus is made postburns 116 patients. Disease duration - from 1 month to 31 years. Subtotal shunt esophagocolonoplastik left half of the colon made 68, extirpation of the esophagus with a plastic colon 9, extirpation of the esophagus with a plastic stomach tube in 38 patients. Long-term results of surgical intervention were studied in all patients during the period from 1 month to 13 years. Study of long-term results and quality of life after esophagoplasty showed significant benefits extirpation of the esophagus with esophagogastroplasty before esophagocolonoplastik.

What is syncope for a neurologistIwona

2019 ◽  
Vol 3 (52) ◽  
pp. 12-17
Author(s):  
Iwona Kurkowska-Jastrzębska
Keyword(s):  
General Practitioner ◽  
Neurodegenerative Disease ◽  
Cardiac Arrhythmias ◽  
Refractory Epilepsy ◽  
Neurological Diseases ◽  
Disease Onset ◽  
Epileptic Seizures ◽  
Loss Of Consciousness ◽  
Patient History ◽  
Common Causes

Introduction: Fainting is one of the most common reasons for consulting patients in emergency departments. Diagnosis of a loss of consciousness is usually carried out by an general practitioner and possibly a cardiologist and neurologist, and the most important elements include a well-collected patient history taken from the patient and reliable witness. Aim: The paper discusses the most common causes of loss of consciousness diagnosed by a neurologist: syncope associated with dysautonomy in the course of neurological diseases, seizures and seizure caused cardiac arrhythmias. Summary: Syncope and dysautonomy may precede neurodegenerative disease onset. Difficulties in differentiating syncope and epileptic seizures cause about 10% of false diagnoses of refractory epilepsy.

Preoperative Palliative Care Assessment, Frailty, and Prognostication

2019 ◽  
pp. 55-65
Author(s):  
Bridget N. Fahy ◽  
Myrick C. Shinall
Keyword(s):  
Palliative Care ◽  
Surgical Intervention ◽  
Preoperative Assessment ◽  
Postoperative Outcomes ◽  
Correct Operation ◽  
Surgical Risk ◽  
Goals Of Care ◽  
Care Assessment ◽  
Patient Values ◽  
The Right

Preoperative assessment involves assessing a patient’s physiologic fitness for surgery; counseling patients about risks, benefits, and alternatives to surgical intervention; and prognosticating about anticipated postoperative outcomes. The most challenging scenarios involve patients who are marginal surgical candidates, when the outcome of the operation is uncertain, or when the goals of the operation are not well defined. Under these circumstances, applying the key tenets of surgical palliative care is essential. Surgeons must be able to address goals of care by incorporating patient values, preferences, hopes, and fears. With this information, surgeons are then prepared to ensure that the right patient undergoes the correct operation at the right time. Tools available to surgeons as they perform these aspects of preoperative assessment and prognostication include frailty indices and surgical risk calculators.

scholarly journals Canalicular Curettage to the Rescue: a report of three cases

2020 ◽  
Vol 12 (2) ◽  
pp. 333-338
Author(s):  
Sabin Sahu ◽  
Prerna Arjyal Kafle ◽  
Diwa Hamal ◽  
Adit Gupta ◽  
Dipesh Kumar Ram ◽  
...  
Keyword(s):  
Conservative Management ◽  
Surgical Procedure ◽  
Foreign Bodies ◽  
Surgical Intervention ◽  
Postoperative Recovery ◽  
Squamous Papilloma ◽  
Size And Shape ◽  
Silicone Stent ◽  
Successful Outcomes

Introduction: Canalicular curettage is a surgical procedure used to remove canalicular contents and debris from canaliculi. It is usually indicated for chronic, persistent or recalcitrant canalicular diseases with no resolution of symptoms after conservative management. We describe 3 different cases of persistent canalicular diseases which needed canalicular curettage to rescue from the conditions leading to successful outcomes. Cases and observations:• Case 1: A 45-year-old male presented with recurrent punctal granuloma 3 months after DCR surgery. Canalicular exploration and curettage with one-snip punctoplasty following excision of the mass revealed a segment of remnant silicone stent. There was no recurrence of mass in subsequent follow up visits.• Case 2: A 35-year-old female presented with recurrent canaliculitis for last 6 months. Canalicular curettage revealed multiple small calcified masses of varying size and shape. The patient had good postoperative recovery and showed no recurrence of symptoms.• Case 3: A 32-year-old female presented with gradually increasing pedunculated mass arising out of punctum for last one month. Excision of mass with canalicular curettage was done. Biopsy proved it to be squamous papilloma of the canaliculi. There was no recurrence of mass. Conclusion: Canalicular curettage is a simple, safe and effective surgical intervention to rescue from the recalcitrant canalicular conditions like canaliculitits, retained foreign bodies, canalicular neoplasms leading to successful outcomes.

scholarly journals Radiculopathy in the setting of lumbar nerve root compression due to an extradural intraforaminal lipoma: a report of 3 cases

2015 ◽  
Vol 23 (1) ◽  
pp. 55-58 ◽  
Author(s):  
Daniel B. Loriaux ◽  
Owoicho Adogwa ◽  
Oren N. Gottfried
Keyword(s):  
Surgical Intervention ◽  
Treatment Guidelines ◽  
Postoperative Recovery ◽  
Clinical Suspicion ◽  
Spinal Lipoma ◽  
Compression Neuropathy ◽  
Lumbar Nerve Root ◽  
Spinal Epidural ◽  
Herniated Discs ◽  
Early Surgical Intervention

A true adult spinal lipoma is an exceedingly rare cause of lumbar compression neuropathy. Only 5 cases of true extradural intraforaminal lipomas have been documented in the medical literature. The diagnostic criteria and treatment guidelines for this specific lipoma have yet to be established. This report features 3 histologically confirmed cases of extradural intraforaminal spinal lipomas that recently presented to the authors’ practice. In addition, the literature was surveyed to include the 5 previously reported cases of true adult extradural intraforaminal spinal lipomas. The consistency in presentation, response to surgical intervention, and postoperative recovery in these 8 cases supports surgical intervention at the time of diagnosis. The authors’ findings support elevated clinical suspicion, efficient diagnosis based on MRI, and early surgical intervention for this rare pathological entity. All cases presented in this report were symptomatic and occurred in the absence of other significant pathologies such as general spinal epidural lipomatosis, intradural lesions, tethering, or severe degenerative stenosis or herniated discs. The clinical, neuroradiological, and histological findings characteristic of a true adult extradural intraforaminal lipoma are emphasized to differentiate this lesion from the more common etiologies for lumbar compression neuropathy. Heightened awareness and clinical suspicion for the focal, foraminal spinal lipoma as a cause of radiculopathy symptoms will enable more efficient diagnosis and treatment.

scholarly journals Patient-Centered Approach Might Effectively Tackle The Definition Of Progression In Chronic Neurological Diseases: Results From The EmBioProMS Trial In Progressive Multiple Sclerosis

2021 ◽  
Author(s):  
Ahmed Abdelhak ◽  
Markus Krumbholz ◽  
Makbule Senel ◽  
Joachim Havla ◽  
Uwe K. Zettl ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Progression ◽  
Disease Duration ◽  
Inflammatory Diseases ◽  
Neurological Diseases ◽  
Clinical Care ◽  
Final Analysis ◽  
Progressive Multiple Sclerosis ◽  
Patient Reported Outcome ◽  
Patient Reported

AbstractBackgroundProper identification of disability accumulation in the routine clinical care of progressive multiple sclerosis (PMS) patients is usually a challenging task. Patient-reported outcome measurements (PROMs) can provide a practical, cost-efficient, and remotely accessible tool to assess disease progression.MethodsEmBioProMS is a prospective, multicentric cohort, conducted in 7 specialized MS centers in Germany. PROMs were evaluated at inclusion and compared between patients with retrospective evidence of disease progression in the last two years and those with stable disease. Patients with either primary or secondary progressive MS according to the McDonald criteria 2017 were included in the analysis, while patients with incomplete PROMs scores, MS relapses, other neurological or systemic inflammatory diseases were excluded. The disease progression was assessed using a combined outcome parameter, including EDSS score, timed 25-foot walk test, and nine-hole-peg test.Results185 patients were included in the final analysis (SPMS, n=77; PPMS, n=108). The median age and disease duration were 55 years and 13 years, respectively. Disease progression was diagnosed in 114 of 185 patients (61.6%). BDI-II, MSIS-29, and FSMC scores were worse in patients with evidence of disease progression in the last two years. Patients with any of the included PROMs above the 90th percentile had an odds ratio of 3.8 (95% confidence interval: 1.4–10.6, P=0.01) for having progression in the last two years in a binomial regression model adjusted for age, sex, disease duration, treatment status, center effect, and Expanded Disability Status Scale (EDSS). Similar results were observed in patients with PROM scores in the 80th and 70th percentile (OR: 2.9 and 3.7, P=0.015 and 0.003, respectively).ConclusionPROMs can be a simple and effective way to detect disability worsening in a chronic neurological disease like PMS and, therefore, substantially contribute to better classification and prognostication of the disease course through objective and structural patient-doctor communication.Trial RegistrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien - DRKS), DRKS00020132

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