scholarly journals Preoperative evaluation of the pacient with bronchopulmonary cancer

2021 ◽  
Vol 17 (1) ◽  
pp. 6-13
Author(s):  
Igor Maxim
Keyword(s):  
Myocardial Infarction ◽  
Surgical Treatment ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Advanced Lung Cancer ◽  
Functional Evaluation ◽  
Perioperative Mortality ◽  
Metabolic Equivalents ◽  
Number Of Patients ◽  
Postoperative Myocardial Infarction

BACKGROUND.In the Republic of Moldova, we have reported 983 cases of bronchopulmonary cancer (BPC) annually, in 2019. This impressive number of patients requires a more efficient mobilization of the medical system to solve these cases. AIM. The high incidence of newly diagnosed cases of BPC in advanced stages implies a reserved attitude for the surgical treatment of these patients, as well as the presence of associated pathologies, compromise more the situations, and the possibility to provide effective solutions to solve these cases. The group of patients who have tertiary prevention as a measure of treatment becomes imposing. This order of ideas outlines the need for a different medical-surgical approach for this category of patients. METHODS AND RESULTS.For the assessment of functional criteria for operability for patients with BPC, especially in advanced lung cancer, using comorbidity scores (ASA, Charlson, Elixhauser) and the formation of indications for surgical treatment are significant, because surgery offers the greatest opportunity for healing. The team responsible for the preoperative assessment should include both a perioperative mortality risk assessment and a postoperative pulmonary function prediction to optimally advise patients on anticipated outcomes. Due to both advanced cancer on presentation and comorbid conditions, only one-third of patients are ultimately considered candidates for surgical resection. Despite modern surgical, anesthetic, and postoperative techniques, there is still a perioperative mortality rate of 1-5%. Postoperative myocardial infarction is an important source of morbidity and mortality for those undergoing extensive lung resections, especially trans-pericardial pneumonectomies. Until surgery is suggested, preoperative evaluation of the cardiovascular system should be required for the existence of active heart disease (unstable angina, recent myocardial infarction, decompensated heart failure, arrhythmias, or valve defects).In addition to identifying cardiac risk factors, a preoperative assessment is incomplete without quantifying a patient's functional capacity. This can be achieved by the results of a formal stress test, measured in units of metabolic equivalents of task (MET). Geriatric assessment (GA) is a method used to collect information about the physical condition of elderly patients, which may be useful in estimating life expectancy and predicting treatment toxicity. GA includes an assessment of functional status, fatigue, cognitive function, mental health, nutritional status, the individual's ability to complete instrumental activities of daily living, comorbidities, social support, and the presence of geriatric syndromes. CONCLUSIONS. A thorough analysis of the results of diagnostic tests, referring to the functional evaluation of patients with advanced BPC and/or comorbidities, would allow the extension of surgical indications to obtain new results and increase over time the survival and quality of life of these patients.

scholarly journals Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Adam S. Weinstein ◽  
Martin I. Sigurdsson ◽  
Angela M. Bader
Keyword(s):  
Cardiac Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Metabolic Equivalents ◽  
Cardiac Stress Testing ◽  
Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

Surgical Management of Patients With 22q11.2 Deletion Syndrome

2019 ◽  
Vol 4 (5) ◽  
pp. 857-869
Author(s):  
Oksana A. Jackson ◽  
Alison E. Kaye
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Surgical Decision ◽  
Obstructive Sleep ◽  
Spine Abnormalities ◽  
Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
R King ◽  
D Giedrimiene
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Acute Myocardial Infarction ◽  
Primary Care Physician ◽  
Care Physician ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p< 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p< 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p < 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.

Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

2021 ◽  
pp. 000313482199506
Author(s):  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Won-Suk Lee ◽  
Jeong-Heum Baek
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Nonsurgical Treatment ◽  
Perioperative Outcomes ◽  
Rank Test ◽  
Kaplan Meier ◽  
Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

scholarly journals Perfil Epidemiológico da Espondilodiscite Tratada Cirurgicamente

2016 ◽  
Vol 29 (5) ◽  
pp. 319 ◽  
Author(s):  
Joaquim Soares do Brito ◽  
António Tirado ◽  
Pedro Fernandes
Keyword(s):  
Staphylococcus Aureus ◽  
Mycobacterium Tuberculosis ◽  
Surgical Treatment ◽  
Epidemiologic Study ◽  
Neurological Impairment ◽  
Tuberculous Infection ◽  
Paravertebral Abscess ◽  
Number Of Patients ◽  
Epidemiological Profile ◽  
Relative Constant

<p><strong>Introduction:</strong> The term spondylodiscitis aims to describe any spinal infection. Medical treatment is the gold standard; nevertheless, surgical treatment can be indicated. The aim of this work was to study the epidemiological profile in a group of patients with spondylodiscitis surgically treated in the same medical institution between 1997 and 2013. <br /><strong>Material and Methods:</strong> Eighty five patients with spondylodiscitis were surgically treated in this period. The authors analysed clinical data and image studies for each patient.<br /><strong>Results:</strong> We treated 51 male and 34 female patients with an average age of 48 years old (min: 6 - max: 80). The lumbar spine was more often affected and <em>Mycobacterium tuberculosis</em> the most frequent pathogen. The number of cases through the years has been grossly stable, with a slight increase of dyscitis due to <em>Staphylococcus aureus</em> and decrease of the dyscitis without pathogen identification. Paravertebral abscess was identified in 39 patients and 17 had also neurological impairment, mostly located in the thoracic spine and with tuberculous aetheology. Immunosuppression was documented in 10 patients. <br /><strong>Discussion:</strong> In this epidemiologic study we found a tuberculous infection, male gender and young age predominance. Despite a relative constant number of patients operated over the years, pyogenic infections due to <em>Staphylococcus aureus</em> seems to be uprising. Paravertebral abscess and neurological impairment are important dyscitis complications, especially in tuberculous cases.<br /><strong>Conclusion:</strong> Spinal infections requiring surgical treatment are still an important clinical condition. <em>Mycobacterium tuberculosis</em> and <em>Staphylococcus aureus</em> represent the main pathogens with a growing incidence for the latest.</p>

scholarly journals Myocardial Infarction as a Rare Cause of Otalgia

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Riza Dundar ◽  
Erkan Kulduk ◽  
Fatih Kemal Soy ◽  
Ersin Sengul ◽  
Faruk Ertas
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Surgical Treatment ◽  
Coronary Artery Stenosis ◽  
Pathological Finding ◽  
Neck Region ◽  
Abnormal Finding ◽  
Head And Neck Region ◽  
Severe Coronary Artery ◽  
Otoscopic Examination

Aim. To present a case referred to our clinic with severe right ear pain but without any abnormal finding during otological examination and diagnosed as myocardial infarction and also to draw attention to otalgia which can occur secondary to myocardial infarction.Case Report. An 87-year-old female admitted with right ear pain lasting for nearly 12 hours and sweating on the head and neck region. On otolaryngologic examination, any pathological finding was not encountered. Her electrocardiogram revealed findings consistent with myocardial infarction. Her troponin values were 0.175 ng/L at 1 hour, and 0.574 ng/L at 3 hours. The patient was diagnosed as non-ST MI, and her required initial therapies were performed. On cardiac angiography, very severe coronary artery stenosis was detected, and surgical treatment was recommended for the patient. The patient who rejected surgical treatment was discharged with prescription of medical treatment.Conclusion. Especially in elderly patients with complaints of ear pain but without any abnormal finding on otoscopic examination, cardiac pathologies should be conceived.

scholarly journals Rupture of the ventricular septum from myocardial infarction: Haemodynamic response to surgical treatment

Thorax ◽  
1969 ◽  
Vol 24 (1) ◽  
pp. 118-123 ◽  
Author(s):  
T. Partington ◽  
J. Somerville ◽  
T. H. Sellors ◽  
L. Resnekov
Keyword(s):  
Myocardial Infarction ◽  
Surgical Treatment ◽  
Ventricular Septum ◽  
Haemodynamic Response

Preoperative evaluation of coagulation status in neuromodulation patients

2021 ◽  
pp. 1-7
Author(s):  
Amir Hadanny ◽  
Zachary T. Olmsted ◽  
Anthony M. Marchese ◽  
Kyle Kroll ◽  
Christopher Figueroa ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
New Anticoagulants ◽  
Laboratory Values ◽  
Normal Ranges ◽  
Hematological Analysis ◽  
Coagulation Status ◽  
Pump Implantation ◽  
Deep Brain

OBJECTIVE The incidence of hemorrhage in patients who undergo deep brain stimulation (DBS) and spinal cord stimulation (SCS) is between 0.5% and 2.5%. Coagulation status is one of the factors that can predispose patients to the development of these complications. As a routine part of preoperative assessment, the authors obtain prothrombin time (PT), partial thromboplastin time (PTT), and platelet count. However, insurers often cover only PT/PTT laboratory tests if the patient is receiving warfarin/heparin. The authors aimed to examine their experience with abnormal coagulation parameters in patients who underwent neuromodulation. METHODS Patients who underwent neuromodulation (SCS, DBS, or intrathecal pump implantation) over a 9-year period and had preoperative laboratory values available were included. The authors determined abnormal values on the basis of a clinical protocol utilized at their practice, which combined the normal ranges of the laboratory tests and clinical relevance. This protocol had cutoff values of 12 seconds and 39 seconds for PT and PTT, respectively, and < 120,000 platelets/μl. The authors identified risk factors for these abnormalities and described interventions. RESULTS Of the 1767 patients who met the inclusion criteria, 136 had abnormal preoperative laboratory values. Five of these 136 patients had values that were misclassified as abnormal because they were within the normal ranges at the outside facility where they were tested. Fifty-one patients had laboratory values outside the ranges of our protocol, but the surgeons reviewed and approved these patients without further intervention. Of the remaining 80 patients, 8 had known coagulopathies and 24 were receiving warfarin/heparin. The remaining 48 patients were receiving other anticoagulant/antiplatelet medications. These included apixaban/rivaroxaban/dabigatran anticoagulants (n = 22; mean ± SD PT 13.7 ± 2.5 seconds) and aspirin/clopidogrel/other antiplatelet medications (n = 26; mean ± SD PT 14.4 ± 5.8 seconds). Eight new coagulopathies were identified and further investigated with hematological analysis. CONCLUSIONS New anticoagulants and antiplatelet medications are not monitored with PT/PTT, but they affect coagulation status and laboratory values. Although platelet function tests aid in a subset of medications, it is more difficult to assess the coagulation status of patients receiving novel anticoagulants. PT/PTT may provide value preoperatively.

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