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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is increasing evidence to support the hypothesis that epidural anesthesia and analgesia (EAA) can improve surgical outcome by reducing postoperative morbidity and hastening recovery. Likely benefits include decreased incidence of cardiac complications in high-risk patients; lower incidence of pulmonary complications, specifically pneumonia, atelectasis, and hypoxemia in patients at risk for pulmonary complications; lower incidence of vascular graft occlusion after lower extremity revascularization; lower incidence of DVT and pulmonary embolus; suppression of the neuroendocrine stress response; and earlier return of gastrointestinal function. Nonetheless, large multicenter prospective randomized studies are required to more definitively assess the impact of EAA on morbidity and mortality, ICU time, length of hospitalization, and cost of healthcare.
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PMID:The role of epidural anesthesia and analgesia in postoperative outcome. 1093 17

Purpose: To assess the cost of implementing 18F-Fluorodeoxyglucose (18FDG) PET scan in the presurgical evaluation of patients with hepatic metastases from colorectal cancer (CRC) detected by Computed Tomography with arterial portography (CTAP).Methods: We performed a cost analysis of two diagnostic pathways based on a population of CRC patients with metastatic disease limited to the liver by (CTAP). The payers' perspective was utilized. The algorithms compared 18FDG-PET with Computed Tomography (CT) versus CT alone. Patients found to have extrahepatic disease by 18FDG-PET or CT were assigned to palliative care. Patients found to be negative for extrahepatic extension were assumed to be surgically resectable. The prevalence of extrahepatic disease, true and false positives and negatives for CT and 18FDG-PET were extracted from published reports (Medline, 1991 to 1999). Three possible outcomes for surgery were considered: uncomplicated, complicated, and death. Surgical complications considered were: urinary tract infection, wound sepsis, intra-abdominal abscess, septicemia, pneumonia, deep venous thrombosis, pulmonary embolism, anemia requiring transfusion, and myocardial infarction. Complication rates, costs for CT, CTAP, 18FDG-PET, surgery and post-surgical complications were obtained from HCFA published data (1997-2000). Palliative care costs were assumed to be identical in both branches.Results: Average expected cost per patient with 18FDG-PET was $16,921, compared to $21,693 for a patient without PET scan. This represents net savings of $4,772 if PET is included in the diagnostic work up.Conclusion: Integration of 18FDG-PET in the presurgical evaluation of patients with liver metastases from CRC by CTP would substantially reduce overall costs.
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PMID:10. Positron Emission Tomography in the Presurgical Evaluation of Patients with Resectable Liver Metastases from Colorectal Carcinoma Detected by Computed Tomography with Arterial Portography. A Cost Analysis. 1115 Jul 67

Pulmonary embolism is nearly always a complication of deep venous thrombosis. The evaluation of risk factors for venous thromboembolism not only aids diagnosis but also guides decisions about the intensity of prophylactic measures. As both the extent and chronicity of pulmonary vascular obstruction vary widely, pulmonary embolism can produce widely differing clinical pictures. From the clinical, pathophysiological and therapeutical point of view, it is convenient to classify pulmonary embolism into four types: acute minor embolism (dyspnoea with or without pleuritic pain or haemoptysis), acute massive embolism (hemodynamic instability), subacute massive embolism (mimicking heart failure or indolent pneumonia), and chronic thromboembolic pulmonary hypertension (slowly progressing dyspnoea). This classification is of importance not only for the rational diagnosis and differential diagnosis, but also for the institution of adequate therapy. Because the disease has many nonspecific manifestations but no pathognomonic symptoms or signs, it is impossible to prove the diagnosis of pulmonary embolism alone on the basis of clinical presentation.
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PMID:[Clinical characteristics of pulmonary embolism]. 1121 69

Pulmonary embolism (PE) was believed to be a rare disease and often misdiagnosed in Thailand. Only a few cases of PE in Thai patients have been reported. The purpose of this study was to describe the characteristics of history, physical examination and laboratory investigations in Thai patients with PE. Forty-nine patients diagnosed as PE in Phramongkutklao Hospital between 1994 and 1998 were included in the study. All patients underwent complete history, physical examination and appropriate laboratory studies. The mean age of this patient group was 53 years. Thirty-four per cent of these patients were first suspected of lung embolism while the others were misdiagnosed as congestive heart failure, myocardial infarction, pneumonia or septic shock. The most common syndrome was isolated dyspnea. Interestingly, chronic thromboembolic pulmonary hypertension which is uncommonly found in western countries was diagnosed in 12 per cent of our patients. Dyspnea, pleuritic pain, leg swelling, cough, tachypnea, tachycardia and increased pulmonary component of second heart sound were common symptoms and signs. A high-probability ventilation/perfusion lung scan and deep vein thrombosis were demonstrated in 93 per cent and 55 per cent of our patients, respectively. The mortality rate was 10 per cent.
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PMID:Clinical and laboratory findings in patients with pulmonary embolism in Phramongkutklao Hospital. 1125 85

A 28-year-old woman with systemic lupus erythematosus and a history of aseptic meningitis, digestive bleeding due to thrombopenia and deep venous thrombosis underwent elective cesarean for transverse presentation at 35 weeks. Preoperative blood work-up showed an antinuclear antibody titre that was slightly positive and steroid treatment was started. Surgery operation was performed with general anesthesia. The outcome was satisfactory even though serious complications can develop during the management of anesthesia in such patients. Systemic lupus erythematosus is a chronic, multisystemic disease that mainly affects women of childbearing age. Antibodies and immunocomplexes play a fundamental role. Given the multiorgan involvement in this disease, preoperative study of the lupus patient should assess all such involvement, including maternal-fetal risk, as well as consider the drug and anesthetic management to be applied. Among the clinical signs that can affect management of anesthesia are the following: aseptic meningitis, high blood pressure, pericarditis, pneumonitis and recurrent venous thrombosis. Anemia, thrombopenia and significantly altered coagulation events are common.
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PMID:[Systemic lupus erythematosus in the pregnant patient. Implications for anesthesia]. 1133 98

Large femoral cortical strut allografts were used to provide structural support of the femur in 20 patients in whom uncemented, extensively porous-coated, press-fit revision femoral stems were applied. The mean followup was 4.7 years. Radiographic analysis of the patients who had revision surgery revealed that in all 20 patients, the cortical femoral strut allografts showed incorporation. Small areas of graft resorption were observed in only two patients. Seventeen of the uncemented femoral revision stems radiographically showed bone ingrowth. Three of the revision femoral stems were interpreted as being fixed only by fibrous ingrowth after early subsidence after surgery. There were no reoperations. Before surgery, all patients were unable to walk and had severe pain. At followup, all patients were ambulatory and had considerable improvement in pain relief and in their ability to walk. The mean Harris hip score after surgery was 75 (range, 57.5-92). Complications consisted of one peroneal nerve palsy, which resolved; one deep venous thrombosis; one gastrointestinal ulcer; and one case of pneumonia. Supportive cortical strut allografts represent an alternative to the use of circumferential bulk allografts and total femoral replacements in patients with large combined proximal and diaphyseal bone defects.
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PMID:Supportive strut grafts for diaphyseal bone defects in revision hip arthroplasty. 1140 Aug 76

Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.
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PMID:Proximal femoral fractures. 1259 64

A prospective study of patients with ventral hernias was undertaken to study the experience with an open intraperitoneal underlay technique utilizing a bilayer prosthetic mesh. From September 1998 to March 2001, 102 patients underwent repair with a bilayer expanded polytetrafluoroethylene (ePTFE) and polypropylene mesh placed intraperitoneally and fixed in place with full-thickness abdominal muscle wall sutures to achieve a 5-cm underlay of the fascial defect circumferentially. There were 67 females and 35 males ranging in age from 29 to 76 years (mean 53 years). Average patient weight was 207 lb with 64 patients in the obese category. Forty patients presented with recurrent hernias. Mean operative time was 103 minutes with an average diameter hernia defect size of 15 cm. Median hospital stay was 3 days. There was no surgical mortality, and major morbidity occurred in six patients (2 wound infections, one deep vein thrombosis, one myocardial infarction, one pneumonia, and one pulmonary embolus). Mean follow-up is 28 months (range 12-42 months). No recurrence has been found with 100 per cent follow-up to date. No bowel obstruction or enteric fistulas have occurred during the follow-up period. The open intraperitoneal underlay mesh technique can be performed with a zero per cent early recurrence rate. Bilayer prosthetic mesh composed of ePTFE and polypropylene can be safely placed intraperitoneally without causing intestinal obstruction or enteric fistula.
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PMID:Intraperitoneal underlay ventral hernia repair utilizing bilayer expanded polytetrafluoroethylene and polypropylene mesh. 1271 85

The scar abdomen is more and more seldom a contraindication of the laparoscopic approach. According to Rohr it is classified in scar abdomen after Mac Burney, suprapubic or supraumbilical approach and of the polyoperated patients. Our trial consists in 452 patients with laparoscopic operations consecutive open abdominal surgery (out of the 3900 patients undergoing celioscopic procedures between 1995-2001). The laparoscopic procedure was performed distant to the previous operation in 95.1%, on a neighboring organ to that initially conventionally operated in 4.1% or on the same organ in 3 patients (0.8%). We lead no preoperative fatalities, but the conversational rate was 12% (54 patients), due to the high-risk dissection or to the unsolvable bleedings by laparoscopic means (2 cases). The operative accidents consisted in visceral injuries soloed by laparotomy. Postoperatively we registered 5 port site seronas, 1 deep vein thrombosis and 1 pneumonia. The evolution and the mean hospitalization was the same for the scar abdomen patients with the operative procedure accomplished laparoscopically as for non previously operated patients. The data support the feasibility of the laparoscopic procedures on scar abdomen, using the "open laparoscopy" with a reasonably increased conversational rate.
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PMID:[The laparoscopic procedures on abdomen with adhesions]. 1273 Dec 19

This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.
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PMID:Preoperative teaching and hysterectomy outcomes. 1281 43


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