304 research outputs found
Improving Multidisciplinary Teamwork in Preoperative Scheduling
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162862.pdf (Publisher’s version ) (Open Access)RU Radboud Universiteit, 11 januari 2017Promotores : Lauche, K., Amelsvoort, P.J.L.M. van, Gooszen, H.G.248 p
Persisting symptoms and decreased health-related quality-of-life in a cross-sectional study of treated achalasia patients
No full textCopyright © 2007 The Authors The definitive version is available at www.blackwell-synergy.comSummaryBackgroundLittle is known about symptom characteristics of treated achalasia patients and their effect on health‐related quality‐of‐life (HRQoL).AimsTo examine clinical remission, achalasia‐associated symptoms and HRQoL in treated achalasia patients.MethodsThe Eckardt clinical symptom score, RAND‐36 and a disease‐specific HRQoL questionnaire were sent to 171 treated achalasia patients.Results76.6% of the patients returned their questionnaire. 44.9% of them were not in symptomatic remission. Prevalence of frequent dysphagia (at least daily) and chest pain (at least weekly) was 46% and 38%, respectively. Achalasia patients had lower general HRQoL scores than control subjects (all RAND‐36 subscales, except health change; P ≤ 0.002). Patients with frequent symptoms of chest pain and dysphagia showed lower HRQoL than patients with less frequent symptoms on three RAND‐36 subscales (pain, social functioning and general health perceptions; P < 0.003). Patients in clinical remission showed higher HRQoL than patients who were not, however HRQoL in the ‘remission group’ remained significantly impaired as compared to controls (all RAND‐36 subscales except emotional role limitations and mental health; P < 0.001).ConclusionsMany achalasia patients remain severely symptomatic after treatment and have decreased HRQoL. Frequent symptoms are associated with lower HRQoL. Patients in clinical remission show substantially improved, but not restored HRQoL.R. Frankhuisen, M. A. Van Herwaarden, R. Heijkoop, A. J. P. M. Smout, A. Baron, J. R. Vermeijden, H. G. Gooszen and M. Samso
Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study
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110654.pdf (Publisher’s version ) (Open Access)ABSTRACT: The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38 degrees C or less than 36 degrees C by the third post-operative day were statistically significant indicators of patient mortality
Prevention and Intervention Strategies in Acute Pancreatitis
No full textAcute pancreatitis is a common, costly, potentially lethal, and poorly understood disease, mostly caused by gallstones. In the past decade the incidence of acute pancreatitis in the Netherlands increased by 50% to over 3400 admissions in 2006, most likely due to an increase of gallstone disease. About 20% of patients will develop severe acute pancreatitis, a disease characterized by organ failure and/or pancreatic necrosis, resulting in a high mortality rate. Because the incidence of acute pancreatitis is increasing rapidly and it is estimated that about 80% of deaths are associated with infections, especially infected pancreatic necrosis, the main aim of this thesis was to develop and test (A) Prevention strategies; aimed at preventing acute pancreatitis and associated infections, and (B) Intervention strategies; aimed at improving outcome of intervention in patients with infected pancreatic necrosis. Most studies described in this thesis are performed by the centres participating in the Dutch Acute Pancreatitis Study Group (2002), including all Dutch university medical centres. Prevention Strategies Previous, small, retrospective studies had suggested that ursodeoxocholic acid was capable of preventing biliary pancreatitis in patients with symptomatic gallstone disease. We disproved this suggestion in a randomised, double-blind, placebo-controlled multicenter trial. Previous, small, placebo-controlled randomised trials had suggested a beneficial effect of probiotic prophylaxis in acute pancreatitis. We performed a randomised double-blind placebo-controlled trial on probiotic prophylaxis in 296 patients and found that in fact mortality doubled due to the use of probiotic prophylaxis. In a follow-up study we found that the negative effect of probiotics was related to intestinal small bowel mucosal damage but solely in patients with organ failure receiving probiotics. In a second follow-up study we found that infections complications occurred much earlier in the course of acute pancreatitis, already in the first days, than previously expected. New studies should therefore start prophylactic therapy earlier than is currently practiced. Intervention Strategies The overall mortality rate for infected pancreatic necrosis in 11 large hospitals in the Netherlands was found to be as high as 34%. The results of minimally invasive approaches seemed promising but their general applicability in patients with infected necrotizing pancreatitis was unknown. In a follow-up study we found that 84% of patients could have been treated via a minimally invasive approach. It had furthermore been suggested that delaying surgical intervention in infected pancreatic necrosis facilitates safer intervention. We confirmed this hypothesis in a systematic review and concluded that, whenever possible, necrosectomy should be postponed until 30 days after initial hospital admission so that the collection becomes encapsulated. The type of intervention in patients with infected peripancreatic collections containing depends on their content (fluid and/or necrosis) as depicted by CT scan. We performed the first interobserver study on the international Atlanta classification (1992) and found that five experienced radiologists agreed in only 4% of cases on the definition of the collection. It was concluded that the Atlanta classification should be revised, a process that is currently indeed underway
Systematic review: open, small-incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis.
No full textItem does not contain fulltextBACKGROUND: Laparoscopic cholecystectomy has become the method of choice for gallbladder removal, although evidence of superiority over open and small-incision cholecystectomy is lacking. AIM: To compare the effects of open, small-incision and laparoscopic cholecystectomy techniques for patients with symptomatic cholecystolithiasis. METHODS: We conducted updated searches until January 2007 in multiple databases. We assessed bias risk. RESULTS: Fifty-nine trials randomized 5556 patients. No significant differences in primary outcomes (mortality and complications) were found among all three techniques. Both minimal invasive techniques show advantages over open cholecystectomy in terms of convalescence. Small-incision cholecystectomy showed shorter operative time compared with laparoscopic cholecystectomy (random effects, weighted mean difference, 16.4 min; 95% confidence interval, 8.9-23.8), but the two techniques did not differ regarding hospital stay and conversions. CONCLUSIONS: No significant differences in mortality and complications were found among all three techniques. Laparoscopic cholecystectomy and small-incision cholecystectomy are preferred over open cholecystectomy for quicker convalescence. Laparoscopic cholecystectomy and small-incision cholecystectomy show no clear differences on patient outcomes
Early versus on-demand tube feeding in pancreatitis
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155104.pdf (Publisher’s version ) (Open Access
Avaliação clínica dos resultados tardios na cirurgia anti-refluxo vídeo-laparoscópica.
No full textTrabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Dapartamento de Clínica Cirúrgica
Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus
No full textItem does not contain fulltextBACKGROUND AND OBJECTIVE: The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. METHODS: A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. RESULTS: The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. CONCLUSIONS: This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption
A prospective study on the effect of the Belsey Mark IV 270-degree fundoplication on lower esophageal sphincter characteristics and esophageal body motility
No full textAbstractThe effect of the Belsey Mark IV operation on lower esophageal sphincter characteristics and esophageal body motor function was prospectively studied in 38 patients who underwent successful operation (relief of symptoms, healing of esophagitis; group I) and 8 who had surgical failure (group II). Mean follow-up was 3 years (0.5 to 8 years). Only in group I a rise in basal lower esophageal sphincter pressure (from 8.3 ± 0.8 mm Hg to 14.5 ± 0.5 mm Hg, p < 0.001), total sphincter length (from 2.7 ± 0.1 cm to 3.4 ± 0.1 cm, p < 0.001), and the intraabdominal sphincter segment (1.3 ± 0.1 cm to 2.3 ± 0.1 cm, p < 0.001) with a reduction of the intrathoracic segment (from 1.5 ± 0.1 cm to 1.1 ± 0.1 cm, p < 0.05) was recorded. Preoperative and postoperative lower esophageal sphincter pressure and length values showed a large overlap. Antireflux operation had no effect on peristaltic amplitude, velocity, and duration, irrespective of the outcome of operation. One of five patients with incomplete swallow-induced lower esophageal sphincter relaxation had moderate dysphagia. Successful operation by 270-degree fundoplication is accompanied by a significant increase in lower esophageal sphincter pressure and length and does not affect esophageal body motor function. (J THORAC CARDIOVASC SURG 1995;109:636-41
Reasons for participating in randomised controlled trials : conditional altruism and considerations for self
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