To clarify the role of a surgical neurectomy on pain in refractory patients after conservatively treated anterior cutaneous nerve entrapment syndrome (ACNES).
ACNES is hardly ever considered in the ...differential diagnosis of chronic abdominal pain. Treatment is usually conservative. However, symptoms are often recalcitrant.
Patients older than 18 years with a diagnosis of ACNES were randomized to undergo a neurectomy or a sham procedure via an open surgical procedure in day care. Both the patient and the principal investigator were blinded to the nature of surgery. Pain was recorded using a visual analog scale (1-100 mm) and a verbal rating scale (score 0-5; 0 = no pain, 5 = severe pain) before surgery and 6 weeks postoperatively. A reduction of at least 50% in the visual analog scale score and/or 2 points on the verbal rating scale was considered a "successful response."
Forty-four patients were randomized between August 2008 and December 2010 (39 women, median age = 42 years; both groups, n = 22). In the neurectomy group, 16 patients reported a successful pain response. In contrast, significant pain reduction was obtained in 4 patients in the sham group (P = 0.001). Complications associated with surgery were hematoma (n = 5, conservative treatment), infection (antibiotic and drainage, n = 1), and worsened pain (n = 1).
Neurectomy of the intercostal nerve endings at the level of the abdominal wall is an effective surgical procedure for pain reduction in ACNES patients who failed to respond to a conservative regimen.
Mean systemic filling pressure (Pms) is a promising parameter in determining intravascular fluid status. Pms derived from venous return curves during inspiratory holds with incremental airway ...pressures (Pms-Insp) estimates Pms reliably but is labor-intensive. A computerized algorithm to calculate Pms (Pmsa) at the bedside has been proposed. In previous studies Pmsa and Pms-Insp correlated well but with considerable bias. This observational study was performed to validate Pmsa with Pms-Insp in cardiac surgery patients. Cardiac output, right atrial pressure and mean arterial pressure were prospectively recorded to calculate Pmsa using a bedside monitor. Pms-Insp was calculated offline after performing inspiratory holds. Intraclass-correlation coefficient (ICC) and assessment of agreement were used to compare Pmsa with Pms-Insp. Bias, coefficient of variance (COV), precision and limits of agreement (LOA) were calculated. Proportional bias was assessed with linear regression. A high degree of inter-method reliability was found between Pmsa and Pms-Insp (ICC 0.89; 95%CI 0.72–0.96,
p
= 0.01) in 18 patients. Pmsa and Pms-Insp differed not significantly (11.9 mmHg, IQR 9.8–13.4 vs. 12.7 mmHg, IQR 10.5–14.4,
p
= 0.38). Bias was −0.502 ± 1.90 mmHg (
p
= 0.277). COV was 4% with LOA –4.22 − 3.22 mmHg without proportional bias. Conversion coefficient Pmsa ➔ Pms-Insp was 0.94. This assessment of agreement demonstrates that the measures Pms-Insp and the computerized Pmsa-algorithm are interchangeable (bias −0.502 ± 1.90 mmHg with conversion coefficient 0.94). The choice of Pmsa is straightforward, it is non-interventional and available continuously at the bedside in contrast to Pms-Insp which is interventional and calculated off-line. Further studies should be performed to determine the place of Pmsa in the circulatory management of critically ill patients. (
www.clinicaltrials.gov
; TRN NCT04202432, release date 16-12-2019; retrospectively registered).
Clinical Trial Registration
www.ClinicalTrials.gov
, TRN: NCT04202432, initial release date 16-12-2019 (retrospectively registered).
Abstract Evidence is scarce about the influence of comorbidity on outcome of surgery, whereas this information is highly relevant for estimating the surgical risk of cancer patients, and for ...optimising pre-, peri- and postoperative care. In this paper, the prognostic role of increasing age and comorbid conditions in patients diagnosed with stage I–III colorectal, stage I–II NSCLC or stage I–III breast cancer between 1995 and 2004 in the southern part of the Netherlands is summarised. Almost all patients with stage I–III colon cancer or rectal cancer underwent surgery regardless of age or comorbidity. In contrast, the resection rate among elderly patients with stage I–II NSCLC was clearly lower than among younger patients and was significantly lower when COPD, cardiovascular diseases or diabetes were present. Among patients with stage I–III breast cancer, those aged 80 or older underwent less surgery, and the resection rate appeared to be lower when cardiovascular diseases or diabetes were present. Among patients with resected colorectal cancer, postoperative morbidity and mortality were higher among those undergoing emergency surgery, and also among those with reduced pulmonary function, cardiovascular disease or neurological comorbidity. Among those with resected NSCLC, postoperative morbidity and mortality were related to reduced pulmonary function or cardiovascular disease. Since surgery for breast cancer is low risk, elective surgery, morbidity and mortality were not higher for elderly or those with comorbidity. Among patients with colorectal or breast cancer, comorbidity in general, cardiovascular diseases, COPD, diabetes (only colon and breast cancer) and venous thromboembolism had a negative effect on overall survival, whereas the effect of comorbidity on survival of stage I–II NSCLC was less clear. Elderly and those with comorbidity (especially cardiovascular diseases and COPD) among colorectal cancer and NSCLC patients had more postoperative morbidity and mortality. Prospective randomised studies are needed for refining selection criteria for surgery in elderly cancer patients and for anticipation and prevention of complications.
This large population-based study focuses on the prognostic role of increasing age and co-morbidity in cancer patients diagnosed in the southern Netherlands. Data of patients diagnosed between 1995 ...and 2002 and recorded in the population-based Eindhoven Cancer Registry were used. Older patients (with serious co-morbidity) with non-small cell lung cancer or prostate cancer underwent surgery less often than younger patients. Elderly with stage III colon cancer, small cell lung cancer, FIGO II or III ovarian cancer or non-Hodgkin's lymphoma (NHL) received (adjuvant) chemotherapy less often, probably because of the higher rate of haematological complications. Administration of adjuvant radiotherapy decreased with age and co-morbidity in patients with rectal cancer, limited small cell lung cancer or breast cancer. In general, elderly did not suffer from more complications than younger patients, except for cardiac complications (colorectal cancer and NHL) and postoperative death (non-small cell lung cancer). For most tumours relative survival was lower for the elderly, except for patients with colon cancer, prostate cancer or indolent NHL. Co-morbidity had an independent prognostic effect, except for tumours with a very poor prognosis. Future prospective studies should investigate whether the guidelines for cancer treatment should be adjusted for elderly with serious co-morbidity.
Purpose
The corrected carotid flow time (ccFT) is derived from a pulsed-wave Doppler signal at the common carotid artery. Several equations are currently used to calculate ccFT. Its ability to assess ...the intravascular volume status non-invasively has recently been investigated. The purpose of this study was to evaluate the correlation and trending ability of ccFT with invasive cardiac output (CO) and stroke volume (SV) measurements.
Methods
Eighteen cardiac surgery patients were included in this prospective observational study. ccFT measurements were obtained at three time points: after induction of anesthesia (T1), after a passive leg raise (T2), and post-bypass (T3). Simultaneously, CO and SV were measured by calibrated pulse contour analysis. Three different equations (Bazett, Chambers, and Wodey) were used to calculate ccFT. The correlation and percentage change in time (concordance) between ccFT and CO and between ccFT and SV were evaluated.
Results
Mean ccFT values differed significantly for the three equations (
p
< 0.001). The correlation between ccFT and CO and between ccFT and SV was highest for Bazett’s (
ρ
= 0.43,
p
< 0.0001) and Wodey’s (
ρ
= 0.33,
p
< 0.0001) equations, respectively. Concordance between ΔccFT and ΔCO and between ΔccFT and ΔSV was highest for Bazett’s (100%) and Wodey’s (82%) equations, respectively. Subgroup analysis demonstrated that correlation and concordance between SV and ccFT improved when assessed within limited heart rate (HR) ranges.
Conclusion
The use of different ccFT equations leads to variable correlation and concordance rates between ccFT and CO/SV measurements. Bazett’s equation acceptably tracked CO changes in time, while the trending capability of SV was poor.
Introduction:
Histidine-tryptophan-ketoglutarate cardioplegia is used for prolonged myocardial protection in complex cardiac surgery. Administration leads to acute hyponatremia in a majority of ...patients, because of its low sodium concentration (15 mmol/L). However, histidine-tryptophan-ketoglutarate solution’s osmolality is slightly hypertonic (310 mOsm/kg). Hypothesized was that acute isotonic hyponatremia will be induced, which does not need to be corrected with hypertonic saline.
Methods:
Cardiac surgery patients who received histidine-tryptophan-ketoglutarate cardioplegia were included in this prospective single center study. Serial blood samples were taken from each patient at five different time points: after induction of anesthesia (T1) and 10 minutes (T2), 6 hours (T3), 12 hours (T4), and 18 hours (T5) after administration of histidine-tryptophan-ketoglutarate cardioplegia, respectively. Blood samples were analyzed for sodium concentration, osmolality, and acid-base balance.
Results:
Twenty-five patients were included. Median blood sodium levels decreased from 140 138-141 at T1 to 128 125-130 mmol/L at T2 (p < 0.001). At T3, T4, and T5, median blood sodium concentrations were 136 134-138, 139 137-140, and 140 137-142 mmol/L, respectively. Median osmolality was 289 286-293 at T1 and increased to 296 291-299 mOsm/kg (p < 0.001) at T2. At T3, T4, and T5, osmolality was 298 292-302, 298 294-304, and 300 297-306 mOsm/kg, respectively. Median pH decreased from 7.38 7.36-7.40 at T1 to 7.30 7.27-7.32 at T2 (p < 0.001).
Conclusion:
Administration of histidine-tryptophan-ketoglutarate cardioplegia during cardiac surgery leads to acute moderate to severe isotonic hyponatremia, which resolves spontaneously in the first 18 hours perioperatively. Correction with hypertonic saline is not necessary.
Background
Five percent of pre-menopausal women experience abnormal uterine bleeding. Endometrial ablation (EA) is one of the treatment options for this common problem. However, this technique shows ...a decrease in patient satisfaction and treatment efficacy on the long term.
Study objective
To develop a prediction model to predict surgical re-intervention (for example re-ablation or hysterectomy) within 2 years after endometrial ablation (EA) by using machine learning (ML). The performance of the developed prediction model was compared with a previously published multivariate logistic regression model (LR).
Design
This retrospective cohort study, with a minimal follow-up time of 2 years, included 446 pre-menopausal women (18+) that underwent an EA for complaints of heavy menstrual bleeding. The performance of the ML and the LR model was compared using the area under the receiving operating characteristic (ROC) curve.
Results
We found out that the ML model (AUC of 0.65 (95% CI 0.56–0.74)) is not superior compared to the LR model (AUC of 0.71 (95% CI 0.64–0.78)) in predicting the outcome of surgical re-intervention within 2 years after EA. Based on the ML model, dysmenorrhea and duration of menstruation have the highest impact on the surgical re-intervention rate.
Conclusion
Although machine learning techniques are gaining popularity in development of clinical prediction tools, this study shows that ML is not necessarily superior to the traditional statistical LR techniques. Both techniques should be considered when developing a clinical prediction model. Both models can identify the clinical predictors to surgical re-intervention and contribute to the shared decision-making process in the clinical practice.
Fetal heart rate abnormalities (FHR) during and after external cephalic version (ECV) are relatively frequent. They may raise concern about fetal wellbeing. Only occasionally they may lead to an ...emergency cesarean section.
Prospective cohort study in 980 women (> 34 weeks gestation) with a singleton fetus in breech presentation. During and after external cephalic version (ECV) FHR abnormalities were recorded. Obstetric variables and delivery outcome were evaluated. Primary outcome was to identify which fetuses are at risk for FHR abnormalities. Secondary outcome was to identify a possible relationship between FHR abnormalities during and after ECV and mode of delivery and fetal distress during subsequent labor.
The overall success rate of ECV was 60% and in 9% of the attempts there was an abnormal FHR pattern. In two cases FHR abnormalities after ECV led to an emergency CS. Estimated fetal weight per 100 g (OR 0.90, CI: 0.87-0.94) and longer duration of the ECV-procedure (OR 1.13, CI: 1.05-1.21) were factors significantly associated with the occurrence of FHR abnormalities. FHR abnormalities were not associated with the mode of delivery or the occurrence of fetal distress during subsequent labor.
FHR abnormalities during and after ECV are more frequent with lower estimated fetal weight and longer duration of the procedure. FHR abnormalities during and after ECV have no consequences for subsequent mode of delivery. They do not predict whether fetal distress will occur during labor.
The Eindhoven Breech Intervention Study, NCT00516555 . Date of registration: August 13, 2007.
Women are known to have worse outcome after coronary artery bypass grafting (CABG) than men. Studies have shown that off-pump coronary artery bypass grafting (OPCAB) might benefit higher-risk ...patients, and therefore might also benefit women. We aimed to determine differences in early and late outcomes between sexes after OPCAB.
Data from all patients undergoing OPCAB, between 2013 through 2021 was retrieved from the Netherlands Heart Registration (NHR) database. Primary outcomes were early mortality, morbidity and late survival. We divided the population into subgroups based on age (aged ≥70 years or < 70 years) and sex.
This study included 8,487 men and 2,170 women (total = 10,657). Female patients received fewer anastomoses (mean (SD)) women 2.38 (1.17) vs men 2.68 (1.23), p < 0.001) and total arterial revascularization was performed less frequently in women than in men (21.3 % versus 29.5 % respectively, p < 0.001).
In the subgroup of patients <70 years, early mortality was 1.7 % in women and 0.6 % in men (p < 0.001). Survival rate at 5 years was 88.4 % in women and 91.1 % in men (p < 0.001). Female sex was associated with worse late survival in the subgroup <70 years (HR (95 % CI) 1.42 (1.10–1.83) p = 0.008).
Sex-differences in outcome after CABG persists in OPCAB surgery. However, these differences are solely present in the younger subgroup. In our data, women undergoing OPCAB surgery seem to be treated differently during surgery as compared to their male counter parts, further research is needed to analyze this finding.
Falling is a common and serious problem in the elderly. Previous studies suggest that the use of psychotropic drugs increases the risk of falling. However, the contribution of these drugs on fall ...risk has not been quantified on a daily basis among the general population of nursing homes until now.
To assess the association between fall incidence and the prescription of psychotropic drugs and different categories of psychotropic drugs (antipsychotics, antidepressants, and benzodiazepines) among a general nursing home population.
Retrospective observational study, data collection per person-day.
9 nursing homes in Eindhoven, the Netherlands.
2368 nursing home residents, resulting in 538,575 person-days.
Association between the prescription of psychotropic drugs and falls.
A total of 2368 nursing home residents were included, which resulted in a data set of 538,575 person-days. Prescription of at least 1 psychotropic drug per day occurred during a total of 318,128 person-days (59.1%). Scheduled prescriptions with or without an as-needed prescription were involved in a total of 270,781 person-days (50.3%). The prescription of psychotropic drugs on a scheduled basis was found to be associated with almost a 3-fold increase in fall incidence (OR 2.88; 95% CI 1.52-5.44). An increase in fall incidence was found following the prescription of antipsychotics (OR 1.97; 95% CI 1.51-2.59) and antidepressants (OR 2.26; 95% CI 1.73-2.95). This increased fall risk was found for prescriptions on a scheduled basis as well as for prescriptions on an as-needed basis.
The prescription of psychotropic drugs is associated with a strongly increased risk of falling among nursing home residents. To our knowledge, this is the first study among the general nursing home population in which the association between daily falls and daily prescriptions of psychotropic drugs and groups of psychotropic drugs was specified.
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