- Risk Factors for Prolonged Postoperative Ileus In Adult Patients Undergoing Elective Colorectal Surgery: An Observational Cohort Study. [Journal Article]
- RRRev Recent Clin Trials 2018 May 20
- Purpose Prolonged postoperative ileus (PPOI) after abdominal surgery may effect unfavourably the patient recovery. The aim of this study was to estimate the incidence of PPOI in patients elective for...
Purpose Prolonged postoperative ileus (PPOI) after abdominal surgery may effect unfavourably the patient recovery. The aim of this study was to estimate the incidence of PPOI in patients elective for colorectal resection and investigate perioperative variables associated with PPOI. Methods A consecutive series of 428 patients undergoing colorectal resection (median age 72, range 24-92, years; men/women ratio 1.14) were analyzed. Data were extracted retrospectively throughout a five-year period from an electronic prospectively maintained database. PPOI was defined as the need for postoperative insertion of naso-gastric tube in a patient experiencing nausea and two episodes of vomiting and further showing absence of adequate bowel function (absence of flatus/stool) with lack of bowel sounds and abdominal distension. Results Incidence of PPOI was 7% [95% confidence interval (95%CI), 4.8-9.9%]. Mean hospital stay was 8 days longer in patients with PPOI. Male gender, cancer, cardiac and respiratory co-morbidity, rectal resection, open/converted access, duration of operation, stoma formation and body mass index were associated with PPOI at univariate analysis (0.001<P<0.048). PPOI was independently associated with male gender [adjusted odds ratio (OR), 4.2; 95%CI, 1.5-11.5], stoma formation (OR, 2.8; 95%CI, 1.2-6.8) and obesity (OR of obese vs. normal weight patients, 3.8, 95%CI, 1.2-12.0). Conclusions After colorectal resection PPOI leads to prolonged hospital stay and slower patient's recovery. An international standardized definition of PPOI is strongly needed to make comparable results from researches and to reliably identify patients with increased risk, also to improve the therapeutic preventive policies in these patients.
- A Woman With Stridor and Respiratory Failure. [Journal Article]
- AEAnn Emerg Med 2018; 71(6):674-702
- Myotonia permanens with Nav1.4-G1306E displays varied phenotypes during course of life. [Journal Article]
- AMActa Myol 2017; 36(3):125-134
- Myotonia permanens due to Nav1.4-G1306E is a rare sodium channelopathy with potentially life-threatening respiratory complications. Our goal was to study phenotypic variability throughout life.
Myotonia permanens due to Nav1.4-G1306E is a rare sodium channelopathy with potentially life-threatening respiratory complications. Our goal was to study phenotypic variability throughout life.
- Nasogastric Tube Syndrome: A Diagnostic Dilemma. [Journal Article]
- JBJ Bronchology Interv Pulmonol 2018 May 16
- CONCLUSIONS: Nasogastric tube syndrome is a potentially life-threatening condition and has to be considered as a possibility in immune-compromised patients who present with voice change and stridor after nasogastric tube insertion.
- [A case of post-intubation tracheal stenosis mimicking bronchial asthma: case report]. [Journal Article]
- VLVnitr Lek 2018; 64(3):314-320
- Postintubation tracheal stenosis (PITS) is one of the most frequent causes of lower airways obstruction. Usually, PITS is the consequence of prolonged intubation period, but may occur also after shor...
Postintubation tracheal stenosis (PITS) is one of the most frequent causes of lower airways obstruction. Usually, PITS is the consequence of prolonged intubation period, but may occur also after short-term intubation. Diagnosis may be difficult if stridor is not present and the post-extubation period is many years long. Bronchoscopy and CT scanning are the diagnostic gold standard. In some cases, lung function tests may also be helpful. Treatment options include conservative treatment, surgery and endoscopic methods. We present a case report of a 23 year old woman with exercise dyspnoea caused by PITS that was incorrectly treated for bronchial asthma during a 2-years long period. Key words: bronchoscopy - cardiopulmonary exercise testing - postintubation stenosis - tracheal stenosis.
- Efficacy of denosumab in two cases with multiple-system atrophy and osteoporosis. [Journal Article]
- TCTher Clin Risk Manag 2018; 14:817-822
- CONCLUSIONS: This is the first study describing osteoporosis in two patients with MSA being treated by osteoporotic treatment. Based on our findings, it can be concluded that denosumab may be an effective therapy for osteoporosis in MSA.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Chest inspection, palpation, and auscultation are key components of the physical examination of patients with respiratory disease. Palpation ascertains the signs suggested by inspecting and assessing...
Chest inspection, palpation, and auscultation are key components of the physical examination of patients with respiratory disease. Palpation ascertains the signs suggested by inspecting and assessing the state of the pleura and lung parenchyma by studying the vocal fremitus. Vocal (tactile) fremitus is palpation of the chest wall to detect changes in the intensity of vibrations created with certain spoken words in a constant tone and voice indicating underlying lung pathology. Pathophysiology Sound vibrations produced in the larynx during phonation are transmitted to the bronchi and lungs and then communicated to the chest wall. Transmission of spoken tones depends on the state of the underlying lung parenchyma in the pleural space. Normal lung parenchyma is a mixture of air-filled spaces and solid lung parenchyma. Air is a poor conductor of low sound frequencies whereas a solid or dense medium increases the transmission of low sound frequencies. Vocal fremitus may be decreased in conditions affecting the lung parenchyma, pleura, or chest wall. Vocal fremitus is decreased in bronchial asthma, emphysema, or bronchial obstruction due to air trapping and decreased density of lung parenchyma. In case of pleural effusion and pneumothorax, air/fluid accumulates in the potential space between the chest wall and lung parenchyma, decreasing the transmission of lower frequency sound vibrations. Vocal fremitus also may be decreased in individuals with obesity. On the other hand, inflammation and consolidation create a dense medium which increases the transmission of lower frequency sounds and vocal fremitus. Vocal resonance is the auscultatory counterpart of vocal fremitus. The following changes in vocal resonance are seen. Bronchophony: A louder sound heard over an area of consolidation. Whispering pectoriloquy: While the examiner auscultates over the lung fields, the patient is asked to whisper "one, two, three." Whispered words are heard clearly in the presence of consolidation. Whispered pectoriloquy has the same significance as increased fremitus and adds no new information to those approaches. Egophony or an "E to A" change: A qualitative change in the voice that resembles the bleating of a goat. Select sound frequencies are able to pass through consolidation and tend to distort the sound of the vowel "E" so that it is perceived by the examiner as "A" or "AAAH." Other types of fremitus: Ronchial fremitus - palpable ronchi. Pleural fremitus - palpable pleural rub.
- Croup: Diagnosis and Management. [Journal Article]
- AFAm Fam Physician 2018 May 01; 97(9):575-580
- Croup is a common respiratory illness affecting 3% of children six months to three years of age. It accounts for 7% of hospitalizations annually for fever and/or acute respiratory illness in children...
Croup is a common respiratory illness affecting 3% of children six months to three years of age. It accounts for 7% of hospitalizations annually for fever and/or acute respiratory illness in children younger than five years. Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough. Many patients experience low-grade fevers, but fever is not necessary for diagnosis. Less commonly, stridor can be associated with acute epiglottitis, bacterial tracheitis, and foreign body airway obstruction. Laboratory studies are seldom needed for diagnosis of croup. Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected. Randomized controlled trials have demonstrated that a single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity. In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization.
- Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients. [Journal Article]
- JPedJ Pediatr 2018 May 11
- CONCLUSIONS: Pediatric patients were at increased risk of lacking vital signs documentation during prehospital care. This represents a critical area for education and quality improvement.
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- Exposures to Single-Use Detergent Sacs Reported to a Statewide Poison Control System, 2013-2015. [Journal Article]
- PEPediatr Emerg Care 2018 May 02
- CONCLUSIONS: Central nervous system and respiratory effects as well as certain brand types predict serious outcomes from SUDS exposures. Manufacturing changes had a brief beneficial effect on the volume of SUDS exposures reported between 2013 and 2015.