Predictors of psychological symptoms in morbidly obese patients after gastric bypass surgery

BackgroundMorbid obesity is associated with debilitating psychosocial consequences, such as depression, anxiety, and low self-esteem. One of the main goals of bariatric surgery should not only be reducing weight and counteracting co-morbid conditions, but also improving postoperative psychosocial functioning. The objective of our study was to determine the preoperative variables that could predict the psychological symptoms 6 and 12 months after surgery to improve the clinical outcome of morbidly obese patients undergoing bariatric surgery. The setting was a university hospital in Spain.MethodsThe study group consisted of 60 morbidly obese patients (46 women and 14 men) who had undergone gastric bypass surgery for weight reduction and had ≥1 year of follow-up. The patients were evaluated using different questionnaires (Symptom Checklist-90-Revised, Body Shape Questionnaire, Rosenberg Self-Esteem Questionnaire, COPE, Medical Outcomes Study Social Support Survey) at 3 points: before surgery, at 6 months postoperatively, and at 1 year postoperatively. To determine the influence of preoperative variables on long-term psychological status, a step-by-step multivariate linear regression analysis was performed, taking P < .05 as statistically significant.ResultsThe variables of self-esteem, instrumental support, and coping focused in the emotions were the main preoperative predictors for psychological symptoms 6 months after surgery. Preoperative drug abuse as a strategy of problem solving and mainly body image significantly predicted most of the psychological disorders 1 year after surgery.ConclusionThe study of different psychosocial variables in patients before bariatric surgery is an important aid to predict postoperative psychological functioning. Self-esteem and body image were the most influential factors in the postoperative psychological outcome of morbidly obese patients in our study.     

Late neurobehavioural symptoms after mild head injury

The present study examined whether patients (n= 11) with post-concussional symptoms (PCS) 12-34 months after mild head injury (MHI) performed less well on selected neuropsychological tests than patients with MHI without PCS (n = 11) and healthy controls (n= 11). Patients with PCS were individually matched with controls for the time elapsed after the injury, age, sex, education and IQ. There were no overall gross differences between the groups in cognitive functioning, except for an isolated deficit on a sustained attention task. Post-hoc analysis of results obtained with two behavioural rating scales showed that patients with higher ratings on a post-concussive/cognitive complaints scale performed less well on a sustained attention task than subjects with lower ratings.     

胃癌患者一级亲属疾病认知水平及影响因素

目的 了解胃癌患者一级亲属对疾病危险因素与预警症状认知现状及其影响因素,为精准和有效地制订干预方案,改善该人群胃癌防控行为提供参考。方法 采用一般资料调查表和胃癌危险因素与预警症状认知问卷,对119名胃癌患者一级亲属进行调查,采用logistic回归分析胃癌患者一级亲属胃癌危险因素与预警症状认知的主要影响因素。结果 胃癌患者一级亲属对疾病危险因素与预警症状认知总分为(15.29±7.25)分,其中27例(22.68%)处于低水平,46例(38.66%)处于中等水平,46例(38.66%)处于高水平。logistic回归分析结果显示,文化程度、工作情况、家庭人均月收入、医疗保险状况是胃癌患者一级亲属胃癌危险因素与预警症状认知水平的主要影响因素(P<0.05,P<0.01)。结论 胃癌患者一级亲属对疾病危险因素与预警症状认知处于中等水平,并受诸多因素的影响。医护人员应结合胃癌患者一级亲属的具体情况开展个体化指导,提高胃癌患者一级亲属对疾病危险因素与预警症状认知水平,以预防和降低胃癌的发生。     

Abdominal compartment syndrome among surgical patients

Abdominal compartment syndrome(ACS) develops when organ failure arises secondary to an increase in intraabdominal pressure. The abdominal pressure is determined by multiple factors such as blood pressure, abdominal compliance, and other factors that exert a constant pressure within the abdominal cavity. Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction. Among surgical and trauma patients, aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS. Other conditions that have also been identified as risk factors are ascites, hemoperitoneum, bowel distention, and large tumors. All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH). Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery, abdominal aortic aneurysm repair, and liver transplantation among others. Close monitoring of organ function and intra-abdominal pressure(IAP) allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP. Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction. There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.     

Late reoperations after surgical and endovascular lower limb revascularisation.

OBJECTIVES: to evaluate the rate of late reoperations after primary lower limb revascularisation. METHODS: a prospectively collected database of 639 consecutive patients, undergoing 763 primary arterial reconstruction for lower limb occlusive disease during the five-year period 1989 through 1993, was analysed with regard to the rates and locations of late (after 30 days) re-operation. The reconstruction was supra-inguinal in 527 (69%) cases, surgical in 391 (Group IA) and endovascular in 136 (Group IB). Infra-inguinal reconstruction had been performed in 236 (31%) cases, surgical in 160 (Group IIA) and endovascular in 76 (Group IIB). The 499 men and 140 women were followed during an average of 32 (range 1-122) months. RESULTS: the 5-year cumulative reoperation rates were 25% after supra-inguinal surgery and 28% after supra-inguinal angioplasty, respectively (NS). The rates were 47% and 33% after infra-inguinal surgery and angioplasty, respectively ( p=0.04). CONCLUSION: limbs treated for occlusive arterial disease carry a high risk of late reoperation whether the initial procedure is open surgery or angioplasty. Reoperations were twice as common for infra-inguinal procedures.     

Measuring the impact of the Thoracolumbar Injury Classification and Severity Score among 458 consecutively treated patients

Abstract

Context

The Thoracolumbar Injury Classification and Severity Score (TLICS) was proposed to improve injury classification and guide surgical decision-making of thoracolumbar spinal trauma (TLST), but its impact on the care of patients has not been quantified.

Study design

Retrospective study.

Patient sample

Analysis of 458 patients treated for TLST trauma from 2000 through 2010 at a single center.

Outcome measures

Neurological status – ASIA Impairment Scale (AIS), failure of conservative treatment, and surgical complications.

Methods

Clinical and radiological data were evaluated. Patients were grouped according to the period before (2000–2006) and after (2007–2010) utilization of the TLICS.

Results

From 2000 to 2006, 148 patients were initially treated conservatively (C) and 66 were surgically (S) treated. In the C group, the TLICS ranged from 1 to 7 (median 1; mean 1.57). In the S group, the TLICS ranged from 2 to 10 (median 2; mean 4.14). The TLICS matched treatment in 97.9% of conservatively treated patients. From 2007 to 2010, 162 patients were initially treated C and 82 were treated S. In the C group, the TLICS ranged from 1 to 4 (median 1; mean 1.48). In the S group, the TLICS ranged from 2–10 (median 4; mean 4.4). The TLICS matched treatment in 98.8% of C-treated patients. Overall, failure of C treatment occurred in nine patients; most failures (7/9) and all three missed distractive injuries occurred prior to use of the TLICS.

Conclusions

After introduction of the TLICS, there was a trend towards more successful conservative treatment with fewer conversions to surgical treatment.     

Measuring the impact of the Thoracolumbar Injury Classification and Severity Score among 458 consecutively treated patients

Context

The Thoracolumbar Injury Classification and Severity Score (TLICS) was proposed to improve injury classification and guide surgical decision-making of thoracolumbar spinal trauma (TLST), but its impact on the care of patients has not been quantified.

Study design

Retrospective study.

Patient sample

Analysis of 458 patients treated for TLST trauma from 2000 through 2010 at a single center.

Outcome measures

Neurological status – ASIA Impairment Scale (AIS), failure of conservative treatment, and surgical complications.

Methods

Clinical and radiological data were evaluated. Patients were grouped according to the period before (2000–2006) and after (2007–2010) utilization of the TLICS.

Results

From 2000 to 2006, 148 patients were initially treated conservatively (C) and 66 were surgically (S) treated. In the C group, the TLICS ranged from 1 to 7 (median 1; mean 1.57). In the S group, the TLICS ranged from 2 to 10 (median 2; mean 4.14). The TLICS matched treatment in 97.9% of conservatively treated patients. From 2007 to 2010, 162 patients were initially treated C and 82 were treated S. In the C group, the TLICS ranged from 1 to 4 (median 1; mean 1.48). In the S group, the TLICS ranged from 2–10 (median 4; mean 4.4). The TLICS matched treatment in 98.8% of C-treated patients. Overall, failure of C treatment occurred in nine patients; most failures (7/9) and all three missed distractive injuries occurred prior to use of the TLICS.

Conclusions

After introduction of the TLICS, there was a trend towards more successful conservative treatment with fewer conversions to surgical treatment.     

Clinical and psychological correlates of somatic symptoms in patients on dialysis

Somatic symptoms are common in patients on dialysis. Their causes are largely unknown and their therapy is unsatisfactory. To examine the relationship of psychological and clinical factors to these symptoms, 191 interviews were done in patients on hemo- and peritoneal dialysis. The severity of 8 somatic symptoms (tiredness, sleep disturbance, cramps, pruritus, headache, nausea, dyspnea, joint pain) of importance in dialysis patients was measured using previously validated scales. Indices of affect and quality of life were obtained, as was demographic, clinical and laboratory information. The severity of each symptom was significantly related to the indices of affect and quality of life. Using multiple logistic regression, poor affect score was the strongest correlate of each of the following somatic symptoms, tiredness, pruritus, sleep disturbance and cramps. It was ahead of any clinical or demographic variable and was also significantly correlated with the severity of the other symptoms. Indices of hyperparathyroidism were significantly associated with headache, joint pain, dyspnea and nausea. We conclude that the strongest correlate of common somatic symptoms in dialysis patients is affect disturbance, and that therapy aimed at improving the affect may improve the symptoms.     

阴茎海绵体白膜破裂术后患者心理、勃起功能及排尿功能变化情况

目的:探究手术治疗阴茎海绵体白膜破裂对患者心理、勃起功能及排尿功能的影响. 方法:选择2010年6月至2015年12月急诊收治的50例阴茎海绵体白膜破裂术后患者作为研究对象,采用Zung焦虑(SAS)和抑郁自评量表(SDS)、IIEF-5和IPSS在术后1d、6个月和18个月评价患者的心理、勃起功能及排尿功能,并对术后...     

Cerebral autoregulation among patients with symptoms of hydrocephalus

OBJECTIVE: To study the relationship between the resistance to cerebrospinal fluid (CSF) outflow and cerebral autoregulation. METHODS: We examined 35 patients who presented with ventricular dilation and clinical symptoms of communicating hydrocephalus. For all of these patients, CSF compensatory reserve was investigated by using a computerized infusion test, with simultaneous recording of blood flow velocity wave forms (by using transcranial Doppler ultrasonography) and arterial blood pressure (with a Finapress finger cuff). The resistance to CSF outflow was calculated as the absolute increase in intracranial pressure (interpolated over vasogenic waves) divided by the infusion rate (1.5 ml/min in most cases). The index of autoregulation was assessed as a correlation coefficient (moving time window of 5 min) between slow waves (with periods of 20 s to 2 min) in mean blood flow velocity and cerebral perfusion pressure. RESULTS: The mean intracranial pressure increased during the test, from 6 mm Hg (standard deviation, 6 mm Hg) to 20 mm Hg (standard deviation, 10 mm Hg) (P < 0.0001). The index of autoregulation was significantly correlated with the resistance to CSF outflow (r = -0.41, P < 0.03), indicating better autoregulation with greater resistance to CSF outflow. CONCLUSION: Patients presenting with ventricular dilation may exhibit either decreased (atrophy) or increased (normal-pressure hydrocephalus) resistance to CSF outflow. Increased resistance is correlated with preserved autoregulation. Patients with low resistance, suggesting brain atrophy, more often have disturbed autoregulation in the middle cerebral artery territory, as assessed by transcranial Doppler ultrasonography.     

Obsessive-compulsive psychological symptoms of patients on the liver transplant waiting list

Introduction

Patients on the liver transplant waiting list have increased emotional and clinical symptoms. The presence of psychopathologic symptoms associated with obsession-compulsion as a reflection of alterations due to anxiety disorders is common in these patients.

Objective

To evaluate obsessive-compulsive psychopathological symptoms in patients on the liver transplant waiting list.

Materials and methods

The study included 50 patients on the liver transplant waiting list. The instrument was the SA-45 questionnaire (Derogatis, 75), whose Spanish version was adapted by González Rivera and De las Cuevas (1988). This dimension was evaluated using five statements.

Results

Among of the patients on the liver transplant waiting list, 46% had no relevant obsessive-compulsive symptoms. Of these, 28% had no symptoms and 18% had some symptoms, but the overall evaluation in these patients was no greater than the cutoff point. The remaining 54% had relevant obsessive-compulsive clinical symptoms, most commonly (1) “Having difficulty making decisions” (P < 3.45 · 10⁻⁹); (2) “Having difficulty concentrating” (P < 1.70 · 10⁻⁸); (3) “One's mind goes blank” (P < 3.04 · 10⁻⁴); (4) “Having to repeatedly check everything being done” (P < 1.37 · 10⁻¹); and (5) “Having to do things slowly to make sure they are done properly” (P < 5.02 · 10⁻¹).

Conclusions

Many patients on the liver transplant waiting list have obsessive-compulsive psychopathologic symptoms. Their detection and application of adequate psychological treatment are important to minimize the effects of emotional changes onward from the pretransplant phase.     

Late results after primary surgical care of recent knee ligament injuries

This report presents late results of primary suture of fresh ruptures of knee ligaments. Considering the rapid development of knee surgery the control of a surgical procedure practically unchanged since 15 years seems necessary. On the basis of these late results immediate suture of ruptured knee ligaments is a useful surgical procedure.     

Late results after surgical correction of pyeloplasty failure in idiopathic hydronephrosis

Late results after a secondary pyeloplasty because of failure of the initial procedure were evaluated by glomerular filtration rate and drainage function studies in 15 patients. Total and separate glomerular filtration rates were measured using the 51chromium-ethylenediaminetetraacetic acid clearance technique and isotope renography. The drainage function of the renal pelvis was evaluated from the isotope renogram. Secondary pyeloplasty was performed 1 to 15 years (mean 8.0 years) after the first procedure because of obstruction, which was verified by diuretic urography and isotope renography. Our results show that a secondary pyeloplasty can be performed after failure of the primary procedure. Functional results 3 to 15 years after reoperation were equally good as after uncomplicated primary pyeloplasty.     

Late surgical conversion after endovascular treatment of the abdominal aortic aneurysm

The authors present a case report of long- term follow up of 66-year old male with the abdominal aortic aneurysm treated with aortouniiliac stent-graft implantation in combination with the cross-over femoro-femoral bypass 14 years ago. Various leaks type Ia, IIb and III developed during follow-up. In spite of endovascular treatment of these complications the size of the aneurysmal sac enlarged and the patient was successfully treated by the aortobifemoral bypass.     

Tetralogy of Fallot: Late outcome after repair and surgical implications

Cardiac surgery has transformed the outcome for patients with tetralogy of Fallot. Repair has conveyed excellent long-term results with most patients remaining well and leading normal lives. However, there are problems with late morbidity and mortality primarily due to right ventricular dysfunction, exercise intolerance, arrythmia, and sudden cardiac death. There has been a dynamic shift in our surgical approach to managing patients with tetralogy over the past 5 decades. This in part accounts for persisting difficulties in predicting late outcome for evry single patient with repaired tetralogy of Fallot. There are, however, several confounding variables, influencing long-term outcome for these patients, namely the underlying anatomical substrate, age at repair, surgical approach to repair, and residual hemodynamic abnormalities. It is gratifying to see that recent knowledge accumulated from long-term follow-up studies is influencing contemporary surgical practice. Individualized strategies aiming to minimize the potential for free pulmonary regurgitation, and the long-term detrimental effects associated with it, need to continue to develop. Preservation of right ventricular and pulmonary valve function combined with early restoration of normal pulmonary blood flow are likely to convey an even better long-term outlook for these patients. Further follow-up studies with assessment of bi-venticular function, however, are needed in both our older and contemporary cohorts with repaired tetralogy of Fallot. Copyright © 2000 by W.B. Saunders Company     

No psychological emergence reactions in schizophrenic surgical patients immediately after propofol, fentanyl, and ketamine intravenous anesthesia

Purpose. We attempted to determine the frequency of adverse psychological events after total intravenous anesthesia with propofol-fentanyl-ketamine (PFK) in surgical schizophrenic patients. Methods. PFK was used in 25 schizophrenic patients undergoing various surgical procedures from 1995 to 1997. Adverse events occurring during and after anesthesia were recorded. Psychiatric follow-up was also done during the first 3 postoperative weeks at least. Results. One patient died postoperatively of airway obstruction from concomitant severe malignant thyroid disease, but in the remaining patients neither respiratory nor cardiovascular states during or after anesthesia became unstable. None of the patients developed adverse psychological emergence reactions immediately after anesthesia. Two patients undergoing major surgical procedures exhibited delirium in the early postoperative days despite taking their routine antipsychotic drugs postoperatively. Conclusions. We suggest that PFK maintains stable respiratory and cardiovascular states, and causes no psychological emergence reactions in schizophrenic surgical patients. However, adverse psychological events may occur postoperatively, probably due to continued psychic stress. We therefore recommend appropriate perioperative management and further psychological studies for such patients. Received for publication on May 18, 1998; accepted on September 20, 1998     

Complications after discharge for surgical patients

AIM: To measure the type and frequency of complications for surgical patients 1 month after discharge. METHODS: A post-discharge patient survey was conducted in 2000 for patients who had undergone one of five elective operations: transurethral resection of the prostate, hysterectomy, major joint replacement, cholecystectomy, herniorrhaphy. Two hundred and fourteen patients (74%) returned the survey forms, which were sent 1 month after surgery. Patients were recruited from two teaching hospitals in the Hunter Area Health Service, New South Wales, Australia. RESULTS: One hundred and thirty-five (63%) patients reported one or more complications and 78 (37%) received treatment for 109 complications. Eighty-six per cent reported pain after discharge and 41% reported moderate to severe pain. Seventeen per cent reported infections after discharge and 94% of these patients were given treatment. Twenty-eight per cent reported bleeding after discharge and 20% of these were given treatment. Eleven (5%) patients were readmitted for treatment of problems related to their surgery including four who required further surgery. One hundred and seventy-two patients accessed a range of health services during the first month after discharge, resulting in 266 occasions of service. Twenty-eight per cent of post-discharge services were unplanned. CONCLUSIONS: The lack of post-discharge monitoring conceals information about surgical outcomes. Patient reporting is an effective method of monitoring post-discharge outcomes. There is scope to develop post-discharge services to improve the quality of care in the areas of post-discharge pain management, the use of prophylactic measures and to provide treatment for complications that occur during this period.