Articles: surgery.
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J Clin Monit Comput · Oct 2016
The use of heart rate variability measures as indicators of autonomic nervous modulation must be careful in patients after orthotopic heart transplantation.
The precise relation between heart rate variability (HRV) and autonomic re-innervation has not been established explicitly in patients after orthotopic heart transplantation (OHT), but can be inferred from the fact that the HRV is reduced immediately after OHT and may increase gradually with time. The aim of this study was to investigate the residual HRV in patients about 1-2 years after OHT, as compared with patients after coronary artery bypass graft (CABG) surgery. Thirteen patients who had received OHT and 14 patients who had received CABG surgery were recruited. ⋯ The slope of the power law relation of HRV became positive in OHT patients, instead of negative in CABG patients. We conclude that patients after OHT have residual HRV which were characterized by severely depressed time and frequency domain HRV, increased HR and nHFP, decreased nVLFP, and positive slope of the power-law relation of HRV. The use of nHFP as the indicator of vagal modulation and the use of nVLFP as the indicator of renin-angiotensin modulation, thermoregulation and vagal withdrawal must be careful in the OHT patients.
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Comparative Study
Long-term outcome characteristics in mesial temporal lobe epilepsy with and without associated cortical dysplasia.
The intention of our study was to identify predictive characteristics for long-term seizure control and running down phenomenon after surgical treatment of pharmacoresistant mesiotemporal lobe epilepsy (mTLE) with and without associated cortical dysplasia. ⋯ Depending on the presence or absence of focal cortical dysplasia in addition to mesiotemporal structural alterations, predictors of long-term seizure control differed regarding the relevant clinical and electrophysiological features. This is important for specific patient counseling in respective groups.
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Occipitocervical junction instability can lead to serious neurological injury or death. Open surgical fixation is often necessary to provide definitive stabilization. However, long-term results are limited to small case series. ⋯ AIS, American Spinal Injury Association Impairment ScaleCVJ, craniovertebral junctionmJOAS, modified Japanese Orthopaedic Association ScaleNLI, neurological level of injurySCI, spinal cord injury.
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The aim of this study is to identify the association between early postoperative troponin elevations and outcomes after major colorectal surgery. ⋯ Most postoperative myocardial injury is asymptomatic and may only be detected by routine troponin screening. Elevated troponin concentrations after colorectal surgery may facilitate identifying patients at postoperative risk and prompt appropriate testing. Early intervention in select patients may lead to potential reduction of mortality after major colorectal surgery.
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Aust N Z J Obstet Gynaecol · Oct 2016
Simulation training in obstetrics and gynaecology: What's happening on the frontline?
Despite evidence supporting simulation training and awareness that trainee exposure to surgery is suboptimal, it is not known how simulation is being incorporated in obstetrics and gynaecology (O&G) training across Australia and New Zealand. ⋯ Despite simulator availability, few trainees are supported by simulation training curricula, allocated time or supervision. Participants believed that simulation training benefits trainees and should be supported with a curriculum and teaching.