To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old...To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old woman with a history of chronic pancreatitis due to pancreas divisum. Four years preceding this event, the patient had undergone a Whipple procedure, and three years prior to that, a Puestow operation. The patient was successfully treated with bowel resection and a side-to-side anastomosis between the most distal aspect of the bowel and the most distal Roux-en-Y reconstruction, which preserved both Roux-en-Y reconstructions.展开更多
Introduction: Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-operative progression to discharge, and have been practiced for more than two decades. Their goal is t...Introduction: Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-operative progression to discharge, and have been practiced for more than two decades. Their goal is to optimize patient care perioperatively in order to decrease costs without negatively affecting morbidity and mortality. However, the factors that predict successful EE are poorly understood, and patients with significant co-morbidities are frequently excluded from protocols. We hypothesize that independent of disease severity, early extubation leads to shorter hospital stays and can be performed safely without negatively affecting outcomes. Materials and Methods: We performed a retrospective review of 919 patients who underwent coronary artery bypass grafting (CABG) at the Southern Arizona Veteran’s Affairs Health Care System medical center over 7 years. We collected pre-operative data regarding patients’ NYHA classification, presence and severity of cerebral vascular disease, peripheral vascular disease, pulmonary disease, diabetes and hypertension. Intra-operative variables were also recorded including ASA scores, ischemic times, and time to extubation. Finally, post-operative variables such as rates of reintubation and tracheotomy, and both length of ICU and total hospital stay were also compared. Results: Prolonged periods of ischemia were found to predict a delayed extubation (HR = 0.992;CI = 0.988 - 0.997, p = 0.0015) while small body surface area (HR = 1.57;CI = 1.13, 2.17, p = 0.007) and higher pre-operative functional status of the patient, such as independent versus dependent status (HR =1.68;CI = 1.30 - 2.16, p = 1.33;CI = 1.03 - 1.70, p = 0.03) were found to be associated with earlier extubation. The early extubation (EE) group (those extubated in less than the median 7.3 hours) had an average hospital stay of 5.1 ± 4.0 days, versus 7.8 ± 8.1 days in the delayed group (>4 hours), p Conclusions: In our study population, pre-operative functional class and total body surface area predicted those patients able to tolerate early extubation after cardiac surgery. Prolonged ischemia resulted in delayed extubation. Patients that were extubated in less than 4 hours had shorter ICU and hospitalization stays, while there was no significant difference between the two groups in rate of reintubation or tracheotomy.展开更多
Objective: To examine the prevalence and correlates of sexual activity and function in postmenopausal women with heart disease. Methods: We included baseline selfreported measures of sexual activity and the sexual pro...Objective: To examine the prevalence and correlates of sexual activity and function in postmenopausal women with heart disease. Methods: We included baseline selfreported measures of sexual activity and the sexual problem scale from the Medical Outcomes Study in the Heart and Estrogen/Progestin Replacement Study (HERS), a study of 2,763 postmenopausal women, average age 67 years, with coronary disease and intact uteri. We used multivariable linear and logistic regression to identify independent correlates of sexual activity and dysfunction. Results: Approximately 39% of the women in HERS were sexually active, and 65% of these reported at least 1 of 5 sexual problems (lack of interest, inability to relax, difficulty in arousal or in orgasm, and discomfort with sex). In multivariable analysis, factors independently associated with being sexually active included younger age, fewer years since menopause, being married, better self- reported health, higher parity, moderate alcohol use, not smoking, lack of chest discomfort, and not being depressed. Among the 1,091 women who were sexually active, lower sexual problem scores were associated with being unmarried, being better educated, having better self- reported health, and having higher body mass index. Conclusion: Many women with heart disease continue to engage in sexual activity into their 70s, and two thirds of these report discomfort and other sexual function problems. Physicians should be aware that postmenopausal patients are sexually active and address the problems these women experience.展开更多
. In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy.... In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff. Methods. From 1995- 2004, 6 of our patients underwent LPUV including 5 patients with stage Ib1 cervical cancer and one patient with Ia1 cervical cancer. Prior procedures were TVH (n = 3), TAH (n = 2) or LAVH (n = 1). Charts were reviewed and follow-up data were collected. Results. Mean age was 40.5 (38- 49) years and Quetelet index was 31.5 (25- 40) kg/m2. Average time from hysterectomy to LPUV was 54 (30- 84) days. Retrospective FIGO staging revealed stage Ib1 (n = 5) and stage Ia1 (n = 1) cervical cancer. Mean duration of surgery was 207 (151- 265) min, average blood loss 300 (100- 500)mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10- 36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs postoperative was 6.4 (0.2- 10.9) % . There were no further postoperative complications during the average hospital stay of 3.5 (2- 5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (350) months of follow-up. Conclusion. LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.展开更多
Objective(s). To compare the type-specific human papillomavirus (HPV) recover y from physician and patient-collected samples. Methods. Three hundred thirty- four (334) women attending colposcopy clinics in three count...Objective(s). To compare the type-specific human papillomavirus (HPV) recover y from physician and patient-collected samples. Methods. Three hundred thirty- four (334) women attending colposcopy clinics in three countries were enrolled i n this cross-sectional study. Cervicovaginal samples were collected by patients and physicians and processed with polymerase chain reaction and reverse line bl ot genotyping. McNemar’s Chi-squared tests and Kappa statistics were utilized to determine statistical associations between physician-versus patient-collect ed samples. Results. Oncogenic HPV infection was identified in 23.2%of patient -collected specimens compared to 34.9%of physician-collected specimens. Physi cian sampling detected significantly more infections with type 16 and 52 than di d self-sampling and significantly more oncogenic HPV infection overall. For non -oncogenic HPV detection, there was no statistical difference between physician -and patientcollected samples. Conclusion(s). Patient sampling for HPV using a single vaginal brush does not identify all oncogenic HPV subtypes.展开更多
文摘To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old woman with a history of chronic pancreatitis due to pancreas divisum. Four years preceding this event, the patient had undergone a Whipple procedure, and three years prior to that, a Puestow operation. The patient was successfully treated with bowel resection and a side-to-side anastomosis between the most distal aspect of the bowel and the most distal Roux-en-Y reconstruction, which preserved both Roux-en-Y reconstructions.
文摘Introduction: Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-operative progression to discharge, and have been practiced for more than two decades. Their goal is to optimize patient care perioperatively in order to decrease costs without negatively affecting morbidity and mortality. However, the factors that predict successful EE are poorly understood, and patients with significant co-morbidities are frequently excluded from protocols. We hypothesize that independent of disease severity, early extubation leads to shorter hospital stays and can be performed safely without negatively affecting outcomes. Materials and Methods: We performed a retrospective review of 919 patients who underwent coronary artery bypass grafting (CABG) at the Southern Arizona Veteran’s Affairs Health Care System medical center over 7 years. We collected pre-operative data regarding patients’ NYHA classification, presence and severity of cerebral vascular disease, peripheral vascular disease, pulmonary disease, diabetes and hypertension. Intra-operative variables were also recorded including ASA scores, ischemic times, and time to extubation. Finally, post-operative variables such as rates of reintubation and tracheotomy, and both length of ICU and total hospital stay were also compared. Results: Prolonged periods of ischemia were found to predict a delayed extubation (HR = 0.992;CI = 0.988 - 0.997, p = 0.0015) while small body surface area (HR = 1.57;CI = 1.13, 2.17, p = 0.007) and higher pre-operative functional status of the patient, such as independent versus dependent status (HR =1.68;CI = 1.30 - 2.16, p = 1.33;CI = 1.03 - 1.70, p = 0.03) were found to be associated with earlier extubation. The early extubation (EE) group (those extubated in less than the median 7.3 hours) had an average hospital stay of 5.1 ± 4.0 days, versus 7.8 ± 8.1 days in the delayed group (>4 hours), p Conclusions: In our study population, pre-operative functional class and total body surface area predicted those patients able to tolerate early extubation after cardiac surgery. Prolonged ischemia resulted in delayed extubation. Patients that were extubated in less than 4 hours had shorter ICU and hospitalization stays, while there was no significant difference between the two groups in rate of reintubation or tracheotomy.
文摘Objective: To examine the prevalence and correlates of sexual activity and function in postmenopausal women with heart disease. Methods: We included baseline selfreported measures of sexual activity and the sexual problem scale from the Medical Outcomes Study in the Heart and Estrogen/Progestin Replacement Study (HERS), a study of 2,763 postmenopausal women, average age 67 years, with coronary disease and intact uteri. We used multivariable linear and logistic regression to identify independent correlates of sexual activity and dysfunction. Results: Approximately 39% of the women in HERS were sexually active, and 65% of these reported at least 1 of 5 sexual problems (lack of interest, inability to relax, difficulty in arousal or in orgasm, and discomfort with sex). In multivariable analysis, factors independently associated with being sexually active included younger age, fewer years since menopause, being married, better self- reported health, higher parity, moderate alcohol use, not smoking, lack of chest discomfort, and not being depressed. Among the 1,091 women who were sexually active, lower sexual problem scores were associated with being unmarried, being better educated, having better self- reported health, and having higher body mass index. Conclusion: Many women with heart disease continue to engage in sexual activity into their 70s, and two thirds of these report discomfort and other sexual function problems. Physicians should be aware that postmenopausal patients are sexually active and address the problems these women experience.
文摘. In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff. Methods. From 1995- 2004, 6 of our patients underwent LPUV including 5 patients with stage Ib1 cervical cancer and one patient with Ia1 cervical cancer. Prior procedures were TVH (n = 3), TAH (n = 2) or LAVH (n = 1). Charts were reviewed and follow-up data were collected. Results. Mean age was 40.5 (38- 49) years and Quetelet index was 31.5 (25- 40) kg/m2. Average time from hysterectomy to LPUV was 54 (30- 84) days. Retrospective FIGO staging revealed stage Ib1 (n = 5) and stage Ia1 (n = 1) cervical cancer. Mean duration of surgery was 207 (151- 265) min, average blood loss 300 (100- 500)mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10- 36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs postoperative was 6.4 (0.2- 10.9) % . There were no further postoperative complications during the average hospital stay of 3.5 (2- 5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (350) months of follow-up. Conclusion. LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.
文摘Objective(s). To compare the type-specific human papillomavirus (HPV) recover y from physician and patient-collected samples. Methods. Three hundred thirty- four (334) women attending colposcopy clinics in three countries were enrolled i n this cross-sectional study. Cervicovaginal samples were collected by patients and physicians and processed with polymerase chain reaction and reverse line bl ot genotyping. McNemar’s Chi-squared tests and Kappa statistics were utilized to determine statistical associations between physician-versus patient-collect ed samples. Results. Oncogenic HPV infection was identified in 23.2%of patient -collected specimens compared to 34.9%of physician-collected specimens. Physi cian sampling detected significantly more infections with type 16 and 52 than di d self-sampling and significantly more oncogenic HPV infection overall. For non -oncogenic HPV detection, there was no statistical difference between physician -and patientcollected samples. Conclusion(s). Patient sampling for HPV using a single vaginal brush does not identify all oncogenic HPV subtypes.
