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1.
Eur Rev Med Pharmacol Sci ; 19(21): 4203-6, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26592848

RESUMEN

Opioids are drugs of reference for the treatment of moderate to severe pain. Their proper use and a periodic assessment of the patient are crucial to prevent misuse. A multidisciplinary group suggests strategies for all stakeholders involved in the management of pain and suggests the importance of the doctor-patient relationship.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/prevención & control , Manejo del Dolor/normas , Relaciones Médico-Paciente , Analgésicos Opioides/efectos adversos , Testimonio de Experto , Humanos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Dolor/diagnóstico , Dolor/tratamiento farmacológico , Manejo del Dolor/métodos
2.
Dis Esophagus ; 24(8): 583-9, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21489043

RESUMEN

Esophageal cancer surgery is traditionally performed by a number of open surgical approaches. Open approaches require thoracotomy and laparotomy. Developments in instrumentation and optics have allowed the use of minimally invasive approaches to esophageal cancer, which had been traditionally managed by open operation. Minimally invasive surgery (MIS) avoids thoracotomy and laparotomy and results in quicker return to normal functions and less morbidity. In this prospective study, we compared the immediate surgical and oncologic outcomes of patients who have undergone MIS with those who have had open surgery. From November 1, 2003 to March 30, 2006, 62 cases of carcinoma esophagus were operated in Surgical unit 3 (MIS unit) in the institute. Out of the 62 patients, 34 (54.8%) underwent minimally invasive esophagectomy (MIE), and the remaining 28 patients (45.2%) underwent open surgery. Both operations were done by the same team of surgeons. The groups were compared in terms of perioperative outcomes, morbidity, mortality, and adequacy of oncologic excision. The average duration for MIS was 312.35 min (60-480 min), which was more than that of open group surgery whose average duration was 261.96 min (60-360 min). This difference was found to be not significant (P < 0.110). The average blood loss was 275.74 mL (200-500 mL) in minimally invasive group compared with 312.50 (200-500 mL) in open group (P-value 0.33). Four patients (11.76%) in MIS group had been converted to open surgery. Average duration of hospitalization was 11.9 (4-24) days in MIS group compared with 12.19 (5-24) days in open group (P-value 0.282). Nine (26.47%) patients in MIS group had developed major or minor morbidity. Similarly, eight (28.57%) patients in open group had morbidity. One patient each expired in each group. The morbidity and mortality rates were not statistically significant. There were four leaks (11.76%) in MIS group and three leaks (10.71%) in open group (P-value 0.85). Regarding the extent of nodal clearance, an average number of 9.5 (0-19) nodes were removed in MIS group compared with an average of 7.26 (0-12) nodes in open group (P-value 0.05). Better visibility and magnification enabled more number of lymph nodes to be removed in MIS group. MIE is oncologically safe compared with open surgery. It has almost similar postoperative course, morbidity pattern, and duration of hospital stay as open surgery. Increased duration of procedure compared with open surgery is a disadvantage of MIS, especially in the early part of learning curve.


Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Países en Desarrollo , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Laparoscopía , Toracotomía , Adenocarcinoma/patología , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Carcinoma de Células Escamosas/patología , Distribución de Chi-Cuadrado , Supervivencia sin Enfermedad , Neoplasias Esofágicas/patología , Femenino , Humanos , India , Laparoscopía/efectos adversos , Tiempo de Internación , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Toracotomía/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
3.
Environ Sci Technol ; 15(6): 680-6, 1981 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-22299745
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