Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and...Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.展开更多
Sarcoidosis is a multisystem inflammatory granulomatous disease of unknown etiology. Neurosarcoidosis (NS) is a rare but potentially devastating manifestation of sarcoidosis, with a prevalence of approximately 5% in p...Sarcoidosis is a multisystem inflammatory granulomatous disease of unknown etiology. Neurosarcoidosis (NS) is a rare but potentially devastating manifestation of sarcoidosis, with a prevalence of approximately 5% in patients with systemic sarcoidosis. Due to the possible involvement of any part of the nervous system, a myriad of neurological manifestations can occur. Clinical features resulting from involvement of the hypothalmo-pituitary axis and cranial nerves, in particular, cranial nerve VII are the more common presentations of this condition. Medical therapy with corticosteroids is the mainstay of treatment and providing tissue for diagnosis remains the principal indication for surgery. Therapeutically, neurosurgery is indicated only for life-threatening complications. We describe the clinical case of a patient with fatally progressive NS who had multiple anesthetic exposures. This case highlights the perioperative considerations of NS and its anesthetic implications.展开更多
Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotom...Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIGO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un?dergone vertical midline incision and to have had COX II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.展开更多
China＇s economic development since 1978 is one of the most significant events in recent history. Many aspects of this development have been extensively analyzed in the published literature. However, the implications ...China＇s economic development since 1978 is one of the most significant events in recent history. Many aspects of this development have been extensively analyzed in the published literature. However, the implications of China ＇s growth for other countries have been relatively neglected. The present paper attempts to fill this gap in the literature. The paper first presents some facts on China＇s role in the world economy, and then measures the impact of China＇s growth on growth in the rest of the world in both the short term and the long term. Short-run estimates based on vector autoregression and error correction models suggest that spillover effects of China＇s growth have increased in recent decades, Long- term spillover effects, estimated through growth regressions based on panel data, are also significant and have extended in recent decades beyond Asia. The estimates are robust to the effects of global and regional shocks, changes in model specification, and sample period.展开更多
文摘Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.
文摘Sarcoidosis is a multisystem inflammatory granulomatous disease of unknown etiology. Neurosarcoidosis (NS) is a rare but potentially devastating manifestation of sarcoidosis, with a prevalence of approximately 5% in patients with systemic sarcoidosis. Due to the possible involvement of any part of the nervous system, a myriad of neurological manifestations can occur. Clinical features resulting from involvement of the hypothalmo-pituitary axis and cranial nerves, in particular, cranial nerve VII are the more common presentations of this condition. Medical therapy with corticosteroids is the mainstay of treatment and providing tissue for diagnosis remains the principal indication for surgery. Therapeutically, neurosurgery is indicated only for life-threatening complications. We describe the clinical case of a patient with fatally progressive NS who had multiple anesthetic exposures. This case highlights the perioperative considerations of NS and its anesthetic implications.
文摘Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIGO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un?dergone vertical midline incision and to have had COX II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.
文摘China＇s economic development since 1978 is one of the most significant events in recent history. Many aspects of this development have been extensively analyzed in the published literature. However, the implications of China ＇s growth for other countries have been relatively neglected. The present paper attempts to fill this gap in the literature. The paper first presents some facts on China＇s role in the world economy, and then measures the impact of China＇s growth on growth in the rest of the world in both the short term and the long term. Short-run estimates based on vector autoregression and error correction models suggest that spillover effects of China＇s growth have increased in recent decades, Long- term spillover effects, estimated through growth regressions based on panel data, are also significant and have extended in recent decades beyond Asia. The estimates are robust to the effects of global and regional shocks, changes in model specification, and sample period.
