Postsurgical Phase Research Articles

Skeletal class III with laterognathia and lower facial third asymmetry. Surgical-orthodontic treatment

Female patient, 16 years of age, who attended the Department of Orthodontics at the National Autonomous University of Mexico. The main reason for consultation was: «I have a deviated jaw». Upon facial clinical examination, from the front view an oval and elongated face may be noted as well as an increased lower third, the chin deviated to the right, the facial midline did not match the dental midline, a non-consonant neutral smile and a 60% exposure of the incisor clinical crowns. On a lateral view: a straight profi le, competent lips, acute nasolabial angle and increased mentocervical length may be observed. Intraorally there is an ovoid-shaped arch, non-coincident dental midlines, crowded teeth, anterior and posterior right crossbite, absence of the first upper molars (nonassessable molar relationship) right and left canine class III, -2 mm overjet and a 2 mm overbite. Radiographic records included a lateral headfilm, a posteroanterior radiograph and a panoramic radiograph as well. The cephalometric analysis revealed a skeletal Class III due to mandibular prognathism, a neutral growth pattern, proclined upper incisors and lower incisor retroclination. The posteroanterior radiograph showed a discrepancy of the maxillo-mandibular line of 4o and a postural asymmetry of 5o. In the panoramic radiograph asymmetric mandibular ramus, ACJ at alveolar crest level, 2:¼ root-crown ratio, upper and lower third molars, absence of the first upper molars and maxillary lateral incisor root with endodontic treatment may be noted. Functionally, the patient presented without any apparent TMJ problems. Treatment consisted of three phase: pre-surgical orthodontic phase, surgical phase and post-surgical orthodontic phase. The objectives were: to correct in all three planes of space the skeletal disharmony presented by the patient, to provide functional occlusion and optimal facial and dental aesthetics as well as joint stability and periodontal health.

Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons

Premorbid cognitive impairment and dementia in older individuals negatively affect functional recovery after hip fracture. Additionally, post-operative delirium is an established risk factor for negative outcomes among hip fracture patients. While the majority of hip fracture patients experience minor post-surgical cognitive dysfunction, the prognostic value of this phenomenon is unknown. Therefore, we investigated the relationship between minor cognitive dysfunction or delirium detected in the early post-surgical phase and the 1-year mortality after index hip fracture. We enrolled 514 patients with hip fracture (77.4% women), aged 65years or older (mean age 83.1±7.3years), who underwent surgical hip fracture repair. Patients were assessed daily from the second to the fourth post-operative day and at 3, 6, and 12months thereafter. All participants underwent comprehensive assessment, including detection of delirium by using the confusion assessment method and evaluation of cognitive function by using mini-mental state examination (MMSE; score range 0 to 30, with lower scores indicating poorer performance). In the absence of delirium, post-surgical cognitive dysfunction was defined as having low performance on MMSE. Vital status of 1year after the index fracture and date of death were gathered from local registries. The observed 1-year mortality rate was 14.8%. Men were more likely to die than women within 1year of the index fracture (p<0.01). Compared to participants with better cognitive performance, those with MMSE<24, as well as those with delirium in the post-operative phase, showed a significantly higher 1-year mortality rate (23.3 versus 17.9 and 8.1%, respectively). Independent of age and sex, post-operative cognitive dysfunction as well as delirium was both associated with a 2-fold increased mortality risk. The presence of minorcognitive dysfunction in the early post-surgical phase is a negative prognostic factor for mortality among elderly hip fracture patients. The burden of minor cognitive dysfunction is likely superimposed on that of delirium in subgroups of frail patients.

Early Viscosupplementation After Anterior Cruciate Ligament Reconstruction

Background: Hyaluronic acid (HA) has been widely used to treat osteoarthritis given its biological and mechanical properties. Because HA is an “intra-articular” treatment approach that affects the joints, it could be used in the management of acute conditions, such as during the early postsurgical phase, to reduce inflammatory stress and improve articular function. Purpose: The aim of the present double-blind, randomized controlled trial was to evaluate pain control and functional recovery provided by a single injection of HA performed the day after anterior cruciate ligament (ACL) reconstruction. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The study enrolled 60 patients affected by primary, chronic, and symptomatic ACL tear requiring surgical reconstruction. All patients were treated with the same reconstructive technique and rehabilitation protocol. Exclusion criteria were (1) concurrent articular lesion requiring surgical treatment, (2) axial malalignment in the index limb, and (3) functional limitation or pain in the contralateral knee. The day after the procedure, the patients were randomized to receive a single injection of 3 mL HA or 3 mL saline solution after surgical drains were removed. All patients were evaluated at baseline and at 15, 30, 60, and 180 days and 12 months after surgery by use of the following tools: Short Form–36 Health Survey (SF-36), International Knee Documentation Committee (IKDC) subjective score, visual analog scale (VAS) for pain, VAS for general health status, and Tegner score. At each follow-up evaluation, the transpatellar circumference and active and passive range of motion (ROM) of both knees were recorded. Results: No severe adverse events were documented after early viscosupplementation. A significant improvement was documented in both treatment groups. Significant differences were documented in the transpatellar circumference at 60 days and in active ROM at 30 days postoperatively; patients who received HA had better values compared with the placebo group (P = .022 and .027, respectively). No statistically relevant intergroup differences were found in the clinical scores. Conclusion: The study documented no adverse events and had some positive findings in terms of active ROM recovery and transpatellar circumference reduction. However, the early postoperative application of viscosupplementation did not lead to significant improvement in clinical scores after ACL reconstruction. Registration: NCT02630407 (ClinicalTrials.gov identifier),

Surgical-orthodontic treatment in a skeletal class III patient. A case report

A 24-year-old patient attended the Orthodontics Clinic of the Division of Postgraduate Studies and Research, Faculty of Dentistry, UNAM, with a previous orthodontic treatment and absence of lower 1st premolars. The chief complaint was an unattractive facial appearance due to a forward position of the mandible and anterior open bite. Upon facial examination, in the frontal view, a leptoprosopic face, collapsed paranasal areas and incompetent lips were observed. In the vertical facial proportions, the lower third was increased. The lateral and oblique view showed a greater projection of the chin, a concave profile and an increased mentocervical length. Intraorally, the molar relationship was class III; a 2 mm anterior open bite and complete anterior cross bite of 1 mm were also observed. The patient presented a mild discrepancy of the dental midline as well. Orthodontic treatment was carried out in three phases: presurgical, surgical and postsurgical. In the presurgical phase dental decompensation was performed and the patient was prepared for surgery. In the surgical phase a segmental maxillary surgery from lateral incisor to lateral incisor was performed in order to produce a movement of sagittal rotation thus projecting the nasogenian area and improving incisor inclination. A mandibular setback via bilateral sagittal osteotomy was also performed. In the postsurgical phase ideal occlusal relationships were achieved in terms of canine class, molar class, overjet, overbite, centered dental midlines as well as a more harmonious profile.

Preventive physical therapy and care humanization in the treatment of a bedridden, home care, neurologic patient

Abstract Introduction: This case study investigated the impact of preventive physical therapy on shoulder problems and the prevention of pressure ulcers (PU) in a bedridden, home care, post-neurological surgery patient. Objective: To highlight the importance of physical therapy in the prevention of comorbidities, chronic neurological sequelae, and PU. Materials and Methods: In the immediate post-surgical phase, the patient was treated with preventive measures against PU, according to the Pressure Ulcer Prevention Protocol of the University of São Paulo, the National Pressure Ulcer Advisory Panel, and the Braden Scale. In addition, we used the modified Ashworth scale to assess spasticity. A kinesiotherapy program based on the Bobath's concept was used to prevent subluxation of the plegic arm and help in the recovery of functional movements. Results: The use of preventive measures and delivery of humanized care during a six-month period helped prevent the development of stage 3 and 4 PU and physical, functional, and respiratory complications. By the end of six months, the patient was found to be at low risk of developing PU. Conclusion: Notwithstanding the difficulties experienced during treatment, especially for the positioning of the arm and performance of transferring and positioning techniques, the results of this study are in agreement with aspects considered important for treatment outcomes.

Aplicación de la terminología nanda-noc-nic en un paciente trasplantado de páncreas riñón

La Diabetes Mellitus (DM), es una epidemia mundial que se cifra en 190.000.000 de casos, 330.000.000 se prevén en 2025, produce 3.200.000 muertes al año o lo que es lo mismo 6 muertos por minuto. En España hay 3.400.000 diabéticos, y esta cifra aumenta a un ritmo del 5% al año, y en nuestra comunidad de Castilla y León se contabilizan 200.000 pacientes con esta patología. La DM es la principal causa de ceguera y de insuficiencia renal crónica (IRC) en el mundo desarrollado, el 21% en España, y en Castilla y León es del 6-8 %, y aumenta la probabilidad de infarto agudo de miocardio y/o hemorragia cerebral y amputaciones1. A largo plazo puede tener numerosas complicaciones, entre ellas la nefropatía diabética, la cual suele aparecer en el 50% de los pacientes a los 20 años de comienzo de la diabetes. La nefropatía diabética es completamente asintomática hasta que se produce un daño grave, y es responsable de que cerca del 30% de los enfermos entre en diálisis periódica y primera causa de trasplante renal en países occidentales2. Actualmente el trasplante de páncreas riñón es la mejor opción terapéutica para el paciente diabético en diálisis, pero la intervención quirúrgica y la fase postquirúrgica pueden presentar diferentes complicaciones. Aplicamos el proceso enfermero, que es un método sistematizado de brindar cuidados centrados en el logro de objetivos (NOC), el uso del proceso enfermero complementa el trabajo de los profesionales de otras disciplinas.

Orthodontic-surgical correction with a bilateral mandibular ramus sagittal osteotomy of a skeletal Class III maloclussion

A case of a male patient of 19 years 3 months of age is reported. The chief complaint was having discomfort in the jaw. The diagnosis was a hyperdivergent skeletal class III, bilateral molar and canine class III with proclined upper incisors, bilateral anterior and posterior cross-bite, upper and lower crowding with a lower dental midline deviation. The patient also had a maxillary collapse. The patient did not refer any habit. Treatment was conducted in three phases: a pre-surgical phase: alignment, leveling, dental decompensation, tripodism (occlusal stability), transverse expansion. Surgical Phase: Mandibular LeFort I Surgery: 5mm advancement. Post-surgical phase: Detailing, retention. Active treatment time was 4 years 4 months. Removable upper and lower Hawley retainers and fi xed canine to canine both in the upper and lower arch were used. Treatment outcome was successful, obtaining bilateral canine and molar Class I, normal overjet and overbite, coincident midlines, adequate intercuspation and a harmonic facial profi le.Key words: Anterior and posterior crossbite, mandibular advancement.

Comparison of Ketamine–Medetomidine-butorphanol and Ketamine–dexmedetomidine-butorphanol Anesthesia in Rats

We evaluated the effect of ketamine-dexmedetomidine-butorphanol (K, 80 mg/kg; D, 0.25 mg/kg, B,0.5 mg/kg) and ketamine-medetomidine-butorphanol (K, 80 mg/kg; M, 0.25 mg/kg, B,0.5 mg/kg) administered intraperitoneally, during anesthesia and immediate recovery post surgical phase, in male Wistar Outbreed rats undergoing surgery for free graft sciatic nerve transplantation. Recovery was determined by first reflexes and movements. Res**ults suggest that both anaesthetic protocols were fast and long-acting, providing immobility, loss of consciousness and analgesia. During anesthesia rats subjected to ketamine-dexmedetomidine-butorphanol protocol had lower heart and respiratory rates compared with the other group (ketamine-medetomidine-butorphanol). During the immediate post surgical phase, rats subjected to ketamine-dexmedetomidine-butorphanol protocol had a slower recovery evolution, associated with higher mortality compared with ketamine-medetomidine-butorphanol.

Psychosocial and functional outcomes of orthognathic surgery: Comparison with untreated controls

ObjectivesOrthognathic surgery is a procedure for patients with dentofacial deformities and provides dramatical dentofacial and psychological alterations. The aim of this controlled study was to evaluate how orthognathic surgery affects patients’ psychosocial well-being and compare them with patients having dentofacial discrepancies and with individuals who do not have any skeletal discrepancies. MethodsHundred and sixty-three adult individuals were included in this study as three groups: patients who underwent orthognathic surgery, patients having skeletal discrepancies and individuals who do not have any skeletal discrepancies. Patients in all groups were asked to fill out two questionnaires concerning the psychological and physical status of the patients at that moment and additional questions were asked to patients in post-surgical phase regarding post-surgical satisfaction. Categorical variables were statistically evaluated by Fisher Exact and chi-square tests. ResultsPatients who were going to seek orthognathic surgery were significantly concerned about their dentofacial appearance, body image and psychosocial status when compared with patients in the post-surgical phase and the individuals who did not have skeletal discrepancies. The results of the patients who underwent orthognathic surgery were approximated to the results of non-patient control group and had high degrees of satisfaction with improvement in appearance brought about by surgery at 6-month post-operatively. ConclusionFollowing orthognathic surgery, patients had better psychosocial status when compared to patients without skeletal deformities. Patients in the pre-surgical phase were not only functionally but also psychosocially the least satisfied group of individuals.

Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate

ObjectiveTo analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180W versus the gold standard transurethral resection of the prostate. MethodsA multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS=15, Qmax=15mL/seg and a prostate volume of 40–80mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications. ResultsA total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (p=0.67). The average direct cost per patient was reduced by 114€ in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: 1209€; p<0.001) but was lower in the post-surgical phase (difference: €−1351; p<0.001). ConclusionsThe GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology.

Serum Leptin is Decreased Thirty Days after Surgery

Background: Leptin plays an important role for the regulation of food intake, energy expenditure and glucose control. The aim of this study was to study the effect of surgery on circulating levels of human leptin in a human elective surgery model. Methods: A prospective observational study was conducted. Blood sampling was carried out prior to surgery and four and thirty days after elective surgery, respectively. Patients undergoing orthopedic surgery (n=29) and coronary bypass patients (n=21) were included in the study. Serum leptin levels were measured using sandwich ELISA. C-reactive protein (CRP) was analyzed by turbidimetry. Results: Leptin values was significantly decreased thirty days after surgery in both orthopedic (p=0.002) and coronary bypass patients (p=0.003) in comparison with presurgical values. Conclusion: Elective surgery is associated with decreased leptin levels in the late postsurgical phase.

Estudio multicéntrico de costes de 2 técnicas quirúrgicas: láser GreenLight XPS 180 W vs resección transuretral de la próstata

ObjectiveTo analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180¦W versus the gold standard transurethral resection of the prostate. MethodsA multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS=15, Qmax=15mL/seg and a prostate volume of 40-80mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications. ResultsA total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October, 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (P=.67). The average direct cost per patient was reduced by €114 in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: €1,209; P<.001) but was lower in the post-surgical phase (difference: €–1,351; P<.001). ConclusionsThe GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology.

Plasma Rich in Growth Factors Improves Patients' Postoperative Quality of Life in Maxillary Sinus Floor Augmentation: Preliminary Results of a Randomized Clinical Study

The control of postoperative discomfort may improve the patient's quality of life as well as treatment acceptance. The aim of the present preliminary report was to assess if the use of autologous platelet concentrate during maxillary sinus augmentation may have a favorable impact on pain and other factors related to patient's quality of life in the first week after surgery. This is an interim report of a randomized single-blind study. Fifteen patients with atrophic edentulous posterior maxilla underwent maxillary sinus augmentation using deproteinized bovine bone matrix (DBBM) as the grafting material (control group). In other 15 patients (test group), autologous plasma rich in growth factors (P-PRP) was added to DBBM, then a P-PRP clot was applied to covering the graft before suturing and finally P-PRP was placed over the suture in liquid form. During the first week postsurgery, all patients filled in a questionnaire for evaluation of main symptoms and daily activities. The outcomes of the questionnaires of the two groups were statistically compared. In the first days postsurgery, the group using P-PRP reported significantly less pain, swelling, and hematoma, and improved functional activities with respect to the control group. The adjunct of P-PRP to the maxillary sinus augmentation procedure produced a beneficial effect to patients' quality of life in the early postsurgical phase.

Efficiency of Calatonia on clinical parameters in the immediate post-surgery period: a clinical study

To assess the efficiency of the Calatonia technique about clinical parameters and pain in the immediate post-surgical phase. A randomised study was carried out with 116 patients subjected to a cholecystectomy, by laparoscopy, divided into an experimental group (58 patients) and a placebo group (58 patients). The experimental group received the Calatonia technique, while the placebo was only subjected to non-intentional touches. The placebo group and the experimental group were considered homogeneous in terms of the variables: sex, age, physical status classification, duration of surgical procedures and also the time spent recovering in the Post-Anaesthetic Recovery Room. The only variable to show a statistically significant difference was the axillary temperature of the body. In relation to pain, the experimental group showed significant results, and hence it is possible to deduce that the relaxation caused by the Calatonia technique brought some relief of the general situation of pain. The application of Calatonia can take up the function of a resource complementary to assistance in the period immediately after surgery. Brazilian Register of Clinical Trials, UTN U1111-1129-9629.

Membrane Guided Regeneration in Periodontal Tissues

Periodontal regeneration is the restoration of lost periodontium or supporting tissues and includes the formation of new alveolar bone, new cementum and new periodontal ligament. The concept of GTR is based on the exclusion of gingival connective tissue cells and prevention of epithelial down growth into the wound, thereby allowing cells with regenerative potential (PDL and bone cells) to enter the wound first. GTR consists of placing barriers of different types to cover the bone and periodontal ligament thus temporarily separating them from gingival epithelium. Excluding the epithelium and gingival connective tissue from the root surface during the post-surgical healing phase not only prevent epithelial migration into the wound but also favors repopulation of the area by cells from the periodontal ligament and bone. Purpose and Scope -This review discusses the rationale for using guided tissue regeneration therapy. The review not only attempts to clarify the concept of selective tissue regeneration using non-resorbable and resorbable barriers, but to discuss differences in healing events after treatment with the two types of barriers together with their significance in periodontal therapy. At present, barrier membranes have potential clinical use in promoting periodontal tissue regeneration if patients to be so treated are selected appropriately. Research is still necessary to determine the critical period for guiding the ingrowth of new attachment forming cells and also to further clarify the concept of GTR involving the "wrong cell type" which inhibits periodontal tissue regeneration.

Evaluation of Minimal Versus Conventional Presurgical Orthodontics in Skeletal Class III Patients Treated With Two-Jaw Surgery

The purpose of this study was to compare changes in hard and soft tissues and the treatment efficacy of 2-jaw surgery combined with nonextraction treatment for skeletal Class III malocclusion in patients who received minimal presurgical orthodontics (MPO) versus those who received conventional presurgical orthodontics (CPO). Thirty-two patients (16 in each group) with skeletal Class III malocclusion who underwent 2-jaw surgery were included in the study. Serial lateral cephalometric films were traced at 4 stages: before treatment (T0), before surgery (T1), 1 month after surgery (T2), and at debonding (T3). Cephalometric measurements and treatment duration were compared using independent t test and Mann-Whitney U test. After the presurgical treatment phase, the angle between the lower incisor axis and mandibular plane, overjet, and soft tissue pogonion to the vertical reference line showed larger changes (P < 0.01) in the CPO group, whereas the pogonion to the horizontal reference line showed larger changes (P < .05) in the MPO group. In the postsurgical phase (T2 to T3), there were no significant differences between the 2 groups. Total treatment duration was significantly shorter in the MPO group. There were no significant differences between the MPO and CPO groups in the hard and soft tissue cephalometric variables. The MPO group had a shorter total treatment time. It is therefore recommended that clinicians consider these results when selecting MPO as a treatment option for accurate diagnosis and treatment planning of Class III surgical patients.

Splitting of the cerebellar vermis in juvenile rats—Effects on social behavior, vocalization and motor activity

Radical resection of malignant midline tumors of the posterior fossa in childhood followed by adjuvant therapies like chemotherapy or radiotherapy often leads to longterm survival and even healing of such patients. Therefore, quality of life becomes particular important. Postoperative neurological deficits, such as cerebellar mutism and ataxia have been attributed to splitting of the cerebellar vermis to remove these tumors.Here, we tested the effect of vermian splitting in juvenile rats on social behavior, vocalization and motor activity. Juvenile male Sprague Dawley rats, aged 23 days, underwent vermian splitting under general anesthesia after medial suboccipital craniotomy (lesioned group, n=16). In sham-lesioned rats, only craniotomy was performed and the dura was opened with release of cerebrospinal fluid (n=16). Naïve rats served as controls (n=14). All groups were tested on day 0 (before surgery), and on days 1–4 and 7 after surgery for locomotor activity, motor coordination, social behavior, and ultrasound vocalization during social interaction. Finally, splitting of the vermis was histologically verified.Social interaction was reduced for two days after surgery in lesioned rats compared to sham-lesioned rats and controls. Vocalization was decreased for one day compared to controls. Locomotor activity was disturbed for several days after surgery in both lesioned and sham-lesioned rats as compared to controls.Deficient social behavior and vocalization after surgery are related to vermian splitting in juvenile rats. These results indicate that similar to the human context vermian splitting can reduce communicative drive in the early postsurgical phase.

Variáveis psicossociais associadas à cirurgia ortognática: uma revisão sistemática da literatura

A cirurgia ortognática é um tipo de tratamento orto-cirúrgico indicado para pacientes com deformidade dentofacial. Este tema tem ganhado repercussão na comunidade científica e, mais recentemente, no ramo das ciências psicológicas, pois as pessoas recorrem cada vez mais a este tipo de tratamento e os psicólogos começam a ser contratados para responderem às necessidades emocionais destes pacientes. Este artigo dedica-se a uma revisão da literatura, dos últimos nove anos, visando explorar particularmente se determinadas características psicossociais do paciente contribuem para a eficácia do tratamento ortocirúrgico. A nossa pesquisa identificou catorze estudos e os resultados são apresentados por setores: (a) fase pré-operatória, (b) fase pós-operatória a curto e médio prazo, (c) fase pós-operatória a longo-prazo. Verificámos que algumas características dos pacientes e uma relação de proximidade estabelecida com os profissionais de saúde parecem contribuir para a satisfação, porém, é apoio psicológico de caráter preventivo dos fatores de risco que parece determinar o sucesso do tratamento orto-cirúrgico. A demasiada valorização das expectativas de benefícios psicológicos, a insegurança na tomada de decisão, o desconhecimento dos custos emocionais da cirurgia, o pobre suporte social (ou a pressão dos familiares) e as perturbações psicopatológicas justificam a utilidade do apoio psicológico. Finalmente são apontadas algumas características psicológicas, positivas e negativas, do paciente assim como sugestões para futuras investigações.

SFR-111 Optimising lifestyle factors to achieve weight loss in surgical patients

The aim of the study was to optimise the exercise regime in a population of patients who have undergone Laparoscopic Adjustable Gastric Banding (LAGB). The study compared an optimised exercise program with standard routine post-operative care to determine if optimising the exercise regime of patients in the post-surgical phase of weight loss further significantly contributes to this surgical weight loss.

Incidence of mutism, dysarthria and dysphagia associated with childhood posterior fossa tumour

Dysarthria and dysphagia are known complications following posterior fossa tumour (PFT) surgery. Outcome studies for these disorders, however, have focused on a select sub-group of children with mutism. Little is known regarding the incidence or features of these impairments in a consecutively admitted sample of children with PFT. This study describes the incidence and features of mutism, dysarthria and dysphagia during the acute post-surgical phase in a consecutive sample of children with PFT, unselected for the presence of mutism. A retrospective medical chart review of children aged 2 to 18 years consecutively admitted with PFT between January 2003 and January 2008 was conducted. Twenty-seven children with PFT were identified. Post-surgical mutism, dysarthria and dysphagia were recorded in 9/27 (33%), 8/27 (30%) and 9/27 (33%) cases, respectively. Dysarthria most commonly involved deficits in articulation; however, impairments in respiration, phonation and prosody were also reported. Dysphagia involved all stages of swallowing (i.e., pre-oral anticipatory, oral preparatory, oral and pharyngeal). Eighty-nine percent of children (8/9) presented with dysphagia at hospital discharge. The incidence of acute presentation of mutism, dysarthria and dysphagia post-surgery was relatively high, affecting around one in three cases. This incidence rate, considered together with the fact that over half of all cases had co-morbid communication or swallowing impairments, suggests that health professionals should be aware of the likelihood of dysarthria and dysphagia presentation in the acute period and consider speech pathology referral where necessary.