Compendiu Pneumo 2013 Editia a 2-A

Cancer neuroendocrine a petite cellule

Neacu, C. Vintil, Paula Popa, N. Dnil Clinica I Chirurgie I. Tnsescu Vl. Buureanu, Spitalul Sf. Aprodu, Doina Mihil, C. Cancer neuroendocrine a petite cellule, Doina Nedelcu, V. Novac, C. Ciut, B. Novac, L. Todosi, I. Hamburda, A. Jakab, O. Ilea, T.

Jutis, F. Sn, C. Pleca, I. Trcoveanu, C. Lupacu, C. Neacu, Felicia Crumpei,A. Vasilescu Clinica I Chirurgie I. Spiridon Universitatea de Medicin i Farmacie Gr. Lunc, N. Romedea, C. Aldea Jurnalul de Chirurgie, Iasi,Vol.

Compendiu Pneumo Editia a 2-A

Trcoveanu Vol. Trcoveanu Vasile Drug, Ed. This concept brings together different perioperative strategies which according to evidence-based medicine hpv research articles useful strategies. The goal of the concept is to optimize the perioperative management of the patient in order to reduce morbidity, to enhance recovery of the patient after a surgical procedure, to reduce hospital stay and to reduce costs.

The authors concluded institution of a multimodal fast-track rehabilitation program reduced hospital stay and medical complications in a comparative, nonrandomized study in elderly high-risk patients undergoing colonic surgery [1]. The hospital stay in the ERAS group was reduced to helminth infection inflammation mean duration of days compared to days in the group of conventional care.

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The growing interest to this concept is reflected by the fact that a lot of studies were published, studies which apply the same strategies in different types of surgery: abdominal surgery, orthopedics, gynecology, urology, a.

The implementation of this concept relies upon hospital policies developed and applied in all departments and services involved in the management of the surgical patients. The team approach cancer neuroendocrine a petite sarcoma cancer vertaling a lot of medical personnel, but the main actors cancer neuroendocrine a petite cellule the surgeon and the anesthetist, which have the most constant and direct contact with the patient.

The fast-track concept refers to all phases of perioperative care: preoperative, intraoperative and postoperative strategies.

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The preoperative strategies include no fasting, no preoperative bowel preparation at least for right colonic resectionpreoperative metabolic and nutritional support and patient education. Compendiu Pneumo Editia a 2-A Along with other well recognized causes an important factor in the development of undernutrition is in-hospital fasting and improper nutrition. Fasting is regularly recommended for the cancer neuroendocrine a petite cellule neuroendocrine a petite cellule procedures and for preoperative bowel preparation and extends upon at least several days.

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Improper nutrition during hospitalization is a word-wide reality. The European Council adopted a resolution in order to draw attention to the spread and consequences of this problem. The classical over-night 6-hours fasting period is in reality usually longer hours.

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It is evidence- based that long-lasting fasting results in increased volume and decreased pH of the gastric content increasing the risk for aspiration. The current recommendations include a 2-hours fasting period cancer neuroendocrine a petite cellule elective surgery in patients without further risk for aspiration. Thus during night the patient is allowed to drink clear fluids. More than that, it is recommended that the patient drinks ml of a clear carbohydrate-rich drink 2 hours before the planned surgical procedure.

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This will increase patient comfort alleviating thirst, hunger and 89 Editorial Jurnalul de Chirurgie, Iasi,Vol. It will promote gastric empting as well, without any further increase in risk of aspiration.

As a result of the carbohydrate intake the surgery-induced stress metabolism is ameliorated and postoperative insulin-resistance decreased.

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Due to lack of means or knowledge or due to restraining medical recommendations patients often decrease their cancer neuroendocrine a petite cellule intake beyond their usual capacities. Preoperative nutritional management includes identification of patients with or at risk for undernutrition and nutritional recommendations. Resume Pneumologie Whenever possible the preferred route is the enteral one.

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For patients at risk for undernutrition it is useful to add to the usual food intake oral nutritional supplements sip drinks. The malnourished patient will benefit from a preoperative nutritional support, mainly in case of cancer or major surgical procedure.

It implies thorough explanations and realistic information about the medical and surgical procedures and about the realities of the postoperative period. In the absence of information delivered by the medical staff the patient will gather anecdotic data delivered by other patients according to their experiences, to cancer neuroendocrine a petite cellule level of understanding and of copping with those realities.

Patient education results in gaining patient cooperation. It will place the patient in the proper position of an important partner in the medical act.

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Also it will result in increased patient satisfaction and in decreased complains. Pre-admission counseling is most advisable. Coeficientul de solubilitate Cum coeficientul de solubilitate al CO2 este de 5 ori mai mare dect al O2, rezult ca i presiunea parial a CO2 este de 20 ori mai mic dect a O2. Sensul de difuziune al unui gaz ntre mediu lichid i cel gazos este dat de diferena dintre presiunile pariale ale gazului n cele 2 medii. Astfel, deoarece presiunea parial a oxigenului este mai mare n alveole dect n snge, acesta va difuza n snge, sensul fiind invers pentru dioxidul de carbon, a crui presiune parial este mai mare n snge dect n alveole.

Difuziunea prin membrana capilar Elementele membranei respiratorii sunt ilustrate n Figura 1. The intraoperative strategies include optimized anesthesia, tranverse surgical incision, atraumatic surgical technique, avoidance of drains and tubes, optimized volume therapy, single dose antibiotic prophylaxis, maintenance of intraoperative normothermia and prophylaxis of postoperative nausea and vomiting PONV.

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Intraoperative use of epidural analgesia combined with general anesthesia will allow decreased use of opioids, will alleviate postoperative stress and will enable effective postoperative epidural analgesia. Over-night permission to drink and what do intraductal papillomas feel like of colonic preparation result in absence of hypovolemia at the start of the surgical procedure and result in decreased intraoperative volume replacement.

Gut hypoperfusion will promote malfunction cancer neuroendocrine a petite cellule the intestinal barrier with release of pro-inflammatory intestinal mediators and bacterial translocation. On the other hand, excessive crystalloid infusion will result in tissue edema, impaired tissue oxygenation and impaired tissue healing.

Încărcat de Avoidance of intraoperative hypovolemia, but also avoidance of excessive crystalloid infusion may be achieved using a combination of crystalloids and colloids.

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It has a lot of consequences, but the most important are impaired hemostasis with increased intra- and postoperative blood loss, delayed metabolism of anesthetic drugs with delayed recovery, increased incidence of postoperative shivering with increased oxygen consumption and increased risk of myocardial ischemia. Often the patient forgets the postoperative pain, but remembers well and long the misery of nausea and vomiting.

The presence of these symptoms impairs the ability to resume oral hydration.

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The postoperative strategies include effective pain relief, early ambulation and early oral hydration and nutrition. Adequate pain relief relies upon use of written protocols, use of epidural analgesia and frequent pain evaluation and documentation pain evaluation results should be written cancer neuroendocrine a petite cellule patients file.

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It means bed rest in the day of major surgery, but at least 6 hours out of bed during day 1 after surgery. It is possible in the presence of adequate pain relief cancer neuroendocrine a petite cellule opioids.

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This strategy proved to be appropriate in case of colonic surgery and with adaptations is explored tratamentul negi genitale în locuri intime forum other types of surgery.

The ERAS protocol for colonic surgery recommends no naso-gastric tube, oral fluid intake in the day of surgery more than ml fluids and stop of iv fluids on day 1.

If necessary colloid administration is encouraged.

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In ERAS protocol for colonic surgery in the day of surgery cancer neuroendocrine a petite cellule nutritional supplements are indicated and solid food during day 1 after surgery combined with oral supplements sip drinks. It is always difficult to change routine. The term is not used meaning comfort, cancer neuroendocrine a petite cellule meaning time-proven ways of doing things.

Neuroendocrine cancer gastric, Neuroendocrine cancer gastric Conținutul Neuroendocrine tumors NETs are found throughout the intestinal tract, the appendix and terminal ileum being the most common locations, and are classified by site of origin and by degree of differentiation, with well-differentiated lesions representing those tumors formerly referred to as carcinoid tumors.