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PubMed1997

Leaving the nest: should vascular surgery seek board status separate from general surgery?

Current changes that impact on vascular surgery include altered financial support, the introduction of endovascular treatments, and possible reentrance of general surgeons into the vascular field. In addition, vascular surgery in competition with interventional specialties (radiology and cardiology) for patients. These changes and the enhanced competition mandate that vascular surgery and vascular surgeons adapt by becoming competent with endovascular techniques to perform their standard operations better and to provide newer, better treatments that replace standard vascular operations. Vascular surgery must also resolve its conflicts with the American Board of Surgery (ABS) and the Residency Review Committee in Surgery (RRC-S) so that adequate numbers of well-trained vascular surgeons will be available to care for vascular disease patients optimally. Whether this can occur by modifying the present system or by having a separate board and residency review committee in vascular surgery will depend on the willingness of the ABS and the RRC-S to recognize that vascular surgery is a separate specialty that is best performed by those with special training and commitment to this field.

Certification↗

PubMed2026

Meta-Analysis of the Efficacy of Ultrasound-Guided Mammotome Minimally Invasive Surgery and Traditional Open Surgery in the Therapy of Benign Breast Tumors.

ObjectiveTo systematically analyze the efficacy of ultrasound-guided mammotome minimally invasive surgery and traditional open surgery in the therapy of benign breast tumors.MethodsA computerized search retrieved original literature on the therapeutic effects of ultrasound-guided mammotome minimally invasive surgery and traditional open surgery for benign breast tumors from authoritative databases, including CNKI, Wanfang, VIP, Web of Science, PubMed, ScienceDirect, Cochrane Library, and Embase. The search covered from database inception to January 2024, using a strategy of subject terms combined with free terms. The retrieved literature was screened, data were extracted, and quality was evaluated. Meta-analysis was performed using RevMan 5.4 software.ResultsA total of 8 literatures were included in the study, and a total of 1909 patients with benign breast tumors were found from 2018 to 2023. The results of meta-analysis showed that the operation time [MD = -12.79, 95%CI (-14.04, -11.55), P < 0.00001], intraoperative blood loss [MD = -11.55, 95%CI (-14.74, -8.36), P < 0.00001], healing time [MD = -2.73, 95%CI (-4.03, -1.43), P < 0.00001] and complication rate [MD = 0.17, 95%CI (0.12, 0.26), P < 0.00001] was apparently different from traditional open surgery (P < 0.05).ConclusionUltrasound-guided mammotome minimally invasive surgery can effectively shorten the operation time of patients with benign breast tumors, reduce intraoperative blood loss, promote healing, and reduce the risk of complications. The effect is better than that of traditional open surgery.

Humans↗

PubMed1993

Outcomes of cataract surgery. Improvement in visual acuity and subjective visual function after surgery in the first, second, and both eyes.

OBJECTIVE: No previous study documents improvement in visual acuity and subjective visual function associated with cataract surgery in the first eye, second eye, and both eyes. Measurement of subjective aspects of visual function and quality of life provides information that cannot be obtained with simple measurement of Snellen visual acuity. METHODS: From 76 ophthalmology practices in three cities, patients undergoing cataract extraction with intraocular lens implantation (n = 613) and comparison patients (n = 408) were enrolled in a prospective study. Questionnaires elicited visual function information before and after surgery, and visual acuity was obtained from the ophthalmologic record. RESULTS: Among patients with cataract and no other eye disease, baseline subjective visual function before surgery in the second eye was better than that before surgery in the first eye. Improvement in subjective visual function was approximately equal postoperatively in first and second eyes. Improvement in subjective function in both eyes postoperatively was significantly greater than that after surgery in the first eye or second eye alone. No statistically significant difference across surgical groups in the proportion of patients demonstrating improvement in visual acuity was observed. CONCLUSION: Patients who underwent surgery in both eyes reported greater improvement in subjective visual function than did those who underwent surgery in one eye. Thus, there seems to be a benefit associated with restoring binocular vision in this population. These findings support the policy recommendation that cataract surgery in both eyes remains the appropriate treatment for patients with bilateral, cataract-induced visual impairment.

Aged↗

PubMed2000

Post-operative 5-fluorouracil for glaucoma surgery.

BACKGROUND: Trabeculectomy is performed as a treatment for many types of glaucoma in an attempt to lower the intra-ocular pressure. The surgery involves creating a channel through the sclera, through which intra-ocular fluid can leave the eye. If scar tissue blocks the exit of the surgically created channel intra-ocular pressure rises and the operation fails. Antimetabolites are used to inhibit wound healing to prevent the conjunctiva scarring down on to the sclera. The principal antimetabolites used are 5-Fluorouracil and Mitomycin C. Both may be applied on a sponge between the conjunctiva and sclera at the beginning of surgery. 5-Fluorouracil may also be given as one or more injections under the conjunctiva after the surgery. OBJECTIVES: The objective of this review is to assess the effects of post-operative injections of 5-Fluorouracil in eyes of people undergoing surgery for glaucoma. SEARCH STRATEGY: We searched the Cochrane Eyes and Vision Group specialised register, The Cochrane Controlled Trials Register (CENTRAL), MEDLINE and EMBASE. We searched the reference lists of relevant articles for additional trials, and we used the Science Citation Index to search for articles that cited the included studies. We contacted investigators and experts for details of additional relevant trials. SELECTION CRITERIA: We included randomised trials of post-operative 5-Fluorouracil injections compared to placebo injections or no injections in trabeculectomy for glaucoma. DATA COLLECTION AND ANALYSIS: We independently assessed trial quality and extracted data. We contacted trial investigators for missing information. Data were summarised using relative risk, Peto odds ratio and weighted mean difference as appropriate. MAIN RESULTS: Eight trials, which randomised a total of 536 participants, are included in the review. As far as can be determined from the trial reports, the methodological quality of the trials was not high. 5-Fluorouracil when delivered by post-operative injection appears to be effective in reducing the likelihood of surgical failure of trabeculectomy both in eyes at high risk of failure and those undergoing surgery for the first time. Complications are more common after 5-Fluorouracil injections, especially early and late wound leaks and temporary damage to the ocular surface. Whilst no evidence was found of an increased risk of serious sight threatening complications, people undergoing initial trabeculectomy had a substantially increased risk of ocular hypotony. None of the trials reported on the participants' perspective of care. REVIEWER'S CONCLUSIONS: This treatment is now rarely used on the basis of a planned series of post-operative injections.This presumably reflects an aspect of the treatment that is unacceptable to both patients and doctors. None of the trials reported on the participants' perspective of care which constitutes a serious omission for an invasive treatment such as this. Increasingly, injections are used on an ad hoc basis. The effectiveness of this strategy is the subject of a future systematic review.

Antimetabolites↗

PubMed1995

Third molar surgery: an audit of the indications for surgery, post-operative complaints and patient satisfaction.

A prospective investigation was undertaken of 522 patients undergoing third molar surgery. Data relating to indications for surgery and quality of care were collected on both pre- and post-operative proformas. This investigation showed that over half of the patients did not have clinically sound indications for surgery. The incidence of post-operative complications was approximately the same as other studies on third molar surgery. Patient satisfaction was at a high level, although this study revealed that a percentage of symptom-free patients undergoing third molar surgery sustained nerve damage some of which remains unreported. Clear and well defined indications for third molar surgery do exist and should be adhered to. Operating on patients without good reason involves unnecessary expenditure to purchasing authorities, cost to the patient in both time off work and post-operative complications and further, may result in potentially avoidable legal problems for practitioners. A reappraisal of the impacted third molar is indicated prior to committing the patient to surgery, such that the indications for surgery are compatible with current views on quality assurance, health service economics and medico-legal common sense.

Cost of Illness↗

PubMed1990

Carcinoma of the major salivary glands treated by surgery or surgery plus postoperative radiotherapy.

From 1975 to 1987, 87 patients with carcinomas of the major salivary glands (70 parotid and 17 submandibular) were treated at our institution by either surgery or surgery followed by postoperative radiotherapy (RT). Surgical procedures included superficial (24%) or total (56%) parotidectomies and submandibular gland resection (20%). Postoperative RT usually began 2 to 4 weeks following surgery. Using 4 MV photons or, infrequently, 60Co, the majority of patients received 6000 cGy in 6 weeks to the parotid region (ranged from 4500 to 7000 cGy). Determinant actuarial survival was 74% at 5 years and 71% at 10 years. For patients with previously untreated disease, 5 of 19 (26%) treated by surgery alone experienced local recurrence, whereas only 2 of 50 (4%) recurred locally following surgery plus postoperative RT (p = 0.01). For patients presenting with recurrent disease, 4/4 (100%) failed locally following surgery as opposed to 3/14 (21%) following surgery plus postoperative RT (p = 0.01). The determinant 5-year actuarial survival for patients receiving postoperative RT was 75% versus 59% for surgery alone. Results were analyzed by multivariate methods using determinant survival or recurrence as endpoints. Five important prognostic factors were identified. (a) Facial nerve paresis was predictive of poor outcome (p less than 0.001) with 3-year relapse free survival of 13%. (b) Undifferentiated histology was associated with decreased survival (p = 0.002). (c) Male sex was associated with poor outcome (p = 0.008). (d) Skin invasion resulted in decreased survival (p = 0.012). (e) Radiotherapy was associated with improved survival (p = 0.014). In addition, postoperative RT was effective in preventing local recurrence (p less than 0.001). The data demonstrate the efficacy of postoperative RT in improving survival and local control for patients with carcinomas of the major salivary glands.

Adolescent↗

PubMed1994

The relation between the surgery-radiotherapy interval and treatment outcome in patients treated with breast-conserving surgery and radiation therapy without systemic therapy.

PURPOSE: This analysis was performed to clarify the relationship between the surgery-radiotherapy interval and the risk of recurrence in patients treated with breast-conserving therapy for early stage invasive cancers. METHODS AND MATERIALS: We retrospectively analyzed data from 653 patients with American Joint Commission on Cancer Stage I or II, pathologically node-negative breast cancer treated by breast-conserving therapy without adjuvant systemic therapy between 1968 and 1985. All patients received a dose of at least 60 Gy to the tumor bed. Two hundred and eighty-three patients started radiotherapy within 4 weeks of surgery, 308 started 5-8 weeks after surgery, and 54 started 9-12 weeks after surgery. Median follow-up in the 531 survivors was 100 months. RESULTS: Pathologic features and treatment characteristics were well balanced between the groups with surgery-radiotherapy intervals of 0-4 weeks and 5-8 weeks. There was no statistically difference in the risk of overall recurrence among patients starting radiotherapy 5-8 weeks after surgery compared with those treated within 4 weeks. Analysis of the 5-year crude rates of failure further demonstrated no difference in the distribution of sites of failure in the 5-8 week group compared with the 0-4 week group. A multivariate model controlling for known risk factors, as well as potential treatment-related confounders, also failed to demonstrate an increased risk of recurrence with the longer surgery-radiotherapy interval (risk ratio = 0.89, p = 0.44). CONCLUSION: This retrospective analysis suggests that a delay of up to 8 weeks in the interval between the last breast surgery and the start of radiotherapy is not associated with an increased risk of recurrence in patients with early stage breast cancer treated with breast irradiation to at least 60 Gy without systemic therapy.

Analysis of Variance↗

PubMed1995

An investigation of pain experience and management following gynecological day surgery: differences between open and closed surgery.

This study aimed to investigate the pain and activity levels of patients for a 5-day period following gynecological day surgery. Patients recorded their degree of pain and activity on visual analogue scales in a diary; completed diaries were returned by 54.9% of the patients approached (106 of 193). The median age of the women was 28.5 years (range, 15-55 years). Each procedure was classified as either open or closed surgery, depending upon whether an incision was necessary. Most (63.2%) of the patients required analgesics on the first morning after their surgery. Open surgery patients experienced significantly more pain for at least 3 postoperative days and were less active until the fifth day (P < 0.05 by Mann-Whitney tests). Drowsiness (47.2%), nausea (30.2%), and headache (30.2%) were the most common adverse effects experienced in the first postoperative morning. The incidence of adverse effects declined over the five days, but a minority of patients still suffered with headache (14.2%), drowsiness (9.4%), sore throat (7.5%), and nausea (5.3%) on the fifth day following surgery. The percentage of patients who experienced constipation peaked at 19.8% on the second day, most likely reflecting the consumption of codeine-containing analgesics on the first and second postoperative days. While day surgery has an important role in many forms of gynecological surgery, the potential discomfort and recovery time following day surgery should not be underestimated.

Adolescent↗

PubMed2005

Urological retroperitoneoscopic surgery for patients with prior intra-abdominal surgery.

OBJECTIVE: To determine whether previous intra-abdominal surgery is associated with surgical outcome in patients undergoing urological retroperitoneoscopic surgery. PATIENTS AND METHODS: One hundred seventeen cases of urological retroperitoneoscopic surgery, including 78 cases of retroperitoneoscopic radical nephrectomy (RN) for localized renal tumor and 39 cases of retroperitoneoscope-assisted radical nephroureterectomy (RNU) for upper urinary tract cancer, were evaluated. Thirty (38.5%) of the 78 patients who underwent RN and 13 (33.3%) of the 39 patients who underwent RNU had a history of intra-abdominal surgery. The patients were divided into two groups: those who had undergone prior intra-abdominal surgery (OP+) and those who had not (OP-). Patients' backgrounds, degree of surgical invasiveness, and period of convalescence were compared between the OP+ and OP- groups. RESULTS: There was no significant difference between the OP+ and OP- groups in terms of background, surgical invasiveness or convalescence, except for age in the patients who had undergone RN. Complications in the studied cases were unrelated to any history of intra-abdominal surgery. CONCLUSION: Previous intra-abdominal surgery is not associated with a negative outcome of urological retroperitoneoscopic surgery in patients with localized renal tumors and those with upper urinary tract cancer.

Abdomen↗

PubMed2006

In a randomized controlled trial, cataract surgery in both eyes increased benefits compared to surgery in one eye only.

BACKGROUND AND OBJECTIVE: Despite recommendation of surgery in both eyes in patients with bilateral cataract, there is little evidence about the benefits of second-eye surgery. The objective of this study was to compare the benefits of cataract surgery in both eyes with those of surgery in one eye only. STUDY DESIGN AND SETTING: Two-arm randomized controlled trial involving 296 patients with bilateral cataracts of two public teaching hospitals. Patients were randomly assigned to receive surgery in one eye only (control group) or surgery in both eyes, one eye at a time (intervention group). The main outcome measures were binocular visual acuity, binocular contrast sensitivity, stereopsis, and patient-reported visual disability (VF-14), measured 4-6 months postoperatively. RESULTS: A total of 135 (91.2%) and 139 (93.9%) patients completed the trial in the control and intervention groups, respectively. Postoperatively, intervention group presented a better visual acuity (difference of 0.07; 95% CI = 0.03, 0.12), stereopsis (0.62 log sec arc; 95% CI = 0.45, 0.79), and VF-14 (8.2 points; 95% CI = 4.4, 12.4). No significant differences were found for contrast sensitivity. CONCLUSIONS: Bilateral cataract patients should have surgery in both eyes. Including stereopsis and patient-reported visual disability in the assessment of cataract patients, especially after first-eye surgery, will improve the evaluation of effectiveness.

Aged↗

PubMed2006

Estimation of true corneal power after keratorefractive surgery in eyes requiring cataract surgery: BESSt formula.

PURPOSE: To describe a new formula, BESSt, to estimate true corneal power after keratorefractive surgery in eyes requiring cataract surgery. SETTING: Moorfields Eye Hospital, London, United Kingdom. METHODS: The BESSt formula, based on the Gaussian optics formula, was developed using data from 143 eyes that had keratorefractive surgery. The formula takes into account anterior and posterior corneal radii and pachymetry (Pentacam, Oculus) and does not require pre-keratorefractive surgery information. A software program was developed (BESSt Corneal Power Calculator), and corneal power was calculated in 13 eyes that had keratorefractive surgery and required cataract surgery. RESULTS: In the eyes having phacoemulsification, target refractions calculated with the BESSt formula were statistically significantly closer to the postoperative manifest refraction (mean deviation 0.08 diopters [D] +/- 0.62 [SD]) than those calculated with other methods as follows: history technique (-0.07 +/- 1.92 D; P = .05); history technique with double-K adjustment (0.13 +/- 2.39 D; P = .05); Holladay 2 with K-values estimated with the contact lens method (-0.76 +/- 1.36 D; P = .03); Holladay 2 with K-values from Atlas topographer (Humphrey) (-0.55 +/- 0.61 D; P<.01). Using the BESSt formula, 46% of eyes were within +/-0.50 D of the intended refraction and 100% were within +/-1.00 D. CONCLUSIONS: The BESSt formula was statistically significantly more accurate than the other techniques tested. Thus, it could significantly improve intraocular lens power calculation accuracy after keratorefractive surgery, especially when pre-refractive surgery data are unavailable.

Astigmatism↗

PubMed2000

Nephron sparing surgery for suspected malignancy: open surgery compared to laparoscopy with selective use of hand assistance.

PURPOSE: Laparoscopic nephron sparing surgery has been reported rarely, likely due to technical difficulty when using only laparoscopic instrumentation. Hand assisted techniques may facilitate the procedure in select cases while maintaining the benefits of minimally invasive surgery. We prospectively compared the laparoscopic with selective hand assistance and open surgical approaches to nephron sparing surgery for suspected malignancy. MATERIALS AND METHODS: We compared our initial 10 laparoscopic nephron sparing procedures for suspected malignancy, including 8 with hand assistance, in 9 patients (11 tumors) with 11 consecutive open surgical procedures for similar indications. Standard laparoscopic technique was used in cases of an exophytic mass with shallow penetration into the parenchyma. Otherwise hand assistance was used. Recovery data were obtained prospectively using self-administered questionnaires. RESULTS: Although mean operative time was 24% greater in the laparoscopic group, recovery was more favorable than in the open surgical group, as evidenced by 62% less parenteral narcotic use, 43% shorter hospital stay, 64% more rapid return to normal nonstrenuous activity, and improved pain and physical health scores 2 and 6 weeks postoperatively. In each group mean lesion diameter was 2.4 cm., 8 of 11 neoplasms were malignant and no margins were positive for malignancy. There were no conversions to open surgery and no major complications in the laparoscopic group. CONCLUSIONS: Laparoscopic nephron sparing surgery appears to have an advantage over open surgery in terms of patient recovery. Facilitation by hand assistance may make laparoscopic nephron sparing surgery a more widely available, minimally invasive alternative to open surgery for small, favorably located renal tumors.

Adult↗

PubMed1993

Cataract surgery in South West Thames Region: an analysis of age-adjusted surgery rates and length of stay by district.

Although the frequency of cataract surgery has increased in the UK, the demand is still not being met. There is no evidence of whether Regional Health Authorities are meeting the national target of 150 cataract operations per 100,000 population. This paper describes variations in age-standardised rates of cataract surgery and lengths of hospital stay (LOS) between the 13 health districts in South West Thames Regional Health Authority (SWTRHA). A retrospective analysis of cataract surgery performed on South West Thames (SW Thames) residents during 1990 was undertaken using the Korner hospital activity data system. The residents of SW Thames Region had 6,729 cataract operations in 1990, producing an overall surgery rate of 266 per 100,000 resident population. Two-thirds of the operations were performed on women, and the greatest number of operations were in the 75-79 and 80-84 year age bands. Women aged over 75 had significantly higher age-specific surgery rates than their male counterparts. The mean age for women was 76.6 years and for men 71.9 years; 12% of cases had a length of stay less than a day (day cases) and 49% were discharged within two days. There were substantial variations in LOS between health districts. Age-adjusted rates revealed significant variations between districts, four of which had rates below the regional average. The crude cataract surgery rate for SW Thames residents has increased threefold since 1975. Women have a significantly higher rate of surgery, which may be due to social factors. Variations in LOS between districts cannot be explained by difference in age structure and may be caused by local custom and practice. It is possible for national, regional and district cataract rates to be calculated, and they are a useful indicator of how the need for cataract surgery is being met in the population.

Age Factors↗

PubMed2000

The importance of vascular surgery training in a general surgery practice.

The aim of this report was to document the practice of vascular surgery for graduates of 4 general surgery training programs.Graduating residents from 1991 to 1995 were surveyed by phone to document the number of reconstructive vascular and dialysis access procedures that they performed during the most recent 12 months. Those who pursued additional training beyond general surgery or who did not successfully complete the certifying examination of the American Board of Surgery (ABS) were excluded. In addition, the Resident Review Committee for Surgery (RRC-S) defined category report for these same general surgeons during their residency was examined.Fifty-five percent (26 of 47) of the board-certified general surgeons do either reconstructive or dialysis access vascular surgery. The average number of procedures in the RRC-S defined category for this cohort was 76. During the focused 12 months, 1986 vascular procedures were done by these 26 surgeons (76 cases per surgeon).In certain regions of this country, a significant volume of vascular surgery is done by general surgeons who have an ABS primary certificate alone. The technique of control and repair of major arteries and veins, the consequences of distal organ ischemia, reperfusion injury, thrombosis, and embolization are important anatomic and physiologic principles that must be taught in the curriculum to general surgeons, regardless of their future surgical careers. (Curr Surg 57:381-383. Copyright 2000 by the Association of Program Directors in Surgery.)

Journal Article↗

PubMed2000

Injectable versus topical anesthesia for cataract surgery: patient perceptions of pain and side effects. The Study of Medical Testing for Cataract Surgery study team.

OBJECTIVE: To compare patient reports of intraoperative pain and postoperative side effects by different anesthesia strategies for cataract surgery. DESIGN: Prospective cohort study. PARTICIPANTS: Men and women 50 years of age and older undergoing 19,250 cataract surgeries at nine centers in the United States and Canada from June 1995 through June 1997. INTERVENTION: Topical anesthesia or anesthesia with injection, with or without sedatives, opioid analgesia, hypnotics, and diphenhydramine (Benadryl). MAIN OUTCOME MEASURES: Patient ratings of intraoperative pain, satisfaction with pain management, and early postoperative side effects (drowsiness, nausea, vomiting, or a combination thereof). RESULTS: Twenty-six percent of surgeries were performed using topical anesthesia alone, and the remainder were performed with peribulbar, retrobulbar, or facial nerve block, or a combination thereof. Local anesthesia by injection with sedatives and diphenhydramine resulted in the lowest reporting of any intraoperative pain (1.3%), with postoperative drowsiness (9.6%) and nausea, vomiting, or both (1.5%) comparable with those administered topical anesthesia alone. Among those receiving topical anesthesia, use of sedatives and opioids reduced reports of any pain during surgery by 56% (95% confidence interval [CI], 34%, 70%), but increased nausea and vomiting (odds ratio, 2.27; 95% CI, 1.26, 4.09) compared with those administered topical anesthesia alone, after adjusting for age, gender, race, American Society of Anesthesiologists risk class, self-reported health status, and duration of surgery. Among those receiving local injections, use of opioids reduced reports of any pain among those receiving sedatives by 37% (95% CI, 15%, 54%), but did not increase postoperative side effects. The use of diphenhydramine among those receiving sedatives decreased reports of any pain by 59% (95% CI, 33%, 75%) and also reduced drowsiness and nausea and vomiting by 57% (95% CI, 48%, 65%) and by 60% (95% CI, 36%, 75%), respectively. Use of hypnotics with sedatives was associated with increased reports of any pain during surgery and increased nausea and vomiting after surgery. CONCLUSIONS: Patient reports of any pain during cataract surgery (5%) and postoperative side effects (16% drowsiness and 4% nausea and vomiting) were low, but varied by anesthesia strategy. Patient perceptions of pain and side effects can be helpful in guiding the appropriate choice of anesthesia strategy.

Administration, Topical↗

PubMed1999

Effect of autologous platelet concentrate in surgery for idiopathic macular hole: results of a multicenter, double-masked, randomized trial. Platelets in Macular Hole Surgery Group.

OBJECTIVE: To evaluate prospectively the efficacy and safety of autologous platelet concentrate (APC) as an adjuvant in surgery for idiopathic macular hole. DESIGN: Multicenter, double-masked, randomized clinical trial. SETTING: Four university-based ophthalmology clinics. PARTICIPANTS: One hundred ten patients with stage 3 or 4 idiopathic full-thickness macular holes of less than 3 years' duration were randomized (53 eyes to the platelet group and 57 eyes to the control group). INTERVENTIONS: Standardized macular hole surgery versus surgery combined with injection of an APC. In all cases, the procedure consisted of three-port pars plana vitrectomy, posterior hyaloid separation, and nonexpansile fluid-gas exchange. After the fluid-gas exchange, patients were randomized to receive either injection of an APC or no adjunctive treatment. After surgery, patients were positioned face down for 12 days. Platelet counts showed that the concentrates contained a mean of 96.106 platelets (range, 82-102). MAIN OUTCOME MEASURES: Anatomic and functional evaluations were performed at 1, 3, and 6 months after surgery in a double-masked fashion by an independent observer. The main outcome was reapposition of the edge of the macular hole 1 month after surgery. Secondary outcomes were anatomic status at 3 and 6 months, changes in Early Treatment Diabetic Retinopathy Study score, and complications. RESULTS: One month after surgery, the anatomic success rate in the platelet group was 52 of 53 (98%; 95% confidence interval, 0.90-1.00) versus 47 of 57 (82%; 95% confidence interval, 0.70-0.91) in the control group (P = 0.009, Fisher's exact test; relative risk, 0.11; 95% confidence interval, 0.01-0.81). Visual acuity was not significantly different between the two groups at any timepoint. There were no complications specifically attributable to the platelet injection. CONCLUSION: Injection of APC improved significantly the anatomic success rate of surgery for idiopathic macular holes of less than 3 years' duration, but postoperative visual acuity of the platelet group was not statistically different from the control group.

Aged↗

PubMed2005

Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial.

BACKGROUND: The safety and short-term benefits of laparoscopic colectomy for cancer remain debatable. The multicentre COLOR (COlon cancer Laparoscopic or Open Resection) trial was done to assess the safety and benefit of laparoscopic resection compared with open resection for curative treatment of patients with cancer of the right or left colon. METHODS: 627 patients were randomly assigned to laparoscopic surgery and 621 patients to open surgery. The primary endpoint was cancer-free survival 3 years after surgery. Secondary outcomes were short-term morbidity and mortality, number of positive resection margins, local recurrence, port-site or wound-site recurrence, metastasis, overall survival, and blood loss during surgery. Analysis was by intention to treat. Here, clinical characteristics, operative findings, and postoperative outcome are reported. FINDINGS: Patients assigned laparoscopic resection had less blood loss compared with those assigned open resection (median 100 mL [range 0-2700] vs 175 mL [0-2000], p<0.0001), although laparoscopic surgery lasted 30 min longer than did open surgery (p<0.0001). Conversion to open surgery was needed for 91 (17%) patients undergoing the laparoscopic procedure. Radicality of resection as assessed by number of removed lymph nodes and length of resected oral and aboral bowel did not differ between groups. Laparoscopic colectomy was associated with earlier recovery of bowel function (p<0.0001), need for fewer analgesics, and with a shorter hospital stay (p<0.0001) compared with open colectomy. Morbidity and mortality 28 days after colectomy did not differ between groups. INTERPRETATION: Laparoscopic surgery can be used for safe and radical resection of cancer in the right, left, and sigmoid colon.

Adult↗

PubMed2002

Comparison between intra-articular bupivacaine with epinephrine and epinephrine alone on short-term and long-term pain after knee arthroscopic surgery under general anesthesia in day-surgery patients.

BACKGROUND: : Postarthroscopy analgesia has been provided with intra-articular bupivacaine, but reported results are conflicting regarding efficacy and the duration of analgesia. The immediate and long-term effects of intra-articular bupivacaine with epinephrine after arthroscopic knee surgery were therefore studied in a day surgery setting. METHODS: : 120 ASA I-II patients scheduled for arthroscopic knee surgery were given general anesthesia with spontaneous breathing via a laryngeal mask. In a randomized and blinded fashion half of them received, at the end of surgery, intra-articularly 20 mL 0.5% bupivacaine with epinephrine (B + E-group) and the other half 20 mL saline with epinephrine (S + E-group). All patients received ketoprofen 100 mg i.v. during surgery and another 100 mg 2-3 h postoperatively. The patients were observed for about 4.5 h in the day surgery unit before discharge. RESULTS: : The results showed that in comparison with the S + E-group, significantly fewer patients in the B + E-group needed analgesics (P < 0.0001) and the amount required was also significantly less postoperatively, before discharge (about 4.5 h postoperatively) (P < 0.0001). The latency to the need for the first postoperative analgesic was shorter in the S + E-group patients (P < 0.0001). At home, during seven days after discharge, the need for analgesic (oral ketoprofen 100 mg) was greater in the B + E-group (P < 0.05), especially only during the second postoperative day, but the visual analoque pain scale (VAPS) scores were low with no differences between the groups. No complication occurred. CONCLUSION: : It is concluded that a good postoperative pain control of intra-articular bupivacaine with epinephrine was found only in the immediate postoperative period (i.e. before discharge) in a day-surgery arthroscopic knee surgery patients.

Adolescent↗