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At least 253 records · Page 14Linked to original sources

PubMed1994

Guidelines for the application of surgery and endoprostheses in the palliation of obstructive jaundice in advanced cancer of the pancreas.

OBJECTIVE: This study was set up to identify patient-related factors favoring the application of either surgery or endoprostheses in the palliation of obstructive jaundice in subsets of patients with cancer of the head of the pancreas or periampullary region. SUMMARY BACKGROUND DATA: In the palliation of obstructive jaundice, surgical biliodigestive anastomosis has traditionally been performed. Surgical biliary bypass is associated with high mortality (15% to 30%) and morbidity rates (20% to 60%) but little recurrent obstructive jaundice (0% to 15%). Biliary drainage with endoscopically placed endoprostheses has a lower complication rate, but recurrent obstructive jaundice is seen in up to 20% to 50% of patients. METHODS: Patients with advanced cancer of the head of the pancreas or periampullary region treated at the University Hospital Dijkzigt, Rotterdam, The Netherlands, between 1980 and 1990 were reviewed. In 148 patients, data were compared concerning the morbidity and hospital stay after the palliation of obstructive jaundice with endoscopic endoprostheses or surgical biliary bypasses. These patients were stratified for long (> 6 months) and short (< 6 months) survival times. RESULTS: In short-term survivors, the higher late morbidity rates after endoprostheses were offset by higher early morbidity rates and longer hospital stays after the surgical bypass. In long-term survivors, there was no difference in the hospital stay between the two groups, but the late morbidity rate was significantly higher in the endoprosthesis group. CONCLUSIONS: These data suggest that endoscopic endoprosthesis is the optimal palliation for patients surviving less than 6 months and surgical biliary bypass for those surviving more than 6 months. This policy necessitates the development of prognostic criteria, which were obtained by Cox proportional-hazards survival analysis. Advanced age, male sex, liver metastases, and large diameters of tumors were unfavorable prognostic factors. With these factors, the risk of short- or long-term survival can be predicted. It is hoped that the application of these data may allow a rational approach toward optimal palliative treatment of this form of malignant obstructive jaundice.

Aged↗

PubMed2003

Virtual endoscopic images by 3D FASE cisternography for neurovascular compression.

Three-dimensional fast asymmetric spin echo (3D FASE) cisternography provides high spatial resolution and excellent contrast as a water image acquisition technique. It is also useful for the evaluation of various anatomical regions. This study investigated the usefulness and limitations of virtual endoscopic images obtained by 3D FASE MR cisternography in the preoperative evaluation of patients with neurovascular compression. The study included 12 patients with neurovascular compression: 10 with hemifacial spasm and two with trigeminal neuralgia. The diagnosis was surgically confirmed in all patients. The virtual endoscopic images obtained were judged to be of acceptable quality for interpretation in all cases. The areas of compression identified in preoperative diagnosis with virtual endoscopic images showed good agreement with those observed from surgery, except in one case in which the common trunk of the anterior inferior cerebellar artery and posterior inferior cerebellar artery (AICA-PICA) bifurcated near the root exit zone of the facial nerve. The veins are displayed in some cases but not in others. The main advantage of generating virtual endoscopic images is that such images can be used for surgical simulation, allowing the neurosurgeon to perform surgical procedures with greater confidence.

Adult↗

PubMedDate not supplied

Minimally invasive approaches to hepatic surgery.

During the last 10 years we have seen dramatic changes in minimally invasive surgery. Important advancements in videoscopy, instrumentation, and surgical skills have allowed us to perform surgical procedures recently viewed as well outside the domain of minimally invasive surgeon. Solid organ surgery has become common place; in particular, hepatic surgery has been shown to be amenable to minimally invasive techniques. Benign cyst excision, abscess drainage, local tumor ablation, and liver resection are all hepatic procedures described in recent literature. Though it is clear that the trend toward less invasive alternatives towards open liver surgery will continue, proper indications and utilization of such procedures requires careful scrutiny using outcome oriented research. This paper gives a brief overview of the technology available and its application in minimally invasive approaches to liver surgery.

Catheter Ablation↗

PubMed2003

[Surgical removal of choroidal neovascularization in angioid streaks].

PURPOSE: All the studies so far on surgical removal of choroidal neovascularization (CNV) in angioid streaks(AS) were conducted on a small number of cases. Therefore, a definitive evaluation of the surgical method was not available. The present study aimed to evaluate this surgical modality. SUBJECTS AND METHOD: We performed surgical removal of foveal CNV accompanied by AS. Eighteen eyes of seventeen patients were available for follow-up of over 12 months. Surgical indications included foveal CNV, fluorescence leakage from the CNV in late-phase fluorescein angiography, and visual acuity of 0.3 or lower. RESULTS: The best visual acuity was improved in 44% and unchanged in 44%. The final visual acuity was improved in 33% and unchanged in 39%. 22% had a preoperative visual acuity of 0.2 or above; and 44% and 17% achieved best and final visual acuity, respectively, of 0.2 or above. Since all cases developed atrophy of the choriocapillaris in the fovea, none of the cases were capable of fixation within atrophy. The fixation point was localized outside atrophy in 56% and fixation was poor in 44%. The diameter of postoperative atrophy of choriocapillaris was significantly greater (p < 0.05) than the preoperative CNV diameter. CNV recurred in 8 eyes(44%), 88% of which occurred within one year. CONCLUSION: Surgical removal of CNV in AS is an effective method to maintain preoperative visual acuity.

Aged↗

PubMed2005

Resident job satisfaction and quality of life before and after work hour reform.

OBJECTIVE: To assess the effect of limiting work hours for obstetrics/gynecology residents on working conditions, job satisfaction and quality of life. STUDY DESIGN: A survey assessing hours worked, working conditions, job satisfaction and quality of life during residency was sent to 10 current residents and 25 residency graduates. Council on Resident Education in Obstetrics and Gynecology scores were also examined. RESULTS: The average hours worked per week dropped (89 to 82.5, p < 0.02). Hours of sleep obtained on call decreased (3 to 2, p < 0.008). Overall, 25% of subjects reported that their clinical judgment was adversely affected by a 24-hour shift and 64% by a 36-hour shift. Seven percent of subjects reported that a 24-hour shift affected their surgical performance, while 54% reported that their surgical skills were adversely affected by a 36-hour shift. Satisfaction with work and Council on Resident Education in Obstetrics and Gynecology scores did not vary significantly. There was an improvement in residents' satisfaction with personal life (2.8 to 1.8 average rating, p < 0.05). CONCLUSIONS: Accreditation Council of Graduate Medical Education reforms improved resident's satisfaction with their personal lives but not CREOG scores or satisfaction with work.

Gynecology↗

PubMed1998

[A case of surgically resected mediastinal mass histologically proven to be a mass-like tissue presenting extramedullary hematopoiesis accompanied by thalassemia].

We experienced with a case showing a mediastinal mass on chest X-ray accompanied by thalassemia. Preoperative diagnosis for this mass was a neulogenic tumor based on the findings of roentgenogram. Surgical resection of the mass was performed, and histology revealed that it was a mass-like tissue presenting extramedullary hematopoiesis. Generally speaking, any tissues functioning as extramedullary hematopoiesis should not be resected in patients with anemia or showing bone marrow suppression. And it is also said that 111In-chloride scintigram is highly diagnostic for patients with a tissue functioning as extramedullary hematopoiesis. We had not performed 111In-chloride scintigram for this case preoperatively and performed a resection of the mediastinal mass carelessly. Care should be taken not to perform surgical resection carelessly in cases with a mediastinal mass accompanied by anemia or bone marrow suppression.

Female↗

PubMedDate not supplied

Surgical ablation of permanent atrial fibrillation by means of maze radiofrequency: mid-term results.

BACKGROUND: The maze procedure can be performed surgically with radiofrequency, generating transmural ablation lines. We report our experience with a biatrial pattern of lesions based on the use of epicardial and endocardial radiofrequency ablation in an effort to minimize maze procedure. METHOD: In 85 patients undergoing cardiac surgery for established permanent atrial fibrillation (>3 months), a biauricular pattern of epicardic-endocardic maze lesions was performed. The main surgical procedures were diverse: 42 mitral valve surgeries, 7 mitrotricuspid valves, 18 mitroaortics, 4 mitroaortic and tricuspids, 2 aortic valves, 3 CABGs, 5 CABG and valve procedures, and 4 atrial septal defects. The mean age of the patients was 61 +/- 12 (range 39-78). The mean duration of atrial fibrillation was 5.8 years (range 0.3 to 24). RESULTS: Sixty-two (72.9%) patients presented postoperative supraventricular arrhythmia. Hospital mortality was seen in five patients (5.8%). Two patients died after a 12-month mean follow-up (range 2 to 32). A total of 14.1% of patients remained with their previous atrial fibrillation and 85.9% recovered and maintained sinus rhythm, with two patients having a permanent pacemaker. A total of 56% patients have been followed-up for a period of more than 6 months, and among them prevalence of sinus rhythm is 87.5%. Echocardiography detected biauricular contraction in 65% of them. After analyzing the data, factors involved in postoperative recurrence of atrial fibrillation after radiofrequency surgery were oldness of the atrial fibrillation (p < 0.01) and pre and postoperative left auricle volume (p < 0.04). CONCLUSION: Intraoperative radiofrequency has permitted us to perform the maze procedure in a simple way, with a low surgical morbid-mortality. We have obtained an 85.9% electrographic effectiveness and a 65% recovery of atrial contraction. Postoperative incidence of arrhythmia is the main postoperative problem.

Adult↗

PubMedDate not supplied

[Surgical repair of inguinal hernia in the adult Clinical, functional, and economic outcomes of surgical practices].

Inguinal hernia repair is the most commonly performed surgical procedure. Nearly one out of three men between 20 and 60 years of age will undergo hernia repair. Multiple surgical techniques are available which have comparable clinical outcomes but which differ in their functional results and economic impact. Despite an extensive surgical literature, no consensus exists regarding an optimal technique. This review aims to compare the indications for the three most common techniques: 1) the Shouldice repair, 2) the Lichtenstein repair, and 3) the laparoscopic hernia repair. To begin with, we present the operative principals of each repair along with criteria for evaluation of outcomes. Evidence-based outcomes data are then presented. We then address the choice of a surgical technique for everyday practice based on these factors. Finally, we propose avenues for future clinical research which may improve clinical, functional, and economic results in the repair of inguinal hernia of the adult.

Adult↗

PubMed1995

Surgical palliation of unresectable pancreatic carcinoma.

The decision to perform surgical versus nonoperative palliation for unresectable pancreatic cancer is influenced by a number of factors. In most cases, patient symptoms clearly dictate the management. In patients with symptoms of duodenal obstruction at the time of presentation, surgery is the only option. In patients with obstructive jaundice alone, the options for management must be weighed against factors such as overall health status, projected survival, and procedure-related morbidity and mortality. A prospective multicenter trial recently analyzed factors influencing perioperative morbidity and mortality following both curative and palliative surgery for pancreatic cancer. This analysis demonstrated that preoperative diabetes, low Kanofsky's index, and liver metastases are significant risk factors in predicting perioperative morbidity and mortality in patients undergoing palliative procedures for pancreatic cancer. Another analysis focusing on tumor characteristics suggested that for patients with Stage I and Stage II disease (i.e., with no evidence of systemic metastases), survival and the potential for late duodenal obstruction favor surgical management. In summary, although patient management must be individualized, most patients with pancreatic cancer in good medical health and with no evidence of systemic disease are most appropriately managed with surgical palliation. This option affords patients the best chance of avoiding the late complications of recurrent jaundice, duodenal obstruction, and disabling pain. Surgical palliation can generally be completed with an acceptable perioperative morbidity and mortality and a hospital stay of approximately 2 weeks. Finally, only surgical exploration can offer full opportunity for resection for cure.

Cholestasis↗

PubMed1997

Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications.

We have performed surgical treatment for Moyamoya disease using the superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-arterio-myo-synangiosis (EDAMS). In this paper, the surgical technique of combined revascularization for Moyamoya disease as well as peri-operative complications are discussed. Craniotomy and dural opening were extensively carried out to expose the brain surface as widely as possible. Dissection of the STA, which is the most powerful resource of direct revascularization, should be carefully carried out using a surgical microscope. The temporal muscle and middle meningeal artery, which have the most potential as sources of indirect revascularization, must be preserved. STA-MCA anastomosis to the frontal branch of the middle cerebral artery is indispensable for improving cerebral circulation of the frontal lobe. A small arachnoid membrane opening and water-tight closure are also important to avoid post-operative subdural and subcutaneous fluid collection. Ischemic events disappeared immediately after surgery in most cases. However, in several cases, transient ischemic attacks recurred for several months after the surgery. Chronic subdural hematoma was seen in two cases.

Adolescent↗

PubMed2004

Technical performance: relation between surgical dexterity and technical knowledge.

Technical performance consists of surgical knowledge, judgment, and dexterity. Although assessment of surgical dexterity is now possible, assessing technical knowledge and its relation to dexterity has not been elucidated. Surgeons of varying experience were recruited to the skills laboratory to undertake three assessments: simple surgical dexterity (at 14 stations scored by motion analysis), an operating room equipment examination, and a novel error analysis. The scores were correlated, and p < 0.05 was deemed to be significant. Thirty surgeons were recruited; and construct validity was exhibited in all areas. Correlations were shown to exist between the two knowledge examinations (Spearman's rho = 0.39). Correlations existed between all dexterity task parameters and the equipment examination, whereas they existed for only 15 of the 28 parameters of the error examination and were always weaker. The stronger correlations between dexterity and instrument and operating room (OR) equipment reflect greater surgical experience and time spent in the OR. The weaker correlations between the error analysis and dexterity suggest that these skills are learned at different times. The identification of common surgical errors should be more formally taught to ensure greater uniformity.

Anastomosis, Surgical↗

PubMed1997

Hypercarbia during tracheostomy: a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy.

OBJECTIVE: Tracheostomy is one of the most commonly performed surgical procedures in the critical care setting. The early use of tracheostomy as a method of primary airway management has been proposed as a means to decrease pulmonary morbidity and to shorten the number of ventilator, intensive care unit, and hospital days. We set out to (1) determine whether hypercarbia occurs during tracheostomy of the critically ill patient and (2) determine the extent to which the partial pressure of carbon dioxide in arterial blood (PaCO2) rises during percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy. DESIGN: Prospective, open clinical trial. SETTING: Surgical intensive care unit and operating room in teaching hospitals. PATIENTS: During mechanical ventilation, patients underwent either percutaneous endoscopic (PET), percutaneous Doppler (PDT), or standard surgical tracheostomy (ST), based on surgeon preference. Arterial blood gas readings were obtained approximately every 4 min throughout each procedure. MEASUREMENTS AND RESULTS: All tracheostomies were successfully performed. No serious complications (including hypoxia) occurred during the study. Significant (p < 0.05 vs PDT and ST) hypercarbia (maximum delta PaCO2 24 +/- 3 mmHg) and acidosis (maximum delta pH -0.16 +/- 0.02) developed during PET. The changes in PaCO2 and pH during PDT (maximum delta PaCO2 8 +/- 2 mmHg; maximum delta pH -0.07 +/- 0.02) and ST (maximum delta PaCO2 3 +/- 1 mmHg; maximum delta pH -0.04 +/- 0.01) were markedly less pronounced. CONCLUSIONS: Continuous bronchoscopy during percutaneous tracheostomy contributes significantly to early hypoventilation, hypercarbia, and respiratory acidosis during the procedure. Percutaneous tracheostomy, when performed using the Doppler ultrasound method to position the endotracheal tube, significantly reduces CO2 retention when compared to PET. Because of a possible rise in intracranial pressure, the potential for hypercarbia should be considered when choosing the method of tracheostomy in the critically ill and/or head-injured patient, where hypercarbia may be detrimental. If PET is to be performed, steps to minimize occult hypercarbia, such as using the smallest bronchoscope available, minimizing suctioning during bronchoscopy, and minimizing the length of time the bronchoscope is in the endotracheal tube, should be undertaken.

Acidosis↗

PubMed1991

Effect of surgical and chemical in ovo bursectomy on hatchability, mortality rate, and antibody response in hypertensive and hypotensive lines of turkeys.

The effect of in ovo bursectomy on hatchability, mortality rate, and antibody response to keyhole limpet hemocyanin (KLH) was studied in hypertensive and hypotensive lines of turkeys. Experiments were conducted to assess the optimal time to perform surgical in ovo bursectomy in turkey embryos for the lowest mortality rate. Factors such as the ease of operation, hatchability, and least deaths were considered. Surgical bursectomies at 25, 24, 23, and 22 day embryonation resulted in 75, 20, 0, and 10% hatchability, respectively. The surgical procedure performed at 25-day embryonation resulted in superior hatchability and ease of operation, and it was less traumatic as evidenced by fewer deaths. The hatchability of embryos injected with testosterone (TE) at 15 days incubation was 55%. Birds subjected to surgery or chemical treatment had increased mortality rates. Cyclophosphamide (CY) treatment at 1 and 2 days posthatch caused a significant increase in deaths over groups not treated with CY. Both primary and secondary KLH responses were significantly lower in bursectomized and TE-injected groups, than in shamoperated or nonoperated control groups.

Animals↗

PubMed1995

Surgical management of thoracic manifestations in human immunodeficiency virus-positive patients: indications and results.

The records of 97 patients with thoracic complications of human immunodeficiency virus (HIV) were analysed to determine the reasons for surgery and the results of these procedures. Of the patients, 79 underwent surgery; the remaining 18 were managed non-surgically. A total of 36 procedures were performed for diagnostic purposes: mediastinoscopy (21 patients), lung biopsy (15 patients). Therapeutic procedures were performed in 61 patients to treat pneumothorax (23 cases) or empyema thoracis (18 cases), for resection of pulmonary lesions (13 cases), and to treat various other pathologies (seven cases). Ten patients died in hospital: seven after surgery and three after a nonsurgical procedure. Eleven patients developed a postoperative complication. Hospital mortality varied from 0 per cent to 20 per cent, depending on the procedure. The mortality rate appears to be linked to the stage of HIV infection at the time of therapy rather than to the type of procedure performed. Surgical decisions must take into account the patient's Centers for Disease Control stage and physiological status, therapeutic possibilities, and the prognosis of the pathology requiring treatment.

AIDS-Related Opportunistic Infections↗

PubMed1997

Simultaneous surgical correction of a common atrium and impure flutter.

We performed surgical correction and treatment of a common atrium and chronic impure flutter using a computerized mapping system in a 49-year-old man. A reentrant circuit was observed to exist around the left atrial appendage. In contrast to the regular activation in the left atrium, the activation sequence of the right atrium was extremely chaotic. Cryolesions were applied to the area of the reentrant pathway. After the operation, sinus rhythm was restored.

Atrial Fibrillation↗

PubMed1995

Subaortic stenosis in the spectrum of atrioventricular septal defects. Solutions may be complex and palliative.

UNLABELLED: From July 1982 through September 1994, 19 children had operative treatment of subaortic stenosis associated with an atrioventricular septal defect. Specific diagnosis were septum primum defects in 7, Rastelli type A defects in 6, transitional defects in 4, inlet ventricular septal defect with malattached chordae in 1, and tetralogy of Fallot with Rastelli type C defect in 1. Twenty-seven operations for subaortic stenosis were performed. Surgical treatment of the outlet lesion was performed at initial atrioventricular septal defect repair in 3 children and in the remaining 16 from 1.2 to 13.1 years (mean 4.9 years, median 3.9 years) after repair. Eighteen of the 19 children had fibrous resection and myectomy for relief of obstruction. Seven children had an associated left atrioventricular valve procedure. One child received an apicoaortic conduit. Seven children (36.8%) required 8 reoperations for previously treated subaortic stenosis. Time to the second procedure was 2.8 to 7.4 years (mean 4.9 years). Follow-up is 0.4 to 14.0 years (median 5.6 years). Six-year actuarial freedom from reoperation is 66% +/- 15%. The angle between the plane of the outlet septum and the plane of the septal crest was measured in 10 normal hearts (86.4 +/- 13.7) and 10 hearts with atrioventricular septal defects (22.2 +/- 26.0; p < 0.01). The outflow tract can be effectively shortened, widened, and the angle increased toward normal by augmenting the left side of the superior bridging leaflet and performing a fibromyectomy. CONCLUSION: Standard fibromyectomy for subaortic stenosis in children with atrioventricular septal defects leads to a high rate of reoperation. Leaflet augmentation and fibromyectomy may decrease the likelihood of reoperation.

Adolescent↗

PubMedDate not supplied

[Characteristics in the treatment of scoliosis in muscular diseases].

INTRODUCTION: Patients suffering from the most frequent muscle disorders Duchenne muscular dystrophy (DMD) and spinal muscular atrophies (SMA), who ceased walking respectively are confined from the outset to the wheel-chair, are developing commonly a progressive scoliosis (collapsing spine) due to an increasing muscle weakness. Basing on the pelvic obliquity these scolioses are leading first of all to problems in sitting as well as difficulties in trunk and head control. Along with the increasing weakness of respiratory muscles these phenomena entail a restrictive respiratory insufficiency. CONSERVATIVE TREATMENT: An effective conservative treatment is not available for these scolioses. The use of a corset, however, can only be taken into consideration as a compromise, either for very young patients or those who refused an operation respectively who have reached an inoperable stage. The exclusive use of so-called "anatomic sitting supports" in the wheel-chair in order to treat or prevent a progressive scoliosis in DMD or SMA is absolutely to be rejected. They should only be applied for very young patients with SMA type II as a transitional solution until a corset or better an surgical stabilisation of the spine will be effected, or as a palliative measure in late stages. SURGICAL TREATMENT: Only the early as possible performed surgical stabilisation of the spine using adequate instrumentation (Luque, CD or modifications), enabling an early mobilization without corset or cast, is the most effective treatment of these scoliosis. Patients with DMD or SMA type III should be stabilized after loss of walking ability and definitive confinement to wheel-chair, if the curve is more than 20 degrees-30 degrees Cobb and progressive and forced vital capacity (FVC) is > 35%. The instrumentation should be applied between D3 or D4 and sacrum. The bony fusion mass should include the lumbar and lumbosacral region. The unfused instrumentation with the telescope-rod after Naumann is a good solution for patients with SMA type II and progressive curves already in the early childhood from ca. 5 years of age. First of all surgical spinal stabilisation improves the sitting comfort. Over and above this the improved cosmetic appearance should not be underestimated for the psychological condition of these patients. Additionally it is proved, that surgical stabilisation of the spine prolongs the life expectancy of patients with DMD. Furthermore stabilization of lung function can be achieved for both DMD and SMA patients in comparison to the natural history of these diseases. Altogether a decisive improvement of quality of life can be reached for all these patients.

Adolescent↗

PubMed2004

[Drug-resistant partial epilepsies: introductory remarks on their classification, pathophysiology and surgical treatment].

There is no validated classification of drug-resistant partial epilepsies in adults that have proved helpful to individualize homogeneous groups of patients, whose clinical course would be predictable at the early stage of the disease and whose treatment, eventually surgical, could be standardized. The only entity fitting with this definition is the syndrome of mesio-temporal lobe epilepsy, which accounts for a high percentage of surgical treatment indications. However the objective to perform surgical treatment in all of these patients is far from being reached in France, as in many other developed countries. Apart from this syndrome, therapeutic decisions are mostly based on case by case clinical and electrophysiological analysis of seizures, in relation with the localization and anatomy of the causal lesion, when the latter can be identified using brain MRI. The pragmatic approach consists in aiming at a consensus regarding the nature and the reliability of presurgical strategies, including invasive electrophysiological investigations, rather than in elaborating a syndromic classification, the pertinence of which cannot be validated. Some concepts and data that might be helpful to reach a consensus are discussed in this brief review article.

Adult↗