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At least 307 records · Page 17Linked to original sources
PubMed2005

[Preventive surgery for familial adenomatous polyposis coli].

Familial adenomatous polyposis coli (FAP) may not be considered a single disease entity with standardized guidelines for operative treatment. However, prophylactic colectomy after the manifestation of polyps but prior to the development of colorectal cancer is essential. The optimal timing of prophylactic surgery remains a clinical decision taken independently of mutation analysis. In case of the classic FAP phenotype, restorative proctocolectomy and ileal pouch-anal anastomosis is the procedure of choice. The development of reliable guidelines for attenuated FAP variants requires further evidence from clinical studies on surgical strategy and the advantages of prophylactic surgery over regular endoscopic screening with removal of polyps.

Adenomatous Polyposis Coli↗
PubMed1979

Management of acute primary angle-closure glaucoma: a long-term follow-up of the results of peripheral iridectomy used as an initial procedure.

For the past 12 years peripheral iridectomy has been used as the initial surgical procedure after an acute attack of angle-closure glaucoma. The operation has been performed 2 to 5 days after the pressure has been controlled medically and has been followed routinely by prophylactic peripheral iridectomy in the fellow eye. Peripheral iridectomy for primary acute angle-closure glaucoma controlled the condition without any need for further medical or surgical therapy in 72% of cases. Careful and frequent follow-up within the first 4 postoperative months is essential to prevent further field loss, which can occur very rapidly if the pressure is not adequately controlled. If the pressure remains uncontrolled, further surgery should not be delayed. It was impossible to decide which patients would eventually need trabeculectomy when they first attended in the acute attack. Peripheral iridectomy as a prophylactic procedure was entirely effective in preventing an acute angle-closure attack in the fellow eye.

Acute Disease↗
PubMed1975

Operative and nonoperative risks in the cardiac patient.

Four hundred and sixteen patients with documented arteriosclerotic heart disease (ASHD) underwent 424 diagnostic and therapeutic surgical procedures during the year 1970 at the Henry Ford Hospital. They were classified according to the specific clinical manifestation of their cardiac abnormality. Patients with a history of old, well-compensated myocardial infarction, and those with cardiac arrhythmia, bundle-branch block, congestive heart failure and A-V block (pacemaker-protected) but no evidence of previous myocardial infarction fared almost as well as subjects of the same age without cardiac disease, and were considered to run the lowest operative risk. Patients with angina, especially if there was a history of infarction, were an intermediate risk in terms of complications and mortality. Patients with a history of previous infarction complicated at the time of the surgical procedure by arrhythmia, A-V block, bundle-branch block, or congestive heart failure were in the "highest risk" category. A severe A-V block indicated the need for insertion of a "prophylactic" pacemaker before any attempt at a diagnostic or therapeutic procedure. No patient with clinical or electrocardiographic evidence of a recent infarction (less than three months' duration) should undergo any elective surgical procedure under any form of anesthesia unless the surgeon is prepared for a high mortality rate that may approach 90 percent. In contrast, the patient with old, well-compensated myocardial infarction and no evidence of dysrhythmia, block or congestive failure can tolerate even a major surgical operation under any form of anesthesia extremely well.

Adult↗
PubMed1996

Does intraoperative blood loss affect antibiotic serum and tissue concentrations?

OBJECTIVE: To determine the effect of intraoperative blood loss on prophylactic cefazolin and gentamicin serum and tissue concentrations. DESIGN: A prospective study of elective spinal instrumentation surgical procedures with an expected large blood loss. SETTING: Tertiary care, inner-city university hospital. PATIENTS: Eleven adult patients who underwent an elective surgical procedure that involved spinal instrumentation. INTERVENTION: Standard perioperative administration of a combination of cefazolin and gentamicin. Serum and tissue samples were obtained consecutively throughout the surgical procedure. MAIN OUTCOME MEASURES: The effect of intraoperative blood loss on serum and tissue cefazolin and gentamicin concentrations and their pharmacokinetics. RESULTS: At the time of the incision, serum cefazolin concentrations were greater than tissue concentrations (P = .07). A mean dose of 1.8-mg/kg gentamicin yielded low or nontherapeutic serum and tissue gentamicin concentrations. Cefazolin and gentamicin were eliminated from the tissue compartment slower than from the serum compartment (P < .03), while the half-life of cefazolin was significantly (P = .06) longer in the tissue compartment. The volume of distribution of cefazolin was normal (ie, 12.5 L), while the volume of distribution of gentamicin was 5-fold greater than expected. At 60 minutes after the incision, blood loss correlated with cefazolin tissue concentrations (r = -0.66, P = .05). Blood loss correlated with the change in tissue antibiotic concentrations for cefazolin (r = 0.73, P = .04). In addition, the clearance of gentamicin from the tissues correlated with blood loss (r = 0.82, P = .01). CONCLUSIONS: Based on measured pharmacokinetic values, additional doses of cefazolin should be administered when the operation exceeds 3 hours and blood loss is greater than 1500 mL. Doses of gentamicin greater than 1.8 mg/kg should be administered more than 30 minutes prior to the surgical incision.

Adult↗
PubMed1996

Hemophilic ankle arthropathy.

Ankle arthropathy remains a frequent source of disability in the hemophilic patient. Bleeding into the ankle most commonly commences in the second decade, and, once established as a target joint, progressive damage leads to significant pain, stiffness, and deformity affecting general mobility and leisure and occupational pursuits. Review of cohorts of hemophilic patients at the Royal Free Hospital has monitored this deterioration and there is no evidence that, despite improvements in medical treatment, the pattern of insidious decline in hindfoot function has changed during the past 4 decades. Based on these observations, a combined clinical and radiologic scoring system has been developed, incorporating ankle specific features, such as talar tilt, tibial osteophytes, and talar dome flattening, which give a better correlation than traditional systems with objective measures, such as treadmill walking. There is no substitution for prophylactic treatment in arresting ankle function decline, and surgical interventions are rare. However, the types of potential procedures are numerous and choices must be made according to the degree of disability and state of overall damage to the joint and adjacent soft tissues.

Ankle Joint↗
PubMed1989

The unerupted or impacted third molar--a critical appraisal of its pathologic potential.

The prophylactic removal of asymptomatic unerupted or impacted third molars constitutes a major proportion of all oral surgical procedures. Patients are advised to have this preventive surgery on the basis that such teeth, if retained, are likely to cause certain pathologic lesions. The evidence in the scientific literature on the prevalence of dentigerous cysts, mural ameloblastoma, epidermoid carcinoma and root resorption indicates that this concern is exaggerated. The retrospective data on the reasons for extractions of third molars confirm this conclusion. Until there are prospective studies which demonstrate a significant patient benefit from surgery exceeding the risks of retention, the practice should be discontinued. Third molars should be removed only where there is a defined pathologic indication.

Dentigerous Cyst↗
PubMed1979

[Endoscopic polypectomy in the colon (author's transl)].

A report is given on the endoscopic removal of 81 polyps of the colon by means of high frequency diathermy. This procedure proved to be without risk to the patient and has largely replaced surgical removal by laparotomy as the method of choice today. Total removal of the polyp with subsequent histological examination is naturally imperative to avoid unnecessary subsequent radical surgical procedures. Since most colonic carcinomas arise in the base of a polyp, polypectomy represents a true prophylactic measure and, in some cases, a therapeutic one.

Adenocarcinoma↗
PubMedDate not supplied

Pars plana vitrectomy. The role of vitrectomy in penetrating ocular injuries.

Pars plana vitrectomy and related procedures occupy an important role in the management of perforating injuries. Vitreous surgery is particularly important in rendering retinal detachments observable and operable. The frequent postvitrectomy complication of delayed retinal detachment appears to be reduced with prophylactic encircling scleral buckle procedures. Although certain categories of injuries continue to carry a poor prognosis, earlier surgical intervention promises improved results.

Eye Injuries↗
PubMed1994

Quality standard for antimicrobial prophylaxis in surgical procedures. The Infectious Diseases Society of America.

OBJECTIVE: The objectives of this quality standard are 1) to provide an implementation mechanism that will facilitate the reliable administration of prophylactic antimicrobial agents to patients undergoing operative procedures in which such a practice is judged to be beneficial and 2) to provide a guideline that will help local hospital committees formulate policies and set up mechanisms for their implementation. Although standards in the medical literature spell out recommendations for specific procedures, agents, schedules, and doses, other reports document that these standards frequently are not followed in practice. OPTIONS: We have specified the procedures in which the administration of prophylactic antimicrobial agents has been shown to be beneficial, those in which this practice is widely thought to be beneficial but in which compelling evidence is lacking, and those in which this practice is controversial. We have examined the evidence regarding the optimal timing of drug administration, the optimal dose, and the optimal duration of prophylaxis. OUTCOMES: The intended outcome is more uniform and reliable administration of prophylactic antibiotics in those circumstances where their value has been demonstrated or their use has been judged by the local practicing medical community to be desirable. The result should be a reduction in rates of postoperative wound infection with a limitation on the quantities of antimicrobial agents used in circumstances where they are not likely to help. EVIDENCE: Many prospective, randomized, controlled trials comparing placebo with antibiotic and comparing one antibiotic with another have been conducted. In addition, some trials have compared the efficacy of different doses or methods of administration. Other papers have reported on the apparent efficacy of administration at different times and on actual practice in specific communities. Only a small group of relevant articles found through 1993 are cited herein. When authoritative reviews are available, these--rather than an exhaustive list of original references--are cited. VALUES: We assumed that reducing rates of postoperative infection was valuable but that reducing the total amount of antimicrobial agents employed was also worthwhile. The cost of and morbidity attributable to postoperative wound infections should be weighed against the cost and potential morbidity associated with excessive use of antimicrobial agents. BENEFITS, HARMS, AND COSTS: More reliable administration of antimicrobial agents according to recognized guidelines should prevent some postoperative wound infections while lowering the total quantity of these drugs used. No harms are anticipated. The costs involved are those of the efforts needed on a local basis to design and implement the mechanism that supports uniform and reliable administration of prophylactic antibiotics. RECOMMENDATIONS: All patients for whom prophylactic antimicrobial agents are recommended should receive them. The agents given should be appropriate in light of published guidelines. A short duration of prophylaxis (usually < 24 hours) is recommended. VALIDATION: More than 50 experts in infectious disease and 10 experts in surgical infectious disease and surgical subspecialties reviewed the standard. In addition, the methods for its implementation were reviewed by the American Society of Hospital Pharmacists. SPONSORS: The Quality Standards Subcommittee of the Clinical Affairs Committee of the Infectious Disease Society of America (IDSA) developed the standard. The subcommittee was composed of representatives of the IDSA (Drs. Gross and McGowan), the Society for Hospital Epidemiology of America (Dr. Wenzel), the Surgical Infection Society (Dr. Dellinger), the Pediatric Infectious Disease Society (Dr. Krause), the Centers for Disease Control and Prevention (Dr. Martone), the Obstetrics and Gynecology Infectious Diseases Society (Dr. Sweet), and the Association of Practitioners of Infection Contr

Anti-Bacterial Agents↗
PubMedDate not supplied

Psychological impact of prophylactic oophorectomy in women at increased risk for ovarian cancer.

Women with a family history consistent with a hereditary breast/ovarian cancer syndrome are at significantly increased risk for ovarian cancer. Prophylactic oophorectomy is an option for high-risk women. This study explores the psychosexual impact of prophylactic oophorectomy. A qualitative methodology was selected as most appropriate as no previous research has examined this issue. In-depth interviews were conducted with fourteen women, between 4 months and 7 years after prophylactic oophorectomy. Of these, six were pre- and eight were postmenopausal at the time of oophorectomy. Even though individual differences were observed, a majority view was expressed on several issues. All but one participant reported being satisfied with their decision to undergo oophorectomy. Women emphasised that the procedure had decreased their anxiety about developing ovarian cancer. Postmenopausal women reported no negative impact on their libido. Amongst premenopausal women all but one commenced hormone replacement therapy (HRT) following surgery and, in these women, HRT appeared to mitigate the sexual impact of the procedure. Premenopausal women reported unmet information needs both before and after the procedure, including the effects of surgical menopause and the link between HRT and breast cancer. This exploratory study suggests that prophylactic oophorectomy is a psychologically acceptable risk reduction strategy in high-risk women.

Adult↗
PubMed2006

Repair of thoracic aneurysms, with special emphasis on the preoperative work-up.

The anesthetic approach to the patient with a thoracic aortic aneurysm depends on the urgency of repair. Symptomatic patients with leaking aneurysms require urgent intervention, and there is generally little time to perform more than the most basic preoperative assessment. For elective repair, however, one must consider nearly every organ system. Many of the specific issues are inherent to the underlying pathophysiology that has resulted in aneurysm formation, and some stem from the requirements of the surgical procedure itself. A thorough knowledge of the extent and location of the aneurysm, the functional status of the heart, and the coronary artery anatomy are critical. Most patients aged older than 40 years undergo coronary angiography preoperatively, as do younger patients with specific risk factors for myocardial ischemia. Respiratory failure is one of the most common sequelae of these procedures, and a thorough preoperative pulmonary work-up is mandatory. Neurologic deficits are not uncommon postoperatively, and pre-existing deficits in the central nervous system must be sought. Coagulopathy is common in the immediate postoperative period, and preoperative assurance of hemostatic competence is important. Computed tomography scans and magnetic resonance imaging are the mainstay of diagnosis, although the adjunctive use of echocardiography provides important information. Routine preoperative laboratory studies include complete blood count, chemistries, coagulation profile, and indices of renal function; an electrocardiogram, and chest radiograph. Close communication with the surgeon regarding the operative procedure, cannulation strategy (where applicable), and planned evoked potential monitoring is necessary to ensure appropriate perioperative management. Prophylactic antibiotics and antifibrinolytics are routine.

Aortic Aneurysm, Thoracic↗
PubMedDate not supplied

The "incubation period" of subacute bacterial endocarditis.

In an attempt to gain information about the "incubation period" of subacute bacterial endocarditis, the literature was searched for case reports stating a specific interval between an event likely to cause bacteremia and the onset of symptoms. In 76 cases of streptococcal endocarditis for which this information was given, the median "incubation period" was one week. Symptoms began within two weeks in 64 of these cases (84%). Although there may be a bias toward reporting short incubation periods, it is concluded that the incubation period of subacute bacterial endocarditis is often shorter than is generally realized, and that procedures carried out more than two weeks before onset of symptoms are less likely to be causally related. In postcardiotomy cases, where timing of the bacteremia causing endocarditis is less easy to define, 27% of 122 cases of staphylococcal endocarditis developed within two weeks of surgery. This information is relevant to the planning and evaluation of prophylactic chemotherapy against bacterial endocarditis.

Cardiac Surgical Procedures↗
PubMed2005

Efficacy and tolerability of a pasteurised human fibrinogen concentrate in patients with congenital fibrinogen deficiency.

The efficacy and tolerability of a pasteurised human fibrinogen concentrate were assessed in an open, multi-centre, non-controlled retrospective study in patients with congenital fibrinogen deficiency. Haemostatic efficacy was assessed by laboratory investigation and clinical observation. The study included 12 patients (afibrinogenaemia, n = 8; hypofibrinogenaemia, n = 3; dysfibrinogenaemia combined with hypofibrinogenaemia, n = 1). Fibrinogen substitution was indicated: to stop an ongoing bleed; as prophylaxis before surgery; or for routine prophylaxis to prevent spontaneous bleeding. In total, 151 fibrinogen infusions were recorded. The median single dosage was 63.5mg/kg body weight for bleeding events or surgery and 76.9 mg/kg for prophylaxis. The median total dose per event for bleeding events or surgery was 105.6 mg/kg. Fibrinogen was administered in 26 bleeding episodes; 11 surgical operations; and 89 prophylactic infusions, of which 86 were received by one patient. The median response (n = 8) was 1.5 mg/dl per substituted mg of fibrinogen per kg body weight (0.8-2.3). The median in vivo recovery (n = 8) was 59.8% (32.5-93.9). Clinical efficacy was very good in all events with the exception of one surgical procedure, where it was moderate. No intercurrent bleeding occurred during prophylaxis. All but one infusion was well tolerated; the patient, who was administered 86 prophylactic infusions, experienced an anaphylactic reaction after the 56th infusion. In addition, one patient developed deep vein thrombosis and non-fatal pulmonary embolism with treatment for osteosynthesis after collum femoris fracture. Fibrinogen substitution could not be excluded as a contributing factor in this high-risk patient. Substitution with pasteurised human fibrinogen concentrate in patients with congenital fibrinogen deficiencies is efficient and generally well tolerated.

Afibrinogenemia↗