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At least 37 records · Page 2Linked to original sources

PubMed1988

Percutaneous lithotripsy in morbid obesity.

Percutaneous lithotripsy is an established, safe, effective method for the management of renal calculi. Obesity long has been associated with increased surgical morbidity and may eliminate a patient from shock wave treatment. We compared 44 obese patients to 226 nonobese patients undergoing percutaneous stone management. Stone number, location and total stone burden were comparable in the obese and nonobese groups. There was no significant difference between the groups in hospital time, operative time, fragment rate, access success rate or morbidity. Percutaneous procedures offer successful alternatives with low morbidity for patients with renal calculous disease.

Adult↗

PubMed1991

A clinical pilot study combining surgery with intraoperative pelvic hyperthermochemotherapy to prevent the local recurrence of rectal cancer.

Intraoperative pelvic hyperthermochemotherapy (IOPHC) with mitomycin C (MMC) was prescribed for 14 patients with resectable advanced rectal cancer in an attempt to prevent a postoperative local recurrence. Immediately after rectal amputation and extended lymphadenectomy, IOPHC was performed using physiologic saline containing 40 micrograms/mL of MMC at 45.5 +/- 0.6 C for 90 minutes, with an apparatus devised for IOPHC. At the end of IOPHC, the esophageal temperature was 37.2 +/- 0.8 C and cooling was not required. Antitumor efficacy and complications in the IOPHC group were compared with findings in 12 rectal cancer patients who underwent surgery only within the same period of time. Operation time was not prolonged with IOPHC treatment. In cytologic examinations of the pelvic lavage just before IOPHC treatment, viable cancer cells were detected in 6 of the 14 patients but were never detected in the postoperative exudate drained from the pelvic cavity. Of the 12 patients in the control group, 2 had a local recurrence, while in the IOPHC group there was no local recurrence for 16.9 +/- 9.7 months at this writing. Postoperative complications did not differ between the groups. This IOPHC treatment is a favorable method in eradicating cancer cells for postoperative local recurrence of rectal cancer.

Aged↗

PubMed1991

Role of quinsy tonsillectomy in the management of peritonsillar abscess.

Peritonsillar abscess (PTA) is the most frequent complication of acute tonsillitis requiring surgical intervention. Debate continues concerning optimal therapy in terms of patient morbidity and cost-effectiveness. A retrospective study was performed on 45 tonsillectomies for PTA in military personnel from December 1986 through December 1988. Twenty-three quinsy (abscess) tonsillectomies and 22 interval tonsillectomies were identified. Parameters studied were age, sex, abscess location, interval prior to operation, blood loss, operative time, operative experience, and combined hospital and convalescent days for the two groups. Significant differences were noted between the quinsy and interval tonsillectomy groups concerning the average number of days hospitalized (3.0 versus 4.5) and their respective convalescent periods (10.3 versus 17.3). We conclude that quinsy tonsillectomy is the best management for PTA in a young work force when the optimal treatment choice is between interval or acute tonsillectomy.

Adolescent↗

PubMed1992

[Simultaneous en-bloc allotransplantation of pancreas and kidney in the animal model. Comparison of separate organ and en-bloc pancreas/kidney transplantation in swine].

The high technical complication rate of pancreas transplantation requires large animal models to improve clinical transplant survival rates. The pig is a very suitable animal due to its anatomy, physiology and immunology which are similar to humans. In this study a model of en-bloc simultaneous pancreas and kidney transplantation was established which--in contrast to separate transplantation of both organs--decreases preservation time, operation time, and clamp time. Furthermore, the rates of intra- and postoperative complications were reduced compared with separate transplantation. The donor aorta (encompassing celiac axis, superior mesenteric artery, and left renal artery) is anastomosed en-bloc to the recipients aorta in a an oblique-to-side fashion. The portal vein is anastomosed end-to-side to the left common iliac vein. The exocrine pancreatic secretions are drained via duodenocystostomy to allow for monitoring of urinary amylase for rejection. The en-bloc technique is an alternative for pediatric donor organs since the risk of vascular complications is lower compared with separate implantation of the donor vessels. Based on our results in a large animal model the en-bloc technique could be used in adult uremic diabetic patients who receive a combined pancreas-kidney transplant from a pediatric cadaver donor.

Amylases↗

PubMed1992

Radical breast surgery with a contact Nd:YAG laser scalpel.

The use of a contact Nd:YAG laser scalpel during radical and modified radical mastectomy was evaluated in 18 patients with carcinoma of the breast. The laser scalpel performed well as a haemostatic tool, the associated mean blood loss for modified radical mastectomy being 132 ml. Operating time, operative blood loss, laser energy required and postoperative wound drainage were all related to patient obesity, correlating significantly with body weight and/or breast weight. The incidence of axillary seroma was not reduced by laser surgery and occurred in 53% of patients undergoing modified radical mastectomy. The Nd:YAG laser scalpel is an excellent haemostatic tool but it does not appear to have any other advantages over conventional surgery for mastectomy.

Adult↗

PubMed1990

Transurethral resection versus transurethral incision of the prostate. A prospective randomized study.

In this ongoing study, patients with an estimated prostate size of no more than 20 gm are randomized to undergo either transurethral resection of the prostate (TURP) or transurethral incision (TUIP) at the 6 o'clock position. To date, 93 patients have been included, and 3 months postoperatively, 80 to 90 per cent of the patients in each group reported improvement. There was also a significant decrease in symptom scores and a significant increase in maximum urinary flow rate, with great variation within each group but without difference between the groups. In both groups, there appears to be some deterioration over time. Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly in favor of TUIP. Loss of ejaculation was reported by 37 per cent of patients after TURP and by 13 per cent after TUIP (not statistically significant). There was no difference between the groups in the need for further surgery. Therefore, TUIP is recommended as an alternative to TURP in patients with small prostates.

Adult↗

PubMedDate not supplied

Anaerobic infection after total hip replacement. Report of three cases.

In a series of 387 consecutive total hip replacements there were nine infections (2.3% infection rate). Three of the infections were caused by an anaerobic gram positive cocci, Peptococcus. This is an increased incidence of infection for this previously rare pathogen. The anaerobic infections occurred despite prophylactic antibiotic coverage with Keflin. No causative factors such as hospital, operating time, operating personnel, medical disease, or blood loss could be associated with the observed anaerobic infections. Two of the anaerobic infections appeared late. This is consistent with other reports of anaerobic infections in implants. Drainage after total hip arthroplasty operation must be cultured for anaerobes as well as aerobes, especially late infections in patients on prophylactic antibiotics. Drainage which is sterile to aerobic culture should alert the physician to a possible anaerobic infection.

Adult↗

PubMed1990

Optimal therapy for patients with biliary atresia: portoenterostomy ("Kasai" procedures) versus primary transplantation.

As the results with liver transplantation have improved, a controversy has arisen regarding the precise role of a portoenterostomy in the treatment of infants with biliary atresia. The controversy centers around three issues: (1) the short- and long-term survival rates achieved with both procedures, (2) the influence of a portoenterostomy on a subsequent transplant, and (3) the shortage of suitable liver donors for very small infants. To address these questions, we retrospectively reviewed the charts of 48 children with biliary atresia who underwent liver transplantation and compared these results with 35 children transplanted for other liver diseases. As a group, the biliary atresia patients had significantly lower mean body weights and ages and spent a significantly longer time on the waiting list. In addition, significantly more of the biliary atresia patients had undergone prior abdominal surgery when compared with the non-biliary atresia group. There was no difference in the intraoperative variables of mean anesthesia time, mean operative time, mean anesthesia preparation time, nor the mean amount of blood transfused intraoperatively between the two groups. However, when the biliary atresia patients who had undergone a portoenterostomy with a stoma were compared with either the biliary atresia patients who did not have a stoma created as part of their portoenterostomy or the non-biliary atresia patients, significant differences were noted in mean total anesthesia time, mean operative time, and the mean amount of blood transfused intraoperatively. The survival rate of the biliary atresia patients was significantly greater than the non-biliary atresia patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗

PubMed1988

Use of ultrasonographic risk score in the timing of operative intervention for acute cholecystitis.

Timing of operative intervention for acute cholecystitis has long been a subject of debate. However, actual or impending perforation constitutes an absolute indication for prompt operative intervention. To discriminate these cases from those undergoing observation with conservative treatment, clinical and ultrasonographic findings were reviewed and analyzed in 17 patients with acute cholecystitis. Specificity, sensitivity, and accuracy of ultrasonography in discriminating cases of acute cholecystitis, in terms of timing of operative intervention, were calculated retrospectively based on the operative findings. The risk score for each ultrasonographic finding was determined, and the total risk score was calculated for each patient. The calculated total risk score was found to be well correlated with the macroscopic appearance of the gallbladder at operation in cases of acute cholecystitis. Therefore, this score should be useful in determining the timing of operative intervention for acute cholecystitis. However, the usefulness of the variables should further be established prospectively in other patient populations.

Acute Disease↗

PubMed1991

Reversal of Hartmann's procedure: timing and operative technique.

A review of closure of Hartmann's colostomy was undertaken to establish guidelines for the timing and technique of reversal. Between 1984 and 1990 there were 69 reversals; 48 patients originally had diverticular disease and 21 had carcinoma. One-third underwent reversal before 4 months and two-thirds after this time. The operative mortality rate was 3 per cent and the anastomotic leak rate 4 per cent. Significant morbidity occurred in 30 per cent. There was no advantage in delayed closure. Complications occurred in 24 per cent of patients undergoing reversal before and 35 per cent undergoing reversal after 4 months. Thirty-five anastomoses were hand-sewn and 34 stapled. There were no differences in operating time for the two techniques, but a greater number were stapled after 4 months than before (P less than 0.05), which may reflect increased rectal stump shrinkage with time. There were no differences in complication rates whether the anastomosis was hand-sewn (34 per cent) or stapled (26 per cent). Closure of Hartmann's colostomy is a safe procedure but has a significant morbidity in nearly one-third of cases. On the basis of these results, there is no indication to delay closure after 4 months have elapsed, and earlier reversal, when the rectal stump is most accessible, is recommended.

Anastomosis, Surgical↗

PubMed1991

[Cholecystectomy: the cost of surgery].

290 patients who underwent cholecystectomy with operative cholangiography were included in the study. Operating time and material cost of each operation were prospectively measured for each patient. The mean operating time was 107 min, and the median time was 100 min. Differences in operating time between surgeons were statistically significant. The shortest mean operating time was 68 min, and the longest was 136 min. The mean cost of material used was 158 francs. The lowest mean cost was 113 francs, and the highest was 174 francs. Such measures of operating time and costs for usual and standardized operations are possible. They should be used to establish a more objective fee system for operations inside a surgical specialty, and between different specialties.

Cholecystectomy↗

PubMed1987

The timing of operation in valvular insufficiency.

The timing of operation is discussed for aortic, mitral, and combined aortic and mitral insufficiency. The effect of surgical mortality on selection is assessed on the basis of the Green Lane Hospital results for valve replacement in the current cardioplegic era. Particular attention is paid to the effect of the preoperative symptomatic status. The criteria for selection of the patient who is essentially asymptomatic are documented in detail. It is concluded that they differ, depending upon whether there is aortic incompetence, mitral incompetence, or incompetence of both valves. The effect of the type of valve used for replacement on case selection includes an up-to-date assessment of the results achieved with freehand aortic homograft valve replacement.

Aortic Valve↗

PubMed1989

Pediatric liver transplantation: a 3-year experience.

From September 1, 1984 to March 1, 1988, 201 patients were evaluated for liver transplantation. Ninety-one orthotopic liver transplants were performed on 80 children ranging in age from 3 months to 15 years. The average waiting time for a transplant was 5 months, with children less than 10 kg in weight waiting a disproportionately long time. The average operative time was 10.6 hours and the average blood product replacement was 2.7 blood volumes. There was a steady improvement in both operative time and blood loss from 1985 to 1987. The overall hepatic arterial thrombosis rate was 9%; complex reconstructions having a thrombosis rate of 39%, and end-to-end anastomoses having a thrombosis rate of 1.4%. The average hospital stay was 37 days, and the major causes of postoperative morbidity and mortality were rejection (75%), infection (50%), and diarrhea (76%). The 1- and 3-year survival rates were 75% and 73%, respectively. Children with a successful transplant returned to home and school. After transplantation, 60% of the children exhibited catch-up growth and 88% have normal liver function. Pediatric liver transplantation is an effective modality in the treatment of children with terminal liver disease. Increased pediatric organ donation and the investigation of new operative techniques and types of preservation are necessary to meet the needs of an expanding recipient pool.

Adolescent↗

PubMed1979

[Caesarean section: low transverse (pfannenstiel) or midline incision? (author's transl)].

In 67 elective Caesarean sections and 70 emergency sections the effect of the duration of anaesthesia upon the condition of the newborn was examined. The induction-delivery time (IDT), the operation time (OT), and the difference between these, delta t, were correlated with the 1-, 5- and 10-minute Apgar scores and the pH's of the venous and arterial umbilical cord blood. A highly significant negative association was found for the pH in the umbilical vein and delta t in the series of primary sections. Analysis of the emergency sections showed a negative association between the operation time and the 5 minute Apgar score, and a positive association between the delta t and 1 minute Apgar score. Despite these findings we have observed that the induction-delivery time which we are able to achieve in our hospital has no negative effect upon the biochemical condition (pH) of the newborn. A comparison of 619 sections performed by low midline incision with 328 section by Pfannenstiel incision showed no difference with regard to postoperative complications such as disturbance in wound healing or haematoma formation. In conclusion, with respect to the IDT and postoperative complications we have found no contraindication to the use of the low transverse Pfannenstiel incision for Caesarean section.

Apgar Score↗

PubMed1988

Contact laser or conventional cholecystectomy: a controlled trial.

There have been claims that the use of lasers in surgery is associated with reduced operative blood loss, trauma, postoperative pain and improved postoperative mobility. With the development of sapphire probes capable of transmitting neodymium yttrium aluminium garnet (Nd: YAG) laser light, it is now feasible to perform direct-contact low-power laser surgery. In a small randomized controlled trial, we have compared cholecystectomy performed by conventional methods (n = 11) with the same operation performed by contact laser (n = 10). Operative time, blood loss, operative stability, analgesic requirement, mobility and response to the trauma of surgery were compared. The only differences between the two groups were a significantly increased wound infection rate (P = 0.051) in the laser surgery group and a significantly increased length of operating time (P = 0.001). Thus, the laser did not confer any advantage over conventional surgery.

Cholecystectomy↗

PubMed1990

Subvalvar aortic stenosis: timing of operation.

Subvalvar aortic stenosis can be associated with progressive left ventricular outflow tract obstruction, aortic insufficiency, and infective endocarditis. We reviewed the records of 36 surgical patients who underwent 39 operations for subaortic stenosis. Seventeen patients had associated congenital cardiac anomalies. One perioperative death occurred in a patient with tetralogy of Fallot. The mean preoperative left ventricular outflow tract systolic pressure gradient was 64 +/- 5 mm Hg (+/- standard error of the mean) and decreased to 9 +/- 2 mm Hg postoperatively (p less than 0.001). Reliable preoperative and postoperative information regarding aortic valve function was available for 27 patients. Aortic insufficiency was found in 17 (63%) of those patients preoperatively. Postoperatively, insufficiency increased in 3 patients and decreased in 4; none of these changes was major. Severity of preoperative aortic insufficiency increased significantly with age (p less than 0.05), but did not correlate with left ventricular outflow tract gradient. The information from this study and previous studies suggests that resection of subaortic stenosis is safe and effective, and operation at the time of diagnosis, regardless of left ventricular outflow tract gradient or symptomatic status, is a reasonable therapeutic alternative.

Adolescent↗

PubMed1987

Incidence, risk factors, and morphology in operating microscope light retinopathy.

A review of 135 consecutive cataract operations identified ten cases (7.4%) of operating microscope light retinopathy. Ophthalmoscopically, these light retinopathy lesions appeared as a focal pigment epithelial change with varying degrees of pigment clumping in the center. Fluorescein angiography accentuated the lesion by demonstrating a sharply demarcated transmission defect, occasionally with multiple satellite lesions. The shape of the lesion matched the shape of the illuminating source of the particular operating microscope used during the surgery. The most significant risk factor associated with the production of these light retinopathy lesions was prolonged operating time. Mean total operating time for the ten patients with light retinopathy was 51 minutes longer than for those without (P less than .0001). Other significant associated factors were the presence of diabetes mellitus (P less than .03), younger age (P less than .05), and the use of hydrochlorothiazide (P less than .04).

Cataract Extraction↗

PubMed1990

An audit of the usage of operating theatre time in a peripheral teaching surgical unit.

A recent report by the National Audit Office found that only 50% to 60% of weekday operating time was being used. This report was examined by the Committee of Public Accounts and much of the blame for underutilization of operating theatres was attributed to poor working practices among surgeons. We investigated theatre utilization in our hospital and found underutilization on the same scale as the National Audit Office. Twenty-five per cent of theatre sessions were not allocated for use, 23% of general surgical lists were cancelled and, of the lists which did take place, a further 23% of theatre time was not utilized. The single largest cause of underutilization was understaffing. To increase theatre utilization higher levels of staffing and expenditure are needed rather than changes in the working practices of surgeons.

Hospitals, Teaching↗