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At least 37 records · Page 2Linked to original sources

PubMed1992

Indications for and results of intraocular lens explantation.

We reviewed the medical records of 97 patients who had 101 consecutive intraocular lens (IOL) explantation procedures, with or without exchange, at the University of Florida Eye Center from January 1, 1983, to December 31, 1987. The majority of the removed IOLs were anterior chamber styles (53.9%), followed by iris-fixated lenses (33.7%). The most common indications for surgery included pseudophakic bullous keratopathy (PBK)--69%, uveitis-glaucoma-hyphema (UGH) syndrome--9%, and IOL instability--7%. The best visual outcome was seen in patients with IOL instability; 50% achieved 20/40 or better visual acuity. Forty one percent of patients with PBK, who had IOL explantation/exchange combined with penetrating keratoplasty, achieved 20/40 or better visual acuity. The poorest visual outcome was seen in patients with the UGH syndrome; 83% had a final acuity of 20/200 or worse. However, these patients achieved resolution of their pain and inflammation and better control of their intraocular pressure as a result of the surgery. Complications leading to IOL explantation tended to occur months to years after the original surgery in patients with closed-loop, semi-flexible anterior chamber lenses and iris-fixated lenses. Posterior chamber lenses were most often removed because of complications unrelated to the implant.

Aged↗

PubMed1992

Fibular osteosynthesis for delayed type II and type III femoral neck fractures in children.

Seventeen transcervical/basal femoral neck fractures in children were treated by free fibular graft and cancellous lag screw. Two cases were failures of a previous surgery, and 15 had been untreated for 3 weeks or more. Four cases had radiological evidence of avascular necrosis of the head and one of the neck preoperatively; five cases had neck resorption. At an average of 48.1 months postsurgery all fractures had united and there was only one new case of avascular necrosis. Four cases had coxa vara, and four cases had premature epiphyseal closure. There were 13 good, three fair, and one poor result(s) using Ratliff's criteria. We recommend this procedure in cases with delayed initial appearance or failed previous surgery. Complications of the procedure such as long screw/graft and fibular fracture are preventable. The incidence of coxa vara in cases with neck resorption may be reduced by adding subtrochanteric osteotomy to the procedure.

Adolescent↗

PubMed1992

Portal vein thrombosis in a complicated case of Crohn's disease.

Portal vein thrombosis is a rare complication of ulcerative colitis and is invariably fatal. This report describes a patient with severe Crohn's disease who underwent elective surgery complicated by an anastomotic disruption with faecal peritonitis. Following emergency laparotomy he developed left hypochondrial pain which was a manifestation of splenomegaly consequent upon portal vein thrombosis. Anticoagulation was successful in preventing further spread of the thrombosis as monitored by colour Doppler ultrasound. Severe active disease, surgery and sepsis have been recognized as predisposing factors for thromboembolic complications in inflammatory bowel disease and this patient was exposed to all three. It is conceivable that portal vein thromboses occur more commonly than suspected and ultrasound scanning could ascertain the prevalence if performed prospectively.

Adult↗

PubMed1978

Protein loss after radical mastectomy as a cause of postoperative hypoalbuminemia.

The concentrations of serum albumin and the cumulative loss of albumin through the drainage tubes were followed in 14 patients who underwent radical mastectomy for cancer. The concentration of serum albumin declined during the postoperative period, and the nadir was on the 5th day. On the first 5 days a good correlation was observed between hypoalbuminemia and loss of albumin from the wound. After this period, hypoalbuminemia persisted unchanged although small quantities of albumin continued to be lost through the drains. It is concluded that in surgery complicated by abundant serum discharge, the albumin loss may be the main cause of postoperative hypoalbuminemia.

Breast Neoplasms↗

PubMed1992

Long-term morbidity and mortality in patients undergoing surgery for unilateral vocal cord paralysis.

Fifty-six patients who had undergone surgery for unilateral vocal cord paralysis (UVCP) were reviewed retrospectively. The etiologies; indications for surgery; timing of onset, diagnosis and surgery; complications; and survival rates are presented. Forty patients had neoplasms of which 32 were malignant and 8 were benign. UVCP was due to direct tumor involvement in 16 cases and surgical trauma in 21 cases. Mean survival for patients who presented with UVCP which was due directly to a malignancy was 5 months versus 22 months for those patients with UVCP due to surgical trauma during resection of malignancies. Mean survival for lung cancer patients was 5 months versus 24 months for patients with other malignancies. The etiology and manner of presentation of UVCP are important prognostic indicators which should be considered when planning surgical intervention for UVCP.

Adolescent↗

PubMed1991

Vaginal reconstruction with rectus abdominis myocutaneous flap: CT findings.

The distally based rectus abdominis myocutaneous flap is used in a new technique for vaginal reconstruction after pelvic exenteration for malignant disease. We identified 27 patients who underwent this procedure, of whom eight had a total of 14 postoperative CT scans and two CT-directed biopsies. The myocutaneous flap appeared as a unilateral arcuate band of soft tissue extending from the linea alba to the rectal fascia or sacrum. Additional CT findings included asymmetric thinning of the ventral abdominal wall (7/8), fluid collections (2/8), vaginal breakdown (1/8), presacral soft-tissue thickening (6/8), and tumor recurrence (3/8). The postoperative CT scan reflects the altered anatomy produced by the surgery. Complications and recurrent disease can be recognized as deviations from the normal postoperative appearance.

Abdominal Muscles↗

PubMed1976

Arterial counterpulsation: review of the first 100 patients.

One hundred patients were treated with arterial counterpulsation over a 52-month period, indications being acute myocardial infarction complicated by cardiogenic shock or refractory cardiac failure, or elective cardiac surgery complicated by continued dependence on cardiopulmonary bypass. Virtually all patients showed initial improvement and 45 were hospital survivors. Serious complications of treatment were relatively infrequent. Long-term results were good, particularly in patients treated early, and in those with infarction who suffered mechanical complications that could be corrected surgically results suggest an important role of arterial counterpulsation in acute coronary artery disease.

Assisted Circulation↗

PubMed1975

The anatomy of orthopaedic malpractice. A study of two hundred and fifty cases.

Nine per cent of all of the Aetna Life and Casualty Company's closed malpractice cases during an eleven and a half-year period were orthopaedic. Two hundred and eleven orthopaedists (164 Board-certified), twelve general surgeons (eight Board-certified), and nineteen general practitioner-general surgeons were involved. Allegations of improper treatment (seventy cases), poor results (severty-four cases), postoperative infection including seven cases of gas gangrene (thirty-one cases), diagnostic error (twenty-six cases), back-surgery complications (twenty-six cases), miscellaneous complications (sixteen cases), and cardiac arrest (seven cases) were the grounds for these malpractice cases. When there was evidence of careful clinical appraisal, good clinical judgment, impeccable surgical technique, good doctor-patient rapport, and well documented records, the defense was successful.

Back↗

PubMed1975

[Retrospective study of congenital hypertrophic pyloric stenosis and pylorospasm: Surgical vs. non-surgical treatment (author's transl)].

Congenital hypertrophic pyloric stenosis and pylorospasm have extensively been studied in 705 infants treated in 5 pediatric clinics in Hamburg, W.-Germany, during 1961 to 1970. With this report and its statistical evaluation we are aiming to provide basical information to answer the question still open to discussion: Are we allowed to demand surgical treatment in every single case of spastic hypertrophic pyloric stenosis? The following questions have been investigated: distribution of cases due to grade of severity; frequency of surgical and non-surgical, conservative treatment in these groups of different severity; its rate of success and of fatal outcome; length of clinical treatment and hospitalization; frequency of additional, intercurrent disease in both groups, with and without abdominal surgery; complications during and after surgery; late complications with regard to the way of treatment. From our results we conclude that surgical intervention is indicated in severe cases and in cases of medium severity, together amounting to 60% of all cases. In less severe, about 40%, cases non-surgical, conservative treatment is promising in almost all cases. The most important parameter to single out these less severe cases besides the general status is the roetgenologic finding that delayed emptying of the stomach starts within 15 to 20 min. Important as well is a balanced electrolyte and acid-base metabolism. Once more we advocate individual and subtle decision of paramount surgical intervention, reasoning from the background of this study where the percentage of infants successfully treated by non-surgical, conservative medical ways is very high.

Acid-Base Equilibrium↗

PubMed1976

Small-Carrion penile prosthesis. A new implant for management of impotence.

More than 75 patients have had excellent results using a new penile implant which consists of a silicone exterior with a silicone sponge interior. The prostheses are inserted into the corpora cavermosa; they feel and look like a normal erect penis. The prostheses are available in several lengths and two diameters, and the proper size is selected for each patient at the time of surgery. Complications have been minimal.

Adult↗

PubMed1992

[Postoperative analgesia by intrathecal morphine and respiratory depression: value of low doses (apropos of 285 cases)].

Morphine at very low dose gives a good post-operatory analgesia without major secondary effects. This study analyses retrospectively 285 spinal anaesthesia with hyperbaric 0.5% bupivacaine 0.2 mg.kg-1 and morphine 0.25 mg in adult urologic surgery. The analysis of enquiry in analgesic during the post-operatory period shows that in most cases (72%) the patients have supported the first 24 hours without any complementary analgesia; 28% of patients needs a complementary analgesia realized with 1 g of paracetamol. Intravenous morphinics have never been necessary in post-operative period. The analgesia was adequate for the patient's comfort, and it never mask a surgery complication. No respiratory complication appeared, even in 13 patients who needed intravenous morphinics in per-operative.

Adult↗

PubMed1992

Comprehensive restaging laparotomy in women with apparent early ovarian carcinoma.

OBJECTIVE: To determine the yield and morbidity of comprehensive restaging laparotomy in women with presumed early ovarian carcinoma who have undergone incomplete initial staging procedures. METHODS: We conducted a retrospective review of 30 women with apparent early ovarian carcinoma who underwent a comprehensive restaging laparotomy including multiple random intraperitoneal biopsies and selective pelvic/para-aortic lymphadenectomy before receiving adjuvant therapy. Positive findings were compared with clinicopathologic features. RESULTS: Only 17% of patients had adequate skin incisions, 53% had pelvic washings, and 37% had omental biopsy at primary surgery. Complications of restaging laparotomy included 53% severe adhesions, 20% bowel complications, and 20% vascular complications requiring suture. Nine patients (30%) had disease upstaged and six (20%) had stage III disease established by comprehensive restaging laparotomy. Two-thirds of the upstaged patients had occult metastases identified only through cytology, random peritoneal biopsies, or selective lymphadenectomy. Women with poorly differentiated or papillary serous lesions were more likely to have disease upstaged than those with well- and moderately differentiated lesions or other histologic types (P < .05). Other clinicopathologic features did not predict upstaging. CONCLUSION: A comprehensive staging laparotomy is needed to detect occult metastatic disease in women with apparent early ovarian carcinoma.

Adult↗

PubMedDate not supplied

[Prognostic factors for postoperative mortality in cancer of the esophagus. Analysis of 46 cases].

Forty six patients with esophageal cancer underwent surgery between January 1986 and January 1990. In 14 patients (30.4%) distant metastases were recognized before surgery, whereas in 29 cases (63%) regional neoplastic lymph node infiltration was observed during surgery. Complications during and after surgery occurred in 32 (69.6%) patients and in 30 cases (65.2%) respectively. During the first 30 days after surgery 12 patients died. This represents a postoperative mortality of 26.1%. Among a total number of 51 variables analyzed in this study, 11 influenced the postoperative mortality: duration of intubation, previous history of toxic syndrome, presence of distant metastases before surgery, presence of neoplastic node involvement during surgery, tumor size greater than 4 cm, localization of the tumor at the middle third of the esophagus, respiratory insufficiency, cardiac failure, septic shock, and suture failure during the postoperative phase. However, multivariate analysis revealed that only three of these variables had an independent prognostic value on postoperative mortality: tumor size, presence of distant metastases, and development of respiratory insufficiency during the postoperative period.

Adult↗

PubMed1992

[Medicolegal implications of sinus surgery].

Possible sinus surgery complications are reviewed. The difficult anatomy and its relationship with the orbit, the optic nerve and the olfactory fossa are the main reason of complication. However by technical improvement of imaging and endoscopy, as well as by surgical skill refinement the complication rate decreases. In the patient's interest, and to avoid medico-legal suits, some recommendations are suggested.

Diagnostic Imaging↗

PubMed1992

Liver injuries: a five-year study at Surat-thani Hospital.

Most liver injuries can usually be handled by simple technique. In this study, 70 per cent of the cases needed only simple suture. There were 10 cases (16.67%) in which no surgical procedures were required at all, because the bleeding had stopped prior to surgery. Complications and mortality varied according to the type of liver injury, the involved organ injury and the most important factor, shock prior to and during surgery. This study reports not only the type of liver injury, causes, treatment, complications and mortality rate but it also compiles the surgical techniques used in managing liver injury according to severity.

Adolescent↗

PubMedDate not supplied

[Identification of the patient at risk of postoperative infectious complications: risk factors and their evaluation].

The authors report their results of a prospective study on 1182 patients who underwent surgical operation relatively on postoperative infections. Studied variables were: structural and anamnestic: sex, age, smoking, drinking; clinical: evidence of functional changes in various organs, as assessed upon clinical basis and laboratory results; pertinent to surgical intervention: entity, duration, anaesthesia; during and early-after-surgery complications (until discharge or within 30 days since intervention). Stepwise logistic regression model was applied to this set of preoperative and operative factors, four of which were found significantly correlate with postoperative infections: bacterial contamination during surgery, duration surgical intervention greater than 120', cholestasis, serum albumin.

Adolescent↗

PubMed1992

Value of MRI in the morphological evaluation of tumors of the third ventricle.

The detection or suspicion of a tumoral expansive process in the third ventricule is usually performed by MRI. The contribution of MRI to the diagnosis is unquestionable in view of its accuracy in the topographical characterization of these lesions and in the detection of small formations. The great histological variety of tumours in that region may result in different treatments which can be associated. MRI, therefore, plays an important role in pretherapeutic morphological evaluation. Fifteen patients with tumour of the third ventricle were examined by MRI before treatment. The results of these examinations were compared with the pathological data and the therapeutic procedures: ventricular shunting, stereotactic needle biopsy, radio- or chemotherapy and surgery. MRI cannot provide a formal histological characterization, but it can individualise some categories of tumours, give details on the walls of the third ventricle (notably in the case of bifocal pineal and suprassellar lesions), visualize the paths of CSF flow and predict the need for cisternoventriculostomy, and detect venous structures in the vicinity of the great cerebral vein which might result in post-biopsy and post-surgery complications.

Adolescent↗

PubMed1992

[The treatment of severe dysplasias by CO2 laser: the respective indications for vaporization and conization. 84 cases].

Fifty-nine conisations and 25 vaporizations were carried out using laser CO2 in order to treat a series of 84 cases of severe dysplasias (CIN III). After a follow-up of 4 and 12 months (median period of observation 25 months) it was found that out of 74 patients that were followed up in this way 72 had benefitted from the use of the treatment. There were 5 cases however of recurrence of dysplasia (1 CIN I, 2 CIN II, 2 CIN III). These had further treatment with laser. Four of those were controlled properly, the fifth had to have surgery. Complications of treatment did not occur when vaporization was used and only rarely when conisation was used. With vaporisation it is not possible to obtain a piece for histological examination, but if it is done according to precise criteria it is safe (7 mm depth at least and vaporisation carried out to 3 mm beyond the lesions). It can be used particularly in young patients who have never been pregnant. If these have been examined carefully with directed biopsies taken colposcopically and where the lesion is strictly limited to the exocervix and the transformation zone has been seen and the lesion is small (2 cm of less), 84% were controlled therapeutically and using Bruhat's criteria the success rate was 96%. Conisation was effective for every one of the other cases. Laser CO2 probably lessens local complications of the procedure and if vaporization is carried out on the rim of the cervix better control of the condition is obtained (98% controlled in the period under review).

Adult↗