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At least 37 records · Page 2Linked to original sources
PubMed1991

Primary and recurrent Crohn's disease. Experience with 1379 patients.

Between 1970 and 1988, 1379 patients with Crohn's disease were treated at the University of Chicago. Of these, 639 (mean age, 32.5 years; 322 men, 317 women) required at least one surgical procedure. The most common indications for operation were failure of medical treatment (n = 215, 33%), presence of a fistula (n = 154, 24%), and bowel obstruction (n = 141, 22%). A fistula was the most common intraoperative Crohn's-related complication. In 582 patients (92%), a resection was necessary, with primary anastomosis in 416 (65%), a temporary stoma in 124 (20%), and a permanent stoma in 42 (7%). The remaining 57 patients underwent diverse procedures (stricturoplasty, bypass, and so on). Two patients (0.3%) died. Follow-up data was obtained in 95%. One hundred eighteen patients developed recurrence requiring reoperation. The recurrence rate was 20% at 5 years and 34% at 10 years. The recurrence involved a permanent stoma or a previous anastomosis in 62 patients (afferent limb in 46, efferent in 16). In the 391 patients without previous surgery for Crohn's disease, a covariate analysis was performed to determine those variables significantly associated with recurrence. Variables included demographic data, findings at operation, surgical procedures, and histopathologic characteristics. The analysis revealed that the number of sites involved was the only variable that was significantly associated with the intra-abdominal recurrence rate (p less than 0.001). The annualized risk of recurrence was 1.6% for patients with single-site involvement and 4% for those with multiple-site involvement. Perineal disease was associated with a significantly higher risk of local recurrence than any other site (p less than 0.02). A subanalysis of 236 patients with single-site involvement but no previous operation allowed us to study the influence of site on indications for surgery and type of operative procedure. Failure of medical treatment was the most common indication for all sites. In contrast the site involved influenced the procedure: resection and primary anastomosis was feasible in 88% of jejunoileal and terminal ileal cases and a temporary ileostomy was necessary in only 12%. No patients with small bowel localization required a permanent stoma. A resection with primary anastomosis was feasible in only 32% of patients with colonic disease. The remaining two thirds of patients required either a temporary or a permanent stoma. It is concluded that multisite involvement is associated with 2.5 times the rate of recurrence of single-site disease, while the presence of perineal disease has a significantly higher incidence of local recurrence.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

[113 Re-operations to correct loosening of prosthesis shafts - personal experiences and conclusions (author's transl)].

one hundred and thirteen re-operations necessitated by loosening of the prosthesis shaft were analyzed with regard to surgical stress, technique and results. Of these operations to replace the prosthesis shaft, the surgical technique employed depended on the individual situation in 94 cases. In some, the implant and cement cone were removed, in some the medullary space was foragad, and in others single or multiple fenestration was performed. The surgical investment in these 94 operations proved to be especially high. The main disadvantage of individually oriented, partly improvised procedures is that granular tissue remains in the former contact zone between cement cone and bone. Uncovering of the shaft of the femur in a planned procedure employing the fenestration/chiseling method (19 patients) represents a way of cleaning the medullary cavity completely prior to fitting the replacement implant, with a low level of surgical stress. Implants whose shape corresponds as closely of the shaft are preferred to the so-called long-shaft implants. The authors see a considerable improvement in the departure from individually oriented and partially improvised procedures in replacement interventions: the surgical stress imposed by the operation is easier to assess and the safety of the implant renders the chances of success greater.

Femoral Fractures↗
PubMed1991

Audit of 'surgery in general' in an African teaching hospital.

A 1-year prospective audit of 2233 operations performed by one general surgical unit in a Central African teaching hospital is presented. In addition to the usual 'general surgical' procedures, operations also included emergency craniotomy, reconstructive surgery for open fractures, and hysterectomy. There were 37 (1.7%) postoperative deaths and 45 other deaths in non-operated patients. Ten of 14 deaths due to sepsis in the 20-40-year age group were associated with HIV infection. The implications for teaching and training of surgical specialists in the tropics are discussed.

Emergency Service, Hospital↗
PubMed1992

[Antibiotic prophylaxis in surgery. Results of a 4-year personal case series].

A prospective study of surgical infections in our Department of Surgery in the years 1986-1989 is reported. 2719 patients entered the study: they represent the total number of patients operated in the above said period (628 urgent and 2091 elective operations). As suggested in 1964 by Altmeier, surgical procedures were classified in four groups according to the potential risk of intraoperative contamination. For every septic complication observed pertinent cultures were performed and responsible pathogens identified. We present our protocol of antibacterial prophylaxis which distinguishes antibiotics given as "ultra short term", "short term", "antibiotic prophylaxis". The results obtained and particularly the total number of infections (3.9%), and the percentage of infections in group 3 (4.6%) and in group 4 (23.1%) procedures validate the usefulness of antibiotic prophylaxis in these patients. In group 1 and group 2 patients the usefulness of antibiotic prophylaxis seems very doubtful.

Aged↗
PubMed1984

Operative risk of general surgical procedures in patients with previous myocardial revascularization.

Eighty general surgical procedures with general anesthesia were performed upon 73 patients who had undergone previous myocardial revascularization for significant coronary artery disease. No deaths occurred in this group of patients. Cardiac complications occurred in two patients. A silent myocardial infarction occurred in one patient while another required a permanent cardiac pacemaker for complete heart block. Six noncardiac complications developed in four patients. We concluded that patients with significant coronary artery disease who have undergone previous myocardial revascularization can tolerate subsequent general surgical procedures with limited risk.

Adult↗
PubMedDate not supplied

Renovascular hypertension: surgical treatment.

Renovascular occlusive disease is a common form of surgically remediable secondary hypertension. Operative options include: Bypass grafts, ex vivo reconstructions, endarterectomy, and transluminal dilation. Primary nephrectomy is undertaken only for irreparably diseased ischemic kidneys. Excellent results of surgical treatment reflect accurate identification of operative candidates and performance of appropriate operative procedures. Surgical benefits are more likely in pediatric patients and adults with fibrodysplastic or focal arteriosclerotic renovascular disease than in patients with clinically overt generalized arteriosclerosis. A review of 1631 renovascular hypertensive patients treated operatively documented a salutary outcome in 85-90% of patients.

Adult↗