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PubMed1980

Membranous obstruction of the inferior vena cava and hepatic veins. Budd-Chiari syndrome? A treatable disease.

Three cases of membranous obstruction of the inferior vena cava (IVC) are presented. Two of them underwent transcardiac membranotomy with good results. The third patient was treated symptomatically and died from gastrointestinal hemorrhage and hepatic coma two years after the diagnosis of Budd-Chiari syndrome. At autopsy, membranes were found in the inferior vena cava and hepatic veins. Differentiation of Budd-Chiari syndrome secondary to the presence of such a membrane is essential since these patients are potentially curable by surgical treatment. Cavography visualizes the obstruction and is the procedure of choice for diagnosis of this condition. Surgical treatment with transcardiac membranotomy is effective. Some hepatic abnormalities regress after surgery. Prophylactic postoperative treatment with diuretics seems advisable in these patients to prevent congestive cardiac failure.

Adult↗
PubMed2006

Prophylactic external fixation and extensive bone debridement for chronic osteomyelitis.

There is universal agreement that treatment of osteomyelitis should consist of debridement, obliteration of dead space, tissue coverage and antibiotic therapy, with debridement as the most important factor for therapeutic success. Four patients, 27 to 72 years old, with chronic osteomyelitis after a fracture of the femur (two), or of the tibia (two), were included in this study. The patients had already undergone 5 to 15 (mean: 9) surgical procedures. The same surgical technique was used in all of them: sinuses were carefully excised down to the bone, and necrotic bone was aggressively resected until normal bleeding was seen. A prophylactic circular external fixation frame, built on one proximal and one distal ring connected to the bone by thin wires and half pins, was used to protect and support the limbs, significantly weakened by radical debridement. Bone grafting or distraction osteogenesis was not necessary. All wounds healed without complications, and the infection did not recur. The average follow-up period was 43 months (range: 38 to 54).

Adult↗
PubMed1989

Use of prophylactic antibiotic in clean surgical cases--a prospective trial of various regimens.

In a randomised controlled prospective trial, different antibiotic regimens were evaluated as prophylaxis in wound infection following elective surgical procedures. Four hundred and four consecutive cases were divided in four groups. Two groups were allotted two different conventional postoperative antibiotic regimens while the fourth group received short term perioperative antibiotic; group one served as control. A higher frequency of postoperative wound infection was observed in the controls. Results showed reduction in gross infection in only group III where short term perioperative antibiotic was used. Combination of penicillin and streptomycin were not found effective, and low infection rate was observed with Cephamendole used perioperatively.

Anti-Bacterial Agents↗
PubMed1995

Asymptomatic severe carotid stenosis: immediate surgery or watchful waiting? A decision analysis.

OBJECTIVE: To analyze, for patients with asymptomatic severe carotid stenosis, the risks and benefits of two strategies: (1) immediate prophylactic carotid endarterectomy (CEA), and (2) medical management followed by CEA only after a transient ischemic attack (TIA) or a minor stroke has occurred. DESIGN: A Markov-based decision analysis model that simulates and counts the possible clinical outcomes (deaths, TIAs, and major strokes) of the two strategies. Data were drawn from the current literature. SUBJECTS: A hypothetical cohort of asymptomatic patients with severe (> 75% diameter reduction) carotid stenosis identified by noninvasive diagnostic tests. MAIN RESULTS: Given the immediate surgery-related risks, patients with a stroke incidence without preceding TIA of 3% per year will benefit from prophylactic CEA only if they survive more than 4 years after the procedure, whereas those with a higher stroke incidence (5% per year) will benefit from prophylactic CEA after just 2 years. However, the gain yielded by prophylactic CEA remains small. As age- or cardiovascular-related mortality increases, the maximum tolerated combined surgical mortality and morbidity rate below which prophylactic CEA yields an improved 5-year stroke- and surgery-related-event-free survival decreases--from 5% for patients aged 55 years to 2% for patients aged 85 years with a stroke incidence of 3% per year, and from 8.5% for patients aged 55 years to 4% for patients aged 85 years with a stroke incidence of 5% per year. On the other hand, for risk-intolerant patients who value the 2-year stroke- and surgery-related-event-free survival more than life in the distant future, the combined surgical morbidity and mortality rate below which prophylactic CEA remains the preferred strategy is below 3% at any age. CONCLUSION: Risk-intolerant patients should not undergo prophylactic CEA. On the other hand, for risk-tolerant patients willing to accept an immediate and dangerous procedure to decrease the future risk of death or chronic disability due to stroke, assessment of both perioperative risk and the risk of premature death from coexistent coronary artery disease should guide individual therapeutic decision-making.

Aged↗
PubMed1978

The use of prophylactic low dose heparin in transurethral prostatectomy.

Low dose heparin prophylaxis has proved effective in reducing postoperative thromboembolic complications in a series combining multiple types of surgical procedures. Our series comfirms its safety for transurethral operations. We recommend its use in patients with predisposing factors to thromboembolic complications.

Heparin↗
PubMed1989

[A technic for radical subcutaneous fasciotomy of the leg].

At the surgical department of District Institute of National Health in Prostĕjov in 1984-1986 eight subcutaneous fasciotomies were performed after embolectomies with prolonged is haemia. The surgical technique was standardized and its safety was proved on 20 lower limbs of corpses. For the implementation a special instrument is needed--a fasciotome made from a Küntschner nail. For reliable decompression of all four osteofascial spaces of the leg it is sufficient to make a 50 mm long transverse incision, about 30 mm proximally from the apex of the external ankle. Local anesthesia of the extent of the skin incision is sufficient, the fasciotomy itself is not painful. Due to its rapid and unpretentious character the procedure is suitable in postischaemic syndrome or a prophylactic operation.

Embolism↗
PubMed2000

[Knee endoprosthetic surgery: tasks and problems of the surgical instrument teams].

About 220 knee endoprostheses are implanted at our clinic annually. This is a routine procedure for the instrument staff. Practice has shown, however, that deficient operating room management as regards the instruments, implants, operating room staff, and surgical planning causes problems. As a result of this, a prophylactic search for sources of error began (risk management). If the sources of error are found, described, and remedied, knee endoprosthetic surgery will be successful for both the patient and the surgical team. Cooperation and communication among manufacturer, surgeon, and surgical nursing staff should serve to minimize forensic risks. The most important task of the instrument staff is to produce adequate structure and procedural quality so that a positive result can be achieved.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Mammary gland architecture as a determining factor in the susceptibility of the human breast to cancer.

The developmental pattern of the breast can be assessed by determining the composition of the breast in specific lobular structures, which are designated as lobules type 1 (Lob 1), lobules type 2 (Lob 2), and lobules type 3 (Lob 3), with Lob 1 being the less developed and Lob 3 being the most differentiated or with the highest number of ductules per lobular unit. In the present work, the patient population consisted of three groups of women who underwent surgical procedures: The first group included women who underwent reduction mammoplasty (RM) for cosmetic reasons. The second group included women who underwent prophylactic subcutaneous mastectomy after genetic counseling for either carrying the BRCA-1 gene or belonging to a pedigree with familial breast cancer (FAM), and the third group included women who underwent modified radical mastectomy (MRM) for the diagnosis of invasive carcinoma. The RM group consisted of 33 women, of whom 9 were nulliparous and 24 were parous. The FAM group consisted of 17 women, of whom 8 were nulliparous and 9 were parous. The MRM group consisted of 43 women, of whom 7 were nulliparous and 36 were parous. The analysis of the lobular composition of all of the samples from the RM group, which is considered the control group, revealed that Lob 1 represented 22%, Lob 2 represented 37%, and Lob 3 represented 38%, whereas the tissue examined from the FAM and MRM groups contained a preponderance of Lob 1 at 48% and 74%, respectively, over Lob 3, which was 10% and 3%, respectively. When the results of the analysis of breast tissue were separated according to the pregnancy history of the donor, it was found that in the control group or RM, there was a significant difference in lobular composition. Nulliparous women of the RM group showed a preponderance of Lob 1 (46%) over parous women, which contained only 17%, whereas the percentage of Lob 3 in the nulliparous group was significantly lower (7%) than the parous group (48%). In the breast tissues obtained from FAM and MRM, no significant differences in lobular composition were observed, as all of the samples contained a higher concentration of Lob 1, independent of the pregnancy history. The breast tissue of FAM and MRM of parous women had a developmental pattern that was similar to that of nulliparous women of the same group and that was less developed than the breast of parous women of the control group. An important difference between the Lob 1 of the FAM group versus the control (RM) and the MRM group was that most of these lobules had thin ductules with an increase in hyalinization of the intralobular stroma manifested in the whole-mount preparation as an alteration in the branching pattern. The data suggest that the breast tissue of women with invasive cancer, as well as those from a background of familial breast cancer, have an architectural pattern different from the control or normal tissues and that the BRCA-1 or related genes may have a functional role in the branching pattern of the breast during lobular development, mainly in the epithelial stroma interaction.

Adult↗
PubMed1990

[Tube-preserving endoscopic surgical procedures in unruptured tubal pregnancy. What significance does laser use have?].

Between 1985 and 1989 115 non-ruptured tubal pregnancies were operated upon, using a pelviscope and preserving of the tube. For the purpose of prophylactic haemostasis 2,5 I.U. ornipressin (Por 8) were injected into the mesosalpinx. The tube was opened (linear salpingotomy) by using various instruments. This method was used in 49 patients by means of the thermocoagulator and hooked scissors; with the remaining 66 patients the following laser systems were employed: CO2-laser (n = 13); Nd: YAG-laser by the contact method (n = 22); argon-laser (n = 31). No intraoperative complications were noted. Postoperative rebleeding occurred in three patients requiring subsequent treatment, and pelviscopy had to be repeated in two patients, because of incompletely removed trophoblastic tissue. The tubal condition (patency; occurrence of adhesion) was checked in 53 (47%) of the patients by means of hysterosalpingography (n = 15) or second-look pelviscopy (n = 38). Tubal patency/peritubal adhesion were found after conventional surgery in 64%/55% of the controlled cases and after laser salpingotomy in 90%/11%, respectively. Summing up, we can say, that the various laser systems are suitable for operating non-ruptured pregnancies due to their accurate incision and simultaneously coagulating effect. Due to the lower postoperative tubal occlusion rate and lower tendency to adhesion, it appears, that the laser systems are superior to the conventional endoscopy instruments, although the rate of complications was highest after CO2-laser application.

Adult↗
PubMed1997

Wound infections following spinal fusion with posterior segmental spinal instrumentation.

Twenty-three of 238 patients (9.7%) developed wound infections following segmental spinal instrumentation. When the infected group and a matched control group were compared, the infected group had a significantly higher number of patients with cerebral palsy and myelodysplasia (nonambulatory), patients with wound hematomas, patients with fusions that extended into the sacral region, and patients who were incontinent of urine. A high incidence of infections with gram-negative aerobic bacilli correlated with the extension of the surgery into the sacral region and bowel and/or bladder incontinence. Prophylactic antibiotics with broader coverage for gram-negative bacilli may be warranted for these procedures. Postoperative wound infections were managed by surgical drainage and debridement as well as antibiotics. Removal of the hardware was not necessary to control the infection in these patients who underwent segmental spinal instrumentation.

Adolescent↗
PubMed1979

The vaginal flora after natural or surgical menopause.

A study was made of the cervical and upper vaginal flora in menopausal women, in an attempt to determine whether such women are predisposed to infections when undergoing gynecologic operations. The series comprised 72 women (age range, 44-80 years) classified as follows: a) 35 with a natural menopause, b) 18 with a surgical menopause induced by abdominal panhysterectomy, and c) 19 postmenopausal women after vaginal hysterectomy performed for genital prolapse. The vaginal flora of these menopausal women consisted predominantly of Gram-positive bacteria which, together with the Gram-negative bacteria, conformed to the normal pattern of microorganisms in the vagina. Such bacteria also are found in women of child-bearing age, but occasionally they can be pathogenic. Despite the inherent biohormonal changes of the memopause, expressed especially by the low estrogen level, 26.4 percent of the cultures in our study were sterile, even after major vaginal operations. Thus, the pattern of the vaginal flora, even though occasionally pathogen, should not be a contraindication to gynecologic surgical procedures in postmenopausal women. Even when vaginal cultures show the presence of these bacteria, it does not seem necessary to use prophylactic antibiotic and hormonal therapy routinely. Rather, it should be given selectively, depending upon the local state of the tissues and upon the postoperative course.

Adult↗
PubMed1960

Pyogenic infections in orthopedic surgery. Prevention and management.

A problem that confronts surgeons in clinical practice is that a patient may acquire new infections while in the hospital. When such infections occur they are predominantly staphylococcal and these bacteria are often, but not always resistant to penicillin, streptomycin and the tetracycline antibiotics. They are often but neither completely nor uniformly sensitive to the newer or less frequently used antimicrobial agents. The extension of antibiotic usage from proven situations to "routine" prophylaxis has been a widespread practice. There are many reasons to discourage and to reexamine the validity and purpose, as well as the safety of this practice. We now have sufficient background and experience to revert from widespread and indiscriminate use to a practice of discriminate prophylactic therapy. In general, soft tissue lacerations and clean wounds do not require operation under an "antibiotic umbrella." Similarly, elective orthopedic surgical procedures of soft tissues such as muscle biopsy, tenorrhaphy and muscle and tendon transplants as well as plastic surgical procedures can be safely performed without antibiotic therapy if technique is good and operation not prolonged. Operations of major magnitude on the motor-skeletal system, such as open fractures, internal fixation of fractures with bone grafts, and major operations of joints are indication for antibiotic therapy for impending infection postoperatively for five days. Reliance is mainly on antistaphylococcal drugs to which hospital organisms are predominantly sensitive. The two remaining indications for antibiotic therapy against impending infection are: (1) major crush injury-for example, to the thigh-and (2) the need for a patient with a healing fracture to have other surgical procedures such as tooth extraction or excision of an infected area which might predispose to transient bacteremia and embolic infection in bone or joint.

Anti-Bacterial Agents↗
PubMed1996

Ewing's sarcoma of the proximal femur.

The cases of 16 patients with Ewing's sarcoma of the proximal femur treated in the era of multiagent chemotherapy were reviewed, with emphasis on the mechanical problem of tumor involvement in this structurally demanding site. Fourteen patients received chemotherapy and local radiotherapy as the initial primary treatment. One patient had chemotherapy and radiotherapy, followed by wide local resection. One patient had amputation, followed by chemotherapy, for pathologic fracture and extensive soft tissue involvement at presentation. Two local recurrences occurred. Excluding the 2 patients whose femurs were fixed prophylactically, the pathologic fracture rate was 79%. In addition, by excluding the 2 patients who died before fracture, the pathologic fracture rate was 92%. Nonunion occurred in 5 (71%) of the 7 pathologic fractures not treated by resection and required as many as 5 additional surgical procedures to obtain union. At latest followup evaluation (average, 6.3 years), 10 patients had no evidence of disease, 1 was alive with disease, and 5 had died of their disease. Options for management should include primary resection and reconstruction or prophylactic internal fixation after completion of chemotherapy plus or minus radiotherapy.

Adolescent↗
PubMed2001

[Current status of endocarditis prevention].

There are currently no randomized and carefully controlled human trials to definitively prove that endocarditis prophylaxis is efficient. Furthermore, most cases of endocarditis are not attributable to a medical procedure. Thus, even with a high level of application of endocarditis prophylaxis only a minority of cases could be prevented. Endocarditis is a rare disease. On the other hand, its morbidity is increasing! In addition, infective endocarditis remains still a major medical concern because of its mortality between 5% and 76%. In addition, in up to 40% of all patients suffering from endocarditis one or more heart valves have to be replaced in the following 5 to 8 years. Without treatment endocarditis has a lethality of 100%. Therefore, there is worldwide agreement that endocarditis prophylaxis is necessary. Combining the recommendations of the German and the American Heart Association, as well as the results of the European consensus conferences, with newer insights into the pathophysiology of endocarditis the following aspects are elucidated: depending on their risk of endocarditis patients are allocated into 3 groups. In the first group there are patients with prosthetic cardiac valves, patients who suffered from previous endocarditis and patients with complex cyanotic congenital heart disease and surgically constructed shunts or conduits of the aorta and/or pulmonary circulation. In these high-risk patients the prophylactic regimen for dental, oral, respiratory tract procedures is oral amoxycillin. In genitourinary and gastrointestinal procedures ampicillin and gentamicin i.v. is recommended. In patients with mostly congenital cardiac malformations, acquired valvular dysfunction, hypertrophic obstructive cardiomyopathy and mitral valve prolapse or thickened leaflets and valvular regurgitation oral amoxycillin is recommended for all medical procedures (second group). The third group consists of patients with isolated secundum atrial defect, previous coronary bypass graft surgery, patients with cardiac pacemakers or defibrillators. In this patient cohort the individual risk of endocarditis is not higher than in the general population. Therefore, endocardits prophylaxis is not recommended.

Antibiotic Prophylaxis↗
PubMed2002

New perspectives in antibiotic prophylaxis for obstetric and gynaecological surgery.

The goals of antibacterial prophylaxis during obstetric/gynaecological surgery are similar to those of prophylaxis during intra-abdominal surgery. The vaginal flora consists of many aerobic and anaerobic organisms, is dominated by peroxide-producing lactobacilli, and is non-pathogenic under normal conditions. Destabilization of the vaginal ecosystem, as in bacterial vaginosis (BV), causes a massive increase in the ratio of anaerobes to aerobes and is associated with a large increase in the risk of infection. The surgical procedures at most risk of postoperative infection are vaginal, abdominal and radical hysterectomy and caesarean section. Both the American College of Obstetricians and Gynecologists and the American Society of Health-System Pharmacists have recommended single-dose prophylactic protocols using a variety of agents (penicillins, cephalosporins and clindamycin). However, it remains doubtful whether prophylaxis is used widely. In Italy, such prophylaxis has proved less effective in women with BV. Accordingly, patients with confirmed BV are given topical clindamycin for 7 days leading up to surgery, in addition to the usual prophylactic regimen. Caesarean delivery carries a 5- to 20-fold greater risk of infection that normal vaginal delivery. A meta-analysis of 66 clinical studies has shown that any prophylactic regimen is effective in reducing postoperative complications. The use of prophylaxis in patients undergoing a low-risk caesarean section remain controversial.

Antibiotic Prophylaxis↗
PubMed1986

[Surgical therapy of chronic polyarthritis of the hand].

Surgical therapy and the common surgical procedures for the rheumatoid hand are presented: synovectomy, boutonnière deformity, swan-neck deformity, arthroplasty, and surgical therapy of the rheumatoid thumb. The indications, early and late results, and the prophylactic value of synovectomy are discussed and compared with synoviorthesis (intra-articular injection of radioisotopic beta-emitters) in early stages of synovitis. In general, radioisotope synovectomy has reduced the need for early operative synovectomy. If synoviorthesis has no significant effect or if biomechanical factors are predominant in the affected joint (tenosynovitis, massive distension of the capsule and extensor mechanism or large masses of fibrin), then operative synovectomy is indicated. Multicenter studies have confirmed that pain can be relieved and joint swelling reduced by synovectomy for over 10 years after the operation. However, no significant preventive or retarding effects could be proven with regard to the progression of deformity or further radiologic changes. The risks in tenosynovectomy are minimal and the prognosis for improved function and prevention of ruptures is excellent. Restorative procedures on tendons are discussed in conjunction with restoration of joint function. Pathogenetic mechanisms of boutonnière and swan-neck deformities and their therapeutical consequences (soft tissue procedures and arthroplasty of the respective joints) are discussed. Because of the unpredictability of joint resection arthroplasty, many attempts have been made to develop joint prostheses. Surgical experience with cemented components, constrained hinges and prostheses with a fixed axis has been disappointing and forbids their routine clinical use. The most widely used device is the silastic spacer developed by Swanson, a silicone rubber implant acting as flexible hinge to maintain the joint relationship and improve resection arthroplasty. Several authors have obtained good long-term results using the Swanson silastic prosthesis for MP and interphalangeal arthroplasty. However, the silastic spacer still leaves room for improvement, which is particularly evident in patients with constitutional or drug-induced (steroid hormones) ligamentous laxity where bone resorption can be seen due to the piston effect and abrasion of the silicone as well as to sinking and often breakage of the prosthesis. Attempts to prevent this effect are reported. To obtain good functional results with MP arthroplasty, adequate function of the interphalangeal joints and thumb is essential.(ABSTRACT TRUNCATED AT 400 WORDS)

Arthritis, Rheumatoid↗