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At least 451 records · Page 25Linked to original sources

PubMed2001

Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing.

OBJECTIVE: To observe and report the clinical results of indirect plating techniques in the treatment of femoral shaft nonunions originally treated with intramedullary nailing. DESIGN: Prospective consecutive. SETTING: Regional trauma center. PATIENTS: A consecutive series of twenty-three patients with nonunion of femoral shaft fractures previously treated with intramedullary nailing. INTERVENTION: Surgical treatment with indirect plating techniques using the AO 95-degree condylar blade plate in nonunions of the distal and proximal one thirds and broad large-fragment dynamic compression plating in nonunions of the middle one third, with selective autologous cancellous bone grafting. Emphasis was placed on preoperative planning, intraoperative attention to soft tissue sparing and selection of the appropriately applied implant to correct deformity and obtain union. MAIN OUTCOME MEASUREMENTS: Healing rate and time, operative blood loss and time, and incidence of complications, including hardware failure, loss of fixation, infection, and postoperative malalignment. RESULTS: Twenty-one of the twenty-three nonunions healed without further intervention at an average of twelve weeks (range 10 to 16 weeks) postoperatively. The two remaining patients (9 percent) had early breakage of their hardware, requiring repeat plating. Union in both of these cases occurred within sixteen weeks of the revision (12 and 16 weeks). Including the two patients requiring reoperation, all twenty-three nonunions healed at an average of seventeen weeks (range 10 to 24 weeks) from the initial plating procedure. There were no intraoperative complications. Average operative time was 164 minutes (range 120 to 240 minutes), and blood loss was 340 milliliters (range 200 to 700 milliliters). There were no cases of significant postoperative axial or rotational malalignment (more than 5 degrees), limb length discrepancy (more than 1 centimeter), or deep infections. CONCLUSIONS: Modern plating techniques are effective in the treatment of femoral shaft nonunions after intramedullary fracture fixation. The authors consider this method particularly valuable in the presence of deformity. Union occurred reliably with few complications.

Adult↗

PubMed2004

Application of robotics in general surgery: initial experience.

Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

Adult↗

PubMed2004

Computer-assisted versus conventional surgery for insertion of 96 cannulated iliosacral screws in patients with postpartum pelvic pain.

BACKGROUND: The purpose of this study was to assess the value of fluoroscopy-based computer-assisted surgery (CAS) for the insertion of iliosacral screws. The results of CAS were compared with the results of a conventionally operated prospective control group. Endpoints of this study were fluoroscopy time, guide wire insertion time, operation time and complication rate. METHODS: The study group consisted of 24 patients with postpartum pelvic pain syndrome. All patients were treated with a stabilization of the pelvic ring by means of an anterior plate fixation and autologous tricortical bone graft as well as two iliosacral screws bilaterally. Consequently, the results of 48 versus 48 iliosacral screw fixations could be evaluated. Conventionally operated patients were turned from the supine to the prone position intraoperatively, whereas CAS operated patients were operated in the supine position. One surgeon performed all operations. RESULTS: The fluoroscopy time in the CAS group was 0.7 minutes versus 1.8 minutes in the conventionally treated group (p < 0.01). The mean insertion time for four guide wires was 20.2 minutes in the CAS versus 19.4 minutes in the conventionally operated group (p = 0.6). The mean operation time in the CAS group was 97 minutes; 116 minutes in the conventional group (p = 0.03). In the CAS group one patient had pain and a sensory deficit of S2 postoperatively. The Fisher's exact test showed no difference in complication rate between the two groups (p = 0.26). CONCLUSIONS: The fluoroscopy time is decreased with a factor 2.5 using CAS. Guide wire insertion time was similar in both groups. The reduction in operation time using CAS was due to fact that patients were operated in the supine position during the whole procedure. This study shows that CAS is a save technique for insertion of iliosacral screws.

Adult↗

PubMed1994

The use of low-viscosity fluids for hysteroscopy.

We reviewed the literature addressing the use and complications associated with low-viscosity distention fluids in urologic and hysteroscopic procedures. The possible causes of fluid complications included elevated intrauterine pressure, myometrial invasion, prolonged operating time, and operative trauma to the cervix or uterine body. Physiologic electrolyte solutions create only fluid overload, and treatment requires cardiovascular support and diuresis. Nonelectrolytic solutions result in acute dilutional hyponatremia, which has been referred to as the transurethral resection of the prostate syndrome. Treatment requires diuresis and a rapid, controlled return of the serum sodium level to 120-130 mmol. These complications can be minimized with proper use of equipment and careful monitoring of fluid volumes. To recognize and treat them, the surgeon must be knowledgeable about the fluid being used and the difficulties it may cause.

Cervix Uteri↗

PubMed1995

Laparoscopic adrenalectomy: clinical results in 25 patients.

Adrenal tumors would be eminently suitable for laparoscopic surgery because of their size and location. We have performed 25 cases of laparoscopic adrenalectomy, and the purpose of this study was to evaluate the clinical results. Since November 1992, 12 men and 13 women with a mean age of 47.3 (range 29-71) years underwent laparoscopic adrenalectomy. Fifteen lesions were on the left side, and ten lesions were on the right side. The clinical diagnosis was primary aldosteronism in eight patients, Cushing's syndrome in seven, and a nonfunctioning adrenal tumor in ten. The mean operating time was 254 +/- 72 minutes (range 155-412 minutes), but the time on the last 10 cases was 216 +/- 40 minutes, which was equal to the mean operating time of the 15 open adrenalectomy cases (190 +/- 66 minutes). There was no difference in the operating time by clinical diagnosis. The time to first oral intake after the operation was shorter in the laparoscopic group, the need for analgesics was less, and the hospital stay and the time until return to preoperative activity were shorter than after open surgery. The laparoscopic cases had no significant complications, and every operation was performed completely. Although there was the learning curve for the performance of laparoscopic adrenalectomy, its operating time was equal to that of open surgery, and the postoperative recovery was significantly faster. Therefore, laparoscopic adrenalectomy would be useful compared with open surgery on the basis of invasiveness and cost.

Adrenal Gland Neoplasms↗

PubMed1997

Neurosurgical trauma call: use of a mathematical simulation program to define manpower needs.

Resource criteria for trauma centers (TC) mandate a first plus backup neurosurgeon (NS) coverage, an unnecessary expense for TC treating few neurosurgery patients. This report uses a mathematical modeling system to define optimal NS trauma coverage. Random data from 749 patients treated with emergency neurosurgery operations (OR) within 24 hours of admission at 97 TC were used to create a 1-year profile of admission by month, day, and hour, operation times, and operation duration. These data were entered into a simulation program to define the frequency that a patient needing a NS consult would wait beyond 30 minutes because the NS was in the operating room at a trauma center with one, two, or three neurosurgeons on-call. One thousand iterations were done for each sample size of 25 to 300 patients in 25-patient increments. The probability that a patient could not be seen promptly by one NS in a trauma center operating on 25, 50, 75, or 100 patients per year is 0.23, 0.9, 1.6, and 3.66 patients per year. Fewer than one patient (0.75) per year will wait more than 30 min in a trauma center doing 225 emergency ORs when two neurosurgeons are on-call. One patient in 10 years would wait more than 30 min in a trauma center doing 300 ORs with a third NS on-call. Mathematical modeling of patient data helps define optimal hospital resources. Mandatory NS backup for TC performing fewer than 25 neurosurgery procedures is unneeded.

Computer Simulation↗

PubMed2001

Which is a less invasive pancreatic head resection: PD, PPPD, or DPPHR?

Less invasive pancreatic head resection, such as pylorus preserving pancreatoduodenectomy (PPPD) and duodenum preserving pancreatic head resection (DPPHR) has been introduced for the treatment of pancreatoduodenal lesions, especially for benign conditions, in consideration of postoperative quality of life. Surgical stress and exocrine and endocrine function of the residual pancreas were examined in 44 patients with PPPD, 10 with conventional pancreatoduodenectomy (PD) and six with DPPHR. Clinical findings including serum levels of C reactive protein (CRP), fasting blood sugar, a 120-min value of the 75-g oral glucose tolerance test (OGTT), N-benzol-L-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion value (a pancreatic exocrine function test), and volume of postoperative pancreatic juice drainage were compared among the three different variants of pancreatectomy. Operation time and operative blood loss in PD were largest of the three, followed by PPPD and DPPHR. Postoperative elevation of serum CRP on postoperative day (POD) 2 or 3 was similar among the three different types of operation. Fasting blood sugar concentrations were not different among the three groups at short- and long-term after the operation, while the 120-min value of the GTT showed a marked elevation at long-term only after PPPD. The volume of pancreatic juice drainage increased up to POD 4 and became constant thereafter. The total amount of pancreatic juice drainage from POD 4 to 13 was smallest in PD (637 ml) followed by PPPD (1,255 ml) and DPPHR (1,431 ml). The BT-PABA value declined after PD (-20.3%, P = 0.0437) and PPPD (-20.2%, P = 0.0239) at short term, but not after DPPHR (8.2%). These findings suggest that the early impairment of the pancreatic exocrine function after PD and PPPD but not after DPPHR may indicate that the invasiveness of pancreatic head resection to the pancreatic functions is greater in PD and PPPD than in DPPHR.

4-Aminobenzoic Acid↗

PubMed2006

Is lack of placement of drains after thyroidectomy with central neck dissection safe? A prospective, randomized study.

OBJECTIVE: Selective use of drains after thyroidectomy has been suggested in the literature. Although the safety of thyroidectomy without drains has been reviewed, there is little specific data available to identify the safety of thyroidectomy combined with central neck dissection (CND) without drains. This study aims to determine the feasibility and safety of thyroidectomy without drains, especially in cases of combined CND. STUDY DESIGN: Prospective, randomized study. MATERIALS AND METHODS: One hundred ninety-eight consecutive thyroidectomized patients were enrolled in this study. Drain group (n = 101) consisted of 41 hemithyroidectomies (HT), 28 total thyroidectomies (TT), and 32 total TT with CND. No-drain group (n = 97) consisted of 42 HT, 18 TT, and 37 TT with CND. The following variables were examined: perioperative complications (hemorrhage, hematoma, seroma), intraoperative bleeding, operation time, volume of resected thyroid gland, time of hospital discharge after operation, duration of drain placement, and total amount of drainage (drain group). RESULTS: There were no significant differences in age, sex, volume of resected thyroid gland, types of operation, operation time, and histopathlologic diagnosis between two groups. In the drain group, overall perioperative complications occurred in seven (7/101, 6.9%) patients. In the no-drain group, overall perioperative complications occurred in nine (10/97, 10.3%) patients. There was no significant difference in overall perioperative complications between the drain and no-drain groups, even in cases of performing CND. Time of hospital discharge after operation was significantly shorter in the no-drain group than the drain group (P < .05). CONCLUSIONS: We conclude that thyroidectomy without drains is safe and effective even in combination with CND and appears to confer several advantages over the routine drainage method. In addition, we achieved significant reduction of hospital stay, which led to a reduction in costs for the patients.

Adolescent↗

PubMed2000

Risk factors in prostatectomy bleeding: preoperative urinary infection is the only reversible factor.

OBJECTIVES: To find out whether any of a preset battery of clinical and laboratory parameters has significant correlation with blood loss caused by transurethral prostatectomy (TURP). PATIENTS AND METHODS: All new patients undergoing a TURP over a 1-year period were included in the study. For each patient the following parameters were documented: (1) Pre-operatively: Age, mode of presentation, blood pressure, complete blood count, coagulation screening, calcification of abdominal blood vessels on plain X-ray, prostate size on digital rectal examination (DRE), pre-operative urine culture, presence of haematuria, ECG changes and drugs taken. (2) Intraoperatively: prostate morphology at cystoscopy, type of anaesthesia, operating surgeon, operating time, weight of resected prostate tissue and any blood transfusions. (3) Postoperatively: Length of irrigation time and prostate histology. All the intra-operative and postoperative blood loss was calculated. Their sum constituted total blood loss which constituted the dependent variable of the study. Statistical methods used included bivariate correlation, Students t test or the chi(2) test as appropriate. RESULTS: Of 140 TURPs, 121 were eligible for final analysis. The mean total blood loss was 552 ml (34 ml per gram of tissue) and the mean resected prostate weight was 18 g. Of the continuous variables, the one with strongest correlation with total blood loss was resected prostate weight (r = 0.47, p = 0.000) followed by prostate size on DRE (r = 0.45, p = 0.000) then operating time (r = 0.39, p = 0.000). Of the categorical variables, the one with the strongest correlation with total blood loss was preoperative urine culture (p = 0.01). CONCLUSIONS: The only reversible factor associated with blood loss caused by TURP is pre-operative urinary infection. Operating time is partly controllable, as it may improve (i.e. decrease) with experience of the operator.

Aged↗

PubMed2003

Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions.

BACKGROUND: Intestinal obstruction is the most severe consequence of adhesion formation. This study examined the annual surgical workload and costs of intestinal obstruction caused by postoperative intra-abdominal adhesions. METHODS: The study was a retrospective case-note review of patients hospitalized for intestinal obstruction caused by postoperative adhesions in a well defined geographical area. The surgical workload and direct costs of inpatient care were analysed. RESULTS: There were 138 admissions for postoperative adhesion-related intestinal obstruction during the study with a total of 1118 inpatient days. The median hospital stay was 4 (range 1-58) days among patients who had non-operative treatment and 11 (range 2-34) days for those who had surgery. Surgery was necessary in 40 patients (29.0 per cent). The mean operating time (time from skin incision to last stitch) and the mean time spent in the operating theatre were 79 and 141 min respectively. The cumulative operating time for the surgical group was 52 h 20 min and the cumulative theatre time was 93 h 44 min. The annual direct hospital cost for postoperative adhesional intestinal obstruction was pound 181 653 in the district studied and the estimated cost for the whole of Finland was pound 2 077 796. CONCLUSION: This population-based study indicates that the workload and costs associated with bowel obstruction caused by postoperative adhesions are substantial.

Adult↗

PubMed1991

Kinetic investigation of penicillin G acylase from a mutant strain of Escherichia coli ATCC 11105 immobilized on oxirane-acrylic beads.

Highly purified penicillin G acylase from a mutant derivative of Escherichia coli ATCC 11105 was immobilized on oxirane-acrylic beads by covalent binding via oxirane groups. The highest specific activity, (322 U g-1 dry matrix at 40 degrees C and at pH 8.0) was obtained by using an enzyme solution having 13.8 U mg-1 specific activity and 72.73 mg total protein. The efficiency of immobilization was 95.8%. Kinetic parameters of immobilized penicillin G acylase were determined at the same pH and temperature by a preparation having 8.1 mg bound protein. The Km value and substrate inhibition constant of the enzyme were found to be 11.36 mmol dm-3 and 680 mmol dm-3 penicillin G respectively. Phenylacetic acid and 6-aminopenicillanic acid were estimated as the competitive and non-competitive inhibitors of the enzyme and their inhibition constants were found to be 90 mmol dm-3 phenylacetic acid and 76.1 mmol dm-3 for 6-aminopenicillanic acid. The activation energy of the hydrolytic reaction was calculated to be 7.75 kcal mol-1. The immobilized enzyme showed highest activity at pH 8.0 and at 55 degrees C. The enzyme was stable when incubated at 4 degrees C for one day at a pH range of 5.0 to 9.0. Thermal stability (over 30 min) was observed up to 40 degrees C but decreased at higher temperatures and was almost absent at 60 degrees C. A 95% conversion rate was observed at 28 degrees C and at 40 degrees C with 60 and 30 min operation times respectively. Operational stability of the enzyme was improved further with dithiothreitol treatment. Activity loss was around 5% following 20 cycles of repeated use of the enzyme at 40 degrees C. No significant loss of activity was observed at 28 degrees C when the enzyme was used for 20 cycles. 6-Aminopenicillanic acid in the reaction mixture was observed to be stable during conversion reactions which were carried out at both temperatures.

Acrylates↗

PubMed1996

Prognostic factors for postoperative recurrence of Crohn's disease. Gruppo Italiano per lo Studio del Colon e del Retto (GISC)

UNLABELLED: Prognostic factors for postoperative recurrence of Crohn's disease (CD) have been widely investigated but not yet clearly identified. PURPOSE: Aim of this study was, therefore, to analyze the association between demographic, clinical, laboratory, and surgical characteristics of patients and the cumulative probability of endoscopic postoperative recurrence. METHODS: The study was performed in 110 patients who were enrolled in the Italian multicenter, randomized, controlled trial on the effectiveness of 5-aminosalicylic acid (5-ASA) in the prevention of postoperative recurrence in CD. Patients had undergone their first intestinal resection for CD of the terminal ileum with or without involvement of cecum ascending colon. Recurrence was defined on the basis of endoscopy. The following variables were evaluated as potential prognostic factors: gender, age, years since diagnosis, clinical course (perforative and non-perforative), Crohn's Disease Activity Index score, white blood count, erythrocyte sedimentation rate, C-reactive protein, and orosomucoids assessed before the operation. Timing of operation (elective or urgent), type of anastomosis (end-to-end, end-to-side, side-to-side), and prophylactic treatment were also evaluated. Colon ileoscopy was performed at 6, 12, 24, and 36 months after operation. The association between variables and the cumulative proportion of recurrence was analyzed both by univariate analysis (life table method, log-rank test) and multivariate regression analysis (Cox's model, stepwise procedure). RESULTS: Results of this study indicate that, of the features considered before surgery, only leukocytosis (white blood count, >9,000 ml) was significantly associated with an increased risk of recurrence (P < 0.05) at univariate analysis. This finding was not confirmed by multivariate analysis. A trend toward a higher risk of recurrence for patients who have had a resection with end-to-end anastomosis compared with those who have had a resection and other types of anastomosis was also observed. This trend reached significantly in the group of patients submitted to treatment with 5-ASA. The multivariate analysis showed that 5-ASA-treated patients with end-to-end had a risk of recurrence more than threefold higher than those with other types of anastomosis (relative risk, 3.40; 95 percent confidence interval, 1.00-11.96; P < 0.03). CONCLUSIONS: From a practical point of view, it has been estimated that the combination of intestinal resection plus side-to-side or end-to-side anastomosis with oral 5-ASA treatment reduces by 64 percent the postoperative recurrence rate in CD at three years follow-up.

Adult↗

PubMed2005

Surgical treatment of cholelithiasis and choledocholithiasis in a 2-month-old premature and low birth weight infant.

Detection rates of cholelithiasis and choledocholithiasis in infants and children have increased since the introduction of ultrasonography, and surgical treatment is gradually tending to increase. However, for cholelithiasis and choledocholithiasis, controversies over etiology, diagnostic means, operation time, and operating method remain. Using ultrasonogram and magnetic resonance cholangiopancreatography (MRCP), we diagnosed cholelithiasis and choledocholithiasis in a premature and low birth weight infant who was admitted to the hospital with complaints of obstructive jaundice and alcoholic feces. We report the successful treatment of this infant by cholecystectomy and T-tube drainage.

Cholecystectomy↗

PubMed2003

Diagnostic and therapeutic laparoscopy for nonpalpable testis.

BACKGROUND: We evaluated the use of laparoscopy in the management of impalpable testis to determine what advantages it might offer over the open approach. METHODS: Over a 5.5-year period, a total of 46 patients with 53 nonpalpable testes underwent a laparoscopic procedure at our hospital. There were 28 cases of intraabdominal testis (52.83%), 18 cases of the vas and vessels entering the internal ring (33.96%), and seven cases of intraabdominally absent testis (13.20%). We performed a laparoscopic orchiopexy for 24 testes (scrotal in 21 cases and partial to the inguinal canal in three cases) and an orchiectomy for three testes. We encountered inguinal hernia in 14 cases (26.41%). RESULTS: At follow-up, all testes were the same size as at the time of operation and were well positioned in the scrotum, except for four testes that required reoperation due to partial migration at the superficial inguinal ring. The operating time was <1 h in unilateral cases and <2 h for the bilateral cases. All procedures were completed successfully without conversion or complications. CONCLUSIONS: Laparoscopy is the only exploratory procedure that is accurate enough to enable the diagnosis of nonpalpable testis and also allow the surgical treatment to be done in the same setting.

Abdomen↗

PubMed2003

Laparoscopic treatment of enteric fistulas.

BACKGROUND: Elective laparoscopically assisted sigmoid colectomy for diverticular disease and ileocolic resection for terminal ileal Crohn's disease are safe and beneficial procedures in many patients. However, few data exist regarding the laparoscopic management of enteric fistulas from diverticular and Crohn's disease. METHODS: We completed a retrospective chart review of patients who underwent laparoscopic treatment of enteric fistulas complicating diverticular and Crohn's disease. RESULTS: During an 8-year period (1994-2002), 72 patients underwent 73 laparoscopically assisted bowel resections for enteric fistulas by one surgeon at the Mount Sinai Medical Center. Ninety percent of patients had Crohn's disease, the average age was 39, and the male/female ratio was 38/34. Patients had a history of prior abdominal surgery in 39.7% of cases. Multiple fistulas were present in 30% of patients and 12.3% underwent multiple resections at the time of operation. Mean operating time was 199 min, and the conversion rate was 4.1%. Average length of stay was 5.2 days. There were no mortalities in the series. Overall morbidity was 11%. CONCLUSIONS: Laparoscopic management of enteric fistula disease is safe and effective. Low morbidity and short hospital stay demonstrate the safety and benefit of the minimally invasive approach for even complicated fistula disease in patients with history of prior abdominal surgery and multiple fistulas, or in patients requiring multiple resections for fistulas from diverticular and Crohn's disease.

Adult↗

PubMed2001

Preinsertion local anesthesia at the trocar site improves perioperative pain and decreases costs of laparoscopic cholecystectomy.

BACKGROUND: Local anesthesia at the trocar site in laparoscopic cholecystectomy is expected to decrease postoperative pain and hence expedite recovery. The aims of this prospective randomized study were to investigate the effect of local anesthesia and to discover whether it is cost effective. METHODS: For this study, 100 patients undergoing laparoscopic cholecystectomy were randomized into two groups. The 43 study patients were injected with 0.5% bupivacaine hydrochloride at the trocar site before the trocars were inserted. They then were compared with 41 control patients who received no local anesthesia. The remaining 16 patients were excluded from the study. The postoperative pain was evaluated at the standard four trocar sites at 4 h and 24 h after surgery on a scale 1 (the mildest pain the patient had ever experienced) to 10 (the most severe pain the patient had ever experienced). Postoperative pain medications and their cost were evaluated. RESULTS: There was no difference between the two groups with regard to gender, age, weight, operative time, estimated operative blood loss, and bile culture. The patients who received bupivacaine at the trocar site clinically had less pain (p < 0.001 for all four sites) both at 4 and 24 h after surgery. The treatment group patients used less mepiridine and promethzine than the control group (p = 0.001 and 0.002, respectively) postoperatively. Overall, the patients who had local anesthesia used less postoperative pain and antiemetic medication than the control patients (p = 0.02). This afforded a significant decrease in the costs and charges of these medications (p = 0.004 and 0.005, respectively). Three patients in the study group were discharged from the hospital the day of surgery. CONCLUSION: Preinsertion of local anesthesia at the trocar site in laparoscopic cholecystectomy significantly reduces postoperative pain and decreases medication usage costs.

Abdominal Muscles↗

PubMed2002

Clinical assessment of spinal and epidural anesthesia in inguinal hernia repair.

PURPOSE: The current study was done to compare the effect of spinal and epidural anesthesia on surgical outcome measures of inguinal herniorrhaphy. METHODS: Ninety-eight male patients undergoing inguinal hernia repair were randomized to either spinal (SA; n = 39) or epidural (EA; n = 59) anesthesia groups anesthetized with either glycosylated bupivacaine (20 mg) or 0.5 % bupivacaine (100 mg). Anesthesia onset time (AOT), postoperative stand-up time (SUT), first pain sensation time (FPT), operation time (OT), analgesic requirement (AR), hospital stay (HS), visual analogue scores of pain (VAS), per- and postoperative complications, and postanesthesia complications were recorded and compared with each other. RESULTS: FPT was 6.6 +/- 0.6 h and 3.1 +/- 0.4 h and OT was 40 +/- 2 min and 33.1 +/- 1 min in the EA and SA groups, respectively (p < 0.05). SUT was also longer in EA group. VAS scores at 12 and 24 h were significantly higher in the EA group (28 +/- 4 mm and 24 +/- 5 mm in EA and 16 +/- 4 and 5 +/- 1 mm in SA; P < 0.05). No statistically significant difference was found between the SA and EA groups with respect to the other outcome measures that were considered. CONCLUSION: Spinal and epidural anesthesia show some differences from each other with respect to outcome measures such as OT, SUT, FPT, and 12- and 24-h VAS scores.

Clinical Trial↗

PubMed2004

Computed tomographic assessment of the surgical risks associated with fibrocavernous pulmonary tuberculosis.

PURPOSE: We evaluated the surgical risks associated with fibrocavernous pulmonary tuberculosis by retrospectively examining chest computed tomography (CT) scans. METHODS: We reviewed the records of 40 patients who underwent pulmonary resection for fibrocavernous pulmonary tuberculosis, for whom preoperative CT scans were available. The disease was categorized as class I, defined as a cavity within one lobe without remarkable pleural thickness, in 21 patients; class II, defined as a cavity extending beyond one lobe or within one lobe with remarkable pleural thickness, in 10 patients; and class III, defined as bilateral cavities, in 9 patients. Four of the nine patients with bilateral cavities underwent bilateral pulmonary resection and five underwent unilateral pulmonary resection. The study parameters were intraoperative blood loss, operative time, hospital stay, major operative morbidity, and hospital death. RESULTS: Intraoperative blood loss and operative time were significantly greater and hospital stay was significantly longer in patients with advanced disease (P = 0.046, P = 0.000, and P = 0.143, respectively). Major surgical morbidity mainly occurred in association with advanced disease (P = 0.028) at the following incidences: class I, 5%; class II, 30%; class III, 44.4%. Two hospital deaths occurred, both following bilateral pulmonary resection for class III disease, accounting for an overall 5% mortality rate. CONCLUSION: The surgical risks associated with fibrocavernous pulmonary tuberculosis were well correlated with anatomic involvement, according to the extent of cavitation and the severity of pleural thickness, as depicted by CT. Staged pulmonary resection or the combination of one-sided resection with other modalities is recommended for the treatment of bilateral cavities.

Blood Loss, Surgical↗