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PubMed2004

Thrombosis-free surgical procedures in severe (Homozygote) factor XII deficiency: report of four additional cases and literature review.

The outcome of various surgical procedures carried out in patients with severe (homozygote) factor XII deficiency were investigated for the appearance of blood coagulation-related complications with particular emphasis on thrombotic complications. The surgical procedures were total mastectomy, tonsillectomy and adenoidectomy, placement of a hip prosthesis, and double hernia repair. None of the patients slowed any complication. Several other reported cases of surgical procedures carried out in several patients ware found in the literature. Bleeding or thrombotic complications were noted in none of these cases. The surgical procedures in some cases were minor such as adenoidectomy, tonsillectomy, or nasal polyp removal. However several major surgical procedures were carried out in some patients (cholecystectomy, gastrectomy, repair of atrial septal defect, coronary bypass). All patients remained asymptomatic. In some cases whole blood and/or plasma were used as requested by the caring surgeons. In a few patients, the plasma was given prophylactically because of the long partial thromboplastin time. Finally, three patients (two for cardiac surgery and one after hip replacement) received heparin prophylaxis as foreseen by accepted procedures without the undue sequels. These data supply further evidence that factor XII deficiency does not only show any bleeding tendency but also can withstand even major surgical procedures without thrombotic complications.

Adolescent↗
PubMed2004

Fatal myocardial infarction after lung resection in a patient with prophylactic preoperative coronary stenting.

In this report we present the case of a 77-yr-old man who underwent resection of the upper lobe of the left lung for a carcinoma, six weeks after percutaneous transluminal coronary angioplasty (PTCA) with stenting of the left anterior descending (LAD) and circumflex coronary arteries. Antiplatelet therapy with clopidogrel was interrupted two weeks before surgery to allow for epidural catheter placement and to minimize haemorrhage. The surgical procedure was uneventful. In the immediate postoperative period, however, the patient suffered severe myocardial ischaemia. Emergency coronary angiography showed complete thrombotic occlusion of the LAD stent. In spite of successful recanalization, reinfarction occurred and the patient died in cardiogenic shock. Prophylactic preoperative coronary stenting may put the patient at risk of stent thrombosis if surgery cannot be postponed for three months. In such cases, other strategies such as perioperative beta-blockade for preoperative cardiac management should be considered.

Aged↗
PubMed2005

'That's like chopping off a finger because you're afraid it might get broken': disease and illness in women's views of prophylactic mastectomy.

While data are accumulating on the efficacy of prophylactic mastectomy as a means to reduce breast cancer risk in high risk women, the effectiveness of the procedure depends on women's interest in undergoing the procedure. We report on women's responses to this surgical option as a prevention tool. Data derive from a multi-method study of women's interest in and understandings about genetic testing for breast cancer susceptibility. The sample comprises 246 women of varying ethnicities and familial breast cancer risk from Seattle, USA. In this paper, quantitative data are presented on the sociodemographic and risk perception correlates of degree of interest in taking a genetic test for breast cancer if prophylactic mastectomy were the only treatment option. In addition, we report results of a content analysis of women's open-ended responses to the question of whether and why they could imagine undergoing prophylactic mastectomy. Our analysis of these data benefits from a central distinction in medical anthropology between the concepts of illness and disease. We suggest that while prophylactic mastectomy may prevent the "disease" of breast cancer, it may be of little interest to women who see this surgery as itself mimicking the "illness" of breast cancer.

Breast Neoplasms↗
PubMed1979

Sepsis in the management of complicated biliary disorders.

Postoperative sepsis developed in 72 per cent of 25 patients with noncalculous proximal biliary tract obstruction. Six episodes of shock and one death resulted. Twenty-eight per cent of septic events occurred despite the administration of prophylactic antibiotics. The incidence of septic complications was similar regardless of the biliary drainage procedure used. Despite the advent of broad spectrum antibiotics and improved surgical techniques for biliary decompression, sepsis remains a serious and frequent complication in patients with chronic bile duct obstruction.

Adolescent↗
PubMed1989

Lymphoscintigraphy as a guide to treatment in malignant melanoma.

Regional node dissection is practiced as a measure of prophylaxis in patients with stage I and II malignant melanoma. Although the drainage pattern of the extremities is obvious, in the head and neck and trunk it may be ambiguous. We have used lymphoscintigraphy to assist in delineating the lymphatic drainage in 22 patients with primary malignant melanoma. Fourteen patients had melanoma in the head and neck region, and eight had melanoma in the trunk region. Based on Clark's classification there were ten level III melanomas, eight level IV melanomas, and two level V melanomas; the levels of the remaining two melanomas were unspecified. Seven melanomas were between 0.76 and 1.5-mm thick, eleven were between 1.51 and 4.0-mm thick, and two were over 4.0-mm thick (the remaining two were unspecified). Regional nodes were clinically negative in 18 patients. The scan distribution was unexpected in 13 patients (59%), and it influenced the surgical procedure in 11 patients (50%). No patient incurred an adverse effect from the scan. We conclude that lymphoscintigraphy may be of value in guiding prophylactic lymph node dissection in melanoma patients.

Adult↗
PubMed1977

Bacterial endocarditis in patients with pulmonary stenosis, aortic stenosis, or ventricular septal defect.

Bacterial endocarditis developed in 24 patients during follow-up in the Natural History Study. It occurred significantly more often in patients with ventricular septal defect (1.5/1000 patient-years) and aortic stenosis (1.8/1000 patient-years) than in those with pulmonary stenosis (0.2/1000 patient-years). Complications, especially emboli and aortic regurgitation, occurred in 50% of the patients. Overall mortality was 25%. Incidence rates were significantly greater for males than for females and greater for patients over 20 years of age than for younger patients. Patients who had had ventricular septal defect treated surgically had a lower incidence of endocarditis than non-surgical patients, whereas surgery did not reduce the incidence in patients with aortic stenosis. The estimated risk of contracting bacterial endocarditis prior to 30 years of age in a patient with medically-treated ventricular septal defect is 9.7%; the risk estimate for surgical patients in 2.0%. Although data regarding the use of prophylactic antibiotics were not available for patients in the Natural History Study, these results certainly suggest that continued antibiotic prophylaxis for dental and certain surgical procedures is mandatory for patients with aortic stenosis, even after successful cardiac surgery. It is the authors opinion that prophylaxis is probably less necessary for patients who have pulmonary stenosis, whether surgically treated or not, and for patients with documented complete closure of VSD.

Adolescent↗
PubMed1987

Pelvic exenteration.

Exenteration, or complete excision of the pelvic viscera, is an ultra-radical surgical procedure intended for curative treatment of the patient with advanced pelvic malignancy--primary or recurrent. At the time of introduction of this procedure, enthusiasm for its use was marred by the high incidence of serious surgical morbidity and mortality, which approached the five-year survival rate. With more careful physiological and psychological selection of patients, concentration of this kind of procedure in centres familiar with its use, improved urinary conduit techniques and careful attention to covering the pelvic floor with omentum and/or synthetic materials, the morbidity and mortality rate has been significantly reduced thus making exenteration a more acceptable treatment option to a wider spectrum of patients. More sophisticated haemodynamic monitoring, both intra- and postoperatively, intravenous hyperalimentation, prophylactic antibiotics and low-dose heparin are undoubtedly important adjuncts to the improvements in surgical technique and judgment. Psychosexual 'rehabilitation' in the broadest sense must be an integral part of patient care for those undergoing exenteration and in most instances necessitates involvement of the patient's partner. Exenteration has only a very limited role in palliation and all attempts should be made to avoid this procedure when cure is clearly not a possibility.

Female↗
PubMed2005

Percutaneous vertebroplasty: current concepts and local experience.

With the aging population in our country, symptomatic osteoporotic compression fractures are increasingly common. Osteolytic compression fractures from spinal metastasis are also becoming more frequently seen because of the longer life expectancy from improvements in chemotherapy. Percutaneous vertebroplasty with PMMA has been shown to be an efficient procedure to treat pain due to these fractures. It is a minimally invasive procedure performed under local anesthesia and sedation. Injection of PMMA provides immediate stability when it hardens, and permits the patient to ambulate without pain. Appropriate patient selection is the key to clinical success. However, this procedure must be treated with respect, and has to be performed by physicians with the necessary training. Otherwise, increased pain, paralysis, and even death may occur from this seemingly innocuous procedure. In this article, I will deal with the background issues of osteoporotic and osteolytic vertebral compression fractures, patient selection, surgical technique, complications, and review of current literature on vertebroplasty. Key areas of development in this field include the use of kyphoplasty, defining the role of prophylactic augmentation, and improvements in biomaterials.

Animals↗
PubMed2000

Single coronary artery and complete transposition of the great arteries: a technical challenge resolved?

BACKGROUND: The origin of the coronary arteries from a single aortic sinus remains a rare congenital anomaly, once regarded as having little clinical significance. Contemporary surgical practice, however, frequently demands precise coronary reimplantation. In this article we emphasize a prophylactic surgical technique found especially helpful in the repair of D-transposition of the great arteries (D-TGA)/single coronary artery. METHODS: We reviewed the institutional cardiac registry. RESULTS: Since 1985, 398 neonates with D-TGA were repaired with the arterial switch procedure. A mortality rate of 38% was encountered in "simple" D-TGA (n = 174)/single coronary (2.9% left facing sinus (IRLCx), 7.5% right facing sinus (IIRLCx)) and 41% in neonates with D-TGA (n = 224)/single coronary (3.6% IRLCx, 12% IIRLCx). During the past 3.5 years the surgical mortality rate of neonates (n = 6) treated with origin of the coronary arteries from a single aortic sinus has dropped to 0%. CONCLUSIONS: The surgical repair of D-TGA/single coronary artery continues to trouble surgeons. The implantation of a well-mobilized coronary "button" into a previously anastomosed neoaorta remains a key prophylactic technique in the achievement of good technical results.

Cardiac Surgical Procedures↗
PubMed1995

Prophylactic Nd:YAG-laser iridotomy versus surgical iridectomy: a randomized, prospective study.

Both surgical iridectomy and YAG-laser iridotomy have been shown to prevent angle-closure glaucoma. However, it remains unknown as to which procedure is superior. We therefore conducted a prospective randomized study, which compared the effect of the two methods on visual acuity, intraocular pressure, endothelial cell density, depth of the anterior chamber, and iris configuration as well as acceptance by the patients. A total of 30 patients, who were treated for acute angle-closure glaucoma in one eye, were subjected to either surgical iridectomy or Nd:YAG-laser iridotomy in the other eye according to a randomized protocol. All patients were followed for 12 months by examination at the 1st, 6th, and 12th month post treatment. No significant difference between the two treatments was found regarding visual acuity or intraocular pressure. The peripheral anterior chamber increased in depth following both methods, whereas the central depth of the anterior chamber was unaffected. A better gonioscopic visibility of the trabecular meshwork resulted from the increased width of the chamber angle. Whereas the number of endothelial cells remained constant in the patients treated with laser iridotomy, a small decrease was observed in the group of patients who underwent iridectomy (-7.2% after 12 months; difference not significant). The subjective acceptance by the patients was better in the group treated with laser iridotomy. We conclude that the two methods are equivalent with regard to intraocular pressure and visual acuity. The constant number of endothelial cells and the better acceptance by the patients suggest Nd:YAG-laser iridotomy to be the preferable method for prophylaxis of acute angle-closure glaucoma.

Acute Disease↗
PubMed2006

Laparoscopic gastric and biliary bypass: a single-center cohort prospective study.

PURPOSE: Relief of gastric outlet and distal biliary obstruction may be accomplished by open surgery or by minimally invasive techniques including endoscopic and laparoscopic approaches. We examined the feasibility and safety of laparoscopic gastric and biliary bypass in all patients with malignant and benign disease requiring surgical relief of obstructive symptoms. MATERIALS AND METHODS: Patients with benign duodenal stricture or inoperable malignancy underwent therapeutic laparoscopic bypass surgery. Prophylactic gastric or biliary bypass was added in selected patients with nonmetastatic malignancy. RESULTS: Twenty-eight patients (17 of them female) with a median age of 67 years (range, 26-81 years) underwent 29 laparoscopic bypass procedures for malignant (n = 23) or benign (n = 6) disease. One patient who underwent a Roux-en-Y gastrojejunostomy for non-steroidal anti-inflammatory drug induced ulcer disease developed stenosis of the stoma that required laparoscopic refashioning 2 months later, accounting for the 29th procedure reported herein in 28 patients. Surgery included the construction of a single gastric (n = 16) or biliary (n = 5) bypass or a double bypass (n = 8), and an additional prophylactic bypass in 5 of 23 cancer patients (21.8%). All procedures were completed laparoscopically. The median operative time was 90 minutes (range, 60-153 minutes) and mean postoperative hospital stay was 4 days (range, 3-6 days). Complications developed following 4 procedures (13.8%) and 1 patient died (3.4%). No complications occurred in patients with prophylactic bypass. One patient required laparoscopic revision of the gastroenterostomy 2 months postoperatively, for benign disease. No recurrence of obstructive symptoms was observed in cancer patients during follow-up. CONCLUSION: Laparoscopic bypass surgery for distal biliary and gastric obstruction in patients with benign or malignant disease results in low morbidity and mortality and short postoperative hospital stay. The addition of prophylactic bypass in patients with nonmetastatic unresectable malignancy appears safe and effective.

Adult↗
PubMed2006

Aortic root disease after the Ross procedure.

PURPOSE OF REVIEW: Autograft root pathology is the most common adverse event late after the Ross operation. Therefore, characterization of prevalence, risk factors and natural history of root disease, as well as identification of preventive and therapeutic strategies, is warranted. RECENT FINDINGS: Autograft root pathology affects up to one third of long-term survivors of the Ross operation. Root replacement technique and preoperative aortic aneurysm are recurrent risk factors. Any age group, except for infants, may be affected. Dilatation is often progressive leading to valve regurgitation, true aneurysm, and, rarely, dissection. Primary prevention involves avoidance of root technique, graft repalcement of aneurysmal aorta, or modifications of the root technique. Use of beta-receptor antagonist or angiotensin converting enzyme-inhibitors for secondary prevention is still empirical. Indications to resection of root aneurysm are based on maximum root area indexed to body height. Reintervention prior to appearance of relevant valve insufficiency increases likelihood of pulmonary valve preservation. Definition of functional outcome after autograft valve-sparing procedures needs longer follow-up. SUMMARY: Over a decade after worldwide embracement of the root replacement technique for the Ross procedure, autograft root pathology is emerging as a prevalent complication. Prophylactic and therapuetic strategies are proposed to mitigate the current and future impact of this phenomenon.

Aortic Aneurysm↗