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At least 487 records · Page 27Linked to original sources
PubMed1993

Results of surgical treatment for calcified tuberculous empyema: improved pulmonary function obtained with lung preserving policy.

We treated thirteen cases of calcified tuberculous empyema during the nine years from 1984 to 1992. Six patients having mild symptoms were categorized as Type I, and the remaining seven with severe symptoms as Type II. The patients of Type I were all successfully treated by complete empyemectomy with or without lung resection. All the patients of Type II suffered from major symptoms and were burdened by larger empyema cavities with formation of bronchial fistulas. Five of the latter were successfully treated, but two died, one from MRSA infection and another from intestinal necrosis following omentopexy. Our guide lines for the treatment of tuberculous empyema are: Lung resection must be minimal. Type I patients could be managed by simple empyemectomy with or without minor thoracoplasty. Open thoracostomy prior to the empyemectomy is not necessary. If the patient who belongs to Type II is aged and in a critical state, open thoracostomy must be taken as the first choice. Omentopexy is reliable, but it should be restricted to selected cases. Reasonable dead space and minor air leakage may safely be left behind if the cavity is surrounded by noninfected raw surface of the chest wall and diaphragm. Better quality of life was revealed by exercise test with improved oxygen consumption, compared to the preoperative state.

Aged↗
PubMed1992

Pharmacologic myocardial perfusion stress tests. Adenosine thallium stress test.

Thallium-201 myocardial perfusion scintigraphy assists in detecting coronary artery disease and assessing the significance of known stenoses. An adenosine infusion protocol is discussed in conjunction with presentation of results obtained in a community hospital setting. Primary indications for pharmacologic stress maneuvers include: Evaluation of patients unable or unwilling to exercise to adequate levels of workload and patients undergoing preoperative evaluation (particularly in patients undergoing vascular surgery). Experience in a community hospital setting attests to the safety of this pharmacologic protocol while showing a diagnostic accuracy similar to results reported in peer review literature. The method has been readily received by referring internists and cardiologists and is associated with a 21% increase in nuclear myocardial perfusion stress tests during the first six months of 1991.

Adenosine↗
PubMed1984

[Plastic surgery of the mitral valve in mitral valve insufficiency - advantages of physiologic surgery].

Nine patients (mean age at the time of surgery 54.5 +/- 0.7 years), who had mitral valve reconstruction for mitral valve insufficiency were studied on an average of 15.0 +/- 7.5 months after the operation using technetium-99m-pertechnetate--or gold scintigraphy. The radionuclid ventriculograms were performed with the patient in RAO-position at rest and during mild exercise (50 watt). Looking at the results of the preoperatively performed heart catheterization with contrast ventriculography our datas showed a postoperative improved left ventricular function as well as a physiologic function of the mitral valve. Clinically the patients improved from class 3.6 to 1.6 (NYHA) on an average. The reconstructive mitral valve insufficiency is able to restore normal left ventricular function. The operation should be carried out on patients graded at class II (NYHA). Technetium-99m-pertechnetate scintigraphy (first pass technique) appears to be particularly suitable for evaluating left ventricular function and the function of the mitral valve after reconstructive mitral valve surgery.

Female↗
PubMedDate not supplied

[Asymptomatic myocardial ischemia before and after surgical revascularization in patients with multivessel occlusive coronary disease].

INTRODUCTION: The objective of this study was to examine the occurrence of asymptomatic myocardial ischemia prior to and after myocardial revascularization in patients with multivessel occlusive coronary disease. Asymptomatic ischemia can be described as real ischemia without anginal pain or other ischemic symptoms in patients with coronary disease or coronary artery spasm. Our study examined silent ischemia after myocardial revascularization. Early detection of silent ischemia is important for prevention of cardiac incidents. MATERIAL AND METHODS: We have examined patients with multivessel coronary disease with occurrence of continued preoperative silent ischemia. All patients have undergone ECG examination, exercise stress test and Holter-monitoring prior to and after myocardial revascularization. RESULTS: The investigation comprised 27 patients and their average age was 54.5 years. All patients with silent ischemia had a multivessel occlusive coronary disease and have undergone myocardial revascularization managed with triple or quadruple aortocoronary bypass surgery. Exercise stress test was performed postoperatively in elder patients, as well as ECG and Holter-monitoring. Silent ischemia was established in 21.6% of patients, while in 87.5% untreated diabetes mellitus was diagnosed. Silent ischemia most often occurred in the early morning hours and it was frequently associated with heart rhythm disturbances (VES) whereas these rhythm disturbances depended on the length of the ischemic episode. Intermittent 2nd degree atrioventricular block was found in one patient. CONCLUSION: Silent myocardial ischemia occurred in 21% of patients after myocardial revascularization. It is most often detected in the early morning hours and is associated with ventricular rhythm disorders. Silent ischemia is easily detected by simple examination procedures providing adequate therapy and prevention of cardiac incidents.

Adult↗
PubMed1978

Hemodynamic studies after De Vega's tricuspid annuloplasty.

Postoperative hemodynamic studies were conducted at rest and during exercise in 24 patients who, in addition to mitral and/or aortic valve surgery, had De Vega's tricuspid annuloplasty. To determine the degree of tricuspid insufficiency (TI), right atrial pressure (PRA) tracings, biplane right ventricular cineangiograms, and ultrasonic Doppler flow patterns were obtained. The TI improved in 14 patients, but still remained mild to moderate in 20 patients. In addition, a mild-to-moderate tricuspid stenosis with pressure gradients from 2 to 7.8 mm Hg were found in 12 patients. There was no significant change in the mean PRA, with 8.0 +/- 4.5 mm Hg preoperatively and 7.5 +/- 3.5 mm Hg postoperatively at rest. During exercise, PRA rose to 17.0 +/- 6.5 mm Hg. The unsatisfactory results are also due to the persistent elevation of left atrial and pulmonary artery pressure after left heart surgery. De Vega's annuloplasty does not answer the tricuspid challenge, since the results are unpredictable.

Adolescent↗
PubMed1993

Preoperative pulmonary function testing for patients with lung cancer.

Preoperative functional assessment of patients who are scheduled to undergo pulmonary resection for carcinoma of the lung can assist the clinician in determining perioperative risk. Physiologic alterations that occur after thoracotomy, including changes in lung volume, ventilatory pattern, gas exchange, and respiratory defense mechanisms, impose an increased risk of complications in patients with moderate to severe respiratory impairment. The use and shortcomings of preoperative spirometry and arterial blood gas analysis as predictors of perioperative complications are reviewed. Quantitative radionuclide scintigraphy, and in some cases exercise testing, can further determine the operative risk of patients with lung cancer. For patients with increased risk, implementation of prophylactic measures may decrease postoperative complications.

Blood Gas Analysis↗
PubMed1997

Intracompartmental pressure before and after fasciotomy in runners with chronic deep posterior compartment syndrome.

Exercise induced pain in the posterior part of the leg is common among runners; the underlying reason for these complaints may be very different. The purpose of the present, controlled study was therefore 1. to confirm a clinically diagnosed deep posterior compartment syndrome by using intramuscular pressure measurements and 2. to evaluate the effect of a surgical release on clinical signs and intracompartment pressure values. Fifteen symptomatic runners with the clinical suspicion of a chronic deep posterior compartment syndrome and nine healthy recreational runners as controls were investigated. Intramuscular pressure was measured both at rest and up to two minutes post-exercise, using a pressure-monitor with a transducer. In symptomatic runners, the average pressure was preoperatively 5.6 mmHg (95%-confidence-interval [CI]: 3.4-7.6) at rest, rising to 18.5 mmHg (CI: 15.4-21.8) post-exercise. Corresponding values in healthy control runners were 5.1 mmHg (CI: 1.9-8.3) at rest, with a decrease induced by exercise to 2.8 mmHg (CI: -0.5-6.1). After fasciotomy of the deep posterior compartment in all fifteen symptomatic runners, average pressure values fell to 2.2 mmHg (CI: 1.0-3.4) at rest, and were further reduced after (now pain-free) exercise to 1.6 mmHg (CI: 0.6-2.6). The decrease between pre-operative and post-operative values was statistically highly significant (p < 0.0001 for values after running, p < 0.005 for values at rest). In conclusion, intracompartment pressure measurement is a useful technique to confirm the clinical diagnosis of deep posterior compartment syndrome prior to recommending surgery. Hereby, an exercise-induced rise in pressure of at least 10 mmHg, corresponding to a two- to threefold increase of values measured at rest, may be a more important diagnostic criterion than absolute levels of pressure measured before or after running.

Adult↗
PubMed1990

Indications for pulmonary function testing.

STUDY OBJECTIVE: To critically assess original studies evaluating the role of preoperative pulmonary function testing in predicting postoperative outcomes. DESIGN: MEDLINE search of English-language articles from 1966 to 1987 using the following medical subjects headings respiratory function tests, lung, lung diseases, and preoperative care. MEASUREMENTS AND MAIN RESULTS: Relevant studies were subdivided by operative site. We included only studies for which we could determine pre- and post-test probabilities of morbidity, mortality, sensitivity, and specificity. Preoperative pulmonary function testing was found to have measureable benefit in predicting outcome in lung resection candidates. In selected patients, split perfusion lung scanning and pulmonary exercise testing appeared to be useful. Confirmation of these reports is necessary before these preoperative tests can be routinely recommended. In studies of upper abdominal surgery, spirometry and arterial blood gas analysis did not consistently have measureable benefit in identifying patients at increased risk for postoperative pneumonia, prolonged hospitalization, and death. Studies of preoperative testing for other patients, including those having coronary artery bypass grafting, lacked adequate data for meaningful analysis. CONCLUSIONS: Preoperative pulmonary function testing helps clinicians to make decisions on management of lung resection candidates. Although many studies of patients before abdominal surgery have focused on the utility of preoperative pulmonary function testing, methodologic difficulties undermine the validity of their conclusions. The impact of testing on care of other preoperative patients is even less clear because of poor study design and insufficient data. Therefore, further investigation is necessary before a consensus can be reached on the role of preoperative pulmonary function testing in evaluating patients before all surgical procedures except lung resection.

Abdomen↗
PubMed2002

Preoperative stress testing: new guidelines.

To date, there are no well controlled trials in the literature that demonstrate an outcome benefit using stress testing as a screening procedure before noncardiac surgery. Perioperative beta-blockade significantly decreases morbidity and mortality, and thus reduces any potential benefit stress testing may have in identifying patients who may advance to more invasive treatment. Preoperative percutaneous coronary intervention has unproven perioperative benefit, and coronary artery bypass graft carries risks that often offset the risk of noncardiac surgery. Unless an outcome benefit from cardiac testing and procedures can be demonstrated in a properly designed trial, their use should generally be restricted to situations in which symptoms or other cardiac findings warrant cardiac evaluation and treatment, regardless of upcoming surgery.

Exercise Test↗
PubMed1989

[The injured and the immobilized muscle cell: ultrastructural observations].

Muscle soreness is a common feature among athletes and untrained individuals who engage in unusual, especially intense eccentric exercise. Various biochemical markers as for example elevated CK demonstrate a damage of muscle cells. The most prominent structural finding is a varying degree of disruption of the contractile material up to cell degeneration. These morphological findings reach their maximum 2 or 3 days after exercise. Signs of regeneration, however, are seen even weeks after exercise. In a prospective study we investigated the structures of the quadriceps muscle in 41 patients with chronic symptomatic instability of the anterior cruciate ligament before, 9 and 26 weeks after operation using the needle biopsy technique. The immobilized muscle showed a rapid and large atrophy which markedly reduced aerobic capacity as well as maximal strength. Preoperative values weren't attained 26 weeks postoperative despite intense physiotherapeutic exercise. The control leg showed an atrophy as well, but only aerobic capacity was reduced, maximal strength remained about the same.

Biopsy, Needle↗
PubMed1984

Glomus tumors of the temporal bone: contemporary evaluation and therapy.

Surgical management of glomus tumors of the temporal bone requires accurate preoperative assessment and a knowledge of temporal bone anatomy, contemporary microsurgical techniques, and appropriate postoperative management. Care should be exercised to minimize postoperative neurologic deficit and deformity resulting from surgery of this usually benign lesion. The primary preoperative goal is to determine the extent of the lesion; although the history and physical examination are helpful, radiologic delineation of the tumor is imperative. Recent advances in surgical approaches and techniques have allowed the removal of larger tumors with lessened mortality and morbidity. Our overall experience in this series of glomus tumors leads us to believe that surgical excision is the treatment of choice for the treatment of glomus tumors of the temporal bone.

Adult↗
PubMedDate not supplied

Laryngoplasty with ventriculectomy or ventriculocordectomy in 104 draft horses (1992-2000).

OBJECTIVE: To evaluate efficacy and safety of laryngoplasty with vetriculectomy (VE) or ventriculocordectomy (VCE) for treatment of laryngeal hemiplegia (LH) in draft horses. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: One hundred four draft horses used for competitive hitch competitions. METHODS: Medical records and postoperative endoscopy for competitive hitch draft horses diagnosed with left LH and treated with laryngoplasty and VE or VCE between January 1992 and December 2000 were reviewed. Follow-up information was obtained from telephone interviews with owners and trainers, and performance scores of 1 to 3 were assigned in which 1 was defined as a horse that was unable to perform (abnormal respiratory noise with or without exercise intolerance), 2 was able to perform but not for its intended use (exercise tolerant but abnormal respiratory noise), and 3 was performing as expected for its intended use (exercise tolerant, no abnormal respiratory noise). RESULTS: One hundred four horses that had 111 laryngoplasty procedures were included. All horses had preoperative performance scores of 1. Follow-up information was available for 79 horses. Improvement in postoperative performance (exercise tolerant, with or without abnormal respiratory noise) was reported in 92% of horses. Respiratory noise was eliminated in 72% (57 horses) of horses. Postoperative performance scores were the following: 3 in 57 (72%) horses, 2 in 16 (20%) horses, and 1 in 6 (8%) horses. There was no significant difference in postoperative performance based on preoperative grade of LH. There was a trend for horses with >/=70% of possible maximal abduction postoperatively to have a performance score of 3. Postanesthetic complications included prolonged recovery (4 horses, 4%) and myopathy or neuropathy (7 horses, 7%). One of these horses was killed because it did stand; triceps myopathy and encephalopathy were confirmed on necropsy. CONCLUSIONS: Laryngoplasty with VE or VCE is an effective and safe procedure for the treatment of LH in the draft horse. Repeat laryngoplasty can be performed successfully, with good performance outcome after laryngoplasty failure. Complications associated with general anesthesia and laryngoplasty in draft horses are higher than reported for light breed horses under similar conditions. CLINICAL RELEVANCE: For LH, laryngoplasty with VCE or VE under general anesthesia is recommended to eliminate abnormal respiratory noise and improve performance in most competitive hitch draft horses.

Anesthesia, General↗
PubMed2004

Discontinuation and reinstitution of medications during the perioperative period.

PURPOSE: The issues regarding the discontinuation and reinstitution of long-term therapies, including cardiovascular agents, anticoagulants and antiplatelet agents, central nervous system agents, and herbal medicines, in the perioperative period are discussed. SUMMARY: It is estimated that one fourth of all patients undergoing a surgical procedure are taking long-term medications. The issues surrounding the decision to discontinue such medications before surgery and when to reinstitute them are complex. In the preoperative period, it is important to avoid the use of medications that may negatively interact with anesthetic agents. Postoperatively, the concern shifts toward avoiding withdrawal symptoms that may develop and possible progression of the underlying disease if the medications are not restarted in a timely fashion. The potential for decreased gastrointestinal motility in the postoperative patient, which may reduce the efficacy of oral medications, must also be considered. Antihypertensive medications may cause cardiovascular complications, such as hypotension or myocardial ischemia. Psychoactive medications may cause prolonged sedation and withdrawal symptoms may develop. Antithrombotic agents may increase the risks of bleeding during surgery. Several herbal medicines may cause a combination of these effects. CONCLUSION: The decision to withhold and restart medications should be based on available clinical data and expert opinion. Health care professionals should exercise diligence in obtaining an accurate medication history on all preoperative patients and in reviewing the medications in the postoperative orders.

Drug Administration Schedule↗
PubMed1984

Effect of coronary artery bypass grafting on left ventricular response to isometric exercise.

The left ventricular (LV) response to isometric exercise was evaluated in 20 patients who performed handgrip exercise tests before and 3 months after coronary artery bypass grafting. Preoperative LV ejection fraction (EF) decreased during the handgrip test from 0.57 +/- 0.08 to 0.49 +/- 0.09 (p less than 0.001); the ratio between the LV peak systolic pressure (PSP) and end-systolic volume index (ESVI) did not change. In 12 patients with patent grafts, the LVEF after operation did not change (0.54 +/- 0.06 at rest and 0.56 +/- 0.06 during handgrip exercise) and PSP/ESVI ratio increased from 4.5 +/- 1.5 to 5.6 +/- 2.1 mm Hg/ml X m-2 (p less than 0.001) during exercise. In 8 patients with occluded grafts, the LVEF after operation decreased from 0.56 +/- 0.10 to 0.48 +/- 0.06 (p less than 0.02), whereas PSP/ESVI did not change during handgrip exercise. Thus, the LV response to isometric handgrip exercise appears to improve after coronary artery bypass grafting in patients with patent grafts, but not in patients with 1 or more occluded grafts.

Adult↗
PubMed2005

Weight loss composition: the effects of exercise following obesity surgery as measured by bioelectrical impedance analysis.

BACKGROUND: Sudden weight loss following bariatric operations for morbid obesity, such as the duodenal switch (DS), can result in a concurrent decrease in lean body mass. Several methods for tracking body composition, such as bioelectrical impedance analysis (BIA), are available to monitor these changes. One method to offset the negative effects of sudden weight loss on body mass composition may be exercise. METHODS: 100 patients who had undergone the DS operation for morbid obesity were classified as exercisers and non-exercisers based on self-reporting. Their body mass compositions were measured using BIA preoperatively and at 0.75, 1.5, 3, 6, 9, 12, and 18 months postoperatively. RESULTS: At no study interval did postoperative percent changes in weight loss differ between the exercise and non-exercise groups. At 18 months postoperatively, the exercise group showed a 28% higher loss of fat mass and an 8% higher gain in lean body mass than the non-exercise group. CONCLUSION: Exercise positively influences body mass composition following the DS. BIA can be successfully employed to monitor changes, diagnose deficiencies, and formulate treatment recommendations.

Adult↗
PubMed1993

Preoperative assessment of patients undergoing pulmonary resection.

A careful preoperative assessment of patients with lung cancer is essential for identifying those at high risk for morbidity and mortality related to the surgical procedure. The clinician must assess the risk associated with such treatment, decide whether the risk is prohibitive, and institute therapy to reduce such risk. Testing modalities used in the preoperative evaluation include spirometry, full pulmonary function tests, measurement of arterial blood gases, radionuclide lung scanning, exercise testing, invasive measurement of pulmonary artery pressure, and a variety of studies involving lobar occlusion or lateral position testing. Studies evaluating the utility of these procedures are reviewed. Additionally, the impact of advanced age on postsurgical outcome is evaluated, as are the possibility of operating on high-risk patients and the use of preoperative interventions.

Aged↗
PubMed1997

Functional and oximetric assessment of patients after lung reduction surgery.

OBJECTIVE: The goal of this study was to clarify the issue of functional oxygen requirement by regimented exercise oximetry in patients undergoing lung reduction surgery. METHODS: Thirty-seven patients underwent lung reduction surgery and were followed up for at least 3 months. Patients routinely completed a 6-week program of cardiopulmonary rehabilitation. Preoperative and postoperative spirometry, dyspnea scores, 6-minute walk distances, respiratory mechanics, and exercise oximetry were recorded. RESULTS: After the operation, patients had a 37% increase in forced vital capacity and a 59% increase in forced expiratory volume in 1 second. Six-minute walk distance increased from 913 +/- 310 feet before the lung reduction operation to 1202 +/- 274 feet 6 months after the operation (p < 0.001). Maximal inspiratory and expiratory pressures were significantly increased in 16 patients after lung reduction surgery. Perceived dyspnea was significantly improved. Exercise pulse oximetry demonstrated that 83% of patients met American Thoracic Society criteria for supplemental oxygen use before lung reduction surgery. After the operation, 70% of patients continued to meet American Thoracic Society criteria for supplemental oxygen use. Notably, 10 patients with exertional desaturation while breathing room air discontinued supplemental oxygen use because of a reduction in dyspnea. CONCLUSIONS: These findings demonstrate significant subjective and functional improvements related to lung reduction surgery. Exercise-induced hypoxia was not reversed by lung reduction surgery. Discontinuance of supplemental oxygen use owing to reduction in dyspnea and improved physical performance may not be warranted in lieu of continued exertional desaturation.

Adult↗