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PubMed1987

Incidence, risk factors, and morphology in operating microscope light retinopathy.

A review of 135 consecutive cataract operations identified ten cases (7.4%) of operating microscope light retinopathy. Ophthalmoscopically, these light retinopathy lesions appeared as a focal pigment epithelial change with varying degrees of pigment clumping in the center. Fluorescein angiography accentuated the lesion by demonstrating a sharply demarcated transmission defect, occasionally with multiple satellite lesions. The shape of the lesion matched the shape of the illuminating source of the particular operating microscope used during the surgery. The most significant risk factor associated with the production of these light retinopathy lesions was prolonged operating time. Mean total operating time for the ten patients with light retinopathy was 51 minutes longer than for those without (P less than .0001). Other significant associated factors were the presence of diabetes mellitus (P less than .03), younger age (P less than .05), and the use of hydrochlorothiazide (P less than .04).

Cataract Extraction↗

PubMed1990

An audit of the usage of operating theatre time in a peripheral teaching surgical unit.

A recent report by the National Audit Office found that only 50% to 60% of weekday operating time was being used. This report was examined by the Committee of Public Accounts and much of the blame for underutilization of operating theatres was attributed to poor working practices among surgeons. We investigated theatre utilization in our hospital and found underutilization on the same scale as the National Audit Office. Twenty-five per cent of theatre sessions were not allocated for use, 23% of general surgical lists were cancelled and, of the lists which did take place, a further 23% of theatre time was not utilized. The single largest cause of underutilization was understaffing. To increase theatre utilization higher levels of staffing and expenditure are needed rather than changes in the working practices of surgeons.

Hospitals, Teaching↗

PubMed1988

Factors influencing bleeding during transurethral prostatectomy.

Operating time, the weight of the prostate, blood loss, and bleeding rate (ml/min) were recorded during transurethral prostatectomy in 417 patients. There were significant correlations between prostate weight and blood loss (r = .589; P less than 0.001) and between operating time and blood loss (r = .551; P less than 0.0001). Bleeding rate was significantly correlated with prostate weight (r = .399; P less than 0.0001) but not with operating time. Results of multiple regression analysis confirmed that bleeding was more closely related to prostate weight than to operating time. Operating time appears to be an iatrogenic factor in blood loss during transurethral prostatectomy.

Adult↗

PubMed2026

F-URS with FANS versus mPCNL for 2-3 cm UUTS: a RCT with a subgroup analysis of 2-2.5 cm stones.

OBJECTIVE: To evaluate the safety and efficacy of flexible ureteroscopy (f-URS) with a flexible and navigable suction ureteral access sheath (FANS) compared with mini-percutaneous nephrolithotomy (mPCNL) in the treatment of 2-3 cm upper urinary tract stones (UUTS), with a prespecified subgroup analysis for stones ≥2 to <2.5 cm. METHODS: This randomized controlled trial enrolled 326 patients with 2-3 cm UUTS between June 2023 and December 2025. Patients were randomly assigned in a 1:1 ratio to undergo either f-URS with FANS or mPCNL. A prespecified subgroup analysis was conducted for stones measuring ≥2 to <2.5 cm. The primary outcomes were the immediate and 1-month stone-free rate (SFR). Secondary outcomes included the operative duration, decrease in haemoglobin, hospital stay, and complication rate. RESULTS: The baseline characteristics were comparable between the two groups. In the overall 2-3 cm cohort, the FANS group achieved immediate and 1-month SFRs comparable to those of the mPCNL group. Although the operative time was longer in the FANS group, it was associated with significantly less haemoglobin loss and a shorter hospital stay, with no significant difference in infection-related complications. Notably, in the subgroup of stones ≥2 to <2.5 cm, the FANS group demonstrated a non-inferior SFR at both time points, and the operative time was not significantly longer than that of the mPCNL group. CONCLUSION: For 2-3 cm UUTS, f-URS with FANS offers a SFR comparable to that of mPCNL, along with the advantages of reduced blood loss and shorter hospitalization. In the ≥2 to <2.5 cm subgroup, FANS shows comprehensive benefits over mPCNL. These findings support FANS as an effective alternative to mPCNL for 2-3 cm stones and a potentially preferred option for stones measuring 2-2.5 cm.

Humans↗

PubMed1975

[Life expectancy in acquired vitium cordis after operative treatment (author's transl)].

Indications and results of operative treatment of acquired heart diseases are presented with reference to our experience with over 1500 operations on the heart valves and over 800 coronary surgical operations. The risk in timely operation for prosthetic substitution of aortic and mitral defects is less than 5%. An essential condition is, however, that no irreversible changes have developed and that the defect could be completely corrected. Surgical treatment of coronary heart disease is superior to conservative therapy and carries a risk of under 2% on strict indication. Timely operation on segmental stenoses before the ischemic myocardium is fibrosed is an essential. 70% of patients operated on can count on freedom from complaint for the time being after these palliative operations.

Adolescent↗

PubMed1991

Blood loss in total hip replacement. A retrospective study.

Two hundred and twelve total hip replacements performed in one clinic over 1 year were reviewed. The mean operative time was 89 min and mean total blood loss 1090 ml. Homologous blood was administered to 74% of the patients. Blood loss was dependent on sex, body weight and height, but these correlations were eliminated when blood loss was related to estimated blood volume. There was no correlation to age. There was a positive correlation between operative time and intraoperative blood loss, but not between any of these factors and postoperative blood loss. Operative time varied significantly between surgeons, but there was no correlation between surgeon's experience and operative time or blood loss. Despite a mean of only 12 total hip replacements per surgeon, both operative time and blood loss were small compared to what was found in other studies. The use of a posterior approach is believed to contribute to a shorter operative time as well as to moderate blood loss. Intraoperative blood loss was less under epidural than under general anaesthesia, but in contrast to others we found higher postoperative blood loss after epidural anaesthesia.

Adult↗

PubMed1989

Hip fractures--treatment and early complications.

A prospective follow-up study was performed on 282 patients with hip fractures with respect to early complications and their possible relation to patient or treatment variables. A hip fracture patient needed at least 1-2 hours in the operating theatre (length of anaesthesia), while the operating time was half or less. The operative trauma, measured in operating time and blood loss, was greater in patients with trochanteric fractures than in those with fractures of the femoral neck. Reduction was difficult and only half the internal fixations were satisfactory, as judged from X-rays at the end of the operation. The immediate results of the operations were satisfactory in the trochanteric group, but some problems were encountered in the group with fractures of the femoral neck. Complications were frequent and interrelated. At multiple discriminant analysis higher age, delay of operation, trochanteric fracture and long operating time were often found to be negative factors. Bladder catheterization increased the risk of urinary tract infection to some degree.

Adult↗

PubMed1986

The efficacy and timing of operative intervention for spontaneous pneumothorax.

To reassess the role and timing of operative intervention for spontaneous pneumothorax, 119 patients were retrospectively reviewed to compare recurrences, complications, and hospital stay between a nonoperative group (Group 1) and an operative group (Group 2). Total hospital days were greater in Group 2, but excluding the length of preoperative stay, the number of hospital days were similar in both groups. Group 1 patients more than 40 years old had a longer postoperative hospitalization, but not a higher rate of complication. Overall, morbidity was not different between the two groups, and there were no immediate or perioperative deaths in either group. There were no recurrences in Group 2. At least 11 of the 49 patients in Group 1 had a recurrence (p = .012). Considering the excellent results achieved with operative pleurodesis and the total hospital days accrued with nonoperative therapy, operative pleurodesis should be considered if an active leak persists more than three days after the initial episode of spontaneous pneumothorax or at the time of the first recurrence in the hospitalized patient.

Adolescent↗

PubMed1991

[Coronary artery bypass grafting combined with operation for non-cardiac disease].

During the last two years and six months, ten patients underwent operation for both coronary artery disease and non-cardiac surgery. There were six patients with vascular disease, three with gastric cancer and one with cholelithiasis. Six patients had simultaneous operation of both coronary artery bypass grafting (CABG) and non-cardiac surgery, and four underwent non-cardiac surgery mean of 105 days after CABG. The number of significant lesions of coronary artery in patients with simultaneous or two-staged operation was 2.2 +/- 0.8 or 2.8 +/- 0.5 per patient, respectively. The operative time in patients with simultaneous operation was 361 +/- 49 minutes. However, in patients with staged operation the time for cardiac surgery was 380 +/- 36 minutes and the time for non-cardiac operation was 388 +/- 83 minutes. There were no patients with complications after either cardiac or non-cardiac operation. In patients having surgical indications for both coronary artery and non-cardiac diseases, CABG should be performed prior to the non-cardiac surgery. In patients with normal cardiac function and sufficient operative time after CABG, concomitant operation seemed to be recommended. In case with advanced malignant disease or incompetent cardiac function, staged operation would be selected for good surgical result.

Aortic Aneurysm↗

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↗

PubMed1988

Mandibular bone grafts for reconstruction of alveolar clefts.

This study evaluated the effect of mandibular bone grafts for reconstruction of alveolar clefts. The study included 25 patients with cleft lip and alveolar process only and three patients with unilateral cleft lip and palate, with a median postoperative follow-up of 8 months (range, 6 to 17 months). The bone grafts were obtained from below the mandibular incisors and canines through an intraoral approach. The marginal bone level achieved was satisfactory in all cases evaluated by occlusal radiographs; the radiographs also demonstrated that the bone grafts were totally integrated after 6 months in all cases. The morphology of the reconstructed alveolar process was satisfactory in all cases evaluated and no periodontal complications were seen. The donor site appeared healed radiologically in all cases 6 months after surgery. The advantages gained by using a mandibular bone graft as compared to an iliac crest graft include reduced morbidity, reduced hospitalization time, reduced operating time, and avoidance of scarring at the donor site. The results of the present study demonstrate that the mandibular symphysis can be used as donor site for reconstruction of small alveolar clefts.

Adolescent↗

PubMed1985

Valve replacement in patients with native valve endocarditis: what really determines operative outcome?

The influence of 27 variables on operative mortality and late complications (defined as residual or recurrent endocarditis or late bland periprosthetic leak) was determined using discriminant analysis for 108 patients undergoing valve replacement for native valve endocarditis at Stanford University Medical Center from March, 1964, to January, 1983. Congestive heart failure was the indication for valve replacement in 86% of patients. Aortic valve replacement was required in 68% and mitral valve replacement, in 26%. Patients were arbitrarily defined as having active (58%) or healed (42%) endocarditis. Follow-up included 515 patient-years and extended to a maximum of 19 years. Operative mortality was 15 +/- 4%, and 17 patients had late complications (linearized rate, 3.3% per patient-year). Seven variables were significantly related to operative mortality in the univariate analysis, but only organism (Staphylococcus aureus versus all others, p = 0.0302) was a significant independent predictor of operative mortality. For late complications, only 2 of 7 significant univariate covariates proved to be significant independent determinants: organisms on valve culture or gram stain and the presence of annular abscess. Patients with S. aureus endocarditis not showing prompt response to antibiotic treatment must be considered for early operation. Similarly, timely operative intervention for patients with annular abscess will be essential in decreasing late valve infections and perivalvular leaks.

Actuarial Analysis↗

PubMed1979

Gastric partitioning for morbid obesity.

The complication rate in jejunoileal bypass for morbid obesity is unacceptably high. Gastric bypass is technically difficult. In our series, 115 patients have undergone gastric partitioning for morbid obesity. The operation consists of stapling across the stomach below the gastroesophageal junction, leaving a gastric food reservoir of 50--60 cc. A 1 cm opening is left in the central portion of the staple line, allowing slow emptying into the distal stomach. The result is a reduced eating capacity and frequency which produce loss in weight. Three-quarters of the patients are women, and the age range is 17--62 years. Preoperative weights averaged 147 kg. Mean operative time was 48 minutes, and postoperative stay was 6.2 days. All patients were extensively evaluated preoperatively with upper GI series, cholecystogram, a number of blood chemistry tests, and endocrinologic and psychiatric consultations. All patients underwent a preoperative Minnesota Multiphasic Personality Inventory test. Cholecystectomy for cholelithiasis was performed on 18% of the patients at the time of operation. Of the seven patients operated on more than one year ago, five have lost an average of 31.6% of their preoperative weight. Of the 12 operated on less than one year but more than six months ago, eight have lost an average of 21% of their initial weight. The early failure rate of 33% has been reduced to 15% at present. One death occurred from pulmonary embolus 10 days following discharge, giving a mortality rate of .08%. The complication rate is 10%, comprising two pulmonary emboli, two psychoses, one wound dehiscence, one wound hernia, and ten wound infections, six of which were minor. There have been no complications of ulcer disease, reflux esophagitis, liver disease, renal disease, or metabolic disorders. Gastric partitioning is a safe, fast effective alternative for the surgical treatment of morbid obesity.

Adolescent↗

PubMed1986

Abdominoplasty combined with gynecologic surgical procedures.

Cosmetic surgery of the abdomen is requested frequently by patients and is being performed increasingly at the time of elective gynecologic surgery. However, little information is available regarding the safety of combining these procedures. In this study intraoperative and postoperative morbidity was compared in the following groups of patients: 1) abdominoplasty plus one of five common gynecologic procedures (N = 76); 2) one of the five gynecologic procedures alone, matched for age, weight, and time of operation (N = 76); and 3) abdominoplasty alone (N = 70). Patients in group 1 experienced significantly longer operative time, longer hospital stays, and greater blood loss, which required more transfusions than group 2 or 3. These problems were accentuated in patients who weighed more than 70 kg or were older than age 35. In addition, five patients (6.6%) in group 1 had a documented pulmonary embolus within 18 days of surgery, whereas no pulmonary emboli occurred in group 2 or 3. Because of the increased morbidity, careful patient selection is necessary when abdominoplasty and gynecologic procedures are performed at the same time.

Abdomen↗

PubMed1978

Intracranial saccular aneurysms--surgical results of 1,000 consecutive cases.

The results of our surgical treatment of 1,000 patients with intracranial saccular aneurysm were analyzed with special consideration for age, site of aneurysm, preoperative condition and operative timing. The results on discharge were as follows: 543 cases, excellent; 186, good; 117, fair; 93, poor; and 61, dead. About three-fourths of the cases except for 23 cases of vertebrobasilar aneurysm showed either excellent or good result. The mortality rate became worse with aging. The results fairly correlated with the preoperative grades by Hunt and Hess (1968), but the cases of Grade Ia were unexpectedly worse. The timing of operation influenced the mortality rate; especially, the cases operated within 3 to 7 days following the last subarachnoid hemorrhage bore poor results. Follow-up studies revealed that excellent and good cases increased and poor cases decreased. The mortality rate for each year decreased annually to 2% in 1975. This improvement may be attributed to the advancement in the operative management with supplementary procedures and in the treatment for cerebral angiospasms and general condition.

Adult↗

PubMed1990

[The dynamic hip screw in comparison with Ender nailing].

Mainly the Ender, Simon-Weidner nailing and the dynamic hip screw (DHS) of the AO compete along with other procedures for the treatment of proximal femur fractures by elderly individuals. The opportunity was taken to control the operative strain and postoperative development of 51 patients with Ender-nailing and 45 patients with DHS from the years 1985 to 1987. Prompt ability to walk and full load bearing capability is obtained by both procedures. Both procedures have slight strain due to operating time and operative trauma. Specific technical complications such as wandering of the nail and defective external rotational positioning were found mainly by the Ender-nailing. Reoperations were necessary in a few cases. The complication rate could be sunk further through the application of the DHS.

Aged↗

PubMedDate not supplied

Combined epidural and general anesthesia in aortic surgery.

The perioperative course of 144 consecutive patients undergoing aortic reconstructive surgery was studied to assess the potential benefit of employing a combined epidural and light general anesthesia technique. A group of 67 patients had general anesthesia alone (GA), while in the group of 77 remaining patients, a combined epidural and general anesthesia (Epi-GA) was employed. The two groups were similar in regards to age, medical risk factors, preoperative assessment of cardiac and pulmonary function, and type of surgical reconstruction. There was no significant difference in the anesthetic, operative time, or operative fluid requirements between the two groups. There was a lower rate pressure product in the Epi-GA group during aortic cross clamping (P less than 0.05). More patients in the GA group required a prolonged ventilatory support (P less than 0.05) and a high parenteral narcotic administration (P less than 0.025) during the first 48 hours. While the mortality rate was similar for the two groups (3.0% for GA group vs 5.2% for Epi-GA group), there was a higher percent of postoperative pulmonary complications observed in the GA group (7.6%) compared to the Epi-GA group (2.6%). By facilitating early extubation and a decreased need for systemic narcotics in the early postoperative period, Epi-GA may be beneficial in the high risk pulmonary patient undergoing aortic reconstruction.

Aged↗

PubMed1986

[Topical use of thrombin in prostatic surgery].

We describe the usefulness of topical application of thrombin as a hemostatic aid in prostatic surgery. We used a specially designed 3-way bag catheter, one way of which opened to the prostatic fossa. After enucleation of the prostate suprapubically, we inserted the bag catheter into the bladder before any hemostatic procedure was performed on the prostatic fossa, inflated the bag, gently pulled down the catheter against the prostatic fossa, and then injected the thrombin solution (5,000 units/5 cc. X 2) into the fossa. Fifty patients were randomized into two groups; the "thrombin" method group and the hemostatic "ligature" group, and compared. The "thombin" method group showed statistically significant superiority to the "ligature" method group in reduced operation time and operative bloodloss. On the contrary, the duration of postoperative hematuria was longer with the "thrombin" method but not significantly. Even the prolonged duration of hematuria, however, produced no clinical problems. Hypofibrinogenemia and poor conditions of drug storage lowered its efficacy. These points should be remembered when using thrombin.

Administration, Topical↗