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Results for “Surgical Procedures, Operative”

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PubMed1998

[Effect of MR mammography on surgical procedure in operative treatment of breast cancer].

In addition to conventional imaging techniques, magnetic resonance (MR) mammography is an important tool in the diagnosis of breast cancer. It has proved to be the method of choice especially for the differential diagnosis of discrepant findings between mammography and ultrasound as well as the detection of multifocal and multicentric disease. In this context MR mammography is a meaningful method for the planning of breast preserving surgery and seems likely to become routine practice as long as the preconditions for high quality performance are guaranteed.

Adult↗
PubMed1991

Primary and recurrent Crohn's disease. Experience with 1379 patients.

Between 1970 and 1988, 1379 patients with Crohn's disease were treated at the University of Chicago. Of these, 639 (mean age, 32.5 years; 322 men, 317 women) required at least one surgical procedure. The most common indications for operation were failure of medical treatment (n = 215, 33%), presence of a fistula (n = 154, 24%), and bowel obstruction (n = 141, 22%). A fistula was the most common intraoperative Crohn's-related complication. In 582 patients (92%), a resection was necessary, with primary anastomosis in 416 (65%), a temporary stoma in 124 (20%), and a permanent stoma in 42 (7%). The remaining 57 patients underwent diverse procedures (stricturoplasty, bypass, and so on). Two patients (0.3%) died. Follow-up data was obtained in 95%. One hundred eighteen patients developed recurrence requiring reoperation. The recurrence rate was 20% at 5 years and 34% at 10 years. The recurrence involved a permanent stoma or a previous anastomosis in 62 patients (afferent limb in 46, efferent in 16). In the 391 patients without previous surgery for Crohn's disease, a covariate analysis was performed to determine those variables significantly associated with recurrence. Variables included demographic data, findings at operation, surgical procedures, and histopathologic characteristics. The analysis revealed that the number of sites involved was the only variable that was significantly associated with the intra-abdominal recurrence rate (p less than 0.001). The annualized risk of recurrence was 1.6% for patients with single-site involvement and 4% for those with multiple-site involvement. Perineal disease was associated with a significantly higher risk of local recurrence than any other site (p less than 0.02). A subanalysis of 236 patients with single-site involvement but no previous operation allowed us to study the influence of site on indications for surgery and type of operative procedure. Failure of medical treatment was the most common indication for all sites. In contrast the site involved influenced the procedure: resection and primary anastomosis was feasible in 88% of jejunoileal and terminal ileal cases and a temporary ileostomy was necessary in only 12%. No patients with small bowel localization required a permanent stoma. A resection with primary anastomosis was feasible in only 32% of patients with colonic disease. The remaining two thirds of patients required either a temporary or a permanent stoma. It is concluded that multisite involvement is associated with 2.5 times the rate of recurrence of single-site disease, while the presence of perineal disease has a significantly higher incidence of local recurrence.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2004

Static and dynamic assessment of biomarkers in surgical patients with severe sepsis.

BACKGROUND: Severe sepsis, defined as a systemic inflammatory response to infection associated with acute organ dysfunction, is common among surgical patients and is a major cause of morbidity and mortality. Severe sepsis has been associated with changes in inflammatory and hemostatic biomarkers. In patients undergoing surgical procedures there may be additional stimulation of cytokine release and activation of the coagulation system. The purpose of this study was to characterize the baseline differences in biomarkers between surgical and non-surgical patients. In addition, we assessed the dynamic changes in biomarkers and coagulation parameters in surgical patients with severe sepsis enrolled in PROWESS and treated with placebo or drotrecogin alfa (activated). METHODS: A blinded PROWESS surgical evaluation committee (SEC) verified patients as having undergone a relevant operative procedure within 30 days of enrollment for inclusion in the surgical cohort of PROWESS. At baseline and on study days 1-7, biomarkers and coagulation parameters available for analysis were D-dimer, interleukin-6 (IL-6), protein C activity, protein S activity, anti-thrombin III (ATIII), activated partial thromboplastin time (aPTT), and prothrombin time (PT). Platelet count was determined at baseline only. Baseline values were compared between SEC-defined surgical and all other non-surgical patients, and between pre- and post-operative surgical patients from the PROWESS trial. Changes from baseline were compared between drotrecogin alfa (activated)-treated and placebo-treated surgical patients. Statistical analyses were performed using ANOVA on the ranked values. RESULTS: The SEC verified 474 (28%) of the 1,690 PROWESS patients as surgical. Median D-dimer, IL-6, aPTT and PT values were significantly higher at baseline for surgical patients than non-surgical patients (p < 0.001). Surgical patients had significantly lower median protein C, protein S, and ATIII activity at baseline than non-surgical patients (p < 0.001). Surgical patients treated with drotrecogin alfa (activated) showed a significant decrease in D-dimer levels on study days 1-5 (p < 0.05), and a more rapid increase in Protein C levels on study days 1-4 (p < 0.05) compared to placebo. CONCLUSIONS: Surgical patients with severe sepsis appear to have a higher severity of illness at baseline as demonstrated by derangements in biomarkers and coagulation markers compared to non-surgical patients. Surgical patients treated with drotrecogin alfa (activated)showed reduced D-dimer concentrations and a more rapid increase in protein C concentrations during the infusion period.

APACHE↗
PubMed2003

Laparoscopic gastric surgery in a Japanese institution: analysis of the initial 100 procedures.

BACKGROUND: Although endoscopic surgical procedures are popular in various fields, reports on its use in gastric surgical procedures are limited. This study was designed to review our initial experience with laparoscopic gastric surgical techniques to evaluate indications and surgical results. STUDY DESIGN: We undertook a retrospective analysis of 100 patients (66 men and 34 women, mean age 63 years) who underwent laparoscopic gastric surgical procedures between 1995 and 2001. Procedures performed were distal gastrectomy (n = 76), wedge resection (n = 20), and intragastric surgical procedures (n = 4). Patients were divided into two groups according to the date of the procedure, from the earliest to the most recent. RESULTS: There were 85 patients with gastric cancers, 14 submucosal tumors, and 1 duodenal ulcer. In 8 cases conversion was made to an open surgical procedure. Operation times required for distal gastrectomy, wedge resection, and intragastric surgical procedures were 330 +/- 69, 144 +/- 34, and 298 +/- 106 min, and blood loss was 354 +/- 251, 56 +/- 94, and 33 +/- 58 g, respectively. Complications included transient anastomotic stenosis (n = 5), leakage (n = 4), and bleeding (n = 1) after distal gastrectomy, and bleeding (n = 1) after intragastric surgical procedures. There were no complications after wedge resection. Comparing the first and second halves of the series, the percentage of distal gastrectomy significantly increased from 66% to 86% (p = 0.02) and the number of dissected lymph nodes at this procedure increased from 20 +/- 13 to 33 +/- 17 (p < 0.01). CONCLUSIONS: Laparoscopic gastric surgical procedures are safe and feasible for early gastric cancers and submucosal tumors. Technical advances in lymph node dissection have made distal gastrectomy a leading and increasingly popular laparoscopic procedure for early gastric cancer.

Aged↗
PubMed1991

Audit of 'surgery in general' in an African teaching hospital.

A 1-year prospective audit of 2233 operations performed by one general surgical unit in a Central African teaching hospital is presented. In addition to the usual 'general surgical' procedures, operations also included emergency craniotomy, reconstructive surgery for open fractures, and hysterectomy. There were 37 (1.7%) postoperative deaths and 45 other deaths in non-operated patients. Ten of 14 deaths due to sepsis in the 20-40-year age group were associated with HIV infection. The implications for teaching and training of surgical specialists in the tropics are discussed.

Emergency Service, Hospital↗
PubMedDate not supplied

Natural language generation of surgical procedures.

A number of compositional Medical Concept Representation systems are being developed. Although these provide for a detailed conceptual representation of the underlying information, they have to be translated back to natural language for used by end-users and applications. The GALEN programme has been developing one such representation and we report here on a tool developed to generate natural language phrases from the GALEN conceptual representations. This tool can be adapted to different source modelling schemes and to different destination languages or sublanguages of a domain. It is based on a multilingual approach to natural language generation, realised through a clean separation of the domain model from the linguistic model and their link by well defined structures. Specific knowledge structures and operations have been developed for bridging between the modelling 'style' of the conceptual representation and natural language. Using the example of the scheme developed for modelling surgical operative procedures within the GALEN-IN-USE project, we show how the generator is adapted to such a scheme. The basic characteristics of the surgical procedures scheme are presented together with the basic principles of the generation tool. Using worked examples, we discuss the transformation operations which change the initial source representation into a form which can more directly be translated to a given natural language. In particular, the linguistic knowledge which has to be introduced--such as definitions of concepts and relationships is described. We explain the overall generator strategy and how particular transformation operations are triggered by language-dependent and conceptual parameters. Results are shown for generated French phrases corresponding to surgical procedures from the urology domain.

Linguistics↗
PubMed2006

[Optimizing surgical hand disinfection].

For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

Disinfectants↗
PubMed1999

[Intestinal obstruction in disseminated malignant tumors of the female genitalia: the surgical procedure and combined operations].

Results of surgical treatment of 103 patients are presented who had spread malignant tumors of the female genitalia with the involvement of different segments of the intestine and urinary tract, and damaged intestinal passage. Combined operations were performed on 57 patients (55.3%), palliative--46 patients (44.7%) 54 patients were operated on urgently. For the last 10 years resectability has been increased 8.5 times owing to active surgical policy. Immediate lethality after combined operations was 10.5%. Cumulative indices of 3- and 5-year survival were 66% and 53.3% respectively. Lethality and 5-year survival after palliative operations were 30.4% and 13.8% respectively. Combined operations for cancer of female genitalia (both primary and recurrent ones and metastases) are quite reasonable in order to provide the optimum volume of cytoreduction and perform chemo- and radiation treatment.

Adult↗
PubMed2004

Safety of drotrecogin alfa (activated) in surgical patients with severe sepsis.

BACKGROUND: We conducted a retrospective evaluation of the overall safety of drotrecogin alfa (activated) in surgical patients with severe sepsis enrolled in PROWESS. METHODS: A blinded Surgical Evaluation Committee (SEC) verified surgical patients as having undergone a significant operative procedure within 30 days prior to enrollment. Serious and treatment-emergent bleeding events, both during the study drug infusion period (120 h) and the entire 28-day study period were analyzed by surgical status and by treatment assignment. Statistical analysis was performed using Fisher's exact test. RESULTS: Serious bleeding rates during infusion in the surgical patients were 3.1% (7/228) and 0% (0/246) in the drotrecogin alfa (activated) and placebo groups, respectively (p = 0.006). Treatment-emergent bleeding rates during infusion in the surgical patients were 16.7% (38/228) and 7.7% (19/246) in the drotrecogin alfa (activated) and placebo groups, respectively (p = 0.003). None of the treatment-emergent bleeding events was fatal. Of seven drotrecogin alfa (activated) serious bleeding events, six were procedure-related. The serious bleeding rates within each treatment group were statistically indistinguishable between the medical and surgical patients. However, the medical patients had numerically higher treatment-emergent bleeding rates than the surgical patients within each treatment group. Despite this observation, overall surgical patients received more transfusions of red blood cells, of platelets, and of fresh frozen plasma than their medical counterparts. CONCLUSIONS: Although treatment of surgical patients with drotrecogin alfa (activated) for severe sepsis is associated with a higher incidence of serious bleeding and subsequent treatment- emergent bleeding events, the magnitude of this increase is small and clinically acceptable.

Dose-Response Relationship, Drug↗
PubMed2004

[Surgical site infections in hospitals and outpatient settings. Results of the German nosocomial infection surveillance system (KISS)].

About 1,000,000 hospital days attributable to surgical site infections can be expected per year in German hospitals. Among the various measures for prevention, surveillance of surgical site infections is strongly recommended. Therefore, beginning in 1997 the National Reference Center for Surveillance of Nosocomial Infections began to establish a hospital infection surveillance system in order to provide data for prevention and control of these infections. The surveillance system (called KISS) documents postoperative surgical site infections in patients undergoing selected indicator procedures. Today we have an overview of 274,050 procedures for a total of 20 operative indicator procedures. A further surveillance component focussing on surgical site infections in outpatient settings has recently been developed (AMBU-KISS). The participating hospitals and outpatient settings regularly receive their infection rates as well as the equivalent data of all hospitals involved in order to assess the position of their own hospital. However, competent and meaningful interpretation of these data is necessary for internal quality management in order to avoid wrong conclusions. The available results demonstrate that this approach can lead to a substantial reduction of surgical site infections.

Cross Infection↗