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PubMed1979

[Progress of technical medicine within the field of gerontoneurology (author's transl)].

1938 respectively 1978 are dates for progress of technical medicine concerning gerontoneurology. Following the discussion of the development in technical (apparatus), chemical and immunological diagnostic activities in neurology the applicability in elderly people should be described. On principle there are no methods of investigations which cannot be used in geriatric causes. Main point of interest is the correct indication. Non invasive methods can be used without somatic risk; one has to observe only the fact of psychological stress for the patient; indications of invasive methods (merely angiography of vessels within the brain) must be focused on special diagnosis of the illness. Suspicious facts of space occupying intracranial process almost everytime ask for angiography following EEG and cranial computertomography. In cases of arteriosclerosis in aged people with typical changes within the vessel system of the brain one should only use angiographical investigations if clinical findings (based on noninvasive methods) show indications for surgical treatment in extracranial regions of the brain vessels. It might be the same procedure if shunt-operation between carotis externa and interna circulation system can be expected as curative or prophylactic influence within the neurological condition. In these cases risk of selective angiography of the vessels within the brain (outgoing from arteria femoralis) are much less dangerous than in direct charges. First of all neurological status, general condition and age will be decive for medical indication. One should not use the full range of diagnostic features in gerontoneurology only to satisfy diagnostic appeasement.

Aged↗
PubMed1993

Hard tissue regeneration for implant success.

The inevitable loss of alveolar bone following tooth loss deserves a prophylactic approach from the dental profession. By preserving bone through regenerative procedures, the patient option and likelihood of successful future dental implant treatment are enhanced. The use of fascia lata similarly extends surgical and restorative options to patients who otherwise might not be candidates for dental implants. A variety of materials is available for these procedures, but whichever are selected, it is imperative that the dental implant professional operate as a member of a team of interrelated disciplines if the results of dental implant treatment are to be optimized.

Alveolar Bone Loss↗
PubMed1985

Antibiotic prophylaxis for major maxillocraniofacial surgery.

A shortened prophylactic regimen of antibiotics for maxillofacial and craniofacial surgery is evaluated. Eighty-five patients were divided into two groups on the basis of the type of incision used. Forty-nine patients undergoing intraoral procedures received penicillin perioperatively and were given one postoperative dose (regimen A). Thirty-six patients undergoing extraoral or combined intraoral and extraoral procedures received penicillin and oxacillin perioperatively, with nine receiving one postoperative dose and 27 receiving an average of seven postoperative doses (regimen B). One infection was observed in the regimen A group, and three were observed in the regimen B group. This infection rate compares favorably to that encountered in the authors' previously reported study on longer prophylactic courses of antibiotics.

Adolescent↗
PubMedDate not supplied

The intraaortic counterpulsation balloon in cardiac surgery. The importance of opportune indication.

The results with the use of this device in patients who develop Low Cardiac Output Syndrome after cardiac surgery with extracorporeal circulation are analyzed. Special emphasis is given to the development of the opportune indication of this procedure, on the basis of a comparison of the results of the first few years to the most recent ones. Finally, the advantages of the prophylactic use of the Intraaortic Balloon Pump are commented.

Adult↗
PubMed1992

Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion.

The majority of cases of Madelung deformity are caused by hereditary dyschondrosteosis at the wrist. The principal lesion in the ulnar zone of the distal radial physis retards growth asymmetrically, especially in late childhood. Resection of this zone and its replacement with autologous fat (Langenskiöld procedure, or physiolysis) restores growth and minimizes deformity. The resection of an abnormal ligament tethering the lunate proximally may assist carpal advancement. A series of 17 patients (24 wrists) treated over a 12-year period is presented, with sufficient follow-up for evaluation of 11 patients (15 wrists). The results of this prophylactic procedure are encouraging, and, if it is performed early, the authors believe that Madelung deformity may be preventable, or at least controllable.

Adipose Tissue↗
PubMed1997

Prophylactic antiemetics in children undergoing tonsillectomy: high-dose vs low-dose ondansetron.

This randomized, double-blind study assessed the impact of two different doses of intraoperative ondansetron on vomiting following tonsillectomy in 240 preadolescent children in a day care surgical setting. After anaesthesia was established by inhalation with N2O/ halothane or intravenously with propofol, the subjects were administered the study drug (50 or 150 micrograms.kg-1 ondansetron, maximum dose 8 mg). Anaesthesia was maintained with N2O/ halothane. The greater dose of ondansetron (150 micrograms.kg-1) had a lower incidence (36% vs 52%) of postoperative vomiting (P = 0.01). In-hospital emesis was not a problem with only 14% of the subjects vomiting. Eight patients sought medical attention for vomiting after discharge from hospital. In-conclusion, 150 micrograms.kg-1 ondansetron is a more effective prophylactic antiemetic than 50 micrograms.kg-1 ondansetron among children undergoing elective tonsillectomy.

Ambulatory Surgical Procedures↗
PubMed1992

[Managements of hospital MRSA infections in digestive tract surgery].

1444 cases if digestive tract surgery in our department were studied for the prevention of postoperative MRSA infections, during the period from September 1987 to February 1992. They were divided into nine stages each six months. There were no significant differences in incidence of postoperative MRSA infections, after some managements for hospital infection among each stage. We used the antibiotics as follows; the first generation of cefem families was used for the upper digestive tract operations and the second generation of cefem families was used for the lower digestive tract operation, and the incidence of postoperative MRSA infections were diminished significantly. This study showed that managements for hospital infections and appropriate selection of antibiotics for the purpose of postoperative prophylactic use are effective for the prevention of MRSA infections.

Cephalosporins↗
PubMed2003

Anaesthesia for day case surgery: a survey of paediatric clinical practice in the UK.

BACKGROUND AND OBJECTIVE: In October 2000, we conducted a national postal survey of day case consultant anaesthetists in the UK to explore the range and variation in practice of anaesthetizing a patient for day case surgery (paediatrics, urology and orthopaedics). This paper reports the findings of this national survey of paediatric day case anaesthetic practice carried out as part of a major two-centre randomized controlled trial designed to investigate the costs and outcome of several anaesthetic techniques during day care surgery in paediatric and adult patients (cost-effectiveness study of anaesthesia in day case surgery). METHODS: The survey used a structured postal questionnaire and collected data on the duration of surgical procedure; the use of premedication; the anaesthetic agents used for induction and maintenance; the fresh gas flow rates used for general anaesthesia; the use of antiemetics; and the administration of local anaesthesia and analgesia. RESULTS: The overall response rate for the survey was 74 and 63% for the paediatric section of the survey. Respondents indicated that 19% used premedication, 63% used propofol for induction, 54% used isoflurane for maintenance, 24% used prophylactic antiemetics and 85%, used a laryngeal mask. The findings of this national survey are discussed and compared with published evidence. CONCLUSIONS: This survey identifies the variation in clinical practice in paediatric day surgery anaesthesia in the UK.

Ambulatory Surgical Procedures↗
PubMed2004

[Ambulatory and brief inpatient thyroid gland and parathyroid gland surgery].

Outpatient or short-stay thyroid and parathyroid surgery is still uncommon in Germany. Although a substantial number of these operations are performed with low morbidity, nearly zero mortality, and short operation time, some potentially lethal complications, especially postoperative hemorrhage, are strong arguments against liberal shortening of hospital stay. Symptomatic hematomas after thyroid and parathyroid surgery are observed in about 1-2% of cases. They frequently occur during the first 8 h after operation (40%). However, two thirds of these major complications occur later, about 20% of them more than 24 h postoperatively. Therefore, an outpatient procedure cannot be generally recommended. Short-stay (<23 h, overnight) thyroid and parathyroid surgery may be attractive, but this concept requires clear release-criteria and professional outpatient structures. Compared to general anesthesia, local and regional anesthesia did not emerge as helpful to shorten hospital stay. Also, prophylactic calcium supplementation is not recommended to enhance early hospital discharge after bilateral thyroid or parathyroid surgery.

Ambulatory Surgical Procedures↗
PubMed1999

Risk neutralization in cardiac operations: detection and treatment of associated carotid disease.

BACKGROUND: A screening and treatment protocol was implemented to extend the benefit of prophylactic carotid endarterectomy to patients who had open heart operations. METHODS: Patients aged 65 or older or who at any age had left main coronary disease, transient ischemic attack, or stroke were eligible for preoperative carotid duplex screening. Carotid endarterectomies and open heart operations were planned as a staged (n = 59) or combined procedure (n = 55) for angiographically confirmed carotid stenosis of at least 80%. RESULTS: Duplex scans were obtained in 1,719 of 7,035 open heart surgical patients over 8 years. The overall stroke rate was 1.5% (108 of 7,035). Seven of these were strokes of carotid origin (0.1%). There were 129 patients with at least 80% stenosis. One hundred fourteen had carotid endarterectomy preceding open heart operation, and none had carotid artery stroke. Twelve patients with at least 80% carotid stenosis by duplex scan had open heart operations without prophylactic carotid endarterectomies. There were four carotid strokes in these 12 patients (p = 0.0001; odds ratio, 20.2). Stroke risk remained significantly elevated (16.8%, p = 0.005) in the 50% to 79% group. The changes associated with the reduced risk afforded by this screening and treatment strategy amounted to $346 for each patient in the study. CONCLUSIONS: The risk of carotid stroke at the time of cardiac operation can be defined by duplex screening. Prophylactic carotid endarterectomy neutralizes the risk in those with at least 80% stenosis. Consideration for lowering the threshold for assessment and treatment of carotid stenoses appears warranted. The economic investment is recouped by the savings in system resources that would have been depleted through care for carotid stroke and its sequelae.

Adult↗
PubMed1998

[Postoperative vomiting. A score for prediction of vomiting risk following inhalation anesthesia].

UNLABELLED: Despite numerous factors are thought to affect postoperative vomiting (PV) recent studies demonstrated that the risk of PV can be predicted by considering just the most important ones. Therefore, the aim of this study was to present the clinically most relevant factors, a risk score based upon those factors and its clinical applicability for other types of surgery. METHODS: In a prospective study 2220 adult inpatients scheduled for elective surgery were monitored for PV after inhalational anaesthesia over 24 hours. None of the patients received prophylactic antiemetic treatment. Multivariate analyses were performed with data of patients who underwent otolaryngological procedures to identify the major risk factors and to derive a risk score. The applicability of the score in surgical and ophthalmological procedures was tested by linear regression analysis of expected and observed incidences. RESULTS: In the multivariate model, clinically most important risk factors for PV were female gender, young age, a positive history of postoperative nausea and vomiting or motion sickness, non-smoking and a long duration of anaesthesia, whereas the relative impact of the "type of operation itself" was small. Expected and observed incidences in patients undergoing other types of surgery were strongly correlated (R2 = 0.99, P < 0.001). CONCLUSION: The risk for PV after inhalational anaesthesia in adults can be predicted using a score which is based on individual risk factors and the duration of anaesthesia only.

Adolescent↗
PubMed1992

Metastatic bone disease of the pelvis and femur.

Metastatic bone disease involving the pelvis and femur is a common clinical occurrence. A pathologic fracture in this region is a catastrophic event that results in significant pain and loss of function. Recent advances in surgical management of pathologic fractures, resulting in secure fracture stability or stable joint replacement, have allowed these patients to resume their pre-fracture level of activity and ambulation. The surgeon must be familiar with the various devices available, because the choice of surgical procedure depends on the location of the tumor. In selected patients with extensive destruction, methylmethacrylate can be used to enhance the security of fixation and stability. Moreover, a more aggressive approach to prophylactic fixation before a catastrophic fracture develops has distinct advantages.

Bone Neoplasms↗
PubMed1995

Granisetron-dexamethasone combination reduces postoperative nausea and vomiting.

The prophylactic antiemetic efficacy of combined granisetron and dexamethasone was evaluated in a randomized double-blind manner in 88 patients undergoing general anaesthesia for major gynaecological surgery. Immediately after recovery from anaesthesia, patients received a single dose of either placebo (saline, n = 22), granisetron (20 micrograms.kg-1, n = 22), dexamethasone (8 mg, n = 22) or combined granisetron and dexamethasone (20 micrograms.kg-1 and 8 mg, respectively, n = 22) iv. The treatment groups were similar for patient demography, surgical procedures, anaesthetics administered and opioids given. Postoperatively, the frequency of nausea was 32%, 23%, 27% and 5% after administration of placebo, granisetron, dexamethasone and granisetron plus dexamethasone, respectively; the corresponding frequencies of vomiting were 23%, 23%, 23% and 5%. The incidence of adverse events postoperatively were not different among the groups. It is concluded that prophylactic administration of combined granisetron and dexamethasone is effective in preventing postoperative nausea and vomiting after anaesthesia.

Adult↗
PubMed2005

Prospective study of balloon inflation pressures and other technical aspects of hemodialysis access angioplasty.

PURPOSE: Balloon angioplasty is a mainstay in the treatment of failing or thrombosed hemodialysis access grafts and fistulas. A sizable body of outcomes data exists concerning percutaneous transluminal angioplasty (PTA) in hemodialysis access, yet there is a relative paucity of technical information available, especially regarding dilation pressures. The aim of the present study was to compile such information, which can be critical to the choice of devices for PTA and to the design of future clinical trials seeking to improve outcomes in this area. MATERIALS AND METHODS: Technical data were collected prospectively for 102 PTA procedures (66 prophylactic PTA procedures and 36 PTA procedures performed during access thrombectomy). Demographic data concerning the access were collected. Technical data were collected individually for each lesion treated, including lesion location; degree of stenosis (in quartiles); lesion length; PTA balloon brand, size, and length; pressure at which the waist of the balloon was effaced; residual stenosis; and reason for additional balloons or inflations if used. Outcomes data other than residual stenosis were not collected, but the endpoint for all interventions was a thrill in the access. RESULTS: A total of 230 lesions were treated. Two (1%) could not be successfully treated with PTA despite the use of "ultra high" pressure (approximately 40 atm); one was treated successfully with parallel wire technique and the other was revised surgically after the use of a cutting balloon also failed. Overall, 55% of lesions required pressures greater than 15 atm to efface the waist. Excluding initial failures, 20% of lesions in native fistulas and 9% in grafts required very high pressure (>20 atm) to efface the waist (P = .02). High pressure was needed less frequently in PTA procedures performed in the setting of thrombectomy procedures than in prophylactic PTA procedures (P = .0001). Residual stenosis was positively correlated with severity of initial stenosis and negatively correlated with duration of inflation. CONCLUSIONS: Conventional angioplasty balloons are inadequate for the treatment of most hemodialysis access stenoses. High pressures (>15 atm) are commonly needed for PTA in hemodialysis access. Very high pressures (>20 atm) are more frequently needed in native fistulas.

Angioplasty, Balloon↗