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Results for “Surgical source control”

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At least 631 records · Page 35Linked to original sources

PubMed2000

Is lymphocele in renal transplantation an avoidable complication?

BACKGROUND: This study evaluated the impact of surgery in the incidence of lymphocele after kidney transplantation (KTx). METHODS: A prospective randomized study was conducted during a 6-year period on a group of patients undergoing KTx and operated on by the same surgeon (CVS). A total of 280 patients undergoing KTx were randomly allocated into two groups: (1) group C (control group) was 140 patients who were submitted to KTx with standard technique: implantation of the kidney in the controlateral iliac fossa with vascular anastomoses on the external iliac vessels; and (2) group M (modified technique group) was 140 patients who underwent a modified technique with a cephalad implantation of the graft in the ipsilateral iliac fossa and vascular anastomoses in the common iliac vessels. Both groups were comparable for age, cold ischemia time, incidence of rejection episodes, presence of adult polycystic kidney disease, and source of donor graft. RESULTS: Group M showed an incidence of lymphocele production (3 patients, 2.1%) significantly lower than group C (12 patients, 8.5%). Eight patients (1 in group M and 7 in group C) required surgical treatment by peritoneal fenestration. No allograft or recipient was lost as a result of fluid collection but the hospitalization was shorter in group M than in group C. CONCLUSIONS: A cephalad implantation of the renal graft in the ipsilateral iliac fossa has been associated with a lower incidence of lymphocele, probably because vascular anastomoses on the common iliac vessels cause less lymphatic derangement than those performed on the external iliac vessels.

Adult↗

PubMed1996

Monocyte tumor necrosis factor receptor levels as a predictor of risk in human sepsis.

OBJECTIVE: To assess peripheral blood monocyte tumor necrosis factor receptor (TNFR) levels and plasma soluble tumor necrosis factor receptor (sTNFR) concentrations in critically ill patients with sepsis syndrome. DESIGN: Prospective, descriptive cohort study with no interventions. SETTING: Surgical intensive care unit of a tertiary-care hospital associated with a university medical school. PATIENTS: Twenty-one patients with a documented source of infection who met currently accepted criteria for sepsis syndrome/septic shock. MAIN OUTCOME MEASURES: Plasma sTNFR p55 and p75 values were quantified by enzyme-linked immunosorbent assay, and monocyte TNFR levels were assessed by fluorescence flow cytometry after the monocytes were stained with biotinylated human recombinant TNF-alpha and streptavidin-phycoerythrin. RESULTS: Compared with healthy controls, plasma sTNFR p55 and p75 values were significantly higher (P <.01) in both surviving and nonsurviving patients with sepsis; in nonsurviving patients with sepsis, however, only sTNFR p55 values were significantly (P < .05) higher than in surviving patients with sepsis. By contrast, monocytes from the nonsurviving patients with sepsis manifested a significant (P < .01) and sustained (up to 4 days) decrease in cell surface TNFR values compared with either the normal controls or the surviving patients with sepsis. CONCLUSIONS: Assessment of monocyte surface TNFR values may provide a rapid prognostic indicator for patients with sepsis who are at increased risk of death.

Analysis of Variance↗

PubMed1990

Upper GI bleeding in an urban hospital. Etiology, recurrence, and prognosis.

Acute upper gastrointestinal bleeding (UGIB) continues to be a common cause of hospital admission and morbidity and mortality. This study reviews 469 patients admitted to a surgical service of an urban hospital. There were 562 total admissions because 53 patients were readmitted 93 times (recurrence rate, 20%). The most common causes of bleeding, all endoscopically diagnosed, included acute gastric mucosal lesion (AGML) (135 patients, 24%), esophageal varices (EV) (121 patients, 22%), gastric ulcer (108 patients, 19%), duodenal ulcer (78 patients, 14%), Mallory-Weiss tear (61 patients, 11%), and esophagitis (15 patients, 3%). Nonoperative therapy was sufficient in 504 cases (89.5%). Endoscopic treatment was used in 144 cases. Operations were performed in 58 cases (10.5%), including 29% of ulcers. Emergency operations to control hemorrhage were required in only 2.5% of all cases. The rate of major surgical complications was 11% and the mortality rate was 5.2%. There were 58 deaths (12.6%), with 36 deaths directly attributable to UGIB. Factors correlating with death include shock at admission (systolic blood pressure less than 80), transfusion requirement of more than five units, and presence of EV (all p less than 0.001). Most cases of UGIB can be treated without operation, including endoscopic treatment, when diagnostic endoscopy establishes the source. Subsequent operation in selected patients can be done with low morbidity and mortality rates.

Adolescent↗

PubMed2001

Surgical management of Parkinson's disease: a critical review.

Parkinson's disease is a progressive disabling movement disorder that is characterised by three cardinal symptoms: resting tremor, rigidity, and bradykinesia. Before the availability of effective medical treatment with levodopa and stereotactic neurosurgery, the objective of surgical management was to alleviate symptoms such as tremor at the expense of motor deficits. Levodopa was the first effective medical treatment for Parkinson's disease, and surgical treatment such as stereotactic thalamotomy became obsolete. After one decade of levodopa therapy, however, drug-induced dyskinesia had become a source of additional disability not amenable to medical treatment. Renewed interest in stereotactic functional neurosurgery to manage Parkinson's disease has been seen since the 1980s. Local experience of deep-brain stimulation is presented and discussed in this paper. Deep-brain stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson's disease, although evidence from randomised control trials is lacking.

Humans↗

PubMed2006

The practicing surgeon as a member of the quality-safety team.

The practicing surgeon is a valuable member of the quality-safety team and is often an underutilized data source for quality initiatives. The authors describe how their efforts in Kentucky, during a 10-year period, encouraged surgeons to become leaders in the quality initiative. Their experience began with the establishment of an organization of surgeons devoted to quality health care and cost control. As their efforts expanded and they gained experience, they were well prepared to transition to a regional and national quality initiative as part of a collaborative effort with the Centers for Medicare and Medicaid Services in the 2004 Surgical Care Improvement Project pilot. As a result of this ongoing experience, the authors we have been able to affect the quality of health care and have a positive influence on health care cost. They have demonstrated that surgeons will participate in and lead quality initiatives, and that these efforts foster an environment of cooperation between surgeons and hospitals.

General Surgery↗

PubMed2006

Radiofrequency and microwave energy sources in surgical ablation of atrial fibrillation: a comparative analysis.

BACKGROUND: Due to its complexity and risk of bleeding, the Maze III procedure has been largely replaced by surgical ablation for atrial fibrillation (AF) using alternative energy sources. Radiofrequency (RF) and microwave (MW) are the most commonly used energy forms. In this study, we sought to compare these energy modalities in terms of clinical outcomes. METHODS: Two hundred five patients underwent surgical ablation of AF, from October 1999 to May 2004 at our institution via an endocardial approach. Patients were categorized into 2 groups: RF and MW. Baseline characteristics, operative details, and clinical outcomes were compared between the 2 groups. Rhythm success was defined as freedom from AF and atrial flutter as determined by postoperative electrocardiograms. RESULTS: One hundred twenty patients (58.5%) were ablated using RF, whereas 85 (41.5%) were ablated with MW. Most of the patients had persistent AF in both the RF and MW groups (85.7% versus 80.0%, respectively; P = .363). Intraoperative left atrial size was 6.4 +/- 1.7 cm for the RF group and 6.4 +/- 1.7 cm for the MW group (P = .820). Postoperative rhythm success at 6 and 12 months was 72.4% versus 71.4% (P +/- .611) and 75.0% versus 66.7% (P = .909) for the RF and MW groups, respectively. Hospital length of stay was comparable for both groups (15.4 +/- 14.0 versus 13.3 +/- 13.9 days; P = .307). Postoperative survival at 6 months, 1 year, and 3 years was 90.4%, 89.5%, and 86.1% for RF patients compared to 87.9%, 86.5%, and 84.4% for MW patients, respectively (log rank P = .490). CONCLUSIONS: RF and MW energy forms yield comparable postoperative rhythm success, hospital length of stay, and postoperative survival. Both sources are rapid, safe, and effective alternatives to "cut and sew" techniques for surgical treatment of AF.

Atrial Fibrillation↗

PubMed1997

Chronic pain states: invasive procedures.

OBJECTIVE: To provide a review of chronic pain states, focusing on neuroanatomic pathways and their influence on treatment strategies (part 2 of a two-part series). DATA SOURCE: A thorough literature review of published articles available in Medline from 1966 to 1996 on the topic of pain management, including diagnosis, pathophysiology, interventions, and treatment. CONCLUSIONS: Understanding the pathophysiology of chronic pain and the role of chemical mediators, such as enkephalins, norepinephrine, serotonin, and substance P, may improve pain management. As a result, pain control measures can target inhibition of the descending pain modulation pathways of the spinal cord, in addition to the peripheral or central actions of traditional analgesics. Fewer ablative surgical interventions are performed for pain control, because they often provide only temporary relief at the expense of significant permanent neurological deficits. However, there are more augmentative procedures now available for the patient with intractable and unresponsive pain, although referral to specialized pain clinics may benefit particularly difficult cases.

Chronic Disease↗

PubMed2026

The use of 3-dimensional (3D) printing in teaching musculoskeletal oncology for medical undergraduates.

INTRODUCTION: The approach to integrating relevant anatomy in the medical curriculum has been debated for many years. Current literature has explored the broad impact of 3D printing in medical education. However, there is little evidence on 3D printing for the teaching of musculoskeletal oncology (MSO). This is a self-controlled case series (SCCS) study that aims to analyse the effectiveness of 3D printed models in MSO in enhancing the learning experience, engagement and understanding of clinical and surgical anatomy for medical students. METHOD: A cross-sectional cohort study involving 75 clinical year medical students across 3 years from 2 medical schools that rotated through a single teaching hospital's orthopaedic department. Participants first viewed a set of computed-tomography (CT) images of a large pelvic osteosarcoma from a free open-source database, the Cancer Genome Atlas Sarcoma Collection (TCGA-SARC). A standardised 10-minute pre-intervention questionnaire which comprised 15 questions categorised by: 4 questions in 'anatomical knowledge', 7 questions in 'spatial awareness', 4 questions in 'surgical planning and complications', was administered to assess the baseline knowledge in their interpretation of the pathology via CT images only. Next, a 3D-printed model of the pelvic osteosarcoma, which included colour-coded adjacent structures, was provided as an adjunct to answer the same questionnaire. This concluded with a 5-point Likert scale feedback survey to gauge their perspectives and experience. RESULTS: The mean scores comparing their pre- and post-intervention assessment questionnaire increased by +1.34 from 8.15 (SD = 1.85) to 9.49 (SD = 1.7) (p < 0.001). The final year students had the greatest improvement of +1.54 from 8.00 (SD = 1.89) to 9.54 (SD = 1.59) (p = 0.004). There was no significant difference between the scores amongst the 2 medical schools. 91% of students agreed that the 3D model had helped them further their understanding of the anatomy of the sarcoma and 87% would want 3D printing models to augment their learning in anatomy. Baseline weaker students demonstrated significantly greater improvement in scores compared with baseline stronger students (mean difference +2.04 vs +0.30, p < 0.001). CONCLUSION: 3D printing is an effective teaching adjunct for musculoskeletal oncology surgical anatomy for medical undergraduates and could be used to enhance their understanding and learning experience. 3D models could be integrated in the teaching curriculum of surgical anatomy for undergraduate students.

Humans↗

PubMed1990

Acute septic arthritis in infancy and childhood.

Despite intensive study of acute septic arthritis in infancy and childhood, poor outcomes continue to occur. Failures are often due to delayed diagnosis and inadequate therapy, but can be due to factors beyond physicians' control such as associated osteomyelitis and occurrence during infancy. Recent advances in the understanding and management of septic arthritis include: (1) demonstration of beneficial effects of continuous passive motion in rabbits; (2) identification of inflammatory mediators of cartilage destruction and their respective sources; (3) recognition of changing patterns of pathologic organisms; (4) evolution of new antibiotics and standards for oral and home intravenous therapy; (5) development of arthroscopic debridement of septic knees; and (6) further refinement of indications for aspiration-irrigation versus open surgical drainage of septic joints. Permanent sequelae from septic arthritis can only be prevented by early diagnosis and aggressive treatment.

Acute Disease↗

PubMed1987

Acromegaly update--etiology, diagnosis and management.

Acromegaly is a disease with unique clinical manifestations. Its confirmatory diagnosis, however, requires basal and dynamic tests of growth hormone secretion. The measurement of circulating levels of somatomedin C has been a valuable addition to the diagnostic armamentarium. We review the etiology of acromegaly, with particular reference to the different histochemical and ultrastructural forms of somatotropic adenomas and their respective clinical behaviors. Ectopic sources of growth hormone-releasing hormone and of growth hormone itself are now well-recognized, though unusual, causes of acromegaly. The treatment of acromegaly is often problematic and far from uniformly successful. Initial enthusiasm for the results of surgical treatment has now been tempered by reports of increasing rates of recurrence on long-term follow-up. The roles of irradiation and pharmacotherapy are reviewed with particular emphasis on the use of bromocriptine, which has added a new dimension to the control of the somatic and metabolic manifestations of hypersomatotropism. Studies have been done recently using a long-acting somatostatin analog with encouraging results.

Acromegaly↗

PubMed2006

Intracoronary air embolism in open heart surgery--an uncommon source of myocardial ischaemia.

We report a case of air embolism detected by transesophageal echocardiography in a patient undergoing open heart surgery for acute mitral regurgitation. Intraoperative transesophageal echocardiography revealed an increased brightness of the apical wall and a severely compromised left ventricular myocardium with severe diffuse hypokinesis after removal of the aortic cross clamps and spontaneous resolution in the control echocardiography.

Cardiac Surgical Procedures↗

PubMed2001

Diverticular disease-associated hemorrhage in the elderly.

Lower gastrointestinal bleeding is frequent in the elderly secondary to diverticular disease and occurs in about 10-30%. It is the most frequent cause of lower gastrointestinal hemorrhage (about 40% of cases) followed by angiodysplasia (up to 20% of cases). The incidence of both diseases increase with age, but the patient's general condition and state of health decrease. Often cardiovascular morbidity coexists, resulting in an eventual risk of ischemic consequences. The intensity of bleeding varies from massive to occult. In diverticular disease, hemorrhage is caused by rupture or erosion of the vasa recti stretched by diverticula. Classically inflammation is absent. Although most diverticula (> 90%) are located in the sigmoid colon, bleeding originates more frequently from the right (> 50%) than the left colon. The preferred diagnostic tool following resuscitation is colonoscopy with an ability to locate the site of bleeding in up to 90% of cases. Additionally, injections and thermocoagulation are available to control bleeding endoscopically with a success rate of about 27%. Angiography is considerably variable concerning positive results (13.6-86%), has a complication rate of about 10% and is expensive. Hence, it is a second-line diagnostic method. Diverticular hemorrhage will cease spontaneously in about 90% of cases. Therefore, conservative treatment is preferred. Patients with persistent, massive or recurrent bleeding despite active conservative measures require surgical treatment. If surgical intervention is necessary, the site of hemorrhage must be sought to allow segmental resection. However, if the source of blood loss cannot be located, a subtotal colectomy is justified.

Age Factors↗

PubMed1983

Preliminary experiences with "real-time" intraoperative ultrasonography associated to the laser and the ultrasonic aspirator in neurosurgery.

Twelve cerebral lesions were operated upon with various laser sources (carbon dioxide, neodymium-yttrium-argon-garnet, and argon) and with an ultrasonic aspirator utilizing the intraoperative "real-time" ultrasonography. With the last method, the tumor was imaged just as well through the intact dura mater as on the brain surface itself, allowing a precise localization of deep intracranial lesions. A sharp selectivity on the healthy tissues is, in this way, achievable to reach the tumor, which is successively removed with the laser and ultrasonic aspirator checking the surgical maneuvers on the visual control of the ultrasonograph.

Adult↗

PubMed2005

Tubular complexes as a source for islet neogenesis in the pancreas of diabetes-prone BB rats.

Tubular complexes (TC) in the pancreas contain duct-like structures with low cuboidal or flattened cells surrounding a large lumen and are thought to be a response to pancreatic injury. TC have been studied in animal models of chemical or surgically induced pancreatic damage but their occurrence has not been reported in rodent models of spontaneous autoimmune type I diabetes. We hypothesized that TC would be increased during the active phase of islet destruction in autoimmune diabetes and could contain islet progenitor cells. We analyzed TC in pancreas of Wistar Furth (WF), control (BBc) and diabetes-prone BioBreeding (BBdp) rats using immunohistochemistry and morphometry. TC were observed in all rat strains during active pancreas remodeling ( approximately 13 days). They increased between 60 and 93 days only in BBdp rats coincident with the increase in diabetes cases. Most TC were infiltrated with CD3(+) T-cells. Duct-like cells in the TC had low expression of the exocrine marker amylase, increased expression of epithelial cell markers, keratin and vimentin, and remarkably high cell proliferation and cell death. TC islets contained cells stained positive for insulin, glucagon, somatostatin, pancreatic polypeptide, as well as PDX-1, chromogranin, and hepatocyte-derived growth factor receptor, c-met. Transitional cells that were keratin(+)/insulin(+) and keratin(+)/amylase(+) cells were present in TC. The stem cell marker, nestin was upregulated in the TC region. Duct-like cells in TC of BBdp rats expressed markers of committed endocrine precursors: PDX-1, neurogenin 3 and protein gene product 9.5. This study demonstrates that TC are upregulated during beta-cell destruction and contain potential endocrine progenitors.

Amylases↗

PubMed2003

An unusual case of haemobilia.

Arterio-biliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudo-aneurysm causing arterio-biliary fistula and presenting as severe melaena and cholangitis. Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolization of the pseudo-aneurysm successfully controlled the bleeding. Pseudo-aneurysm of the hepatic artery is mostly iatrogenic due to biliary intervention, as demonstrated in this case. Difficulty in diagnosis and management is discussed together with a review of the literature.

Aneurysm, False↗

PubMed2004

Cervicofacial necrotizing fasciitis: can we expect a favourable outcome?

Necrotizing fasciitis of the head and neck is an uncommon, progressive, destructive soft tissue infection of mixed aerobic and anaerobic organisms, having high mortality if left untreated (22 to 100 per cent). This study makes an attempt to analyse various factors and management methods determining the overall prognosis. A retrospective analysis of all cases of necrotizing fasciitis involving the head and neck, with exclusion of those involving the eyelid and the scalp, was undertaken. Various parameters such as demography, aetiology, complications, management and outcome were studied. Males outnumbered the females with the latter having a greater risk of involvement after 60 years. Odontogenic infection was the primary source of infection. Anaerobes were cultured in seven out of 17 cases, with six others showing mixed Gram positive and Gram negative organisms. Anaemia was the most commonly associated illness, with diabetes affecting four out of 17 cases. Aggressive surgical debridement with triple antibiotic therapy was used in the management of necrotizing fasciitis with an overall mortality of 11.8 per cent. Patients having late referral, anaemia and one or other complication had increased duration of total hospital stay. Better results can be obtained with proper control of infection by early diagnosis, aggressive surgical debridement and triple antibiotic therapy, along with timely control of complications and associated illnesses.

Adult↗

PubMed1976

Neurosurgical materials and devices. Report on regulatory agencies and advisory groups.

The current status of voluntary consensus standards writing procedures in neurosurgery and the current progress of government efforts to regulate materials and devices are described. A survey of the national and international standards writing bodies is presented, along with an introduction to related organizations and agencies and nomenclature. The intent of this review is to provide the neurosurgeon with a reference source regarding past and present neurosurgical activities in the materials and devices field. When President Ford signed the 1976 Medical Device Amendments on May 28, 1976, the Food and Drug Administration assumed direct legal authority to control medical devices and potentially assumed the power to regulate those professionals using them.

Government Agencies↗

PubMed1986

Total parenteral nutrition and cancer clinical trials.

Twenty-eight prospective randomized controlled clinical trials evaluating the use of total parenteral nutrition (TPN) in cancer patients were identified through a search of major indexing sources. The data were pooled across studies to increase the ability to detect therapeutic effects. The impact of publication bias and the quality of reporting each trial were used to critically assess the conclusions drawn from the pooled analysis. The authors conclude that TPN may be useful when used preoperatively in patients with gastrointestinal tract cancer. It appears to be beneficial in reducing major surgical complications (pooled P = 0.01) and operative mortality (pooled P = 0.02). No statistically significant benefit from TPN could be demonstrated in survival, treatment tolerance, treatment toxicity, or tumor response in patients receiving chemotherapy or radiotherapy. An increase in the risk of developing an infection in chemotherapy patients given TPN (pooled P less than 0.0001) underscores the importance of demonstrating significant benefits in randomized trials before TPN is used routinely in these patients.

Clinical Trials as Topic↗