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At least 649 records · Page 36Linked to original sources
PubMed1991

Surgical instrumentation as a palliative treatment for spinal cord compression.

This paper describes a surgical procedure occasionally used to ameliorate symptoms caused by spinal cord compression in patients with metastatic cancer. After decompression of the spinal cord, Luque instrumentation has been effectively used to stabilize the spine and provide pain relief. Two malleable rods are fixed to the spine by sublaminal wires to several healthy laminae above and below the site of the metastatic lesions. Pre- and postoperative nursing care involves constant assessment to detect early neuromuscular and autonomic functional changes. Effective pain management is crucial to the patient's well-being. This surgery does not alter a patient's prognosis but can dramatically affect quality of life.

Adult↗
PubMed1986

Vasomotor rhinitis.

Vasomotor rhinitis is a nonallergic, noninfectious cause of nasal obstruction and rhinorrhea. The etiology is believed to be an imbalance of the autonomic neural supply to the nasal mucosa with resultant vasodilation and hypersecretion. Management hinges on identification of a treatable diagnostic entity, such as rhinitis medicamentosa or allergic rhinitis. Psychotherapy, medical therapy, and surgery all have roles in the treatment of vasomotor rhinitis. Response to therapy is often disappointing.

Autonomic Nervous System↗
PubMed2000

Subclinical Cushing's syndrome.

Classic Cushing's syndrome is a rare disease with an estimated incidence of 1 case per 100,000 persons. With routine use of imaging techniques such as ultrasound and CT, adrenal masses are being detected with increased frequency. A substantial percentage of these incidentalomas are hormonally active, with 5% to 20% of the tumors producing glucocorticoids. Autonomous glucocorticoid production without specific signs and symptoms of Cushing's syndrome is termed subclinical Cushing's syndrome. With an estimated prevalence of 79 cases per 100,000 persons, subclinical Cushing's syndrome is much more common than classic Cushing's syndrome. Depending on the amounts of glucocorticoids secreted by the tumor, the clinical spectrum ranges from slightly attenuated diurnal cortisol rhythm to complete atrophy of the contralateral adrenal gland with lasting adrenal insufficiency after unilateral adrenalectomy. Patients with subclinical Cushing's syndrome lack the classical stigmata of hypercortisolism but have a high prevalence of obesity, hypertension, and type 2 diabetes. All patients with incidentally detected adrenal masses scheduled for surgery must undergo testing for subclinical Cushing's syndrome to avoid postoperative adrenal crisis. The best screening test to uncover autonomous cortisol secretion is the short dexamethasone suppression test. Because the adrenal origin of a pathologic cortisol secretion is anticipated, the author prefers a higher dexamethasone dose (3 mg instead of 1 mg) to reduce false-positive results. A suppressed serum cortisol level of less than 3 micrograms/dL (80 nmol/L) after dexamethasone excludes significant cortisol secretion by the tumor. A serum cortisol level greater than 3 micrograms/dL requires further investigation, including confirmation by high-dose dexamethasone (8 mg) suppression testing, a CRH test, and analysis of diurnal rhythm. Determination of urinary free cortisol is less useful because increased values are a late finding usually associated with emerging clinical signs of Cushing's syndrome. Patients with suppressed plasma ACTH in response to CRH generally have adrenal insufficiency after surgery and require adequate perioperative and postoperative substitution therapy. Whether patients with subclinical Cushing's syndrome should undergo adrenalectomy is a matter of debate. The author performs surgery in young patients (< 50 years), in patients with suppressed plasma ACTH, and in patients with a recent history of weight gain, substantial obesity, arterial hypertension, diabetes mellitus, and osteopenia. In completely asymptomatic patients with normal plasma ACTH concentrations and in patients older than 75 years, the author recommends a nonsurgical approach. A large prospective randomized study is necessary to evaluate the benefits of surgery versus conservative treatment in patients with subclinical Cushing's syndrome.

Adenoma↗
PubMed2002

[The effect of cervical spine instability on sympathetic cervical spondylosis].

OBJECTIVE: To investigate the effect of cervical spine instability on sympathetic cervical spondylosis. METHODS: Twelve patients with cervical spondylosis showing sympathetic symptoms from 1992 to 2 000 were evaluated for cervical spine instability, immobilization of collar brace, MRI and surgical results. RESULTS: Radiologic evaluation cervical instability was observed radiologically in 7 of the 12 cases. Collar brace was obviously effective in 5 of the 12 cases and slightly effective in 7 cases. MRI showed abnormal signal for instability of the cervical spine in 7 cases. Surgery was markedly effective in 7 cases and moderately effective in 4 cases. CONCLUSION: Cervical spine instability was an important factor for sympathetic cervical spondylosis, which can be improved effectively by surgery.

Adult↗
PubMed2005

[National project for the management of clinical processes. Surgical treatment of inguinal hernia].

INTRODUCTION: The high prevalence of surgical treatment for inguinal hernia (especially in general surgery) prompted the Spanish Association of Surgeons to perform a national study to identify the most important indicators. OBJECTIVE: To analyze healthcare quality in elective surgery for inguinal hernia by evaluating scientific-technical quality, efficiency, effectiveness, and patient satisfaction. MATERIAL AND METHODS: A prospective, longitudinal, descriptive study from diagnosis to postoperative follow-up was performed. Patients who underwent surgery for unilateral or bilateral, primary or recurrent inguinal hernias were included. Exclusion criteria were emergency surgery and associated surgical procedures. Clinical indicators were selected after a literature review. RESULTS: Forty-six hospitals corresponding to 16 Autonomous Communities with a total of 386 patients participated in this study. The mean follow-up was 18 months. The mean age of the patients was 56.33 years and 88.3% were male. Half the patients (50.1%) were American Society of Anesthesiologists (ASA) grade I. A total of 95.6% did not comply with the protocol for preoperative tests of the Spanish Association of Surgeons. Antibiotic prophylaxis was used in 75.39% and thromboembolic prophylaxis was used in 40.04%. Ambulatory surgery was performed in 33.6%. Local anesthesia and sedation only were used in 16.36% of the patients. The most frequently used surgical procedures involved mesh repair (Lichtenstein 50%, Rutkow-Robbins 17.1%), laparoscopy was used in 5.2% of the patients, and the Shouldice technique was used in 8.5%. The mean length of hospital stay was 47.5 hours in inpatients and was 11.65 hours in patients who underwent ambulatory surgery. Notable among the complications was hematoma in 11.6%. Ninety-six percent of the patients were satisfied or highly satisfied. The most highly scored items in the satisfaction survey were those related to information, personal dealings with staff, and the staffs kindness. The lowest scored items dealt with punctuality and accessibility. Follow-up at 18 months showed a recurrence rate of 4.11% with a total recovery time estimated by patients of 7.26 weeks. CONCLUSIONS: Analysis of the process revealed areas for improvement and strong points. Strong points consisted of up-to-date choice of surgical technique. The most frequently used techniques were tension-free procedures and the Shouldice technique. The following areas for improvement were identified: adherence to protocols for preoperative evaluation, increased use of ambulatory surgery, local anesthesia and sedation, appropriate use of antibiotic and thromboembolic prophylaxis in selected patients and a reduction in the length of hospital stay in inpatients. Patient satisfaction with the treatment was acceptable.

Adult↗
PubMed2005

Neurologic recovery and improved detrusor contractility using muscle-derived cells in rat model of unilateral pelvic nerve transection.

OBJECTIVES: To create a model of peripheral neuropathy and explore the potential of using muscle-derived cells (MDCs) to facilitate the regeneration of autonomic nerves and improve bladder function. Damage to the peripheral nerves that innervate the bladder from radical pelvic surgery is refractory to the currently available treatments. METHODS: Rat MDCs were isolated from the gastrocnemius muscle using the preplate technique. The unilateral pelvic nerve was cut in female Sprague-Dawley rats. Three experimental groups were included: control (n = 5); unilateral pelvic nerve transected with sham injection (n = 5); and unilateral pelvic nerve transected with injection of MDC (3 x 10(5) cells/site; n = 5). Two weeks after injection, the intravesical pressures were measured during electrical stimulation of the proximal transected preganglionic nerve. The contralateral major pelvic ganglion was excised to ensure that any observed bladder activity was due exclusively to inputs on the unilateral side. The rats were killed, the experimental side major pelvic ganglion was removed, and enkephalin immunoreactivity was counted. RESULTS: After unilateral pelvic nerve transection, no change occurred in bladder weight or capacity or postvoid residual urine volume. The maximal intravesical pressures for the control, sham, and MDC groups, after the contralateral pelvis had been cut, was 31.7 +/- 10.3, 9.6 +/- 4.5, and 15.2 +/- 7.7 cm H2O, respectively (P <0.05). After transecting the preganglionic pelvic nerve, the intensity of pericellular enkephalin immunoreactivity varicosities was significantly decreased in the sham group but unchanged in the MDC group compared with the control group. CONCLUSIONS: MDCs can promote peripheral autonomic nerve regeneration. The morphologic changes correlated with the functional neurologic recovery effect of MDCs. The underlying neurologic recovery mechanisms of MDCs need to be exploited.

Animals↗
PubMed2006

Anatomy of autonomic nerve component in the male pelvis: the new concept from a perspective for robotic nerve sparing radical prostatectomy.

The DaVinci Robot (Intuitive Surgical, Sunnyvale California) with its magnified 3-D vision and multi-jointed wristed instruments enabled us to perform radical prostatectomy with consideration for the pelvic anatomy. In the present paper, we review the pelvic autonomic neuroanatomy with respect to robotic prostatectomy and demonstrate the procedures and critical points of nerve-sparing robotic radical prostatectomy based on novel anatomic concepts. Microscopic and macroscopic data were acquired from 30 fresh and 25 fixed male cadavers. A video study of 205 surgeries was performed for establishing the anatomy relevant to robotic prostatectomy. From a practical standpoint, we could group the relevant neural tissue into three broad zones: (1) proximal neurovascular plate (PNP), (2) predominant neurovascular bundles (PNB), (3) accessory distal neural pathways (ANP). Autonomic ganglion cells existed widely not only in nerve components but also along the viscera. The critical areas of nerve sparing surgery were the distal end of PNP, the entire PNB, and the circumference of the apex. Interindividual differences of cell counts were evident in all sites. Based on these concepts, we established the Athermal Robotic Technique (ART) for nerve sparing prostatectomy. Surgical and oncological outcomes were not mature but feasible. These tri-zonal and ganglion cell concepts may be of benefit to new surgeons undertaking nerve-sparing robotic radical prostatectomy.

Autonomic Pathways↗
PubMed2003

Proficiency in interscalene anesthesia-how many blocks are necessary?

STUDY OBJECTIVE: To determine the number of interscalene blocks that are necessary for a resident in anesthesiology to complete so as to achieve autonomous success with that specific block. DESIGN: Survey questionnaire of all CA1 and CA2 residents in the Department of Anesthesiology, Mount Sinai School of Medicine. SETTING: University hospital. MEASUREMENTS AND MAIN RESULTS: Seventeen CA-1 and CA-2 residents reported their experiences in performing interscalene blocks over an 8-month period. Data were collected regarding the number of previous attempts, technique, attending supervisor, patient weight, level of autonomy in the performance of the current block, and adequacy of the block for surgery. Eighty-two blocks were performed (1 to >15 per resident), supervised by 7 attending physicians, and 96.3% of blocks were reported as adequate for surgery. With an experience of seven to nine previous blocks, only 50% of residents were able to perform an interscalene block autonomously, whereas with >15 blocks, 87.5% reported autonomous success. CONCLUSIONS: Experience with only 40 unspecified peripheral nerve blocks, as currently required by the Residency Review Committee as of January 2001, may not provide adequate opportunity for an individual to develop expertise in regional anesthesia.

Anesthesia, Conduction↗
PubMedDate not supplied

Surgical adrenal diseases.

There are four adrenal disorders in which surgery is the treatment of choice: pheochromocytoma, Cushing's syndrome due to ACTH-independent adrenal disease (adenoma, carcinoma or autonomous hyperplasia), primary aldosteronism due to an adrenal adenoma and some adrenal non-functional "incidentilomas". In all four categories, the optimal result of surgical intervention depends on the following factors: 1. Definitive diagnosis by accurate biochemical assessment of the functional status of the adrenal lesion. 2. Precise localization of the lesion using simple routine as well as advanced imaging techniques. 3. Adequate preoperative preparation and intraoperative monitoring. 4. Close immediate and long-term postoperative follow-up. In this review, the above factors are briefly summarized for each of the four disorders. A small proportion of adrenal lesions requiring surgery are bilateral and in such situations, special intra- and postoperative care should take into consideration the need for appropriate gluco-corticoid and mineralo-corticoid replacement. The advent of laparoscopic surgery has served to reduce the postoperative morbidity of adrenal surgery and is becoming increasingly the procedure of choice except for large lesions (> 8 cm in diameter).

Adrenal Gland Diseases↗
PubMed2005

Relationship between surgical procedure and spontaneous urination after rectal cancer surgery.

OBJECTIVE: The aim of this study was to determine the relationship between surgical procedures and spontaneous urination after rectal cancer surgery. METHODS: We reviewed the time of removal of the Foley catheter in 91 patients with middle and lower rectal cancer who had undergone curative surgery, either abdominoperineal resection (APR) or sphincter-preserving operation (SPO), without pelvic lymphadenectomy (PL). We also reviewed the time of catheter removal in 40 rectal cancer patients who had undergone one of four types of autonomic nerve preserving (ANP) operations. RESULTS: The mean time of removal of the catheter was 7.3 postoperative days (POD) in patients who underwent APR and 3.1 POD in patients who underwent SPO (p = 0.01). The mean time of removal in patients who underwent ANP for the entire plexus without PL (type 1a) was 6.7 POD. It was 5.6 POD in ANP for the entire plexus with PL (type 1b), 13.8 POD in ANP for bilateral pelvic plexus with PL (type 2) and 15.8 POD in ANP for unilateral pelvic plexus with PL (type 3). CONCLUSION: The type of operation and the volume of preserved nerves could be influential factors in the time to removal of the Foley catheter after rectal cancer surgery.

Autonomic Nervous System↗