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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↗

PubMedDate not supplied

Treatment of pertrochanteric and subtrochanteric fractures of the femur by the Ender method.

The Ender method consists of insertion of round, flexible, condylocephalic intramedullary nails. In 104 patients with a median age of 77 years and 80% older than 70 years, the morbidity was high (owing to concomitant diseases in 73%). Follow-up examination of survivals showed good functional results. There was some tendency to shortening, more than 2 cm in 15% of the patients. External rotation deformity of more than 20 degrees was observed in 15% of patients. Towards the end of the series when precautionary measures were taken to avoid this, the number of patients with such deformity decreased. The advantages of the Ender method are: a short operation time, minor operative trauma and early mobilization and weight-bearing. Because of some rotational instability the method should be reserved for patients older than 65--70 years.

Adult↗

PubMed1977

Vaginal hysterectomy in obese women.

The influenced of obesity in vaginal hysterectomy was examined by comparing the characteristics and outcome in 108 patients who weighed 200 pounds or more with matched controls weighing less than 200 pounds. Obese and nonobese subjects were similar in age and surgical indications, though overweight patients, who averaged nearly 60% above standard weight for height and age, were more likely to have hypertension and diabetes mellitus. Both operating time and operative blood loss were greater in obese patients, presumably because of more frequent employment of vaginal repair in this group. However, obese and nonobese patients did not differ significantly with respect to mortality (none in either group), postoperative febrile morbidity (62 and 56%, respectively), or postoperative hospitalization in excess of 12 days (19 and 16%, respectively). Thus, obesity does not seem to impose additional risks in vaginal hysterectomy, in contrast to abdominal hysterectomy in which the increased morbidity relates to wound infection.

Female↗

PubMed1988

The effects of Ro 15-4513 on the behavioral actions of ethanol in an operant reaction time task and a conflict test.

Ro 15-4513, an analogue of the benzodiazepine receptor antagonist Ro 15-1788, has been reported to selectively block the anxiolytic and intoxicating properties of ethanol in rats. To examine the specificity and selectivity of this ethanol antagonism, the effects of Ro 15-4513 were tested on the actions of ethanol in an operant reaction time and conflict test in rats. The operant reaction time task involved holding down a lever for 0.25-2.0 seconds to obtain food, and animals treated with 1 g/kg of ethanol showed a significant disruption in performance. This disruptive effect was reversed by Ro 15-4513 in doses of 1.5-5.0 mg/kg. Ro 15-4513 was also tested in an operant conflict paradigm sensitive to alcohol effects. Ro 15-4513 (0, 1.5, 3.0, 6.0 mg/kg) produced a significant decrease in both punished and unpunished responding in the conflict test. Ethanol (0.75 g/kg), pentobarbital (5 mg/kg) and chlordiazepoxide (5 mg/kg) all produced a significant release of punished responding that was blocked by pretreatment with 6.0 mg/kg Ro 15-4513, but again Ro 15-4513 suppressed responding on its own at this dose. These results suggest that Ro 15-4513 has inverse agonist properties that may explain its ethanol-antagonist action.

Animals↗

PubMed1989

Thallium-technetium isotope subtraction scanning in primary hyperparathyroidism.

Between January 1983 and March 1986, 75 consecutive patients underwent cervical exploration for primary hyperparathyroidism. Each patient had a thallium-technetium subtraction isotope scan of the neck performed preoperatively. Of 71 patients with technically satisfactory scans, 68 came to 'first-time' neck exploration while three underwent reoperation for persistent hypercalcaemia. At primary cervical operation 53 of the 68 patients each had a solitary adenoma as the cause of their hyperparathyroidism. In 28 (53%) of these individuals the scintigram accurately predicted the site of the parathyroid tumour ('helpful' scans). The technique was 'unhelpful' in 17 patients (32%) with false-positive scans and in eight patients (15%) with false-negative scans. There was a highly significant difference between the median weight of adenomas removed from patients with helpful scans (1.05 g) and that of adenomas retrieved from individuals with unhelpful scans (0.47 g), (P less than 0.001). Since 1 January 1985 we have adopted a policy of 'scan-directed' unilateral neck exploration for patients with hyperparathyroidism on the basis of solitary adenoma and in whom the isotope scan was positive. The mean operating time for these patients (n = 18, mean operating time 1.24 h) was significantly shorter than that for patients with unhelpful scans (n = 14, mean operating time 1.55 h, P less than 0.01) who were submitted to standard bilateral cervical operation. Subtraction scanning was helpful, in terms of localization of enlarged parathyroid glands, in only three of eight patients with multigland hyperplasia. The investigation was of positive help in locating the adenoma in two of three individuals submitted to cervical re-exploration for persistent hyperparathyroidism.

Adenoma↗

PubMed1992

The role of calcium alginate swabs in adenotonsillectomy.

A randomized controlled study using swabs of calcium alginate versus gauze was undertaken to evaluate the haemostatic capabilities and the shortening of operative time. Haemostasis in adenoidectomy was shown to be more effective and the operating time shortened (P = 0.05) by the use of calcium alginate. Haemostasis and operating time for tonsillectomy were not affected.

Adenoidectomy↗

PubMed1991

Combined study to assess the role of calcium alginate swabs and ligation of the inferior tonsillar pole in the control of intra-operative blood loss during tonsillectomy.

Bleeding is the major source of morbidity and mortality of tonsillectomy and most operative time is spent securing haemostasis. Calcium alginate reduces experimental wound blood loss. This study assessed the efficacy of alginate swabs during tonsillectomy and inferior tonsillar pole ligation in the control of blood loss during tonsillectomy. Ninety-nine tonsillectomy patients were randomized to gauze or alginate swab use. A haemoglobinometer measured blood losses collected by suction during dissection and by swab until haemostasis was secured. Operative time, complications and healing were also assessed. Mean total blood losses and operative times were similar for the two groups. Swab blood loss was significantly lower for surgeons who ligated the lower tonsillar pole, compared with surgeons who used a snare. This finding was independent of swab type. Independent assessment showed no difference in the healing rate. Alginate swabs offer no advantage over gauze in terms of blood loss, operative time or complications of tonsillectomy. The results show that routine lower pole ligation significantly reduces post-dissection blood loss. We suggest that this technique should be more widely adopted.

Adolescent↗

PubMed1985

Sutureless intraluminal graft for repair of abdominal aortic aneurysm.

A series of seven patients undergoing elective repair of abdominal aortic aneurysms using sutureless intraluminal aortic prostheses for infrarenal tube grafts was reviewed. Follow-up was five to seven months. There was no morbidity related to the graft and one late mortality. In the uncomplicated cases, the average total operative time was two hours 14 minutes with no bank blood transfusions. The overall average operative time was two hours 41 minutes with an average operative transfusion of 0.28 units and total transfusions of 1.70 units of bank blood per case. Based on this experience and the observation that operative time and blood loss are major determinants of mortality with emergency abdominal aortic aneurysm repairs, we believe that use of sutureless intraluminal prostheses in suitable cases of leaking or ruptured abdominal aortic aneurysms has the potential to markedly improve survival.

Aorta, Abdominal↗

PubMed1992

The impact of selective use of dipyridamole-thallium scans and surgical factors on the current morbidity of aortic surgery.

Preoperative cardiac testing in patients undergoing vascular surgery remains controversial. We have advocated selective use of dipyridamole-thallium scans based on clinical markers of coronary artery disease before aortic surgery. The present study assessed both the efficacy of this policy and the role of surgical factors in the current morbidity of aortic reconstruction. Two hundred two elective aortic reconstructions (151 abdominal aortic aneurysms, 51 aortoiliac occlusive disease) performed in the period from January 1989 to June 1990 were reviewed. Preoperative dipyridamole-thallium scanning was performed in 29% of all patients, prompting coronary angiograms in 11% and coronary artery bypass grafting/percutaneous transluminal coronary angioplasty in 9% of patients before aortic reconstruction. The overall operative mortality rate was 2%, with one cardiac-related death. Major cardiac (nonfatal myocardial infarction, unstable angina) and pulmonary complications occurred in an additional 4% and 6%, respectively, of patients. Coronary artery disease clinical markers and surgical factors were analyzed with stepwise logistic regression for the prediction of operative mortality rates and major cardiopulmonary complications. Variables retaining significance in predicting postoperative death or cardiopulmonary complications included prolonged (more than 5-hour) operative time (p less than 0.004), operation for aortoiliac occlusive disease (p less than 0.010), and a history of ventricular ectopy (p less than 0.002). Prolonged operative time (p less than 0.006) and the detection of intraoperative myocardial ischemia (p less than 0.030) were predictive of major cardiac complications after univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1989

Totally stapled abdominal restorative proctocolectomy.

A technique of totally stapled abdominal restorative proctocolectomy is reported in 20 consecutive patients using a 20 x 20 cm J pouch and a stapled ileoanal anastomosis. The stapled ileoanal anastomosis had to be abandoned in three patients because of attempted mucosectomy in one and megarectum in two. One patient receiving steroids had a covering ileostomy. The remaining 16 patients had a totally stapled procedure without a covering ileostomy. Three patients developed serious postoperative morbidity but they were the only patients receiving steroids at the time of the operation. Of the remaining 13 patients none developed serious complications, the median hospital stay was 14 days and the median operating time was 150 min. The operation may be a technical advance particularly in allowing pouch construction without ileostomy in fit patients who are not receiving steroids at the time of operation.

Adolescent↗

PubMed2026

Vaginal Hysterectomy Versus Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery Hysterectomy; Results of a Randomised Controlled Trial.

OBJECTIVE: To compare Vaginal Hysterectomy (VH) with Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) hysterectomy (VANH) as a day-care procedure. DESIGN: Single-blind, multicentre randomised controlled trial. SETTING: Two Dutch non-academic teaching hospitals. POPULATION: Women aged ≥ 18 years undergoing hysterectomy for benign indications. METHODS: Women were randomised 1:2 (VH or VANH). Primary outcome was SDD. Secondary outcomes included operative time, rate of elective salpingectomies, intraoperative blood loss, complications (Clavien-Dindo), pain scores (NRS) and analgesic use, post-operative recovery (RI-10), and quality of life (EQ-5D-5L). Analyses were performed on an intention-to-treat basis. RESULTS: A total of 113 patients were included in the analyses (n = 42 VH, and n = 71 VANH). SDD occurred significantly more frequently in the VANH group (87.3%) than VH group (71.4%; OR 2.76, 95% CI 1.04-7.25; p = 0.04). VANH was associated with a significantly shorter operative time (median 55 min versus 65 min; p = 0.005), less blood loss (median 50 mL vs. 150 mL; p < 0.001) and more often elective opportunistic salpingectomy compared to VH (100% vs. 77.4%; p = 0.008). NRS were significantly lower in the VANH group the first hour post-operative (3 vs. 1, p < 0.001). Post-operative complications (VH 9.5% vs. VANH 15.5%; p = 0.34), readmission (VH 4.8% vs. VANH 8.5%; p = 0.47), analgesic use, recovery, and quality of life were not statistically significant. CONCLUSIONS: VANH is a safe and effective alternative to VH, offering a higher likelihood of SDD, shorter operative time, reduced blood loss, and more often an elective salpingectomy, without increased complications or differences in pain, recovery, or quality of life.

Humans↗

PubMed1985

Pseudarthrosis after spinal fusion for scoliosis. A comparison of autogeneic and allogeneic bone grafts.

This study was undertaken to compare the incidence of pseudarthrosis in fusions supplemented with autogeneic and frozen allogeneic grafts. The records of 208 patients with adolescent idiopathic scoliosis who were treated by posterior fusion and Harrington instrumentation were studied. The fusion was supplemented by an autogeneic iliac bone graft in 114 patients and by an allogeneic bank bone graft in 94 patients. The fusion mass was explored in all patients with suspected pseudarthrosis; therefore, all pseudarthroses reported in this series were proved by surgical exploration. Pseudarthrosis developed in five patients (4.4%) receiving an autogeneic graft and in five patients (5.3%) receiving an allogeneic graft. The incidence of pseudarthrosis was not significantly different at the 95% level of certainty. Average blood loss and operative time were determined for all patients. The decreases in average blood loss and operative time in those patients receiving allogeneic grafts were significant (p less than .01). Thus, based on the incidence of pseudarthrosis, allogeneic frozen bank-stored bone is an attractive alternative to autogeneic iliac bone for fusion supplementation in the treatment of scoliosis. Total operative time and blood loss can be decreased, and possible complications associated with a donor site can be avoided.

Adolescent↗

PubMed1976

[Relationship between the proliferation waves of the hepatocytes after hepatectomy and the waves of diurnal rhythm of mitotic activity. 1. Dependence of the form of the mitotic wave and the time of attaining its maximal degree on the time of operation].

The diurnal rhythm of mitotic activity (MA) of intact animal hepatocytes and the proliferative wave of hepatocytes after partial hepatactomy at time t0 are thought to appear as a result of formation of an initial proliferative wave, Pk-wave, within the G0-phase at constant moments of the day--time tk+1=tk+TMA(TMA=24hrs/K, k=1, or 2, . . ., or K) under the influence of the regulating system of the organism. Cells of the Pk-wave pass during a short time deltat (deltat less than TMA) from the G0-phase into the transformation phase, and then into the G1-phase. The 1st stimulated proliferative wave is formed at time tk, if tk--TMA less than t0 less than or equal to tk; its intensity depends most likely on the intensity of the corresponding Pk-wave of the intact liver. It was noted that time t0 of partial hepatectomy was necessary to coordinate with tk, but not with the time of the maximal mitotic activity, and that it was necessary to hepatectomize all animals within the interval from time tk--TMA to time tk. The model was shown to compare well with data by Post et al. (1963), Barbason (1970), and Van Cantfort and Barbason (1972) for hepatocytes of Wistar rats with TMA=8hrs, and tk (k=1,2,3) within intervals (2 a.m.; 4 a.m), (10 p.m.; noon), and (6 p.m. 8 p.m.). The maximal rate of liver generation was observed for all the hepactomized animals with the time of operation being between 8 p. m. and 2 a.m.

Animals↗

PubMed1988

[Diagnosis and timing of operation for strangulation ileus--especially concerning the usefulness of ultrasonography].

This is a clinical report on the usefulness of ultrasonography in the diagnosis of strangulation ileus and the timing of operation for this entity. Fifty-eight cases of strangulation ileus were investigated retrospectively and twenty-five cases had undergone ultrasonography. Ultrasonography delineated the strangulated intestinal tract as an akinetic distended intestinal tract and the intestinal tract on the oral side of the strangulated part as a movable distended tract with peristalsis and to-and-fro movement of the intestinal content. Retention of ascites was seen in many cases. Utilization of ultrasonography improved the rate of accurate preoperative diagnosis of strangulation ileus to 92%, resulting in timely surgery. Consequently, the number of cases requiring enterectomy because of intestinal necrosis sharply decreased. Shock, peritoneal irritation sign, leukocytosis, roentgenographic findings were inferior to ultrasonography in the preoperative diagnosis for the prediction of intestinal necrosis in strangulation ileus.

Humans↗

PubMed2026

Surgical outcomes and complications of fixation strategies for distal tibial fractures: a systematic review and network meta-analysis.

BACKGROUND: Multiple fixation options exist for distal tibial fractures, but the optimal approach remains controversial. Common techniques includeopen reduction and internal fixation(ORIF), minimally invasive plate osteosynthesis (MIPO), external fixation combined with limited open reduction and internal fixation (EF + LORIF), intramedullary nailing (IMN), and retrograde tibial nailing (RTN). METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched through March 19, 2026. Network meta-analysis (R v4.5.1) assessed operation time, fracture healing time, malunion, delayed union/nonunion, and infection, reporting MDs or RRs with 95% CIs. RESULTS: Eleven randomized controlled trials and 18 cohort studies (2145 patients) were included. MIPO was associated with a longer operative time and a longer time to union than IMN-IP (MD = 8.23, 95% CI 0.44-16.01; and MD = 1.02, 95% CI 0.10-1.93, respectively). For malunion, ORIF had a lower risk than MIPO (RR = 0.30, 95% CI 0.11-0.82), whereas MIPO had a higher risk than EF + LORIF (RR = 3.26, 95% CI 1.08-9.80) and IMN-SP (RR = 4.03, 95% CI 1.30-12.48). ORIF, EF + LORIF, and IMN-SP also showed lower malunion risk than IMN-IP. No significant differences were observed for delayed union and nonunion. Infection risk was generally higher with ORIF and MIPO than with several comparators, particularly EF + LORIF and intramedullary nailing-based strategies. CONCLUSIONS: No single strategy was consistently superior. Operation time and impaired union ( delayed union and nonunion) did not differ significantly among techniques. MIPO may be associated with longer time to union than IMN-IP and higher malunion risk than EF + LORIF and IMN-SP. Infection risk appeared higher with ORIF and MIPO in network estimates, although several comparisons remained uncertain. Findings should be interpreted in light of imprecision and study-level heterogeneity. PROTOCOL REGISTRATION: INPLASY2025120055.

Humans↗

PubMed1990

[Gluco, lipometabolic and trace elements alteration in bile with acute purulent cholangitis].

Analysis was made of the gluco, lipometabolic materials and trace elements in bile from patients. The specimens were collected in 11 cases with acute purulent cholangitis and 13 cases of selective biliary surgery at both inter-operational time, at which the bile were got by needling from the common bile duct, and post-operational time, at which the bile was obtained from T tube drainage bile before the extraction of the T tube or discharge from hospital. It was found that lactic acid and glucose markedly decreased and LDH activity increased in the cholangitis group at inter-operational time. Lifted hepatic glyconeogenesis and gluco-consumption and hepatic cellular damage were indicated. At the same time, most of the lipo-materials and lipase activity increased, as compared with the selective group, which showed that lipolysis was encouraged and that lipo-materials had flowed into the bile because of hepatic cellular damage. At the time of acute cholangitis, the Zn and Fe in bile markedly increased but the Cr in bile decreased, and the mechanism was not clear.

Acute Disease↗

PubMed1989

Effects of preoperative embolization on glomus jugulare tumors.

The charts of 35 patients were reviewed retrospectively to determine the effects of embolization on glomus jugulare tumors. Eighteen patients underwent embolization; 17 did not. All tumors were removed with a type A infratemporal fossa approach. The charts were evaluated for operative blood loss, operative time, length of hospitalization, new postoperative cranial nerve deficits and recurrence of tumor. Embolized patients had significantly less operative blood loss and operative time. Embolization did not affect length of hospitalization or reduce the incidence of new postoperative cranial nerve deficits. The surgeon's experience also plays a central role in reducing operative blood loss and operative time. The potential risks of embolization must be considered in the treatment regimen of glomus jugulare tumors.

Adult↗