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At least 775 records · Page 43Linked to original sources

PubMed2006

Clinical results with the medennium phakic refractive lens for the correction of high myopia.

PURPOSE: To evaluate the predictability, safety, stability, complications, and biocompatibility of the phakic refractive lens (PRL) as a posterior chamber intraocular lens to correct high myopia. METHODS: Fifty eyes of 31 patients who underwent posterior chamber PRL implantation were evaluated prospectively. Mean preoperative myopia was -12.54 +/- 4.22 diopters (D) (range: -4.50 to -23.50 D) and mean astigmatic refractive power was -1.38 +/- 1.24 D (range: -1.00 to -4.50 D). Surgical implantation was performed through a 3.0- to 4.0-mm clear cornea sutureless incision using parabulbar (sub-Tenon's) anesthesia. Intra- and postoperative complications were recorded. RESULTS: Three months after surgery, the mean spherical equivalent refraction was -0.21 +/- 0.42 D (range: +1.00 to -1.75 D). At 6 and 12 months, mean spherical equivalent refraction was -0.23 +/- 0.38 D (range: 0 to -1.25 D). At the last examination, uncorrected visual acuity was > or = 20/40 in 41 (82%) eyes and > or = 20/20 in 22 (44%) eyes. Best spectacle-corrected visual acuity (BSCVA) was > or = 20/40 in 42 (84%) eyes and > or = 20/20 in 27 (54%) eyes. Comparison of pre- and postoperative BSCVA at 12 months showed that 12 (36.4%) of 33 eyes gained > or =1 lines of BSCVA and 7 (21.2%) of 33 eyes gained > or =2 lines. One (2%) eye developed anterior subcapsular cataract requiring lens exchange, and 1 (2%) eye developed acute angle closure glaucoma requiring YAG-iridotomy. One (2%) eye developed macular hemorrhage. CONCLUSIONS: At 6 months and 1 and 2 years, PRL implantation yielded encouraging visual and refractive results with excellent biocompatibility. The efficacy, stability, and short-term safety of this lens was established. Serious complications, such as cataract and acute angle closure glaucoma, may occur, and long-term safety needs to be evaluated.

Adolescent↗

PubMedDate not supplied

Pars plana vitrectomy: comparison of three techniques for the treatment of diabetic vitreous hemorrhage.

BACKGROUND AND OBJECTIVE: To compare the outcome of three vitrectomy techniques in the treatment of diabetic vitreous hemorrhage. PATIENTS AND METHODS: The study group included 38 patients (38 eyes) with diabetic vitreous hemorrhage. Three-port pars plana vitrectomy was used in 20 eyes, unimanual vitrectomy with indirect ophthalmoscopy in 10 eyes, and sutureless 25-gauge vitrectomy in 8 eyes. Main outcome measures were operative time, preoperative and postoperative visual acuity and intraocular pressure, and postoperative complications. RESULTS: Mean operative time was 66 minutes for three-port vitrectomy, 35 minutes for indirect vitrectomy, and 40 minutes for 25-gauge vitrectomy. Mean duration of follow-up was 26 months (range = 5 to 43 months). All three techniques successfully treated the vitreous hemorrhage, with similar best-corrected visual acuity outcome and similar complication rates. A greater tendency for hypotony on the first postoperative day was observed in the 25-gauge vitrectomy group. CONCLUSIONS: The three major techniques for treating vitreous hemorrhage are similarly effective and yield similar outcomes. The specific technique used should be selected on the basis of the clinical status of the patient and the skills of the surgeon.

Adult↗

PubMedDate not supplied

Giant prosthetic reinforcement of the visceral sac: the Stoppa groin hernia repair in 234 patients.

BACKGROUND: Recurrent and complex bilateral inguinal hernias are associated with a high recurrence rate. Giant prosthetic reinforcement of the visceral sac (GPRVS) is popular in America and Europe, but there are no prospective data from Iran. PATIENTS AND METHODS: From 20 March 1995 to 20 March 2003, 234 patients (227 men and 7 women) with 420 inguinal hernias (186 bilateral and 48 unilateral) underwent repair using a large polyester mesh based on Stoppa's preperitoneal technique. Mean age was 60 years (range 25 to 88) and 44.8% had one or more comorbid conditions. In 154 instances, the relapsed hernia had already been operated once or twice for recurrence. RESULTS: Mean hospital stay after surgery was 2.2 days (range 1-13 days). The mean operative time was 45 minutes (range 30-75 minutes). General complications were one case of upper gastrointestinal bleeding, one case of ileus and one case of atelectasis. Local complications consisted of three local seroma formations. In no instance was postoperative neuralgia, chronic pain or testicular atrophy, mesh infection or death reported. Follow-up was obtained in all patients. The recurrence rate was 0.71% (3 of 420) per inguinal repaired or 0.85% (2 of 234) per patient. Factors predicating a high risk for recurrence included large hernia size (>5 cm), failure of one or more previous repairs (65.8%, 154 of 234), chronic cough and associated lower abdominal hernias. CONCLUSION: GPRVS is anatomic, sutureless, tension-free and the absolute weapon to eliminate all type of groin hernias. No other technique produces better results for the repair of recurrent and re-recurrent groin hernias.

Adult↗

PubMedDate not supplied

[DRG and gastrointestinal surgery].

The diagnosis-related-groups (DRG) is the cost-based system for hospital reimbursement. However, the proceeds does not coincide with the costs. Aim of the study was to identify the profit, which we could gained with 147, 155, 158, 162, 165, 198 gastrointestinal surgery DRG. 30 consecutive patients, undergone to surgery in Clinica Chirurgica of L'Aquila University, had been studied. We had calculated the daily costs of medical and nursing practice, diagnostic tests, drugs, hospitalization, surgical instruments for every patient's therapy. The DRG-proceeds had been correlated with the DRG-costs. The "major gastrointestinal surgery" had not profit (147 DRG: anterior resection of rectum = -354428 Pounds, Miles = -94020 Pounds; 155 DRG: total gastrectomy = -1920641 Pounds). On the contrary, "minimal surgery" had good profits (158 DRG: hemorroidectomy with local anestesia = 1469605 Pounds;162 DRG: sutureless groin hernioplasty = 1561200 Pounds; 198 DRG: videolaparochole-cystectomy: 1208807 Pounds). The study seems to demonstrate the disparity of the reimbursement system related to DRG. However, the surgeons, as managers, must employ warily the resources for producing DRG.

Gastrectomy↗

PubMed1997

[Secondary foldable intraocular lens implantation].

OBJECTIVE: To investigate the effectiveness and technique of secondary foldable intraocular lens implantation. METHODS: The silicone intraocular lens was implanted secondarily in 25 aphakic eyes with intact posterior capsule and zonules or capsule rupture at central zone through a 3.5 mm sutureless scleral tunnel incision. RESULTS: 21 of the eyes (84%) achieved a uncorrected visual acuity equal to 0.5 or better and 9 eyes (36%) to 1.0 or better 1 day after the operation. All eyes achieved a postoperative corrected visual acuity equal to or better than that of the corrected visual acuity before the surgery in the follow-up periods. CONCLUSION: Secondary foldable intraocular lens is the most simple and effective method to correct aphakia with intact or almost complete posterior capsule.

Adolescent↗

PubMed1999

[Endoscopic visualization of BAR (biofragmentable anastomotic ring)].

The authors present information on the use of a modern sutureless anastomotic connection by means of a biofragmentable ring--BAR (Biofragmentable Anastomotic Ring) which was used in patients to restore the continuity of the GIT after resections in the upper portions of the digestive tract. The authors present their initial clinical experience and emphasize the importance of visualization of biofragmentable anastomoses by gastroscopic examination in case of postoperative complications with the possibility of therapeutic provisions, if necessary.

Adult↗

PubMedDate not supplied

[Mesh repair of inguinal and femoral hernia].

The authors describe a 6-year experience with mesh repair of inguinal and femoral hernia in a surgical teaching department. Two hundred and ninety-seven hernioplasties were performed in 256 consecutive patients: 237 Trabucco sutureless and 11 Lichtenstein tension-free hernioplasties for inguinal hernia; 21 tension-free hernioplasties for femoral hernia; 20 Wantz GPRVS and 8 Rutkow tension-free hernioplaties for recurrences. Local anaesthesia was used in 59% of cases. Seventy-two patients (28.1%) refused this type of anaesthesia. The hospital stay was two days in all cases. The local postoperative morbidity rate was 8.7% (wound infections: 1.0%; neuralgia: 1.3%; haematomas: 2.0%; seromas: 2.3%; no testicular atrophies). The recurrence rate was 1.9% in the group of patients undergoing surgery from 1994 to 1997 (103 herniorrhaphies; follow-up: 3-6 years) and 0% in the group of patients operated on after 1997 (170 herniorrhaphies; follow-up: 2 years-6 months). The results confirm that the use of a prosthetic mesh (patch and plug) is the treatment of choice for hernia repair. Moreover, this experience in a surgical teaching department shows that these procedures can be safely and effectively performed by all surgeons.

Adult↗

PubMed2000

[The history and evolution of coronary artery bypass grafting].

It is nearly 40 years since the introduction of coronary artery bypass grafting (CABG) in humans. A. Carrel (1910) attempted the first CABG in animals and G. Murray (1954) succeeded in performing experimental CABG using the internal mammary artery (IMA). The first reported CABG using the IMA in humans was performed by R. Goetz using the sutureless technique in 1960. V. Kolessov (1964) performed the first sutured bypass grafting using the IMA. From 1962 to 1967, human CABG using autogenous saphenous vein grafts was performed by D. Sabiston (1962). H. Garrett (1964), D. Kahn (1966), and R. Favaloro (1967). Saphenous vein grafting became the most common CABG technique for the next two decades. In Japan, Y. Sezai et al. performed CABG using the free femoral artery, we performed CABG using the IMA, and S. Asada et al. performed CABG using the saphenous vein in 1970. In 1986, F. Loop et al. reported that the long-term survival rate of CABG was significantly higher when the IMA rather than the saphenous vein was used. IMA grafting, supplemented by the gastroepiploic artery, inferior epigastric artery, and radial artery, has enabled complete arterial revascularization to be performed in almost all patients. In the graft selection for CABG, the first choice is the left IMA and the second choice is the right IMA. The third choice is the gastroepiploic artery and/or radial artery, depending on the target anastomotic site, degree of stenosis, size of the distal graft, and in situ or free use.

Coronary Artery Bypass↗

PubMedDate not supplied

[Inguinal hernioplasty with calibrated prosthesis (personal modification of the Trabucco technique].

From January 1994 to December 1997, the authors operated on 636 patients with primary inguinal hernia, using an original modification of Trabucco's tension-free and sutureless technique. The hernial defect is sized according to Gilbert's classification modified by Rutkow and Robbins and repaired with one or more plugs (up to four in the authors' experience) in relation to its extent. The posterior wall is reconstructed over the plugs encompassing the transversalis fascia and a wing of the plug superiorly and the iliopubic tract inferiorly. The double-layer polypropylene mesh is fashioned intraoperatively and the key-hole tailored to the variable distance between the spermatic cord and the pubic tubercle. All patients ambulated immediately after the operation, had a light meal two hours later and were discharged within one day of surgery. During a 3 months to 4 year follow-up only one recurrence has been recorded (0.16%). The proposed technique allows to perform a repair to measure ("calibrated") with minimal pain, immediate rehabilitation and early return to unrestricted activity.

Aged↗

PubMed2001

[Successful new method for surgery of the postinfarctional left ventricular free wall rupture].

Authors discuss a history of a 78-years old male who suffered from left ventricular free wall rupture due to acute transmural myocardial infarction. Cardiac surgical intervention was carried out immediately after the ECHO examination which established the diagnosis. First time in Hungary authors used a sutureless technique to close the rupture and utilised double component glue and synthetic patch for this purpose. The patient had uneventful recovery and remained free of symptoms throughout his three months period of follow up. Current available data and knowledge are summarised about this life threatening disease.

Aged↗

PubMed2001

[Total anomalous pulmonary venous connection].

Recently the surgical results of simple (isolated) total anomalous pulmonary venous connection have improved markedly, and even the most severely affected patients presenting with marked hypoxia soon after birth have become salvagable partly due to the perioperative use of nitric oxide and extracorporeal membrane oxygenation. However, the outcome after complex surgery, particularly in asplenia, is still very poor in newborns. Common pulmonary vein atresia is still an ominous diagnosis and according to the literature only a few patients have survived surgery. The results of reoperation for postoperative pulmonary vein stenosis are also poor, although the good results of the "sutureless technique" which have recently been reported are encouraging. Prenatal diagnosis using echocardiography is difficult, but postnatal diagnosis using echocardiography and magnetic resonance imaging is usually precise and can obviate the need for cardiac catheterization which often aggravates the hypoxic status in critically ill infants.

Humans↗

PubMed2001

[Experimental elaboration and perspectives of application of electric welding of the live tissues].

In experiment on pigs, rabbits and white rats there was examined method of electric welding (electrothermoadhesion) of live tissues--intestine, stomach, gallbladder and bladder, peritoneum, elements of mesentery, liver, spleen. We distinguish among "welding" of the hollow organs wall with restoration of their passability and "overwelding" of masses of the tissues with production of coagulational furrow, along which resection of necessary parts is executed. According to data of morphological investigations obtained the security of the method was established. Peculiarities of welding suture of tissues were studied. The method is introducing in the clinical practice actively due to its simplicity and safety in sutureless connection of tissues.

Animals↗

PubMed2002

[A comparison of clinical effects between phacoemulsification and intraocular lens implantation through "L-shaped" and 3.2 mm scleral tunnel incision].

OBJECTIVE: To study the implant surgery through a newly designed L-shaped sutureless scleral tunnel incision and compare the therapeutic effects of this incision with the conventional 3.2 mm scleral tunnel incisions. METHODS: Phacoemulsification was performed through a L-shaped incision with implantation of 6 mm PMMA intraocular lens (IOL) and 3.2 mm scleral tunnel incision with implantation of acrylic foldable IOL. Uncorrected visual acuity and corneal topography were examined before the operation and 1 day, 7 days, 1 month, 3 months after the operation. RESULTS: From 1 day to 3 months post-operatively, there was no statistical difference between the two groups in uncorrected visual acuity, surgical induced astigmatism and axis of corneal astigmatism. The preoperative and the post-operative corneal topographies of the two groups were similar. CONCLUSION: The therapeutic effects of the two groups are similar. In the L-shaped scleral tunnel incision group, the less expensive PMMA IOL can be used.

Aged↗

PubMedDate not supplied

Acute-onset postoperative endophthalmitis: review of incidence and visual outcomes (1995-2001).

BACKGROUND AND OBJECTIVE: To determine the incidence rate of acute-onset postoperative endophthalmitis and to assess visual acuity outcomes after treatment from the most recent 7 years (1995-2001) compared with the previous 11 years (1984-1994) among patients undergoing intraocular surgery at the same institution. PATIENTS AND METHODS: The medical records were reviewed of all patients undergoing intraocular surgery at the Bascom Palmer Eye Institute between January 1, 1995 and December 31, 2001. RESULTS: The 7-year incidence rate of acute-onset postoperative endophthalmitis was 0.05% (17 of 35,916 intraocular surgeries). The number of patients with endophthalmitis (incidence) and their median final visual acuity for each surgical category are as follows: cataract extraction: 8/21,972 (0.04%) - 20/100; glaucoma surgery: 4/1,970 (0.2%) - 20/70; penetrating keratoplasty: 2/2,362 (0.08%) - light perception; pars plana vitrectomy: 2/7,429 (0.03%) - hand movements; secondary intraocular lens placement: 1/485 (0.2%) - 20/40. Of the 8 cases of endophthalmitis after cataract surgery, 6 cases occurred after phacoemulsification and 2 of these cases had a dear corneal sutureless incision. CONCLUSION: The most recent 7-year incidence rate of acute-onset postoperative endophthalmitis is significantly lower than that of the previous 11 years (0.05% versus 0.09%; = 0.031) at the same institution. Visual acuity outcomes after treatment were generally better in cataract surgery, glaucoma surgery, and secondary intraocular lens categories compared to pars plana vitrectomy and penetrating keratoplasty categories.

Acute Disease↗

PubMedDate not supplied

Improvements after sheathotomy for branch retinal vein occlusion documented by optical coherence tomography and scanning laser ophthalmoscope.

A 55-year-old man presented with decreased visual acuity of 20/400 and central foveal thickness of 450 microm as measured using optical coherence tomography due to a superior temporal branch retinal vein occlusion. Adventitial sheathotomy was performed with a 25-gauge sutureless transconjunctival vitrectomy system. At 1 day, 1 month, and 6 months postoperatively, visual acuity improved to 20/80, 20/40, and 20/30 OS, respectively; central foveal thickness decreased to 228, 195, and 161 microm, respectively; and the scanning laser ophthalmoscope microperimetry showed improved retinal sensitivity and fixation pattern with more stable and central fixation at both postoperative visits. This case indicates optical coherence tomography can detect an early positive effect of sheathotomy surgery on macular edema, and scanning laser ophthalmoscope can document associated improvement in fixation stability.

Decompression, Surgical↗

PubMed2003

A flow visualization study of an anatomic coronary artery anastomosis model with an implant.

Flow Streamlining Devices is a new tool in Coronary Artery Bypass Grafting (CABG). They aim in: a) Performing a sutureless anastomosis to reduce thrombosis at the veno-arterial junction, and b) Providing a hemodynamically efficient scaffolding to reduce secondary flow disturbances. Thrombosis and flow disturbances are factors that have been reported as contributing factors to the development of intimal hyperplasia (IH) and failure of the graft. By reducing thrombosis and flow disturbances, it is expected that IH will be inhibited and the lifetime of the graft extended. To evaluate the hemodynamic benefits of such an implant, two models were designed and fabricated. One simulated the geometry of the conventional anastomosis without an implant, and the other simulated an anastomosis with a flow streamlining implant. Identical flow conditions relevant to a coronary anastomosis were imposed on both models and flow visualization was performed with dye injection and a digital camera. Results showed reduction of disturbances in the presence of the implant. This reduction seems to be favorable to hemodynamic streamlining which may create conditions that may inhibit the initialization of IH. However, the compliance and geometric mismatch between the anastomosis and the implant created a disturbance at the rigid compliant wall interface, which should be eliminated prior to clinical applications.

Anastomosis, Surgical↗

PubMedDate not supplied

Total anomalous pulmonary venous return complicated by progressive pulmonary venous stenosis after total repair: report of one case.

Total repair of an infracardiac type total anomalous pulmonary venous return was performed on a 3-day-old female newborn. Echocardiogram study showed a smooth connection between the pulmonary veins and the left atrium one week after the operation, however, later echocardiograms showed a progressive obstruction of the pulmonary veins. The patient died at 50 days of age due to lung congestion. The autopsy revealed severe intima hypertrophy and upstream obstruction in every pulmonary vein, while the anastomosis between the left atrium and the pulmonary venous confluence remained well patent. In view of the high rate of progressive pulmonary venous stenosis after total repair in patients with infracardiac type total anomalous pulmonary venous return, it is advised that the operator should try to mobilize every pulmonary vein, make larger areas of anastomosis with pericardial patch augmentation and avoid using continuous suture. When the progressive pulmonary venous stenosis occurred during the follow-up period, a 'sutureless neoatrium' procedure can be used to resolve the obstructions.

Echocardiography↗

PubMed2002

Salvagable free wall rupture of the left ventricle.

Free wall rupture of the left ventricle remains a lethal complication of acute myocardial infarction. Nevertheless, where it presents subacutely with tamponade, salvage with a good outcome is still possible with timely pericardiocentesis preceding definitive repair using a sutureless technique.

Cardiac Tamponade↗