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At least 811 records · Page 45Linked to original sources
PubMedDate not supplied

[Recurrent groin hernia: a cognitive survey in Piedmont].

The aim of this study was to analyze, using a cognitive survey, how recurrent groin hernia are treated in our region by surgical centres. A form was sent to 49 surgical centres in our region, considering the period 2002 -first six months of 2004, asking the number of primitive hernias treated, surgical technique, number of recurrent hernias treated, surgical technique, kind of anaesthesia and types of complications. We sent 49 forms, 41 (83.7%) were given back. During the considered period, 18 580 primitive hernias and 1102 recurrent (5.6% of all repair) were treated. The greatest part of it was performed with an open mesh technique tension free (77% of primitive hernias, and 62% of recurrent ones). Laparoscopic repair was performed in 0.2% of primitive hernias and 3.2% of recurrent ones. The operations were carried out mainly in spinal anaesthesia (722, 65.5%). Recurrence occurred in 34 cases (3.1%). In our region inguinal hernia repair both for primitive and recurrent groin hernia has been performed mainly by an open mesh technique, tension free and sutureless and, in greatest part, in spinal anaesthesia. Laparoscopic repair has not been used very much.

Hernia, Inguinal↗
PubMed1990

[A combination surgical-radiological approach for the treatment of carcinoma of the hepatic duct bifurcation with involvement of both hepatic duct trunks].

The only curative treatment to proximal bile duct cancers with involvement of both hepatic ducts is liver transplantation. A curative resection with wide lateral clearance is limited due to the neighbourhood of vital anatomic structures in the liver hilum. The majority of patients with bile duct cancers is over 60 years of age and due to concomitant disease, they do not fulfill the requirements for liver transplantation. Our treatment strategy in adequate cases is palliative tumor resection and reconstruction of bile passage by sutureless biliodigestive anastomosis as proposed by Rodney Smith. We treated 11 patients with this method, in 5 patients an additive combined radiotherapy by percutaneous radiation and intraluminal after-loading therapy was performed. Our results indicate that this strategy leads to effective palliation in cases provided that only microscopic residual tumor is left in situ (R1-resection). Our observed survival times compare favorably to survival times after liver transplantation (average survival time 11.5 months median survival time 10 months).

Aged↗
PubMed2006

[Fibrin sealant in tension free hernioplasty: our experience].

The aim of this study was to prove that it is possible to fix mesh sutureless with Tissucol in the Lichtenstein procedure. The mesh fixation with Tissucol was done in 28 patients. Respect the traditional Lichtenstein technique, which was done in the remaining 28 patients, the advantages of using Tissucol are: no surgical trauma, total mesh fixation, no pain, reduced morbidity and reduced costs. Furthermore it is a safe and reproducible method. The results are promising, even if the verification goes more carried out with consisting casuistics and longer follow-up.

Aged↗
PubMedDate not supplied

Transcatheter placement of an intraluminal prosthesis for the thoracic aorta. A new approach to aortic dissections.

A new aortic prosthesis (SAP, shape memory aortic prosthesis) was developed with its transfemoral placement system to treat aortic dissection with minimal invasion. The SAP consists of a Nitinol stent and polyurethane tube, and it is designed in such a configuration that it can be compressed inside a 14 Fr catheter when cold. It regains its original shape when warmed to 30 degrees C. From the results of intra-aortic sutureless placement of SAP in 10 mongrel dogs, we concluded that a SAP of proper diameter could be implanted safely for more than 3 months. The transfemoral placement system is composed of a delivery catheter, pushing rod, catching catheter, and pulling wire. Using these devices, transfemoral placement of SAP was demonstrated successfully in three dogs and one sheep. The original SAP and delivery system can be used as an emergency procedure for aortic dissections, such as Stanford type B. The advantages of the procedure are minimal invasion of acutely ill patients and prompt application in the catheter laboratory.

Alloys↗
PubMed1991

[THe surgical treatment of aneurysmatic lesions of the ascending aorta: the immediate and long-term results in 40 patients].

From January 1981 to January 1991, 40 patients underwent operation for acute ascending aorta dissection (AAD, 14 patients), chronic ascending aorta dissection (CAD, 9 patients) or aortic ectasia (AE, 17 patients), with simultaneous aortic valve replacement in 30 cases (75%). Average age was 54 years with a 3:1 M/F ratio. In 20 cases (50%) a composite graft bearing a mechanical bileaflet valve was inserted with coronary artery reattachment (Bentall operation). In 16 cases (40%) the ascending aorta was replaced by a woven dacron graft alone (7 cases) or associated with aortic valve substitution (7 cases) or resuspension (2 cases). In 1 case (2.5%) a sutureless ring graft replacement of ascending aorta was carried out and 3 patients (7.5%) underwent aortoplasty with aortic valve substitution. Postoperative mortality rate was 21% for AAD group, 11% for CAD group and 6% for AE group. Non-fatal postoperative complications developed in 36% of AAD patients and in 78% and 29% of CAD and AE patients respectively. These complications occurred in 45% of patients who underwent Bentall operation, in 44% of those who underwent ascending aorta replacement associated with aortic substitution or resuspension, and in 14% of those operated of simple ascending aorta replacement. Average follow-up was 41.6 months (range 1.7-107.4 months). During this period 5 deaths occurred for a long-term mortality rate of 14.2%. Out of 30 survivors 21 (70%) underwent CT-study to evaluate the natural course of the false channel and the risk of redissection or late aneurysm formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

No-stitch cataract surgery: 1 year experience.

Hundred and fifty-three planned no-stitch cataract operations with follow-up between 1 and 12 months are reviewed. After a scleral step-incision, a bimanual phacofragmentation technique is done, with implantation of an oval lens in PMMA (5.0 by 6.0 mm). The patient selection is reviewed. The visual results are very good: little induced astigmatism, faster visual recovery and more stable refraction. Two cases of incarceration of the iris are described: one of the first cases, and another one through the small corneal side-opening. We conclude that the wound healing in correctly done sutureless surgery is obtained faster and safer than in the more "classic" cataract surgery.

Cataract Extraction↗
PubMed1991

Arthroscopy wounds: to suture or not to suture.

The arthroscopic wounds of 100 Caucasian patients were either sutured or simply bandaged on a random basis. The patients were reviewed after 2 and 12 weeks to ascertain the outcome of the two techniques. Suturing an arthroscopic wound resulted in an increased incidence of hematomas and superficial abscesses. A sutureless technique probably favors early hematoma draining, thus removing a potential cause of infection.

Abscess↗
PubMed1990

[H2-receptor antagonists and the incidence of gastroduodenal ulcer perforation and hemorrhage. An epidemiological study].

The only curative treatment to proximal bile duct cancers with involvement of both hepatic ducts is liver transplantation. A curative resection with wide lateral clearance is limited due to the neighbourhood of vital anatomic structures in the liver hilum. The majority of patients with bile duct cancers is over 60 years of age and due to concomitant disease, they do not fulfill the requirements for liver transplantation. Our treatment strategy in adequate cases is palliative tumor resection and reconstruction of bile passage by sutureless biliodigestive anastomosis as proposed by Rodney Smith. We treated 11 patients with this method, in 5 patients an additive combined radiotherapy by percutaneous radiation and intraluminal after-loading therapy was performed. Our results indicate that this strategy leads to effective palliation in cases provided that only microscopic residual tumor is left in situ (R1-resection). Our observed survival times compare favorably to survival times after liver transplantation (average survival time 11.5 months median survival time 10 months).

Adult↗
PubMed1990

[Use of fibrin glue in prevention and therapy of intra-abdominal adhesions].

In prevention of the recurrent intestinal obstruction we performed at the Department of Pediatric Surgery of the University of Mannheim a sutureless plication of the small bowel with fibrin glue only over the last 7-year period. The postoperative course was uncomplicated in all patients. The clinical and experimental experiences suggest that the high concentrated human fibrinogen is able to start healing of the lesions of the serosa to prevent intraabdominal adhesions prospectively. Furthermore the time saving and easy procedure is to be stressed. First of all the high risk of tissue necrosis or intestinal perforation due to ischemia by sutures and stitches like in the traditional technique of plication is not present.

Animals↗
PubMed1987

[Microsurgical suture and fibrin gluing of nerve anastomoses. Animal experiment study using Cohn I human plasma fraction].

In a comparison of suture and fibrin bonding (using human plasma fraction Cohn I) direct as well as autologous and homologous nerve transplantations were performed in animal experiments. The study was carried out in a total of 66 Nn. ischiadici in Albino Wistar rats. With and without transplants the anastomoses were provided 26 times with the usual microsurgical single-button suture technique and 11 times tith a fibrin adhesive cuff with sequential application of the two components (500 I. U. thrombin/ml, 3,000 units contrycal) or simultaneous application after premixing of the components (5 I. U. thrombin/ml, 50 units contrycal). The qualitative evaluation was carried out after 4, 6, and 12 weeks according to the clinical and histological findings. With the use of sufficiently long transplants the nerve anastomoses could be fixed sutureless with the adhesive cuff more simply than with sutures. Histologically an undisturbed growing forth of the axons without foreign-body reactions and scarred constrictions could be proved. The sutured anastomoses, too, showed a good regeneration; owing to the 2-3 single button-sutures only low-degree tissue reactions occurred around the threads without any greater impairment of the proliferation of the neurites. In case of the direct uniting of the nerves adhesion was only possible in combination with a holding suture. In most cases, however, anastomose dehiscences with a bad result were nevertheless found. The direct nerve suture had to be carried out with 5-7 single-button sutures. In this case, considerably pronounced foreign-body reactions were sometimes found histologically. The nerve regeneration, however, was much better than in case of bonding by adhesion. In contrast to the application in direct nerve joining, the Cohn I adhesive could be used with good results for nerve transplantations.

Anastomosis, Surgical↗
PubMed1987

Non-sutured fibrin adhesive vs. sutured anastomosis. A comparative intra-individual study in dog colon.

In each of ten dogs the colon was subjected to a two-layered sutured anastomosis and a non-sutured fibrin adhesive anastomosis. Intra-individual comparisons showed no significant difference of in vivo bursting strength after 7 days between the colon segments with sutured and those with non-sutured anastomoses. Under experimental conditions it was thus possible to achieve a safe, sutureless anastomosis in the colon using only fibrin adhesive.

Anastomosis, Surgical↗
PubMed1988

Experimental studies in animals on the use of a fibrin glue from the human plasma fraction Cohn I in nerve reconstruction.

In order to compare the effects of suture and glue direct nerve connections and nerve transplantations in the sciatic nerve in rats were performed. 4, 6 and 12 weeks later, the nerve anastomosis were histologically studied. In the direct nerve connections, despite a single holding suture, dehiscences were frequently detected with the penetration of the adhesive between the nerve ends. Due to the exact adaptation with the aid of inserted nerve grafts, the anastomoses could be repaired sutureless successfully using a fibrin glue cuff. Since histologically, in comparison to suture, no foreign body granulomas were found, the findings in the literature could be confirmed. No cicatricial contractions of the anastomoses could be found. In the interfascicular nerve transplantation, comparatively good results may be obtained using the two-component adhesive on the Cohn I-fraction basis.

Anastomosis, Surgical↗
PubMed1989

Surgical treatment of the ascending aorta. Fourteen years' experience with 83 patients.

Between December 1972 and December 1986, 83 patients with aneurysmal disease (n = 37) or dissection (n = 46) involving the ascending aorta underwent a variety of operations, including composite value-graft repairs (n = 39), separated replacements of the aortic valve and ascending aorta (n = 18), resuspension and graft replacement of the ascending aorta (n = 9), graft replacement of the ascending aorta only (n = 8), homograft root replacement (n = 3), aortic valve replacement with aortorrhaphy (n = 3), aotorrhaphy alone (n = 2), and use of a sutureless intraluminal prosthesis (n = 1). The inclusion method was used in nine patients. The hospital mortality rate was 10% for patients with annuloaortic ectasia, 21% (70% confidence interval 13% to 30%) for acute dissection, and 18% (70% confidence interval 14% to 22%) for the entire group. Logistic regression analysis showed age and cumulative bypass time to be significant for hospital death. The estimated 5-year survival rates are 69.5% +/- 7.2% and 67.0% +/- 9.0% and 10-year estimates are 34.6% +/- 10.6% and 61.4% +/- 9.8% for dissection and aneurysm, respectively. Patient survival was related to differing pathology and type of operation, and log-rank testing showed no differences at the 5% level. Attrition (17 late deaths) was mostly due to left ventricular dysfunction, myocardial infarction, or aneurysmal disease in ungrafted aorta. Actuarial freedom from thromboembolism in patients with prosthetic valves is 92.0% +/- 4.0% and 83.5% +/- 6.8% at 5 and 10 years. Freedom from all late graft and cardiac complications is 72.5% +/- 9.1% and 48.8% +/- 13.1% at 5 and 10 years for aneurysmal disease and 79.1% +/- 7.3% and 67.3% +/- 9.9% at 5 and 10 years for dissection. Reoperation in nine patients was required for pseudoaneurysms (n = 3), other aortic aneurysms (n = 3), persistent aortic regurgitation (n = 1), and obsolescent valve prosthesis (n = 2). Thus hospital mortality does not seem to be significantly related to the type of operation used for pathologic conditions of the ascending aorta unless cumulative bypass time exceeds about 2 hours. Many nonfatal late complications are associated with a prosthetic valve, but late death is due primarily to cardiac causes and residual disease in other parts of the aorta.

Aortic Dissection↗
PubMed1988

[Dynamics of the recovery of the structure and function of the sciatic nerve and skin receptors in reinnervation of the hindlimb of white rats].

The dynamics of the structural and functional repair of nerve trunks and receptor endings in the rat foot skin was studied on the model of sutureless connection of the damaged nerve by and implanted arterial vessel. Neurohistological and neurophysiological methods were used to show that the anatomical repair of the nerve integrity, maturation of nerve fibers and formation of receptor endings preceded their functional restoration. Terms of myelinization of regenerating axons, their diameters and initial stages of the formation of receptors in the foot skin were established. The restoration of the skin receptor function was shown to occur within 11-13 months after operation.

Action Potentials↗
PubMed1988

[Regeneration of the rat sciatic nerve after various experimental lesions (morphologic and morphometric analysis)].

Dynamics of structural restoration of the peripheral nerve (n. ischiadicus) have been studied in the noninbred rats in 3 series of experiments: after local freezing, pinching and cutting with a subsequent connection of the nerve ends by means of an implanted arterial vessel. As demonstrate the methods of light and electron microscopy, myelinization of the nervous fibers in the distal part of the nerve begins between the 10th-20th days after the effect. Further, amount of the myelinated nerve fibers (NF) significantly increases, they become essentially thicker. However, even in the later time of the observation (9 months) most of NF remain thinner than in the control nerve; this demonstrates that the reparative processes take a longer time than it was supposed before. The comparative analysis makes it possible to recommend the cryogenic lesion of the nerve as the most perspective model to study processes of the reparative histogenesis. Certain positive signs of sutureless connection of the cut nerve by means of the implanted arterial vessel are noted for clinical substitution of vast diastases of the nerve.

Animals↗
PubMed1986

Ventral abdominal, transdiaphragmatic approach for implantation of cardiac pacemakers in the dog.

Surgical implantation of a sutureless myocardial electrode and pulse generator was performed in 18 dogs, using a ventral abdominal, transdiaphragmatic approach. Twelve dogs were greater than or equal to 10 years old. The 18 dogs weighed from 3 to 54 kg. Indications for permanent cardiac pacemaker implantation included complete (3rd degree) atrioventricular block, sick sinus syndrome, and sinus bradycardia. Few complications developed during or after surgery. One dog died during surgery from ventricular fibrillation, and hypertrophic cardiomyopathy was found at necropsy. Five dogs died 1 to 19 months after surgery (mean, 8.6 months) because of renal failure, hepatic cirrhosis, congestive cardiomyopathy, or idiopathic causes. Twelve dogs were alive 1 to 48 months after surgery (mean, 15.1 months). The surgical approach was used a second time in 3 dogs to replace the myocardial electrode wire and pulse generator 4, 16, and 26 months after surgery; technical complications were not associated with the second surgery in these 3 dogs. In 2 dogs that had initial pacemaker implantation via lateral thoracotomy, a transdiaphragmatic approach was used to replace the myocardial electrode lead and pulse generator 25.5 and 26 months after surgery. According to results of this study, the ventral abdominal, transdiaphragmatic approach for permanent pacemaker implantation in the dog is a simpler technique, with decreased surgery time, decreased time of tissue exposure, and decreased rate of infection, as compared with results described by investigators who used lateral thoracotomy or midline celiotomy and caudal one-third median sternotomy.

Animals↗
PubMed1986

[Morphofunctional restoration of a nerve trunk by filling the defect with a blood vessel].

Dynamics of morphologic and functional restoration of the nerve trunk and separate receptive skin formations have been investigated in white rats after a sutureless connection of the cut nerve by means of the implanted artery. For testing the reparative processes neurohistological and electrophysiological techniques have been used. In spite of a relatively early restoration of the integrity of the injured nerve and reaching the nervous fibers up to the skin, functional organization of the dermal sensory apparatus is observed only in a year after the operation.

Animals↗