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At least 109 records · Page 6Linked to original sources

PubMed1995

[Laparoscopic resections in Crohn disease].

39 patients with Crohn's disease underwent laparoscopic bowel resections during January 1993 to May 1995 (16 female, 23 male, with an average age of 33 years). The duration of the disease ranged from one to 18 years. 21 of the 39 patients were under steroid therapy at the time of operation. Seven patients have had ileocaecal resection for Crohn's disease. The operative technique is laparoscopically assisted. We performed: small bowel resections (8), ileocaecal resections (16), hemicolectomies (11), subtotal colectomies (2), colectomies (2). Operative time ranged from 90 to 280 min for ileocaecal resections and from 330 to 420 min for colectomies. Intraoperative complications were not encountered. Postoperatively one patient developed a subhepatic abscess which was drained under sonographic guidance on day 6. One patient was reoperated for a different disease on postoperative day 2. Two patients had fever till day 9 and 13 without clinical relevance. Two patients had delayed incision site healing. Postoperative clinical stay was 11 days. The main benefit for the patients was early mobilisation due to reduced pain. Patients experienced the small abdominal incision as a ray of hope in their chronic disease.

Adolescent↗

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↗

PubMed1984

[Advantages and hazards of preventing infection following cesarean section--clinical and bacteriologic results of a high-dosage treatment with mezlocillin and oxacillin short-term preventive following clamping of the umbilical cord].

Between August 1980 and August 1981 a prospective randomised study was conducted at the Krankenhaus Nordwest , Dept. of OBGYN , Frankfurt, to investigate the efficacy of a short term prophylaxis using mezlocillin and oxacillin ( Optocillin ) in reducing infections after Caesarean section (6 gs Optocillin after clamping the umbilical cord and after 8 and 16 hours, respectively). Both the study group (sg) and the control group (cg) consisted of 50 patients each. Both groups were statistically homogeneous . Infections were significantly reduced by the prophylaxis: sg 26%/cg 64% - p less than 0,001, febrile morbidity: sg 10%/cg 38% - p less than 0,001, endometritis: sg 6%/cg 20% - p less than 0,08, UTI: sg 18%/cg 36% - p less than 0,05, wound infections: sg 2%/cg 18% - p less than 0,02. Severe infections, however, were seen in neither group. The duration of infections was shorter in the sg. The various postoperative infections were associated with different risk factors (rf) - endometritis: green amniotic fluid, operating time greater than 75 min; cervical dilatation less than 2 cm, UTI: PROM (greater than 6 hs), operating time less than 75 min, internal monitoring, cervical dilatation greater than 2 cm, wound infections: green amniotic fluid, internal monitoring, frequent vaginal examinations (greater than 6), cervical dilatation greater than 2 cm and operating time greater than 75 min. The prophylaxis was especially effective in the presence of the following rfs: green amniotic fluid, internal monitoring, frequent vaginal examinations (6), operating time greater than 75 min and when associated with combined rfs. The reduction of wound infections following the prophylaxis can be ascribed to the elimination of organisms (Staph. spec., enterococci,) at the site of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cesarean Section↗

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↗

PubMed1995

The role of preoperative localization in primary hyperparathyroidism.

Hyperparathyroidism is being increasingly recognized by the detection of hypercalcemia on routine blood chemistry. Improvement in preoperative localization has been proposed as a way to decrease operative time and decrease morbidity and mortality. The purpose of this study was to retrospectively review the Guthrie Clinic experience of parathyroidectomy with and without preoperative localization. One hundred nineteen patients who presented with primary hyperparathyroidism between 1983 and 1990 were evaluated. There were 27 males and 91 females with an average age of 61. Preoperative localization resulted in a significant decrease in operative time with preoperative localization decreasing operative time from 97 minutes without localization to 70 minutes with localization. Also, complications were less in patients undergoing preoperative localization (5.8% versus 13.9%). Preoperative localization was positively affected by gland size, with larger glands being easier to localized. In conclusion, accurate preoperative localization decreases operative time and decreases complications in this series of patients undergoing exploration for primary hyperparathyroidism. In our institution the thallium technitium scan is most accurate and is the localization procedure of choice.

Adenoma↗

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↗

PubMed1995

Laparoscopic dismembered pyeloplasty: preliminary report.

As a reconstructive laparoscopic procedure, dismembered pyeloplasty was done in 5 patients: the laparoscopic procedure was completed in 4 and converted to an open operation in 1. Within this series operative time decreased from 390 to 190 minutes. The main operating time was devoted to laparoscopic suturing of the anastomosis. Spreading the renal pelvis by either pulling the sutures transcutaneously or with intra-abdominal stay sutures improved visualization and facilitated the anastomosis. Mean postoperative hospitalization was 8 days (range 7 to 10). After a mean followup of 9 months (range 6 to 15) excretory urography and renal scintigraphy revealed significant radiographic improvement and no obstruction in 4 patients. Compared to open pyeloplasty and endo-pyelotomy, laparoscopic pyeloplasty may combine the advantages of open surgery (excision of the stenosis and reduction of the renal pelvis) with those of minimally invasive surgery (minimal postoperative morbidity), provided the operative time can be shortened and the technique simplified.

Adult↗

PubMed1981

Evaluation of splenorrhaphy: a grading system for splenic trauma.

Since April 1977, we have used splenorrhaphy as the procedure of choice for splenic trauma. To evaluate the efficacy of this procedure, we graded splenic injury based upon the extent of splenic repair in 77 patients with blunt abdominal trauma. This grading system is as follows: Grade 1-capsular treatment (five patients); Grade 2-capsular or parenchymal injuries requiring topical hemostatic agents (13 patients); Grade 3-parenchymal injuries requiring suture repair (nine patients); Grade 4-parenchymal injuries requiring partial splenic resection (seven patients); Grade 5-total splenic devascularization or uncontrollable bleeding from the splenic pedicle requiring splenectomy (43 patients). Twenty-nine patients had associated orthopedic injuries, and 42 patients had associated intra-abdominal or thoracic injuries. Mean operative time was 130 +/- 10 minutes. Operative time increased with severity of associated intra-abdominal injuries. Mean operative transfusion requirement was 500 +/- 100 cc of packed red blood cells. Transfusion requirements were not related to the severity of splenic injury. Twenty-three patients developed complications. Pancreatitis occurred in three patients, atelectasis of pneumonitis in eight patients, ten developed wound infections, and two patients required reoperation for small-bowel obstruction. Complication rates were not related to the degree of splenic injury. The grading system described herein provides a framework for sound clinical judgment and comparison of results in the management of splenic injuries.

Abdominal Injuries↗

PubMed1994

[New semi-automatic ROI setting system for brain PET images based on elastic model].

We have developed a semi-automatic ROI setting system for brain PET images. It is based on the elastic network model that fits the standard ROI atlas into individual brain image. The standard ROI atlas is a set of segments that represent each anatomical region. For transformation, the operator needs to set only three kinds of district anatomical features: manually determined midsagittal line, brain contour line determined with SNAKES algorithm semi-automatically, a few manually determined specific ROIs to be used for exact transformation. Improvement of the operation time and the inter-operator variance were demonstrated in the experiment by comparing with the conventional manual ROI setting. The operation time was reduced to 50% in almost all cases. And the inter-operator variance was reduced to one seventh in the maximum case.

Brain↗

PubMed1995

Prognostic effect of timing of operation in relation to menstrual phase of breast cancer patient--fact or fallacy.

The effects of the timing of operation in relation to menstrual phase and hormone receptor protein positivity and concentration of the 5 year survival of 267 premenopausal women with operable breast cancer were evaluated. The patients were treated in the Tampere University Hospital Area in 1980-87, and information about menstrual cycle was recorded before the operation. Patients operated on during the luteal phase (days 15-32) had a trend towards a better survival rate (80.4%) than those treated in the follicular phase (days 1-14) (75.9%), but the difference did not reach statistical significance (P = 0.079). There was a small difference in the positivity and concentration of hormone receptor proteins, depending on the phase of the menstrual cycle. A more sensitive analysis found a statistically significant linear association between survival and day since last menstrual period (LMP) which was not totally accounted for by the variation in hormone receptor levels during the menstrual cycle or other main prognostic factors (P = 0.018 by Cox's multivariate regression analysis when LMP was used as a continuous variable). One possible mechanism for the effect of timing can be that physiological changes related to different phases of menstrual cycle unfavourably affect the quality of diagnostic and/or treatment procedures. Variation in the lag between the diagnostic confirmation and the operation of the patient affects the evaluation of such an effect and may account for the inconsistent results reported so far.

Breast Neoplasms↗

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↗

PubMed1995

Laparoscopic-assisted colectomy learning curve.

PURPOSE: The purpose of this paper is to establish the number of cases necessary to master laparoscopic removal of the left or right colon. METHODS: Data were obtained by chart review and by individually completed questionnaires. RESULTS: A total of 144 laparoscopic-assisted or intracorporeal right or left hemicolectomies were completed by four surgeons at separate institutions. Questionnaires were completed by each surgeon for each sequential hemicolectomy, and data concerning the type of surgery and total operating time were recorded. Times were plotted to diagram individual learning curves for each surgeon, and data grouping methods were used to determine the curve for each surgeon as well as for the combined data base. Learning was said to have been completed when the surgeon's operative time reached a low point and subsequently did not vary by more than 30 minutes. A total of 78 right colectomies and 66 left colectomies were completed by the group. Respectively, each surgeon appeared to learn the procedure after 16, 21, 11, and 6 cases. When the entire database was analyzed as a whole, it was shown that between 11 and 15 completed colectomies were needed for learning, after which operative times remained relatively stable. CONCLUSIONS: This analysis, using total operative time as an indication of learning, shows that approximately 11 to 15 completed laparoscopic colectomies are needed to comfortably learn this procedure.

Colectomy↗

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↗

PubMed1994

Laparoscopic varicocelectomy: invasiveness and effectiveness compared with conventional open retroperitoneal high ligation.

The invasiveness of laparoscopic varicocelectomy and open retroperitoneal high ligation of the internal spermatic veins were compared and the surgical effects on fertility of these two procedures determined. 48 of 97 men diagnosed with varicocele testis underwent laparoscopic varicocelectomy, while the remaining 49 underwent open retroperitoneal high ligation of the internal spermatic vessels. Operating time, number of post-operative days to walking, length of hospital stay and analgesic use were measured as peri-operative indicators of invasiveness. In addition, seminal parameters were determined in order to evaluate the effects of these procedures on fertility. The operating time required for laparoscopic surgery was significantly longer than that for open surgery (96.6 vs 78.1 min., p = 0.0078). The patients in the laparoscopic surgery group began walking earlier post-operatively than did those who underwent open high ligation (0.97 vs 1.42 days, p = 0.00037). Length of hospital stay for the laparoscopic patients was shorter than for the open surgery group (7.05 vs 9.55 days, p = 0.00001). There were no statistical differences between the groups in terms of semen quality or improvement in the post-operative rate of pregnancy of partners. These findings indicate that laparoscopic varicocelectomy is associated with a shorter period of convalescence than open high ligation of the internal spermatic vessels.

Adolescent↗

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↗

PubMed1994

Laparoscopic Pomeroy tubal ligation as a teaching model for residents.

We reviewed our preliminary experience with laparoscopically directed bilateral midtubal resection for tubal ligation (endoscopic Pomeroy) as a potential teaching tool for the acquisition of endoscopic skills during residency training. Thirty-five laparoscopic Pomeroy and 206 banding procedures were reviewed. Age, parity and weight were similar in the two groups. The operative time for banding was reduced slightly after experience with > 10 procedures. In contrast, the operative time for laparoscopic Pomeroy procedures decreased dramatically after individual experience with only a few (< or = 5) procedures. The mean operative time for the Pomeroy group approached that of the more traditional banding technique at five procedures. Our data indicate that laparoscopic Pomeroy sterilization can be an effective teaching tool for operative laparoscopy, allowing residents to repeatedly perform an easy and safe procedure that incorporates basic techniques. Advanced operative endoscopic procedures could then be taught more efficiently after the acquisition of basic skills.

Adult↗

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↗