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PubMed1990

[Diagnosis and treatment of ophthalmoplegia].

The author discusses the signs and symptoms appearing in the course of so called noncommittant squints. Noncommittant squints are divided into squints caused by paresis or by a total paralysis of the motor muscles. One can divide the therapeutical procedure into the conservative and surgical treatment. The conservative treatment is carried out for one year since the onset of the palsy. After 12 months in the case of a lack of improvement a surgical intervention is performed. Surgical operations are divided into 3 types: 1) Rotation of the eye, that is to say operation of a recession-resection type--on the affected eye, 2) the principle paresis-counter-paresis or interventions performed on the muscles of the healthy eye, 3) transpositions of the muscles.

Eyeglasses↗
PubMed1989

[Lumbar sympathectomy in the aged subject: surgery or phenolization? Prospective study of early results].

Lumbar sympathectomy, which is usually indicated in the arteritic patient in cases of severe ischemia and occlusion of leg arteries when bypass surgery is not feasible, can be performed surgically or by scanner-guided phenolization. Surgical sympathectomy was performed by resection of the 2nd, 3rd, 4th and 5th lumbar ganglia under general anesthesia by a retroperitoneal route. Chemical sympathectomy involved scanner-guided injection of phenol diluted 6.7% into the sympathetic nervous system at L3 and L4 level. This act, performed on outpatients, required no anesthesia. Prospective study of the early results (within one month) obtained with these two techniques in 428 patients indicates that rates of death, amputation and noteworthy complications for those less than 70 yr (table IV, VI and VIII) were respectively 4.7%, 8.5% and 7.4% for surgery, and 2.5%, 5% and 0% for phenolization; for those greater than 70 yr the rates were respectively 12%, 11% and 10% for surgery, and 10%, 9% and 8% for phenolization. It may be concluded that phenolization of the sympathetic nervous system provides the same results as surgical sympathectomy but has the advantage of lower morbidity and shorter hospitalization (24 h vs 10 days). The results of these two techniques in terms of limb conservation are disappointing and markedly poorer than those of distal bypass surgery.

Aged↗
PubMed2000

Cognitive performance in surgically menopausal women on estrogen.

Estrogen replacement therapy (ERT) may help maintain normal cognitive function. Nondemented surgically menopausal women on ERT (n = 10) enrolled in a longitudinal aging study performed better than age- and education-matched control subjects (n = 25) on selected tests of verbal memory and constructional ability. These results suggest that ERT initiated soon after surgical menopause can have long-term neuroprotective effects in cognitively intact women.

Aged↗
PubMed2003

[Interleukin-8 serum levels in patients with various types of open heart surgical procedures performed under extracorporeal circulation].

Serum concentrations of proinflammatory cytokine interleukin-8 (IL-8) in 15 patients with surgically revascularized myocardium by triple venous cardiopulmonary bypass (CPB x 3) and in 10 patients with implanted artificial aortic valves (AV) were measured. Average IL-8 concentrations in (CPB x 3) patients and in those with artificial aortic valve were 7.3 +/- 11.6 pg/mL 24 hours before surgery, i.e. 3.3 +/- 3.4 pg/mL; six hours after surgical procedure 32.7 +/- 71.4 pg/mL, i.e. 8.9 +/- 9.9 pg/mL; and 24 hours after surgery 10.9 +/- 9.7 pg/mL, i.e. 8.3 +/- 4.6 pg/mL. Extracorporeal circulation (ECC) caused significant increase of IL-8 serum concentration in both investigated groups six hours after surgery. Comparing preoperative values of the both groups, as well as those of 6 and 24 hours after surgery, no significant values of IL-8 were found. Various types of open heart surgical procedures had no influence on the extent of the production and secretion of proinflammatory IL-8 cytokine measured in patients during 24 hours after surgery.

Adult↗
PubMed2003

Longitudinal observation of antenatally detected congenital lung malformations (CLM): natural history, clinical outcome and long-term follow-up.

OBJECTIVE: The objective of the study is to present longitudinal observations in antenatally detected congenital lung malformations (CLM), particularly pulmonary sequestration (PS) and cystic adenomatoid malformation (CAM). METHODS: Fetuses found to have a CLM on prenatal ultrasound (US) were included in this study and followed up until delivery. In all newborns radiographs and computerized tomography (CT) studies of the thorax were performed. Surgical procedures included sequesterectomy, lobectomy, segmentectomy, and non-anatomic resection. Based on prenatal US findings, intrauterine course, postpartum chest radiographs and CT scans, as well as clinical signs and surgical findings patients were divided into six groups. RESULTS: Over a period of 6 years, routine prenatal US revealed suggestion of CLM in a series of 35 consecutive fetuses. In six cases pregnancy was terminated or the fetuses suffered fetal demise. Another four fetuses became symptomatic in utero when sequential scanning revealed hydrops, hydrothorax, and enlargement of cysts or polyhydramnios. Three cases in this group received serial therapeutic amniocentesis and serial puncture of either the hydrothorax or intrapulmonary cysts. After postpartum treatment in the intensive care unit surgical procedures were performed uneventfully and confirmed the diagnosis of CAM, PS or hybrid type lesions. In 11 patients US findings were considered to demonstrate spontaneous resolution of the lesion, but disappearance without sequelae could be confirmed only in six infants. Five infants were shown to have persistent CLM on postpartum CT scans. These infants underwent resection of the lesion within the first year of life. In 11 fetuses CLM were continuously demonstrated during pregnancy with only slight changes in size and structure. Postpartum the infants were asymptomatic and were subjected to a systematic plan of diagnostic work-up and treatment. Surgery in these infants revealed a large number of hybrid type lesions (n=5). In three infants, the primary diagnosis of PS or CAM had to be corrected during the diagnostic and therapeutic work-up. CONCLUSION: CLM are diagnosed antenatally with an increasing frequency and are shown to be quite different from previously applied concepts. The expected clinical outcome is far better than thought to be possible.

Abortion, Legal↗
PubMed1993

Focal myositis of the thigh: report of two cases.

Focal myositis is a benign inflammatory pseudotumor of skeletal muscle, presenting as a localized painful swelling within the soft tissue of an extremity. Histological examination reveals lymphocytic infiltration, scattered muscle fiber necrosis and regeneration, and interstitial fibrosis. Complete recovery follows surgical removal of the lesion. Two cases are presented of young active males with a localized painful swelling of the thigh. Clinical examination, standard laboratory tests, electromyography (EMG), magnetic resonance imaging (MRI) and surgical biopsies were performed. Surgical biopsies were formalin-fixed, paraffin-embedded and sections were stained with hematoxylin and eosin, van Gieson, modified Gomori trichrome and Mallory's method for iron. Clinical examination in both cases revealed an indolent lump in the quadriceps femoris muscle. Standard laboratory tests and electromyography were normal. MRI prior to surgery visualized the focal nature of the lesions. Histological examination of repeated surgical biopsies showed scattered muscle fiber necrosis, regeneration, and interstitial fibrosis but few lymphocytes. Both patients recovered after surgical removal of the lesion. Two years after surgery there was no recurrence of the lesions and repeated EMGs were normal.

Adolescent↗
PubMed2004

[Surgical treatment of high risk patients with icterus].

Thorough analysis of complications and fatal cases of surgical patients has shown, that polyorganic pathology resulted in severe progressive surgical complications and considerable pathological changes of cardiovascular and bronchopulmonary systems. Minimal as possible number of surgical complications allow performing surgical operations more effectively. The results of analysis of a series of cases indicates for the necessity of improving operation technique to decrease the risk of complications. With growing experience of minimal invasive surgical technique and comparing surgical treatment results with other alternative methods of treatment, it is possible to reveal high reliable factors to prevent them.

Digestive System Diseases↗
PubMed1995

[Abnormal origin of left coronary artery from pulmonary artery].

OBJECTIVE: To assess the frequency and severity of the anomalous origin of the left coronary artery (ALCA) from the pulmonary artery (PA). DESIGN OF THE STUDY: Prospective study of case series between March 1991 and December 1994. SETTING: Referral-based Paediatric Cardiology Department of a Tertiary Care Center. PATIENTS AND METHODS: Five consecutive patients (pts) with anomalous origin of the LCA from the PA; there were three infants aged 4 months and two children one 8 year and one 9 year old. There were three girls and two boys. All pts had clinical and 2D-echo and Doppler investigation prior to cardiac catheterization (CC). Indication for CC was based in the association of symptoms and signs of myocarditis or dilated cardiomyopathy of acute or subacute onset and electrocardiographic (ECG) signs of ischemia in infants. In older patients (pts) diagnosis was suspected mainly from ECG. During CC in all pts, aortograms and when necessary selective coronary angiograms were performed. Surgical correction was performed in all children. In two pts stress exercise ECG and stress Thallium studies before and after surgery were performed. RESULTS: two pts had "adult" an three had "infantile" type of ALCA from the PA. CC was performed and diagnosis was confirmed at surgery in all cases. In one child, correct diagnosis was made by ECO prior to CC and in one case LCA to PA fistula was suspected on Colour-Doppler study. No complications were attributed to CC. Several types of surgery were performed: reimplantation of the ALCA from the PA to the aorta (three pts); tunnel connection of the aorta to the ALCA via the PA (one pt) and left internal mammary to LCA anastomosis (one pt). Two infants died intraoperatively due to extensive myocardial infarction and poor left ventricular function. All the three survivors are asymptomatic after a mean follow up of 34 months. Two oldest pts are currently in New York Heart Association functional class I with normal ECG and improved myocardial perfusion on Thallium scan despite almost total occlusion of LCA at the site of implantation in the aorta as diagnosed on coronary angiogram. CONCLUSIONS: ALCA from PA is associated with major morbidity and mortality. Diagnosis should be suspected in pts with unexplained myocardial ischemia on ECG and even more if it is associated to clinical signs of dilated cardiomyopathy or myocarditis. Careful assessment on ECO and pulsed Doppler and colour flow mapping should make the diagnosis in most cases. Although surgery can be performed based only on ECO diagnosis, we strongly advise for angiography in all cases as in our experience there are false negative diagnosis by ECO. Preoperative Thallium studies can be useful for the selection of the type of surgery as pts with very little viable myocardium will not survive the establishment of a direct systemic to coronary blood flow and may be candidates for heart transplantation.

Abnormalities, Multiple↗
PubMed1999

Prestige of training programs and experience of bypass surgeons as factors in adjusted patient mortality rates.

OBJECTIVES: The relation of physician performance to physician training and experience is not well understood. The aim of this study was to examine whether indicators of physician background and experience were associated with an objective measure of physician performance. METHODS: Physician background information obtained from the Directory of Board-Certified Medical Specialists was linked to physician risk-adjusted mortality rates obtained from three statewide data bases of coronary artery bypass surgeons. Subjects were 275 surgeons who performed CABG surgery on 83,547 patients during the years 1989 to 1992. Surgical performance was measured by the mortality ratio (MR), the ratio of the observed to the predicted patient mortality rate as determined by detailed clinical information. Training institutions and physicians were characterized as prestigious if they were listed as outstanding in published articles. RESULTS: Surgical performance was not associated with graduation from an American medical school; attendance at a prestigious medical school, residency, or fellowship program; or an academic appointment. Mortality ratios decreased with increased volume and increased with years of experience, age, and academic rank. Surgeons were more likely to be considered a "best doctor" if they had more years experience and trained at a prestigious residency or fellowship program. CONCLUSIONS: Training at a prestigious institution was associated with identification as a "best" doctor but not with lower mortality ratios.

Adult↗
PubMed1987

Effect of sleep deprivation on the performance of surgical residents.

Surgical residents were tested under sleep-deprived and nonsleep-deprived conditions. Three performance domains were tested: factual recall, the ability to concentrate, and manual dexterity. Sleep deprivation was defined as less than 3 hours of sleep in a 24 hour period. A randomized, repeated measures design was used. Split-plot analysis of variances was used to analyze the mean scores, and it revealed that there were no significant differences in performance in the sleep-deprived condition compared with performance in the nonsleep-deprived condition in any of the three domains tested. Moderate sleep deprivation appeared to be well tolerated by the surgical residents studied in this investigation.

Adult↗
PubMed1997

Comparison of direct monocular endoscopic, two- and three-dimensional display systems on surgical task performance in functional endoscopic sinus surgery.

Surgeons performing functional endoscopic sinus surgery (FESS) traditionally rely on direct endoscopic viewing through a single monocular Hopkins rod lens telescope. While the majority of surgeons have found this satisfactory, most other endoscopic surgical specialties have moved to 2-D video endoscopy, where a monoscopic image is presented on a television monitor. This study set out to determine whether 2-D or 3-D display systems had any advantage over direct endoscopy in FESS. Ten otolaryngology trainees performed a series of standardized procedures on a FESS model using direct endoscopic vision, 2-D and 3-D. A performance score was obtained by dividing the execution time by the number of tasks achieved. There was a significant difference in both surgical and diagnostic task performance with 2-D (mean scores 56.8 and 41.1) performing better than direct endoscopy (mean scores 94.1 and 74.1) (P < 0.05). Tasks were also performed significantly better with 3-D compared with 2-D (P < 0.05).

Endoscopy↗
PubMedDate not supplied

[Ultrasonography and surgical treatment of facial skin neoplasms].

In the second half of the 20 century, echosonography has been used in many medical specialities. In 1992 and 1993 highfrequencies echosonography was used in the examination of irritant and allergic skin lesions in order to examine the effects of different therapeutical agents on the skin lesions [1-4]. Hoffmann used highfrequencies echosonography in the examination of healing of skin lesions [3]. By their incidence skin tumours are the largest group of newly discovered tumours, and their usual location is on the face [5-7]. By clinical examination it is not possible to precisely determine the depth of tumour border; therefore, the radically performed surgical excision is the only correct surgical treatment. The aim of this study was to estimate the results of preoperatively performed high frequencies echosonography in order to reduce the number of incorrectly performed surgical excisions of skin tumours. The group was composed of 40 patients with 45 tumours, who first underwent echosonographic diagnostic procedure (20 MHz, Hadsund electronic, Hadsund Technology, Denmark) and then surgical excision; patients in control group (45 patients with 45 tumours) were only subjected to surgical excision. Excised tumours were then pathohistologically analyzed, and measurements of tumour depth progression were performed. Margins of pathohistological specimen were controlled for the presence of tumour cells. Results of measurements of tumour depth obtained by echosonography and pathohistological measurements were compared. By Jate's modification of c2 test results regarding correct and incorrect surgical excision in patients and control group were compared. By linear regression analysis results of tumour depth obtained by echosonographic and pathohistologic examinations were compared. Hypoechogen zone echosonographic results were used like criteria for tumour expansion. Results of tumour depth measurements are presented in Table 1. Linear regression analysis showed (R = 0.64) that echosonographic examination gave objective pictures of tumour depth. Six specimens were excluded from this examination, and only the presence of tumour cells on specimen margins were analysed. All tumours in patients were excised radically; in control group tumour cells were present on pathohistological specimens margins of six cases. In comparison p = 0.5016 was a not significant value. Success of 100% of specimens correctly excised in operated patients is the success which is very close to success of Moh's micrographic surgery (by Fleming only 1% of tumour relapse in a five-year follow-up period) [8]. Result of 13.33% of incorrect excision in control group is close to results obtained by Leshin and al [9]. Result of p = 0.05016 is not statistically significant, but is very close to statistically significant values. This might require future examinations in a larger group of patients. Results of R = 0.64 correlate with results obtained by Hoffmann [3], because they show that highfrequencies ultrasound examination gives an objective picture of skin tumours depth. Results of this examination show that preoperative highfrequencies ultrasound examination can determine the progression of tumour depth, and give to surgeon data which can help him to perform correct surgical excisions.

Basal Cell Carcinoma↗
PubMedDate not supplied

Evaluation of humeral head replacements using time-action analysis.

New surgical technologies are often introduced without objective evaluation of their efficiency. Commonly, their results are only related to surgical outcome and complication rate. In this study, time-action analysis was applied to evaluate the per-operative process and to measure surgical performance during 8 humeral head replacements. An overview of the operative theater and a detailed view were recorded on video simultaneously. The duration and number of actions grouped to functions, limitations, and repeated actions were determined. The duration and number of performed actions varied between procedures. The efficiency of the procedure, defined as the percentage of goal-oriented functions, was about 55%. Repeated actions were frequently observed during the alignment and insertion phase. We conclude that time-action analysis can be used to evaluate surgical performance objectively. Limitations of the surgical process that can be improved could be identified. These findings enable the evaluation of new operative techniques, protocols, and instruments.

Arthroplasty, Replacement↗
PubMed2000

A comparative experimental study evaluating the performance of surgical robots aesop and endosista.

The aim of this study was to experimentally assess and compare the accuracy of the surgical robots Aesop and Endosista as camera holders for use in laparoscopic surgery. The performance of these two robotic systems was examined for linear (upwards, downwards, diagonal), complex, and "in and out" movements using laparoscopic training boxes. Standard distances and tests were used for each system, and the time required to achieve each task was measured. The majority of the linear movements of the verbal and preprogrammed modes of Aesop were quicker than those of Endosista. Diagonal movements were significantly faster with the preprogrammed-mode Aesop. Complex or three-dimensional movements were also significantly faster with both modes of Aesop than with Endosista. Under the experimental conditions, Aesop, particularly in the preprogrammed mode, is quicker and more accurate than Endosista.

Evaluation Studies as Topic↗
PubMedDate not supplied

Risk-adjusted monitoring of binary surgical outcomes.

A graphical procedure suitable for prospectively monitoring surgical performance is proposed. The approach is based on accumulating evidence from the outcomes of all previous surgical patients in a series using a new type of cumulative sum chart. Cumulative sum procedures are designed to "signal" if sufficient evidence has accumulated that the surgical failure rate has changed substantially. In this way, the chart rapidly detects deterioration (or improvement) in surgical performance while not overreacting to the expected fluctuations due to chance. Through the use of a likelihood-based scoring method, the cumulative sum procedure is adapted so that it adjusts for the surgical risk of each patient estimated preoperatively. The procedure is therefore applicable in situations where it is desirable to adjust for a mix of patients. Signals of the chart lead to investigations of the cause and to the timely introduction of remedial measures designed to avoid unnecessary future failures.

Cardiac Surgical Procedures↗
PubMed2003

Depth cue reliance in surgeons and medical students.

BACKGROUND: Depth perception is reduced in endoscopic surgery, although little is known about the effect this has on surgical performance. METHODS: To assess the role of depth cues, 45 subjects completed tests of depth cue reliance. Surgical skill was assessed using the Minimally Invasive Surgical Trainer-Virtual Reality, a previously validated laparoscopic simulator. RESULTS: We could demonstrate no difference in cue reliance for three depth cues--namely stereo, texture, and outline--between surgeons and medical students. Greater dominance on stereo for medical students was a positive finding and a negative finding for the surgeons when correlated with surgical performance. CONCLUSIONS: We suggest that surgeons learn to adapt to the nonstereo environment in MIS, and this is the first study to show evidence of this phenomenon. This difference in stereo reliance is a reflection of the experience that surgeons have with laparoscopy compared with medical students, who have none.

Adult↗