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PubMed1978

Intracranial saccular aneurysms--surgical results of 1,000 consecutive cases.

The results of our surgical treatment of 1,000 patients with intracranial saccular aneurysm were analyzed with special consideration for age, site of aneurysm, preoperative condition and operative timing. The results on discharge were as follows: 543 cases, excellent; 186, good; 117, fair; 93, poor; and 61, dead. About three-fourths of the cases except for 23 cases of vertebrobasilar aneurysm showed either excellent or good result. The mortality rate became worse with aging. The results fairly correlated with the preoperative grades by Hunt and Hess (1968), but the cases of Grade Ia were unexpectedly worse. The timing of operation influenced the mortality rate; especially, the cases operated within 3 to 7 days following the last subarachnoid hemorrhage bore poor results. Follow-up studies revealed that excellent and good cases increased and poor cases decreased. The mortality rate for each year decreased annually to 2% in 1975. This improvement may be attributed to the advancement in the operative management with supplementary procedures and in the treatment for cerebral angiospasms and general condition.

Adult↗

PubMed1990

[The dynamic hip screw in comparison with Ender nailing].

Mainly the Ender, Simon-Weidner nailing and the dynamic hip screw (DHS) of the AO compete along with other procedures for the treatment of proximal femur fractures by elderly individuals. The opportunity was taken to control the operative strain and postoperative development of 51 patients with Ender-nailing and 45 patients with DHS from the years 1985 to 1987. Prompt ability to walk and full load bearing capability is obtained by both procedures. Both procedures have slight strain due to operating time and operative trauma. Specific technical complications such as wandering of the nail and defective external rotational positioning were found mainly by the Ender-nailing. Reoperations were necessary in a few cases. The complication rate could be sunk further through the application of the DHS.

Aged↗

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↗

PubMed1981

Technique of internal suspension for transverse fractures of the middle third of the face.

A simplified technique for craniofacial fixation is suggested that has many advantages in terms of short operative time, small operative trauma, and reduced postoperative inconvenience. Although it acts on the same structures as the procedure of Adams and its modifications, the proposed technique also has the advantages of anterior craniofacial fixation and the maxillomandibular fixation already described.

Facial Bones↗

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↗

PubMed1994

[Laparoscopic-assisted colectomy].

After gaining experience in laparoscopic cholecystectomy, laparoscopic appendectomy and other laparoscopic procedures, we decided to perform laparoscopic-assisted colectomy. During July 1992 to February 1993 we performed 14 such procedures. Ages ranged from 46-83 years (mean, 68). In all cases the indication for surgery was neoplasm of the colon. 8 of the tumors were located in the right colon and 6 in the sigmoid. Procedures performed were laparoscopic-assisted right hemicolectomy with a biofragmentable anastomotic ring or laparoscopic-assisted sigmoidectomy with end-to-end anastomosis. In 1 operation we combined laparoscopic cholecystectomy with laparoscopic right hemicolectomy. Operation time varied from 90-130 min (mean, 100 min). In our opinion the procedure is as radical as standard laparotomy with the number of lymph nodes per specimen ranging from 4-10 (mean, 7); the surgical margins were free of tumor in all cases. There was less pain in the postoperative period than with the standard procedure and the average time from operation to discharge was 7 days (range, 5-9). Complications included 1 fatality due to postoperative myocardial infarction, and 1 case of duodenal perforation which was sutured during the operation. We conclude that laparoscopic-assisted right hemicolectomy and laparoscopic sigmoidectomy are feasible for carcinoma, and that recovery is quicker and with less pain. However, we need a larger series and long-term follow-up to conclude whether the laparoscopic assisted technic is an adequate operation in cases of cancer.

Aged↗

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↗

PubMed1995

The laparoscopic learning curve.

To characterize the learning curve for laparoscopic cholecystectomy, we compared the first 47 cases (group A), which were performed by two senior attending surgeons who assisted each other when the procedure was introduced into clinical practice (1990-1991), with the first 46 cases (group R) performed by two surgical chief residents who were assisted by members of the teaching faculty in 1992-1993. The patient groups were comparable in terms of age, sex, and anesthetic class, but pathologically proven acute cholecystitis was more common in group R (33% vs. 9%; p < 0.005). To analyze operative procedures and outcomes, we compared operative time, frequency of successful operative cholangiography (attempted in all cases), frequency of conversion to open cholecystectomy, major complication rate, and days of postoperative stay for all patients and for those without complications. Of these parameters, only operative time for nonacute cases differed significantly between the groups (144 min for group A vs. 114 min for group R; p < 0.05). Complications in group A included one ductal injury and one case of postoperative pancreatitis; group R had one ductal injury and two cases of postoperative bleeding. We conclude that (a) the learning curve has similar structure for senior surgeons and resident trainees; and (b) the resident learning curve is not hazardous when teaching assistants are trained in the procedure, which has implications for safe instruction and proctoring of residents and staff.

Acute Disease↗

PubMed1996

Acute cholecystitis treated urgently by nonselective laparoscopic cholecystectomy.

Beginning in 1990, all patients encountered by the author requiring cholecystectomy were attempted by laparoscopy. This study reports the results of 83 patients with acute cholecystitis who were urgently treated, nonselectively, by laparoscopic cholecystectomy. Acute cholecystitis was diagnosed clinically by the presence of right upper quadrant peritoneal pain, gallbladder phlegmon and fever, and/or increased white blood cell count. In addition, a confirming pathology report and/or elevated white blood cell count was present in all 83 patients. Age ranged from 18 to 82 years with an average of 39.4 years. Fifteen patients were male and 68 female. Insufflation was obtained in all patients without a complication. Discharge occurred by postoperative Day one for 24 patients, Day two for 66 and by Day three for 75 patients (range 19-300 hours). No patient had common duct stones. Most patients had stones impacted in the cystic duct, including one patient who had Mirizzi's syndrome. Operative time ranged from 28 to 300 minutes, with an average of 106.3 minutes. No conversion to open cholecystectomy was required. Complications included bile spillage in five patients, stone spillage in ten, and ileus in three patients. One patient with Mirizzi's syndrome required a postoperative radiological procedure for removal of a cystic duct stone remnant that was not completely removed at the time of operation. The high complication rate initially associated with laparoscopic cholecystectomy probably resulted from violating cardinal principles of surgery, not from the inappropriateness of laparoscopy. In conclusion, it is recommended that urgent laparoscopy is an appropriate initial approach for patients with acute cholecystitis.

Acute Disease↗

PubMed1996

Laparoscopic appendectomy: comparison with open appendectomy in 720 patients.

We conducted a review of laparoscopic appendectomies (LA) and open appendectomies (OA) over a 3-year period, including 720 patients (253 LA, 467 OA) who underwent appendectomy during the study period. Computer records were reviewed with respect to demographics, length of stay, operating room time, operating room cost, hospital cost, and morbidity. All patients were sent surveys to assess their posthospitalization recovery. The LA patients had significant shorter hospital stays (2.06 days vs. 3.44 days, p < .001), lower morbidity rates (5 vs 14%, p < .02), and comparable overall hospital costs ($4,800 vs. $4,950). The LA patients also reported less postoperative pain and were able to return to work sooner. Our results show that LA can significantly decrease morbidity and hospital stay with a comparable hospital cost and result in quicker patient recovery.

Adult↗

PubMed1996

[Infrequent application of intraoperative ultrasonography in urology].

Among the usual indications of intraoperative ultrasounds, we describe four infrequent applications that show how useful and powerful this technique could be for interventive urologists. The first case regards a 66 years old male who was affected by a renal metastasis from thoracic cage chondrosarcoma. The use of intraoperative ultrasounds permits to highlight atypical sonographic features of the secondary lesion that were not seen in preoperative radiologic exams and that are completely different from the usual renal lesions. The second case regards the treatment of prostatic abscess performed by echoguided transperineal puncture in which the use of transrectal ultrasound probe permits a precise and correct placement of the needle and the drainage in order to obtain a fast relief of the symptomatology. The third case shows the role of intraoperative ultrasounds in the localization of a parathyroid adenoma in a 52 years old male affected by primary hyperparathyroidism and with recurrent renal colics. In this case the blind surgical exploration of the parathyroid gland and so the possibility of iatrogenic lesions to the recurrent laryngeal nerve were avoided by the use of the intraoperative sonography for the identification of the adenoma. At the same time the operation times were reduced. The last case underlines the importance of using intraoperative ultrasounds in the real-time monitoring for the creation of the neovagina in sex reassignment surgery in male-to-female transexualism in order to avoid a dangerous postoperative complication represented by the iatrogenic lesion of the rectum during the dissection of the perineal region.

Abscess↗

PubMed1997

[Early repair of ventricular septal rupture in patients over 80 years of age: infarction exclusion technique].

Since 1994, three patients more than 80 years of age underwent early repair of ventricular septal rupture complicating acute myocardial infarction at our hospital. The infarction exclusion technique introduced by David and Komeda was employed. Average aortic clamp time, cardiopulmonary bypass time and operation time were 83 minutes, 129 minutes and 228 minutes, respectively. No hemostatic suture were required to the left ventricular suture line. All patients survived. One patient with posterior ventricular septal rupture had residual shunt and necessitated transient hemodialysis but recovered. Thus, the infarction exclusion technique seems to be useful in the elderly with unfavorable tissue fragility.

Aged↗

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↗

PubMed1994

Timing of ileocolonic resection for symptomatic Crohn's disease--the patient's view.

Eighty patients were asked if they would have preferred their ileocolonic resection and anastomosis for Crohn's disease, to have been carried out sooner, later or at the same time as it was done. Seventy of the patients replied (88%). No patient would have preferred their operation to have been later, while 74% thought it should have been earlier. A preferred operation time was given for 69 resections, between 0 months--that is, at the same time--and 15 years earlier. The median preferred operation time was 12 months earlier (95% confidence intervals 18 months earlier to 7 months earlier). The remaining 18 patients were satisfied with the timing of their operation. Reasons given for earlier surgery in 58 resections included the severity of Crohn's symptoms preoperatively (97%), the ability to eat normally after resection (86%), feeling of well being after the resection (62%), and abolishing the need for drugs (43%). Patients preferring an earlier operation time were less likely to have had a previous resection (13/58) than patients in the 'same time' group (10/21, chi 2 = 4.746; p < 0.05).

Anastomosis, Surgical↗