SEARCH · PubMed Health

Results for “Prophylactic Surgical Procedures”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources

PubMed2006

Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery.

BACKGROUND: Obesity is considered a highly prevalent risk factor for venous thromboembolism (VTE) in hospitalized patients. However, recommendations for VTE prophylaxis in obese patients are not clear. METHODS: To evaluate obesity as a risk factor for VTE in medical and bariatric patients and the efficacy of VTE prophylaxis, we performed a systematic review in MEDLINE, Cochrane Database of Systematic Reviews and LILACS from 1976 to 2006. Evidence was evaluated independently by 2 authors and presented descriptively. RESULTS: Of the 124 studies found, 87 were excluded based on predefined criteria. There is no consensus among studies, but prospective cohorts show that obesity is associated with a higher risk of VTE in medical patients. There is evidence that the risk of VTE exceeds that attributable to the surgical procedure alone in bariatric surgery. Only 6 studies evaluated prophylactic methods (unfractionated heparin, low molecular weight heparin and sequential compression devices) in obese patients. Although these studies have some methodological flaws, they suggest efficacy of VTE prophylaxis in medical and surgical obese patients. CONCLUSIONS: Obesity is a risk factor for VTE in obese medical patients and patients undergoing bariatric surgery. Obesity appears to play an adjuvant role for the development of VTE in hospitalized patients with other risk factors. The small number of prospective trials in this population prevents a definite conclusion about the most effective and safe VTE prophylactic method for obese patients. Thus, randomized clinical trials to compare VTE prophylactic methods in obese patients are still highly warranted.

Bariatric Surgery↗

PubMed2001

Risk-benefit analysis of prophylactic pinning in slipped capital femoral epiphysis.

There is a broad and controversial discussion about the surgical procedure and the type of hardware for internal transfixation of the epiphysis and metaphysis in slipped capital femoral epiphysis (SCFE). Prophylactic pinning is even more controversial. One hundred and nine patients showing SCFE underwent a one-stage bilateral fixation of the epiphysis with three or four Kirschner wires (pins). From these 109 patients (69 male and 40 female), 94 had an unilateral slip and were operated prophylactically on the contralateral side. There were no complications such as avascular necrosis of the femoral head, chondrolysis, bone fracture, failure of metal implant, osteomyelitis or deep wound infection either at the time of surgery or at the minimum follow-up of 1 year with prophylactic pinning in SCFE. Therefore, we consider pinning allows for efficient stabilization, reliably preventing any progression of SCFE on the affected side and, furthermore, prevents the incidence of a secondary slip on the primarily nondisplaced contralateral side. The transfixation of epiphysis and metaphysis with Kirschner wires (pins) shows good subjective and objective long-term results compared with other surgical methods and implants. There is only a low morbidity rate with this method, because reoperations may only become necessary in the younger age group owing to normal growth of the femoral neck, compared with a high benefit from prophylactic surgical treatment of the nonaffected opposite side at the time of unilateral onset of the disease. The pins may no longer catch the epiphysis but further growth will allow for remodeling of the femoral head and for an optimal neck/shaft ratio. In case of further growth and relative shortening of the pins, refixation may become necessary. Therefore, we like to recommend the Kirschner-wire transfixation (pinning) of the epiphysis and metaphysis in patients with SCFE for primary treatment of SCFE as well as for prophylactic pinning of the contralateral side in one sitting.

Acute Disease↗

PubMed1987

Effect of prophylactic intravenous ceftriaxone in maxillofacial surgery.

Cephalosporins are commonly used in maxillofacial surgery because they achieve high concentrations in bone. Prophylactic antibiotic therapy was given to 65 patients undergoing diverse surgical procedures. 20 patients received cefotiam in 2 doses of 2 g for 5 days; 15 patients received cefotiam in 2 doses of 2 g only perioperatively. No difference was found between these two groups with respect to prophylactic protection against infection. A further 15 patients received ceftriaxone in a single dose of 2 g preoperatively. Since we found that local infection and febrile morbidity was not significantly different even in the 'one-shot' group, we investigated the effect of 'low-dose' prophylaxis with only 1 g ceftriaxone preoperatively in another 15 patients. We found that this dose was sufficient to prevent infection in patients.

Adolescent↗

PubMed1975

Indications for prophylactic preoperative insertion of pacemakers in patients with right bundle branch block and left anterior hemiblock.

To determine the need for prophylactic temporary pacing in bifascicular block during surgical and other procedures, a retrospective analysis was carrried out in 38 patients who underwent a total of 74 procedures. The male:female sex ratio was 3.2:1 and mean age was 74 (range 48-96) years. Known organic heart disease was absent in 45 percent of the total group. Patients were divided into four groups on the basis of their preoperative electrocardiograms. Of the 74 procedures, 19 were carried out under general, 22 under spinal and 29 under regional anesthesia; four endoscopic procedures were done without anesthesia. There was only one complication relating to deterioration of AV conduction. It is concluded that asymptomatic patients with right bundle branch block and left anterior hemiblock do not require prophylactic preoperative pacemaker insertion. Though experience is limited, the same may be true of patients with the additional finding of prolongation of PR interval.

Aged↗

PubMed1994

[Antibiotic prophylaxis in thoracic surgery, pulmonary endoscopy, thoracic injuries and lung transplantation].

Effectiveness of prophylactic antibiotics is at present time well documented for many surgical procedures. In lung surgery, numerous randomized double-blinded studies have demonstrated the effectiveness of 1st or 2nd generation cephalosporins, administered over a short period of time, not exceeding 24 h. In the opposite, thoracic injuries do not seem to require prophylactic antibiotics, except penetrating injuries of the chest, which could benefit from a single antibiotic injection. In case of lung transplantation, infectious complications result from many factors, among which immunosuppression plays an important role. A prolonged antibiotherapy is routinely used by many transplantation teams, despite the lack of studies proving the effectiveness of this practice.

Anti-Bacterial Agents↗

PubMed2000

Review article: gall-bladder motility after intestinal surgery.

There is a close relationship in humans between gall-bladder motility and gastrointestinal motility during the fasting state, as well as in the post-prandial period. Only a minority of publications take this relationship into account in the description of biliary dysmotility after various surgical procedures. Most publications deal with post-prandial gall-bladder motility or with stimulation of gall-bladder contraction from various prokinetic drugs or gastrointestinal hormones. Impaired gall-bladder motility has been demonstrated after Billroth II gastric resection, pyloroplasty and colectomy, but the epidemiological data on the risk of gallstone formation in these patients are too scarce and equivocal to recommend prophylactic cholecystectomy. Future studies on gall-bladder motility after surgical procedures should include measurements of gall-bladder motility during the fasting state, as well as in the post-prandial period. The measurements should be related to the migrating motor complexes, and this necessitates a simultaneous recording of gastrointestinal motility.

Cholelithiasis↗

PubMed1999

Preventing postoperative infections: current treatment recommendations.

Surgical site infections (SSI) remain a major source of postoperative morbidity. The preventive effect of antimicrobial drugs on postoperative infections is without debate. The common basis of accepted indications for prophylaxis is available evidence of effect. Valid reasons to administer antimicrobial prophylaxis include a significant reduction of SSI or reducing the risk of SSI in procedures where the consequences of infection are serious or even disastrous. The antimicrobial drug must be effective against pathogens associated with infection after a given procedure. The first generation cephalosporin, cefazolin, has been considered one of the prophylactic drugs of choice in many authoritative guidelines. The optimal timing of intravenous antimicrobial prophylaxis in surgery is considered to be about 30 minutes before incision, i.e. at induction of anaesthesia. A single dose of antimicrobial drugs before the operation is sufficient prophylaxis for most surgical procedures. The development of bacterial resistance is associated with antimicrobial use, and therefore prophylactic antibiotics should be used as little as possible; in addition, the spectrum of activity of drugs used should be as narrow as possible. Although the principles of antimicrobial prophylaxis in surgery have been clearly established, many reports continue to describe inappropriate drug use. Overconsumption in terms of invalid indications or use of drugs with too broad a spectrum of activity should be eliminated by adhering to accepted guidelines. Practical suggestions are given to optimise timing, such as simple reminders on the daily operating programme, the display of prophylaxis regimens according to type of surgery in table format in the operating room and having the anaesthetist note the complete drug regimen on the patient's anaesthesia record. Such measures will help to optimise antibiotic prophylaxis and restrict if to the operating room where it belongs.

Anti-Infective Agents↗

PubMed1988

Combined surgical procedure for the prevention of blindness caused by progressive high myopia.

A combined prophylactic procedure consisting of the strengthening of the sclera by fascia lata implants and the laser photocoagulation of peripheral retinal degenerations has been developed for the prevention of blindness caused by progressive high myopia. More than 7 years of experience gained with over 400 patients showed that none of the treated eyes developed retinal detachment or other severe complications of high myopia. Moreover, the degree of myopia decreased by a mean value of 3.0 D in 90%, and the visual acuity improved by a mean value of 0.15 in 70% of the patients treated. The authors suggest that their combined prophylactic procedure should be tried out and introduced to general ophthalmological practice.

Adult↗

PubMed1987

Prophylactic use of antimicrobial agents in adult patients.

Prophylactic antimicrobial agents are recommended for prevention of a variety of conditions, including tuberculosis, endocarditis, rheumatic fever, recurrent cellulitis and lymphangitis in patients with lymphedema, meningococcal meningitis, bite wounds, and herpes virus infections. In addition, prophylactic antimicrobial agents have proved effective in certain surgical procedures such as a variety of abdominal operations, hysterectomy, and head and neck operations for cancer. Except for oral bowel preparations, administration of antimicrobial agents for prophylaxis should be limited, in general, to the perioperative time period. Doses given more than an hour before or 3 hours after a surgical procedure have not been shown to increase effectiveness, and such an approach increases the cost and the probability of toxicity and superinfection. Investigation of antimicrobial prophylaxis necessitates adequate evaluation of potential advantages and disadvantages in prospective double-blind fashion.

Adult↗

PubMed1989

Antithrombotic drugs in pelvic surgery.

From the discussion, it is clear that several agents are available for the prophylactic antithrombotic management of pelvic surgery. Unlike other surgical procedures, the interventions are performed in women with many physiologic and pathologic predisposing factors. There is an increased risk of bleeding in these patients and the selection of an antithrombotic drug with a high safety to efficacy ratio is imperative. Although the introduction of newer drugs, such as defibrotide and low molecular weight heparins, provides certain advantages over the conventional drugs, large-scale prospective clinical trials are required to justify their use. Combination therapy will also be a useful and more effective approach in the management of pelvic surgical patients. However, optimization of dosage and an empiric determination of the safety and efficacy of different drugs used in combination will have to be made. Newer therapeutic agents will have a direct impact in this area in coming years. The practicing clinician should keep an open mind to provide better patient care.

Female↗

PubMed1977

Peripheral iridectomy in closed angle glaucoma-- late complications.

Of 70 eyes with therapeutic peripheral iridectomy (PI), 51% suffered a loss of two or more lines on the Snellen chart; 57% developed posterior synechiae (PS) and 57% showed lens opacities. Thirty-three per cent of eyes that underwent PI prophylactically had a vision drop of two lines or more, 39% developed PS and 42% showed varying degrees of lens opacities. Although vision drop, lens opacities and PS were less marked in the prophylactic group, it appears that PI is a surgical procedure not without its hazards. We therefore suggest that peripheral iridectomy should not be performed routinely on the second eye not suffering an acute attack. This procedure should be undertaken only in cases with positive provocative tests and/or clinical signs of closed angle glaucoma.

Adult↗

PubMed2004

Cerebral mass lesion due to cytomegalovirus in a patient with AIDS: case report and literature review.

Cytomegalovirus (CMV) disease in acquired immunodeficiency syndrome (AIDS) patients most commonly presents as chorioretinitis and gastro-intestinal infection. Neurological involvement due to CMV may cause several clinical presentations: polyradiculitis, myelitis, encephalitis, ventriculo-encephalitis, and mononeuritis multiplex. Rarely, cerebral mass lesion is described. We report a 39 year-old woman with AIDS and previous cerebral toxoplasmosis. She presented with fever, seizures, and vulval ulcers. Her chest X-ray showed multiple lung nodules, and a large frontal lobe lesion was seen in a brain computed tomography scan. She underwent a brain biopsy through a frontal craniotomy, but her condition deteriorated and she died in the first postoperative day. Histopathological studies and immunohistochemistry disclosed CMV disease, and there was no evidence of cerebral toxoplasmosis, bacterial, mycobacterial or fungal infection. CMV disease should be considered in the differential diagnosis of cerebral mass lesion in AIDS patients. High suspicion index, timely diagnostic procedures (surgical or minimally invasive), and proper utilization of prophylactic and therapeutic medication could improve outcome of these patients.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Accidental displacement of impacted maxillary and mandibular third molars.

Displacement of impacted third molars is frequently mentioned in oral and maxillofacial surgery textbooks, but rarely reported. However, should this complication arise in general practice, the clinician should not embark on potentially complicated and hazardous surgical procedures to retrieve the displaced tooth. Administration of prophylactic broad spectrum antibiotics and urgent referral to an oral and maxillofacial surgeon, is recommended.

Adolescent↗

PubMed1996

[Results of preoperative autotransfusion with ferrous ascorbate prophylaxis in orthopedic surgery patients].

PURPOSE: Restrictive erythropoiesis caused by iron deficiency may hinder pre-deposit autotransfusion in surgical procedures. In order to evaluate the response to prophylactic ferrous ascorbate, a prospective study was conducted on patients subjected to orthopaedic surgery and autotransfusion. PATIENTS AND METHODS: Sixty-eight patients were included in the study: hip prostheses 67%, knee prostheses 25%, other procedures 7.4%. Their mean age was 61.3 +/- 10.2 years, and there were 42% male and 57% female. A mean of 2.8 +/- 0.6 units (450 mL) of blood were drawn to each patient in a month. Starting one week before their first blood donation and up to 2 months after surgery, each patient received 99 mg elementary iron per days as oral ferrous ascorbate. Blood cell counts were done at the beginning of the programme and after the first, second, third and fourth blood withdrawal, as well as one month after finishing the treatment. A survey of iron profile including serum iron, total iron binding capacity, transferrin saturation, serum ferritin and free erythrocyte protoporphyrin was carried out at onset and end of the programme in each patient. All data were analysed with the SPSS-PC 4.0 statistical programme. RESULTS: Haemoglobin rates decreased in every control, returning to values close to the initial ones by the end of the programme (mean figures are as follows: 14.63; 13.17; 12.70; 11.88; 14.11 g/dL); and similar changes were seen with respect to the other parameters of blood. The initial and final values for ferritin were 157.32 and 91.06 ng/mL, respectively, and no significant changes were appreciated in the other data from the iron profile, regardless of the number of blood units collected in a given case. Minor intolerance to ferrous ascorbate appeared in 11% of the patients. No significant differences with control patients were seen regarding hospitalization (16.54 vs 19.82 days) or postoperative fever (14.1% vs 17.11%). CONCLUSIONS: As opposed to others, we feel that iron treatment should be maintained up to 2 months after surgery since better results are thus attained. Recombinant erythropoietin is more expensive a method. Ferrous ascorbate is better tolerated than ferrous sulphate plus additives.

Anemia↗

PubMed1976

[Urate nephrolithiasis. Cause of consequence?].

After World War II the incidence of urolithiasis increased consistently among the general population in this country. Nearly 25% of all examined renal calculi contain uric acid, sodium acid urate or ammonium acid urate as constituents. There are two peaks in lifespan of occurring urate stones: in the adolescence and in the age between 40 and 60 years. The following conditions are due to the formation of uric acid-containing stones: 1. Gout and primary hyperuricemia; 2. secondary hyperuricemia; 3. idiopathic cases with normal renal excretion of uric acid and normouricemia, but with a higher degree of acidity of the urine than normal considering the total renal excretion of acid products; 4. iatrogenic hyperuricemia during insufficient uricosuric therapy. Up to more than 30% of all the patients with recurrent formation of oxalate stones show a clear association with hyperuricemia, hyperuricosuria and increased renal excretion of calcium. In the presence of sodium urate a considerable promotion of precipitation of crystals consisting of calcium oxalate from a meta-stable solution may occur (so-called epitaxy). Frequently the existence of uric acid stones is without any symptoms. Modern views with regard to prophylactic procedures, diet, general and specific medical management including surgical intervention are presented.

Calcium↗

PubMed1988

Hospital survey of antimicrobial prophylaxis to prevent endocarditis in patients with prosthetic heart valves.

The American Heart Association (AHA) has published guidelines for use of prophylactic antibiotics to prevent bacterial endocarditis, but few data are available about physician compliance with these guidelines. A retrospective review was conducted of the use of prophylactic antibiotics in patients with prosthetic heart valves who were undergoing diagnostic or operative procedures or heart catheterization at three hospitals. Compliance with AHA recommendations was only 30 percent (14 of 46) for procedures considered high risk for patients with prosthetic heart valves. Six (23 percent) of 26 patients who underwent right or left heart catheterization received prophylactic antibiotics (not recommended by AHA). Antibiotics were given to 42 (74 percent) of 57 patients who underwent surgical procedures considered at low risk of bacteremia, but only 33 (58 percent) received antibiotics that cover organisms commonly present at the site of the procedure. The results indicate that clinicians frequently do not administer prophylactic antibiotics in patients with prosthetic heart valves who are undergoing invasive procedures or do not follow published AHA guidelines when antibiotics are administered.

Adult↗

PubMed1995

A perspective on the use of FVIII concentrates and cryoprecipitate prophylactically in surgery or therapeutically in severe bleeds in patients with von Willebrand disease unresponsive to DDAVP: results of an international survey. On behalf of the Subcommittee on von Willebrand Factor of the Scientific and Standardization Committee of the ISTH.

An international registry was established by the Subcommittee on von Willebrand Factor of the SSC/ISTH on the treatment of patients with types of von Willebrand disease (vWD) unresponsive to DDAVP infusion. Data was collected on 76 surgical events in 64 patients from 19 treatment centers. Thirty-three non-mucosal, 12 mucosal, 10 orthopedic and 21 dental procedures were reported. In the 76 surgical events, 14 cases prophylactically received cryoprecipitate while 62 received factor VIII (FVIII) concentrate. Surgical hemostasis was reported as satisfactory, good, or excellent in 75 of the 76 cases. Post-infusion bleeding times were measured in only three of 14 surgical events treated with cryoprecipitate. All three cases had a reduction but not correction of the bleeding time. The post-infusion bleeding time was measured in 27 of 62 cases in which FVIII concentrates were used. The bleeding time time was normalized in 15, reduced but not normalized in eight, and not changed from baseline in four. Data was also collected from 16 treatment centers on 50 serious bleeding events in 35 patients. These included 19 gastrointestinal, 15 other mucosal, four central nervous system, seven orthopedic, and five other mucosal, four central nervous system, seven orthopedic, and five other bleeds. Eleven cases received cryoprecipitate and 39 received FVIII concentrate as primary therapy. The efficacy of treatment was considered good or excellent in 49 of 50 cases. Post-infusion bleeding times were measured in only 15 of the 50 reported bleeding events. The post-infusion bleeding time was normalized in six, decreased but not normalized in eight, and not changed from baseline in one. In this retrospective survey, FVIII concentrates were subjectively as efficacious as cryoprecipitate in both the surgical setting and for the treatment of severe bleeds in patients with types of vWd unresponsive to DDAVP. Since the bleeding time was monitored during therapy in only a minority of these cases, a definitive relationship between the efficacy of therapy and normalization or reduction of the bleeding time in these two clinical settings cannot be established from this study. A prospective study on the use of FVIII and/or vWf concentrates in these clinical settings is necessary to address this issue.

Cryoglobulins↗

PubMed2002

Technical difficulties and perioperative complications of retrogasserian glycerol rhizotomy for trigeminal neuralgia.

In 139 patients, 260 consecutive retrogasserian glycerol rhizotomies for trigeminal neuralgia were retrospectively analyzed regarding technical surgical difficulties and immediate and early complications. Technical obstacles occurred in 47.3%. In 21 cases (8.1%), the surgical procedure had to be interrupted due to circumstances such as vasovagal reactions, cardiac arrest, or difficulties to find the trigeminal cistern. Complications or side effects, being either transient or persistent, occurred in 67.3%. In the vast majority, those unwanted effects were related to mild sensory deficits. However, in 28.1% the complications were other than mild affection of facial sensibility. These slightly graver complications included labial herpes (3.8%), anesthesia dolorosa (0.8%), moderate or severe affection of sensibility (18.8%), dysesthesia (22.7%), chemical meningitis (1.5%) and infectious meningitis (1.5%). In 5 patients (1.9%) hearing was affected. In one of them, this condition was also brought about by tinnitus, and in another patient a preexisting tinnitus deteriorated. Although the frequency of surgical difficulties was high, the success of the glycerol injection was hampered only in a minor number of procedures. The frequency of complications and side effects was high, but they were mostly mild due to their nature and non-disabling for the patient. However, long-lasting disabling side effects occurred, and this should not be neglected when informing patients preoperatively. The surgical training needed to perform the procedure is stressed, and the use of prophylactic antibiotics when accidentally penetrating the oral bucca is recommended. We consider retrogasserian glycerol rhizotomy to be a good surgical option for patients with trigeminal neuralgia not suitable for microvascular decompression and when pharmacological therapy is not sufficient or is not tolerated.

Blood Loss, Surgical↗