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At least 19 recordsLinked to original sources
PubMed2000

[Postoperative mortality a university Department of General Surgery: incidence of cardiac-related deaths].

OBJECTIVES: To evaluate the incidence of cardiac deaths following noncardiac nonvascular surgery. STUDY DESIGN: Retrospective survey. PATIENTS: All patients undergoing mainly endocrinous and digestive surgery in a University department of general surgery between 1991 and 1996. METHODS: Analysis of all deaths occurring intra- and postoperatively, until discharge of the patients. Demographic and medical data, including patent myocardial ischaemia and risk factors for coronary artery disease, were recorded and compared with a control group including all patients undergoing surgery from January to September 1996. RESULTS: In the 8,700 patients who underwent mainly endocrine neck surgery (66%), or intra-abdominal surgery (31%), the mortality rate (n = 96) was 1.1% (95% confidence interval [95% CI] = 0.9-1.3%). Patent myocardial ischaemia or high risk factors for coronary artery disease were existing in 24% of patients with neck surgery, 31% of those with intra-abdominal surgery, and in 60% of the deceased patients (P < 0.01 vs control group). Those who died were older, were in a higher ASA physical class, and had undergone an emergency procedure more often than patients of the control group (P < 0.002 for each parameter). Two cardiac deaths, in patients with a patent cardiopathy, were recorded (cardiac mortality: 0.02%; 95% CI = 0.003-0.08%). The main cause of death was infection (n = 46), followed by haemorrhage (n = 12). Seven deaths remained unexplained. CONCLUSION: This study suggests that cardiac morbidity is a rare cause of death after noncardiac nonvascular surgery.

Adult↗
PubMed1999

[Thyroid and parathyroid surgery under hypnosis: from fiction to clinical application].

Since 1992, we have used hypnosis routinely in more than 1400 procedures in plastic surgery. Our clinical success and experience with this technique led us to test wether hypnosis using active patient collaboration, could be used as an effective adjunct to conscious intravenous sedation ("hypnosedation", (HS)) for endocrine surgery, as an alternative to general anaesthesia. On a total of 1905 cervical endocrine surgical procedures performed between 1995 and 1998, 296 thyroidectomies and 33 cervical explorations for hyperparathyroidism were conducted under HS. Conversion to GA was needed in three cases (0.9%). All patients having HS reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the costs of medical care. The postoperative convalescence was significantly improved after HS and full return to social or professional activity was significantly shortened. We conclude that HS is a very efficient technique that provide physiological, psychological and economic benefits to the patient.

Alfentanil↗
PubMed2000

Endocrine surgery.

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Endocrine Surgical Procedures↗
PubMed1997

The physiology of the endocrine system.

Understanding the basic physiology of endocrinology and metabolism is important for the safe conduct of anesthesia of patients with endocrine disease. Full endocrine assessment and considered interpretation of the results is essential before anesthesia and surgery. In this chapter, we have covered the background physiology and the basic investigations that may be required to diagnose and direct treatment in order to optimize perioperative care.

Anesthesia↗
PubMed1999

Hypnosedation: a valuable alternative to traditional anaesthetic techniques.

Hypnosis has become routine practice in our plastic and endocrine surgery services. Revivication of pleasant life experiences has served as the hypnotic substratum in a series of over 1650 patients since 1992. In retrospective studies, followed by randomised prospective studies, we have confirmed the usefulness of hypnosedation (hypnosis in combination with conscious IV sedation) and local anaesthesia as a valuable alternative to traditional anaesthetic techniques. The credibility of hypnotic techniques and their acceptance by the scientific community will depend on independently-confirmed and reproducible criteria of assessing the hypnotic state. Based on the clinical success of this technique, we were interested in confirming this phenomenon in healthy volunteers. The revivication of pleasant life experiences thus served as the cornerstone of a basic research program developed to objectify the neurophysiological attributes of the hypnotic state. We compared hypnosis to normal alertness with similar thought content. In our experience, the activation profile obtained during the hypnotic state was completely different from simple re-memoration of the same subject matter during normal alertness. This represents an objective and independent criteria by which to assess the hypnotic state.

Anesthesia, Local↗
PubMed1998

Endocrine surgery.

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Adrenal Gland Diseases↗
PubMedDate not supplied

[Transnasal transsphenoidal approach to pituitary adenomas].

The results of transnasal transsphenoidal surgery of pituitary adenomas were retrospectively analyzed in a group of 42 patients, 22 females and 20 males, aged 19-70, of average age 43 years. Histopathological examination showed null-cell adenomas in 4, growth-cell in 11, prolactin-cell in 3, adrenocorticotropin-cell in 6, plurihormonal adenomas in 6, craniopharingeoma in 1, metastasis of pulmonary carcinoma in 1, pituitary abscess in 1, and normal pituitary tissue in 9 cases, respectively. Out of 30 patients with adenomas, 21 had macro (> 1 cm) and 9 had microadenomas (< 1 cm). Cerebrospinal fluid leakage (8.7%) and meningitis (6.5%) were the most frequent postoperative complications. There was no operative mortality. Full adenoma recurrence (clinical, hormonal, and radiological) was found in 3, clinical and hormonal in 3, hormonal and radiological in 1, and radiological in 2 patients, respectively. The repeated transsphenoidal surgery was performed in 4 patients. The transnasal transsphenoidal approach is the procedure of choice for surgical treatment pituitary adenomas.

Adenoma↗
PubMed1998

Re-operative surgery for recurrent or persistent primary hyperparathyroidism.

BACKGROUND: While initial surgery for primary hyperparathyroidism, in experienced hands, will result in a cure in 98% of cases, re-operative surgery remains a significant challenge. Because attitudes as to who should perform initial exploration for hyperparathyroidism are significantly different around the world, the approach to re-operative surgery may also vary. The aim of the present study was to examine a local experience of re-operative surgery for recurrent or persistent primary hyperparathyroidism. METHODS: Information on indications for surgery, the procedure performed, pathology and complications of all re-operative procedures for primary hyperparathyroidism in the period January 1962 to December 1996 were obtained from a prospective database. RESULTS: Sixteen patients with persistent (n = 12) or recurrent (n = 4) primary hyperparathyroidism were treated in the unit over the study period. Eight patients had their initial operation within the unit at Royal North Shore Hospital and eight were referred from elsewhere for re-operation. Nine of the 12 patients with persistent hyperparathyroidism were cured by re-operation with failures due to spillage at first operation (n = 1) or failure to find any additional pathology (n = 2). All four patients with recurrent hyperparathyroidism were cured. All the failures occurred early in the learning phase of the unit, with a 100% cure rate for re-operative procedures performed in the last 15 years. The most common finding in patients referred from elsewhere with a failed initial operation was a missed inferior adenoma in association with the thymus. Localization studies had a variable sensitivity, with sestamibi scintigraphy, selective venous sampling and ultrasonography providing the most reliable information. CONCLUSIONS: Re-operative surgery for persistent or recurrent hyperparathyroidism is an uncommon procedure in Australia when compared to major centres in the USA. Successful surgery depends upon experience and an accurate knowledge of the embryology and anatomy of the parathyroid glands.

Adenoma↗
PubMed1999

Surgical technique for vascularized thymus transplantation in mice.

Traditionally, mouse nonvascularized thymus implants have been used to investigate various aspects of thymus function. However, these grafts are easily damaged by ischemia and fail to reproduce the normal anatomy of the thymus. In addition, the function of these grafts has not been fully examined. We have recently developed a vascularized thymus transplant model in mice. The donor operation consists of isolating the right lobe of the thymus and creating a single vascular pathway. In the recipient surgery, end-to-side anastomoses between donor brachycephalic artery and recipient right common carotid artery, and between donor superior caval vein and recipient right external jugular vein, were performed. We performed 10 consecutive isografts in BALB/c mice with a success rate of 90%. The thymus grafts had a normal histology and function. This study illustrates that it is technically possible to transplant a mouse vascular thymus graft. This model has several advantages that make it a useful tool to study many aspects of thymus function. We plan to use this model further to study the potential for induction of tolerance by thymus grafts.

Animals↗
PubMed1994

RETRACTED: Volume loading with hypertonic saline solution: endocrinologic and circulatory responses.

Hypertonic saline solution appears to be an attractive method of volume expansion. In 45 patients undergoing elective aorto-coronary bypass grafting, endocrinologic and circulatory responses to volume loading with hypertonic saline solution prepared in low molecular weight (MW) hydroxyethyl starch (HES) solution (72 g/L NaCl, HES concentration: 6%; MW: 200,000 D; degree of substitution [DS]: 0.5) (HS-HES) was compared randomly to patients who had received low molecular weight HES solution (LMW-HES). A group of patients without volume loading served as a control. Volume was infused to double the low pulmonary capillary wedge pressure (PCWP < 5 mmHg) after induction of anesthesia. Plasma levels of atrial natriuretic peptide (ANP), endothelin, vasopressin, and catecholamines were measured before, during, and after cardiopulmonary bypass (CPB) until the first postoperative day. In addition to systemic circulatory changes, capillary skin blood flow was measured by laser Doppler flowmetry. ANP plasma concentration increased in both volume groups (HS-HES: +79%; HES: +32%), whereas it decreased in the control (-20%). Infusion of HS-HES resulted in an increase in plasma endothelin concentration before and after CPB (from 3 to 6 pg/mL). Five hours after CPB, both treatment groups had higher endothelin plasma concentrations than the control patients (P < 0.05). Epinephrine and norepinephrine plasma levels increased most markedly in the control patients and were highest in the postbypass period in these patients. CI increased most after infusion of HS-HES (+65%) (P < 0.05). In the postbypass period, CI remained significantly higher in both volume groups than in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Natriuretic Factor↗