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At least 19 recordsLinked to original sources
PubMed1991

Acute subdural hematoma: morbidity, mortality, and operative timing.

Traumatic acute subdural hematoma remains one of the most lethal of all head injuries. Since 1981, it has been strongly held that the critical factor in overall outcome from acute subdural hematoma is timing of operative intervention for clot removal; those operated on within 4 hours of injury may have mortality rates as low as 30% with functional survival rates as high as 65%. Data were reviewed for 1150 severely head-injured patients (Glasgow Coma Scale (GCS) scores 3 to 7) treated at a Level 1 trauma center between 1982 and 1987; 101 of these patients had acute subdural hematoma. Standard treatment protocol included aggressive prehospital resuscitation measures, rapid operative intervention, and aggressive postoperative control of intracranial pressure (ICP). The overall mortality rate was 66%, and 19% had functional recovery. The following variables statistically correlated (p less than 0.05) with outcome; motorcycle accident as a mechanism of injury, age over 65 years, admission GCS score of 3 or 4, and postoperative ICP greater than 45 mm Hg. The time from injury to operative evacuation of the acute subdural hematoma in regard to outcome morbidity and mortality was not statistically significant even when examined at hourly intervals although there were trends indicating that earlier surgery improved outcome. The findings of this study support the pathophysiological evidence that, in acute subdural hematoma, the extent of primary underlying brain injury is more important than the subdural clot itself in dictating outcome; therefore, the ability to control ICP is more critical to outcome than the absolute timing of subdural blood removal.

Accidental Falls↗
PubMed1991

Preoperative localization of parathyroid tumours does not reduce operating time.

Accurate preoperative localization of abnormal parathyroid glands might be expected to result in a reduction in operating time. To test this hypothesis the duration of surgery was recorded in a consecutive series of 50 patients who underwent neck exploration after preoperative localization by thallium-201 and technetium-99m subtraction scanning and were found to have parathyroid tumours. A total of 34 patients had accurate localization by the scan, and these patients had a median operating time of 90 min. When the tumour had not been localized before operation, the median operating time was not significantly different (80 min). Accurate preoperative localization of parathyroid tumours does not reduce operating time.

Humans↗
PubMed1990

Blood loss, operating time, and positioning of the patient in lumbar disc surgery.

Many textbooks and papers on lumbar disc surgery still, nearly 40 years after the first description of a variant of the kneeling position, pay no attention to the positioning of the patient. In this study, the association between intraoperative blood loss, operating time, and position of the patient was studied in 436 patients undergoing a standard macrosurgical operation for lumbar disc herniation. Prone position on bolsters was used in 216 cases, 192 of which were primary operations, and a frame-supported kneeling position in 220, 203 of which were primary operations. The mean blood losses in prone versus kneeling positions in the primary operations were 376 ml and 150 ml, respectively (P less than 0.001), and the mean operating times were 74 minutes and 52 minutes, respectively (P less than 0.001). The 99% confidence interval for the difference between the mean operating times was from 15 to 29 minutes. A moderate nonlinear positive correlation was found between intraoperative blood loss and operating time. No intraoperative complications attributable to the position of the patient emerged. On the basis of the findings in this study, the use of kneeling position is strongly advocated.

Adult↗
PubMed1990

[Clinical study on developmental hydrocephalus and its operative timing in lumbo-sacral meningomyelocele].

Nine infants with lumbo-sacral meningomyelocele were evaluated in the diagnosis and the operative timing of hydrocephalus. Seven cases received early operation for meningomyelocele within 36 hours after birth. Two cases with closed meningomyelocele were operated on 8 days and 32 days after birth. All of them were not infected in the central nervous system before and after its surgery. Five out of nine cases had rapidly developed hydrocephalus within a few weeks, and received ventriculo-peritoneal shunt (Shunt group: Case1-5). Two cases with gradual enlargement of the lateral ventricles and two cases with normal development have been observed without shunt procedure (Non-shunt group: Case 6-9). The authors recorded the head circumference, Evans' index on CT, and intracranial pressure of those infants at birth and following days. The head circumference at birth was almost within a normal size in both groups. On the other hand, an average of Evans' index in shunt group at birth was greater than that of non-shunt group. Moreover, the growth rate of head circumference and lateral ventricle of shunt group were more markedly increased than that of non-shunt group. The head circumference and the ventriculomegaly on a computed tomography at birth were poor prediction of hydrocephalus, however, there was positive correlation between the rate of head growth and the rate of hydrocephalic development. That is to say, the growth rate of a head circumference and growth of Evans' index suggested the prediction of a progressing hydrocephalus during the first few weeks.

Cephalometry↗
PubMed1989

[Traumatic cervical myelopathies. Effect of the operative timing and systemic complications on the functional outcome].

Results concerning 42 (38 males-2 females) cervical vertebro-medullary traumas are described in which early surgery was undertaken. 24.3% were operated within 24 hrs from trauma; 45% between 24 hrs and 7 days; 26% more than 7 days after: 69.3% during first week. Six patients died (5 of grade 1 in accordance with Sunnibrook; 1 of grade 2) within 30 days after trauma (5 during first week after surgery). These patients had more frequent systemic complications (56% respiratory and cardio-vascular insufficiency). Total mortality during one year was 22.7%. The neurological and rehabilitation observations support the opinion that early operated patients limitedly improved.

Adult↗
PubMed1992

Limited incision cholecystectomy.

Eighty-one consecutive cholecystectomies were retrospectively reviewed; five were dropped because of incomplete data. The remaining 76 were divided into group A, patients who underwent a limited incision cholecystectomy (LIC) defined as less than 10 centimeters, and group B, those who underwent a standard subcostal incision (STD). An STD was used for 18 patients in 1984 and an LIC for subsequent patients unless anatomy dictated extension of the incision for safe surgical exposure. The groups were evaluated for possible benefits and disadvantages of the LIC approach. Multivariate analysis was done to contrast the approaches regarding operative time, operative and postoperative complications, postoperative pain, and hospital stay. The operative time was comparable between the two groups. The LIC approach was superior with less postoperative pain and shorter hospital stay. There were no intraoperative complications or mortality in either group. The postoperative complications were also comparable. No differences were noted in body size, weight, sex, or whether the patient was suffering from acute or chronic disease. The limited incision cholecystectomy can be utilized in the majority of patients with cholecystitis without added operative time or complications when compared to the traditional approach. The benefits of less postoperative pain, shorter hospital stay and better cosmetic results afford a higher degree of patient acceptance. This procedure should be considered when open cholecystectomy is required.

Cholecystectomy↗
PubMed1991

Penetrating injuries to the stomach.

The charts of 298 consecutive patients with penetrating gastric injuries were reviewed. Mechanisms of injury were gunshot wounds in 167, stab wounds in 107 and shotgun wounds in 24. Twenty-eight patients died within 24 hours and 27 patients had serosal injuries. These patients were excluded from the study. The morbidity of gastric injury was defined in 243 patients. The probability of morbidity from the gastric wound was assessed by a multivariate analysis of 11 factors, including number of associated injuries, amount of contamination, age, mechanism of injury, shock, thoracostomy tube, injury to operation time, operative time, blood replacement and injury to the diaphragm or colon. Extensive complications developed in 65 patients. Eleven patients died. The gastric injury was directly associated with 15 extensive complications: ten instances of empyema after gastric and diaphragmatic injuries, two instances of gastric repair breakdown, gastric repair bleeding requiring exploration, a missed gastric injury and one instance of gastric outlet obstruction. One patient died of sepsis after breakdown of the gastric repair. Complications were statistically associated with age, gunshot wounds and the use of 2 or more units of blood. Other factors did not statistically increase complications. The 12.5 per cent empyema rate (ten of 81 patients) with gastric and diaphragmatic wounds was unexpected, but not statistically significant. Morbidity from penetrating gastric injuries is secondary to technical and infectious complications. Age, mechanism of injury and blood transfusion correlated with morbidity. The increased incidence of empyema suggests consideration of pleural lavage in combined gastric and diaphragmatic injuries.

Chi-Square Distribution↗
PubMed1991

The bottom end. Handling of the perineal wound after abdominoperineal resection.

There are a number of options for handling the perineal wound following abdominoperineal resection, including open packing or primary closure with suction drainage. Open packing has not been widely accepted, fearing that it may delay perineal wound healing. The purpose of this paper, therefore, was to retrospectively evaluate, the experience at Ferguson Hospital with abdominoperineal resection from 1977 through 1986. The study population consisted of 288 patients undergoing abdominoperineal resection for rectal adenocarcinoma. Forty-six patients had the perineal wound closed primarily and 242 had the perineal wound packed open. Ninety-four patients had the pelvic peritoneum left open and 194 underwent closure of the pelvic peritoneum. Overall operative mortality was 2.1 per cent, and there was no significant difference between primary closure and open packing of the perineal wound with respect to hospital stay, operating time, operative blood loss, perioperative mortality, incidence of postoperative bowel obstruction, incidence of postoperative complications, or average time for perineal wound healing. Therefore, it would appear that packing the perineal wound following abdominoperineal resection is a viable means of handling the bottom end.

Adenocarcinoma↗
PubMed1992

Radical hysterectomy for treatment of cervical cancer: a prospective study of two methods of closed-suction drainage.

Two closed-suction drainage methods were prospectively compared in 96 patients after radical hysterectomy with pelvic lymphadenectomy in stage IB cervical cancer. In group 1 (n = 49) two pelvic sidewall drains and a vaginal drain were used, and in group 2 (n = 47) only the vaginal drain was used. The groups were similar for mean age, preoperative weight, hemoglobin and serum albumin level, operating time, operative blood loss, and blood transfusions. The febrile morbidity rates and the operative site infection rates were similar in the two groups. Ninety vaginal drains were removed by day 3. By day 6 55% of patients in group 1 had at least one sidewall drain, with a mean drainage of 150 ml/day. The median postoperative stay was similar in both groups. A pelvic lymphocyst developed in one patient in each group. The single vaginal closed-suction drain is safe, efficient, more acceptable to patients, and more cost-effective.

Adult↗
PubMed1990

En bloc simultaneous pancreas and kidney allotransplantation in the pig.

The pig is a large animal suitable for experimental pancreas transplantation due to its anatomy and transplant immunology, both of which are similar to humans. We established a model of en bloc simultaneous pancreas and kidney transplantation that decreases preservation time, operation time, and clamp time. The donor aorta--with celiac axis, superior mesenteric artery, and left renal artery--is anastomosed en bloc to the recipient's aorta in a side-to-oblique fashion. The portal vein is anastomosed end-to-side to the distal vena cava, and the left renal vein end-to-side to the left common iliac vein. The donor duodenum is anastomosed to the bladder to allow monitoring of the urinary amylase for rejection. En bloc transplantation is preferable for separating pancreas and kidney anastomoses in pigs. This technique could be used in humans, especially in adult uremic diabetic patients who receive a combined pancreas/kidney transplant from a pediatric cadaver donor.

Anastomosis, Surgical↗
PubMed1991

A clinical pilot study combining surgery with intraoperative pelvic hyperthermochemotherapy to prevent the local recurrence of rectal cancer.

Intraoperative pelvic hyperthermochemotherapy (IOPHC) with mitomycin C (MMC) was prescribed for 14 patients with resectable advanced rectal cancer in an attempt to prevent a postoperative local recurrence. Immediately after rectal amputation and extended lymphadenectomy, IOPHC was performed using physiologic saline containing 40 micrograms/mL of MMC at 45.5 +/- 0.6 C for 90 minutes, with an apparatus devised for IOPHC. At the end of IOPHC, the esophageal temperature was 37.2 +/- 0.8 C and cooling was not required. Antitumor efficacy and complications in the IOPHC group were compared with findings in 12 rectal cancer patients who underwent surgery only within the same period of time. Operation time was not prolonged with IOPHC treatment. In cytologic examinations of the pelvic lavage just before IOPHC treatment, viable cancer cells were detected in 6 of the 14 patients but were never detected in the postoperative exudate drained from the pelvic cavity. Of the 12 patients in the control group, 2 had a local recurrence, while in the IOPHC group there was no local recurrence for 16.9 +/- 9.7 months at this writing. Postoperative complications did not differ between the groups. This IOPHC treatment is a favorable method in eradicating cancer cells for postoperative local recurrence of rectal cancer.

Aged↗
PubMed1991

Role of quinsy tonsillectomy in the management of peritonsillar abscess.

Peritonsillar abscess (PTA) is the most frequent complication of acute tonsillitis requiring surgical intervention. Debate continues concerning optimal therapy in terms of patient morbidity and cost-effectiveness. A retrospective study was performed on 45 tonsillectomies for PTA in military personnel from December 1986 through December 1988. Twenty-three quinsy (abscess) tonsillectomies and 22 interval tonsillectomies were identified. Parameters studied were age, sex, abscess location, interval prior to operation, blood loss, operative time, operative experience, and combined hospital and convalescent days for the two groups. Significant differences were noted between the quinsy and interval tonsillectomy groups concerning the average number of days hospitalized (3.0 versus 4.5) and their respective convalescent periods (10.3 versus 17.3). We conclude that quinsy tonsillectomy is the best management for PTA in a young work force when the optimal treatment choice is between interval or acute tonsillectomy.

Adolescent↗
PubMed1992

[Simultaneous en-bloc allotransplantation of pancreas and kidney in the animal model. Comparison of separate organ and en-bloc pancreas/kidney transplantation in swine].

The high technical complication rate of pancreas transplantation requires large animal models to improve clinical transplant survival rates. The pig is a very suitable animal due to its anatomy, physiology and immunology which are similar to humans. In this study a model of en-bloc simultaneous pancreas and kidney transplantation was established which--in contrast to separate transplantation of both organs--decreases preservation time, operation time, and clamp time. Furthermore, the rates of intra- and postoperative complications were reduced compared with separate transplantation. The donor aorta (encompassing celiac axis, superior mesenteric artery, and left renal artery) is anastomosed en-bloc to the recipients aorta in a an oblique-to-side fashion. The portal vein is anastomosed end-to-side to the left common iliac vein. The exocrine pancreatic secretions are drained via duodenocystostomy to allow for monitoring of urinary amylase for rejection. The en-bloc technique is an alternative for pediatric donor organs since the risk of vascular complications is lower compared with separate implantation of the donor vessels. Based on our results in a large animal model the en-bloc technique could be used in adult uremic diabetic patients who receive a combined pancreas-kidney transplant from a pediatric cadaver donor.

Amylases↗
PubMed1992

Radical breast surgery with a contact Nd:YAG laser scalpel.

The use of a contact Nd:YAG laser scalpel during radical and modified radical mastectomy was evaluated in 18 patients with carcinoma of the breast. The laser scalpel performed well as a haemostatic tool, the associated mean blood loss for modified radical mastectomy being 132 ml. Operating time, operative blood loss, laser energy required and postoperative wound drainage were all related to patient obesity, correlating significantly with body weight and/or breast weight. The incidence of axillary seroma was not reduced by laser surgery and occurred in 53% of patients undergoing modified radical mastectomy. The Nd:YAG laser scalpel is an excellent haemostatic tool but it does not appear to have any other advantages over conventional surgery for mastectomy.

Adult↗