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At least 19 recordsLinked to original sources
PubMed1978

[End-to-side mesenteric caval in children - significance of blood flow physics in defining the surgical procedure preoperatively (author's transl)].

Elevated blood pressure of the portal circulation in children may be lowered to defined levels by end-to-side shunting of the mesenteric and the portal vein. The question is, whether an optimal geometry of the ellipsoid anastomosis can be calculated preoperatively. A simplified model of the shunt system is presented using electric and hydraulic analogs of the real blood flow physics. It is not taken into account in this model, that there are two capillary beds connected in series in the portal circulation, which both exhibit high blood flow resistance. Shunt resistance as being calculated on the basis of this model in 6 children, and real shunt resistance as being measured in these patients intraoperatively actually turned out to be in the same order of magnitude inspite of the handicaps of the model. Thus to our opinion the calculations presented are suited to determine preoperatively the optimal geometry of an ellipsoid shunt anastomosis intended to lower blood pressure in the portal circulation to levels as desired.

Arteriovenous Shunt, Surgical↗
PubMed1987

Parathyroid imaging: its current status and future role.

The management of autonomous (primary or tertiary) hyperparathyroidism is controversial for two important reasons: (1) Diagnosis of primary or tertiary hyperparathyroidism (as distinct from reactive or secondary hyperparathyroidism) has been revolutionized in the past 20 years as a result of routine inclusion of serum calcium concentration assays in serum multiautomated analysis, now obtained routinely for both hospitalized as well as ambulatory patients. The prevalence of primary hyperparathyroidism in the general population has appeared to rise as a consequence of this assay and the enhanced detection of this disease. This situation has confused the management of hyperparathyroidism since most patients now present with asymptomatic disease, and the need for surgical treatment is controversial in asymptomatic individuals. (2) Primary hyperparathyroidism usually is caused by hypersecretion of parathyroid hormone by an autonomously functioning parathyroid adenoma. In a small percentage of cases, multigland hyperplasia is present. In experienced hands, surgical removal of an adenoma within the thyroid bed cures the hyperparathyroidism 90% to 95% of the time, without performance of a preoperative procedure to localize the adenoma. Approximately 10% of parathyroid tissue is ectopic in location, however. Furthermore, approximately two thirds of "missed" adenomas are within the thyroid bed. Reexploration in the event of a failed operation therefore is not an uncommon occurrence. Parathyroid localization procedures clearly are indicated in patients with primary hyperparathyroidism who have evidence of persistent disease after a failed attempt at surgical cure. In patients first presenting with primary hyperparathyroidism, the need for a localization procedure is less clear, since surgery appears to be successful much of the time without it. Regardless of the nature of the above controversies, surgery for autonomous hyperparathyroidism continues, and localization procedures become more popular. Preoperative localization procedures such as angiography and venography with venous sampling for parathormone are cumbersome and invasive. Noninvasive tests to localize the parathyroid glands have emerged in the past 10 years, including dual tracer radionuclide scintigraphy with 201-thallous chloride and 99m-technetium pertechnetate, high-resolution computer tomography, and fine parts ultrasonography. Dual tracer scintigraphy with thallium and technetium is reported to have a localization sensitivity of 70%-90%. False-negative studies occur primarily in patients with small adenomatous or hyperplastic glands.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed1979

The value of preoperative screening procedures in stage I and II malignant melanoma.

Fifty patients with melanoma (30 with clinical Stage I disease and 20 with clinical Stage II disease) were analyzed retrospectively along with the screening test done prior to surgery. While the value of the chest X ray is unquestioned in preoperative screening, the same cannot be said of liver, brain, and bone scans. The bone marrow biopsy, however, done with a Janshidi needle was of value in detecting one patient with bone-marrow metastases who on examination had clinical Stage II disease and precluded surgery in this same individual. Therefore, we feel that in the preoperative scanning of patients with Stage I or Stage II human malignant melanoma, and especially in the latter, the bone-marrow biopsy should be done routinely in addition to a hematological profile, liver profile, and chest X ray.

Bone Marrow Examination↗
PubMed1990

[Consensus prevention of hospital infections].

Purpose of this consensus development conference held in Utrecht on 19th May, 1989 was to reach agreement on hygienic hand washing and disinfection procedures, preoperative hand disinfection, isolation procedures, implementation of rules and regulations. A working party had prepared 18 statements on these four subjects, with added explanations. The audience which had received this information in advance, was invited to discuss and possibly modify or reject the statements. Agreement was reached about the following: regular washing of the hands of personnel on the wards is useful to prevent hospital infections; this should be done according to an agreed and feasible protocol defining when and how. Disinfection of the hands of care personnel on the wards should be done with 70-80% alcohol with cetiol; for non-infected patients with normal resistance hand washing and hand disinfection are judged equivalent. Hand disinfection procedures are advocated for personnel caring for immuno-compromised or infected patients. Alcohol (70-80%) with added chlorhexidine (0.5%) and cetiol was chosen for preoperative hand disinfection to be applied after a washing session; brushes should be used sparingly. A category specific isolation system was preferred to a disease specific system. Except for air transmitted infections, barrier nursing is usually adequate. It was deemed important to register practical problems before trying to implement the regulations.

Cross Infection↗
PubMed1989

[Treatment results in locally disseminated rectal cancer (based on data from the Armenian SSR)].

Data on rectal cancer morbidity in the Armenian SSR for the last two decades are presented and the causes of high-frequency incidence of advanced tumors are analysed. The results of combined and complex treatment using different preoperative procedures are discussed. High effectiveness of preoperative medium- and large-fractionated irradiation was shown, particularly, in application of cell cycle synchronizing effect of 5-fluorouracil treatment.

Armenia↗
PubMed1991

Perioperative nutritional support.

In selected malnourished patients, perioperative nutritional support can decrease the morbidity and mortality rates associated with major surgical procedures. Preoperative nutritional support should be delivered via the gastrointestinal tract whenever feasible, generally in the form of enteral diets, which can be given via a feeding tube or as a dietary supplement. Patients with a functional gut who cannot eat because of anorexia or upper gastrointestinal tract obstruction are candidates for preoperative tube feedings. Total parenteral nutrition should be the mainstay of nutritional support when the gastrointestinal tract cannot be used adequately. An improvement in nutritional indices (e.g., serum transferrin, lymphocyte count) may be associated with decreased perioperative morbidity, although the strength of this relation is not clear. In the absence of improvement in such indices, the duration of nutritional support required to decrease operative morbidity is unknown. Postoperatively, enteral tube feedings (delivered via a nasojejunal tube or feeding jejunostomy) should be provided to all preoperatively malnourished patients with a functional gastrointestinal tract who are unable to consume adequate calories orally. Postoperative TPN should be reserved for malnourished patients with a nonfunctional gut or for patients who develop a postoperative complication that precludes enteral feeding. Current nutritional formulas have often neglected the metabolic and nutritional requirements of the intestinal tract. In the future, the combined use of specific nutrients and growth factors may improve nutritional rehabilitation in catabolic patients.

Enteral Nutrition↗
PubMed1989

Effects of sensory and procedural information on coping with stressful medical procedures and pain: a meta-analysis.

A meta-analysis of studies on preparation for medical procedures and pain evaluated the relative effects of sensory; procedural, and combined sensory-procedural preoperational information on coping outcomes. Results indicated that, in contrast to sensory information, procedural information provided no significant benefits over control group instruction. Combined sensory-procedural preparation, however, yielded the strongest and most consistent benefits in terms of reducing negative affect, pain reports, and other-rated distress. The meta-analytic results are consistent with the dual process preparation hypothesis, which proposes that the information combination is optimal because procedural details provide a map of specific events while sensory information facilitates their interpretation as nonthreatening. It is concluded that a combined preparation is the preferred clinical option.

Adaptation, Psychological↗
PubMedDate not supplied

Distal calcaneal osteotomy in resistant talipes equinovarus.

In resistant talipes equinovarus deformity, posterior medial release alone may be inadequate. Procedures involving the lateral column are sometimes necessary. Thirty-nine patients were treated by a distal calcaneal osteotomy and plantar fasciotomy. Good results were obtained in 30 of 39 patients; two had fair results and seven of 39 had poor results. Of the lateral column procedures, distal calcaneal osteotomy avoids the articular surfaces and provides for easier rotational positioning and correction of the forefoot. Older patients who have had multiple operations and, potentially, more severe pathology do not do well with this procedure. Preoperative evaluation of certain radiographic parameters is important in patient selection for these procedures.

Braces↗
PubMed1989

[New selection criterion for Fontan procedure: pulmonary artery clamping test and pulmonary vascular resistance in increased pulmonary blood flow].

A new selection criterion for Fontan procedure, pulmonary artery clamping test (PACT) was developed and employed in 13 candidates for Fontan procedure. PACT was aimed to evaluate the response of pulmonary vascular bed to increased pulmonary blood flow and calculate the pulmonary vascular resistance in the increased pulmonary blood flow as a selection criterion for Fontan procedure, preoperatively. After a median sternotomy incision, an electromagnetic flow meter was employed for measuring the pulmonary blood flow (Qp) on the pulmonary trunk. By clamping the left pulmonary artery and the right pulmonary artery, right pulmonary vascular resistance and the left pulmonary resistance in the pulmonary blood flow of Qp were calculated respectively. By means of electrical analogue, right and left lungs were simulated as resistors in parallel. And the equivalent pulmonary vascular resistance Rpc was calculated as the predicted pulmonary vascular resistance in the increased pulmonary blood flow of two times Qp. Fontan procedure was performed in 9 cases with a Rpc of less than 3 unit.m2 with a successful result and no death. Postoperative cardiac index ranged from 2.6 to 3.7 L/min.m2 with a mean of 2.8 L/min.m2. Postoperative pulmonary vascular resistance ranged from 1.6 to 3.2 unit.m2. Postoperative cardiac index was correlated with postoperative pulmonary vascular resistance. And postoperative pulmonary vascular resistance was well correlated with equivalent pulmonary vascular resistance but was not correlated with preoperative pulmonary vascular resistance measured by Fick's method at the preoperative catheterization. In Fontan procedure, the pulmonary blood flow frequently increases to a certain degree postoperatively. And pulmonary vascular resistance is not a static resistance, but a dynamic resistance. Hence, in discussing a pulmonary vascular resistance as a selection criterion for Fontan procedure, the pulmonary blood flow in which the pulmonary vascular resistance stand should be taken into account. Equivalent pulmonary vascular resistance Qpc is a theoretical selection criterion for Fontan procedure and well reflects the postoperative pulmonary vascular resistance. Fontan procedure can be successfully performed with a Rpc of less than 3 unit.m2.

Adolescent↗
PubMed1990

Serum amylase levels after obstetric and gynecologic operations.

The incidence of postoperative hyperamylasemia was evaluated in 131 patients who underwent obstetric and gynecologic procedures. Preoperative and postoperative serum amylase levels were determined in 178 patients who underwent routine surgical procedures. In our sample, we could not document any elevations in serum amylase levels after operations. These findings contradict those of previous reports of a high incidence of postoperative hyperamylasemia after surgical procedures except those performed upon the gastrointestinal tract. Furthermore, in spite of the fact that the female internal genitalia is rich in amylase and that pregnancy is considered a predisposing condition for the development of postoperative pancreatitis, the preoperative and postoperative serum amylase levels were consistently within normal range. We would like to conclude that the manipulation of female internal genitalia, pregnant or not, does not induce hyperamylasemia. Therefore, hyperamylasemia in postoperative gynecologic and obstetric patients should alert the clinician to the possibility of postoperative pancreatitis. We believe that our findings should be confirmed on large samples of patients.

Amylases↗
PubMed1987

The determinants of mortality and morbidity after multiple-valve operations.

The factors predictive of hospital mortality and morbidity after contemporary multiple-valve surgical procedures were identified to develop strategies to improve the results of such procedures. Preoperative, intraoperative, and postoperative information was collected prospectively on 90 consecutive patients undergoing surgical procedures between 1982 and 1984. The operative mortality was 5.6%, and the incidence of postoperative low-output syndrome was 16.7%. Multivariate logistic regression analysis identified tricuspid regurgitation (p less than .03, improvement-of-fit chi square) and the aortic valve lesion (p less than .03) as the independent predictors of postoperative complications (mortality or low-output syndrome). Patients with tricuspid regurgitation and right ventricular decompensation and those with aortic stenosis and left ventricular hypertrophy had limited ventricular functional reserve and faced an increased risk. Improved methods of myocardial protection may reduce the risk in these patients.

Adult↗