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V Velanovich

Publications and source records attributed to V Velanovich.

At least 91 records · Page 5Linked to original sources
PubMed1991

A meta-analysis of prophylactic antibiotics in head and neck surgery.

Although it is generally agreed that prophylactic antibiotics are necessary for the prevention of postoperative wound infection, the choice of antibiotic regimen is controversial. In an attempt to determine the most effective antibiotic regimen, a meta-analysis of published clinical trials of prophylactic antibiotics for head and neck surgery was undertaken. The meta-analysis revealed a relative difference in infection rates of 43.7 percent in favor of the use of antibiotics versus placebo, of 8.3 percent in favor of multiple antibiotics versus a single antibiotic, of 13.7 percent in favor of multiple antibiotics versus cefazolin, and of 4.1 percent in favor of multiple-day prophylaxis versus single-day prophylaxis. This meta-analysis suggests that a 1-day course of clindamycin may be the most effective prophylactic antibiotic regimen for head and neck surgery.

Anti-Bacterial Agents↗
PubMed1991

Lower extremity lymphocele development after saphenous vein harvesting.

Damage to the lymphatic vessels may occur after surgery on the greater saphenous vein. We describe the development of a lymphocele in a patient after saphenous vein harvesting for a coronary artery bypass graft. Treatment of these lymphoceles should initially be conservative, but if this approach fails, surgical excision should be performed and special attention paid to identifying and ligating the feeding lymphatic vessel.

Coronary Artery Bypass↗
PubMed1991

The value of routine preoperative laboratory testing in predicting postoperative complications: a multivariate analysis.

The purpose of this study was to evaluate the ability of preoperative laboratory testing to predict postoperative complications. Five hundred twenty patients undergoing elective surgery had their American Society of Anesthesiologists' classification, ponderal index, electrolyte values, glucose levels, blood urea nitrogen/creatinine values, complete blood counts, coagulation studies, total protein/albumin/lymphocyte count, electrocardiogram, chest radiograph, urinalysis, pulmonary function tests, type of anesthesia, and type of operation recorded preoperatively. Patients were followed prospectively after surgery for the development of complications. The data were analyzed by univariate and multivariate methods. Postoperative complications were strongly associated with American Society of Anesthesiologists' classification, type of anesthesia, and type of operation. However, only a few laboratory tests, such as electrocardiogram, chest radiograph, and nutritional status, were associated with postoperative complications. Therefore, in general, preoperative laboratory testing should only be undertaken for specific indications. Recommendations for routine tests are made depending on the age of the patient.

Adult↗
PubMed1990

Choice of treatment for stage I floor-of-mouth cancer. A decision analysis.

Controversy exists over optimal treatment of stage I floor-of-mouth cancers, with advocation of either primary radiotherapy or surgical resection with or with-out a neck dissection. A decision analysis was undertaken to determine the outcomes of these treatment options. The quality-adjusted life expectancies were determined using best estimates from the literature of survival, recurrence, short-term morbidity, and quality of life for radiotherapy and surgical resection. The quality-adjusted life expectancies were as follows: for surgical resection with neck dissection, 18.50 years; for surgical resection without neck dissection, 14.48 years; and for primary radiotherapy, 7.95 years. Sensitivity analysis showed that these results varied with quality of life assumptions and survival data. Therefore, each institution needs to review its own survival data and question patients about quality of life to determine how treatment options fit into the decision analysis.

Decision Trees↗
PubMed1990

Treatment of ischemic leg ulcers with pentoxifylline: a case report and theoretical considerations.

Ischemic ulcers remain difficult to treat. We describe a patient with bilateral ischemic leg ulcers treated preoperatively with pentoxifylline. She had a successful skin graft with no rejection of the graft. The theoretical advantage of treatment with pentoxifylline is discussed, with emphasis not only on its hemorheological properties, but also on its actions on the prostaglandin pathway, platelet aggregation, and thrombosis. We suggest that preoperative pentoxifylline treatment may be a useful adjunct in the closure of ischemic ulcers.

Aged↗
PubMed1990

A five-year U.S. Army experience with 36,250 abdominal hernia repairs.

Thirty-six thousand two hundred fifty abdominal hernia repairs were performed in U.S. Army medical treatment facilities during a five-year period. This study presents data about the type of hernia, incidence of complications by obstruction or strangulation, age, sex, and mortality. Hernias occurring with intestinal obstruction or gangrene (strangulation) are referred to as complicated hernias. Inguinal hernias in children less than two years of age, femoral hernias, and unusual (such as internal or obturator) hernias were found to have an increased incidence of complications. Surgical repair of ventral, umbilical, and femoral hernias was done with a low surgical risk and the presence of complications did not significantly increase this risk. An increased risk of mortality is associated with the repair of complicated unusual hernias and complicated inguinal hernias in patients more than 60 years of age.

Adolescent↗
PubMed1990

Ponderal index as a predictor of postoperative complications.

Four hundred sixty-eight patients undergoing elective surgery were prospectively followed for the development of postoperative complications. There was a trend toward increasing complication rate with a lower ponderal index. However, lower ponderal indices were associated with increasing rates of diabetes mellitus and hypertension. Of these patients, forty cases with postoperative complications were matched to 40 control cases for sex, age, concomitant illness and operation performed. The cases of postoperative complications had a statistically significantly lower ponderal index than the controls (11.98 versus 12.43). The increased risk of postoperative complications in those patients with a ponderal index of less than 11 was 3.36, and less than 13 was 3.44. Surgeons who treated patients with lower ponderal indices need to have a high index of suspicion for the development of postoperative complications in these patients.

Body Mass Index↗
PubMed1990

Bayesian analysis of the reliability of peritoneal lavage.

The popular methods of reporting the reliability of a test--sensitivity and specificity--do not tell the practicing physician what the chance is that a patient has the disease if the results from the particular test for that disease are positive or negative. Bayesian analysis, however, does answer this question. In this study, the data from 29 studies of peritoneal lavage were analyzed using the Bayesian method. The probability of an intra-abdominal injury being present if findings from lavage were positive ranged from 0.448 to 1.0. The probability of an intra-abdominal injury being present if findings from lavage were negative ranged from zero to 0.286. These probabilities varied with the criteria for positivity, technique used and type of trauma. In general, results of Bayesian analysis showed that findings from peritoneal lavage were most reliable in diagnosing the patient with blunt trauma when the standard positive criteria and open technique were used.

Abdominal Injuries↗
PubMed1989

Abdominal incision.

Explore the source record for details and available documents.

Abdominal Muscles↗
PubMed1989

Drug injection injuries of the upper extremity.

The increasing incidence of illicit intravenous drug abuse has reached epidemic proportions in western society. Although the accompanying infectious complications such as hepatitis and acquired immunodeficiency syndrome receive the most notoriety, injection injuries are causing an increasing number of problems. A retrospective review of patients requiring admission for acute or chronic drug injection injuries of the upper extremities was made at the Detroit Receiving Hospital from 1980 through 1985. The demographical, historical, physical, microbiological, and follow-up data were analyzed. The majority of the injuries involved subcutaneous injections into the hand with accompanying inflammatory or infectious complications. The bacteriological data revealed unique characteristics and did not reflect patterns expected from inoculation of normal skin flora. A treatment regimen based on the data is proposed.

Adult↗
PubMed1989

Crystalloid versus colloid fluid resuscitation: a meta-analysis of mortality.

Controversy persists over the best choice of fluid to use for resuscitation. A number of published articles promote the use of either colloid or crystalloid fluids. Most of the arguments for use of one fluid or the other are based on cardiopulmonary data collected during and after fluid resuscitation. Although many studies report the mortality rate of patients treated with both fluids, none have critically analyzed this most important aspect of therapy. Meta-analysis is a relatively new statistical method whereby data from a number of clinical trials can be pooled to produce more reliable data. In this study meta-analysis was used to pool mortality data from reports of eight previously published, randomized, clinical trials, in which the efficacy of crystalloid and colloid fluid resuscitation was compared. The overall treatment effect when the data from all the clinical trials were pooled showed a 5.7% relative difference in mortality rate in favor of crystalloid therapy. When the data from only those studies using trauma patients were pooled, the overall treatment effect showed a 12.3% difference in mortality rate in favor of crystalloid therapy. However, when data from studies that used nontrauma patients were pooled, there was a 7.8% difference in mortality rate in favor of colloid treatment. In patients with trauma who are septic and in whom the capillary leak syndrome leads to adult respiratory distress syndrome, it may be assumed that colloid resuscitation would be no better than crystalloid resuscitation. In this study the meta-analysis of published data showed that this form of treatment is deleterious. In patients who are nonseptic or having elective surgery, however, the basement membrane is intact, and meta-analysis of data in this setting showed that treatment with colloids would be efficacious.

Colloids↗
PubMed1988

The use of colostomy bags for chest tube drainage.

Occasionally patients require long-term chest tube drainage. We describe a method whereby a short chest tube may be drained into a colostomy bag to alleviate the necessity of keeping the patient attached to a bulky drainage system. The colostomy bag allows greater mobility, and the patient can be discharged with the bag.

Colostomy↗
PubMed1988

Digital replantation and revascularization. Factors affecting viability, prognosis, and pattern of injury.

As experience with digital replantation increases, preoperative factors affecting outcome are being identified. Injury type, injury cause, ischemia time, and zone of injury have previously been reported. In addition, this report analyzes the effect of injury pattern and surgical group upon outcome. This data implies a multi-factor effect on the viability of replanted/revascularized parts. The lack of thorough reporting of the factors may account for the variability seen in success rates of various centers. An injury-injury type-injury level-ischemia time classification scheme has been proposed to standardize the reporting and the discussing of amputation/devascularization injuries. In clear cut situations, injury pattern may simply reflect type of injury (e.g. avulsion); however, in those situations where the mechanism is unclear, injury patterns may provide prognostic variables valuable in predicting replant viability. Further, a multi-group, multi-surgeon service functioning within a hospital may have results comparable to those of a single surgeon or single group practice.

Adolescent↗
PubMed1988

The effect of hemoglobin and hematocrit levels on free flap survival.

There has been experimental information suggesting that iatrogenic anemia may improve the survival of pedicled free flaps. This has been attributed to a decrease in blood viscosity secondary to hemodilution. The hemoglobin (Hb) and hematocrit (Hct) levels of 14 successful and 6 failed free flaps at the time of operation, during hospitalization, and at discharge are reviewed. There was no difference in Hb or Hct levels between successful and failed flaps. Reconstruction of traumatic defects showed an increased risk of failure. If flaps survived longer than 10-14 days, they were unlikely to fail subsequently. In conclusion, Hb and Hct levels in clinically acceptable ranges have no effect on free flap survival.

Blood Flow Velocity↗
PubMed1987

Control of burn wound sepsis: a comparison of in vitro topical antimicrobial assays.

The Minimal Inhibitory Concentration (MIC) and the Nathan's Agar Well Diffusion (NAWD) tests are bacterial antimicrobial susceptibility predictors. Some suggest that the NAWD is not as reliable as the MIC test. We compared the MIC and NAWD tests as to how well they agree to bacterial sensitivity or resistance and predicted clinical outcome of burn wound infections. Using 65 bacterial isolates from burned patients, the MIC and NAWD tests agreed in 60.0% of the isolates (vs. a perfect agreement of 100%, p less than 0.001), implying that these tests are not interchangeable. From 18 burned patients treated with nitrofurazone or mafenide acetate, 28 infectious isolates were evaluated. The outcome of these infections was correctly predicted by NAWD in 92.8% and the MIC in 72.0% of the cases (p less than 0.05). It seems that for burns treated with topical antimicrobials, the NAWD is a more reliable predictor of bacterial susceptibility.

Bacteria↗
PubMed1987

Statistical analysis and study design in plastic and reconstructive surgical research.

Appropriate study design and proper statistical analysis are necessary ingredients for improving the quality and reliability of the information in journal articles. General surgery and plastic surgery articles were compared for principal author's academic degree, a Ph.D.'s presence as a coauthor, the study type, the presence of statistical analysis, the analysis' appropriateness, and the types of errors in study design or statistical analysis. Ph. D. authorship was associated with increased percentage of articles using statistical analysis. When compared with general surgery articles, plastic surgery articles performed four times fewer statistical analyses. However, when statistical analyses were performed, there were few differences between these two specialties. Although there were no differences in the types of statistical analysis errors, there were differences in the types of study design errors. The causes of these discrepancies may lie in the nature of plastic surgery; they may be reduced by adherence to Feinstein's principles of study design and result interpretation.

Authorship↗