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At least 181 records · Page 10Linked to original sources
PubMed2002

Fast track vaginal surgery.

OBJECTIVE: Our aim was to describe the need for postoperative hospitalization after vaginal surgery for utero-vaginal prolapse with well-defined charts for postoperative care. DESIGN: A prospective, descriptive study. Consecutive women admitted for first-time vaginal surgery for utero-vaginal prolapse at a public university hospital in Copenhagen, Denmark, underwent surgery and postoperative care in a fast track setting from September 15, 1999 to June 15 2000. METHODS: A multimodal rehabilitation model with emphasis on information, standardized general anesthesia, reduced surgical distress, optimized pain-relief, early oral nutrition and ambulation, minimal use of indwelling catheter and vaginal packing. OUTCOME MEASURES: Postoperative hospital stay, complications, re-admission, success rate, patients' satisfaction and acceptability. RESULTS: Forty-one women with a median age of 69 years (range, 44-88 years) were included. All underwent anterior and/or posterior vaginal repair. Nineteen (46.3%) underwent vaginal hysterectomy, and eight (19.5%) underwent the Manchester procedure. Postoperative hospital stay was median 24 hr. Only three (7.3%) were discharged later than 48 hr. No re-admissions occurred. The most frequent complications were urinary retention exceeding 450 ml, and urinary tract infection (12.2%, and 9.8%, respectively). Short-term success rate was 97.6%. Patients' satisfaction rates were 85.4-95.1%. The median score of acceptability was 10 on a 0-10 points scale. CONCLUSION: The need for postoperative hospitalization was median 24 hr after vaginal surgery in a fast track setting, independently of the complexity of the procedure performed. Short-term success rate, satisfaction rates, and acceptability were all excellent. Follow up has been established to evaluate long-term success rates and recurrence.

Adult↗
PubMed1987

Endoscopy in patients undergoing gastroplasty for morbid obesity.

Fifty patients underwent gastroplasty for morbid obesity. The follow-up regimen included both nutritional and weight assessment and gastroscopy. Weight loss was satisfactory in patients with gastric stomas less than 9 mm in diameter. Stomal obstruction was endoscopically diagnosed in 5 patients. Endoscopic dilatation was successful in 4 patients. Gastroscopy should thus be a routine postoperative procedure in patients undergoing gastric partitioning for morbid obesity.

Female↗
PubMed1992

Basic nail plate avulsion.

Correct partial or total nail plate avulsion may be performed in the physician's office. The author recommends certain preoperative, operative, and postoperative procedures that may help assure a more successful outcome.

Anesthesia, Local↗
PubMed2002

[Nursing of tracheostomy].

In this abstract we have analyzed the different techniques of tracheostomy, considering new semplified methods of this procedure and therefore the common use of it in weaning from mechanical ventilation the critical care patients. We've tried to summarize guide lines of the preoperative, operative and postoperative procedures of tracheostomy, comparing our nursing clinical experience in ICU and the latest literature. We've primarily analyzed the nursing aspects of this issue, trying to focus on the priority of the treatment of the tracheostomezed patient.

Contraindications↗
PubMed1978

Cerebral revascularization.

Cerebral vascular insufficiency due to occlusive lesions regarded as inaccessible is a common problem. The degree of cerebral dysfunction associated with such lesions is dependent in part on the amount of collateral circulation present. By anastomosing the superficial temporal artery to a branch of the middle cerebral artery an increase in collateral circulation is provided to the affected hemisphere. This report describes the results of twenty such procedures. Postoperative angiography demonstrates a 90% patency rate. There is frequent neurological improvement following surgery, and the rate of new TIA's or strokes seems less than would be expected. The most damaging complication of the procedure ist intracerebral haemorrhage. The indications for, and the complications of, such procedures are discussed.

Adult↗
PubMed2002

100 consecutive minimally invasive Heller myotomies: lessons learned.

OBJECTIVE: To evaluate the authors' first 100 patients treated for achalasia by a minimally invasive approach. METHODS: Between November 1992 and February 2001, the authors performed 95 laparoscopic and 5 thoracoscopic Heller myotomies in 100 patients (age 49.5 +/- 1.5 years) with manometrically confirmed achalasia. Before presentation, 51 patients had previous dilation, 23 had been treated with botulinum toxin (Botox), and 4 had undergone prior myotomy. Laparoscopic myotomy was performed by incising the distal 4 to 6 cm of esophageal musculature and extended 1 to 2 cm onto the cardia under endoscopic guidance. Fifteen patients underwent antireflux procedures. RESULTS: There were eight intraoperative perforations and only four conversions to open surgery. Follow-up is 10.8 +/- 1 months; 75% of the patients have been followed up for at least 14 months. Outcomes assessed by patient questionnaires revealed satisfactory relief of dysphagia in 93 patients and "poor" relief in 7 patients. Postoperative heartburn symptoms were reported as "moderate to severe" in 14 patients and "none or mild" in 86 patients. Fourteen patients required postoperative procedures for continued symptoms of dysphagia after myotomy. Esophageal manometry studies revealed a decrease in lower esophageal sphincter pressure (LESP) from 37 +/- 1 mm Hg to 14 +/- 1 mm Hg. Patients with a decrease in LESP of more than 18 mm Hg and whose absolute postoperative LESP was 18 or less were more likely to have relief of dysphagia after surgery. Thirty-one patients who underwent Heller alone were studied with a 24-hour esophageal pH probe and had a median Johnson-DeMeester score of 10 (normal <22.0). Mean esophageal acid exposure time was 3 +/- 0.6% (normal 4.2%). Symptoms did not correlate with esophageal acid exposure. CONCLUSIONS: The results after minimally invasive treatment for achalasia are equivalent to historical outcomes with open techniques. Satisfactory outcomes occurred in 93% of patients. Patients whose postoperative LESP was less than 18 mm Hg reported the fewest symptoms. After myotomy, patients rarely have abnormal esophageal acid exposure, and the addition of an antireflux procedure is not required.

Botulinum Toxins, Type A↗
PubMedDate not supplied

Use of radiesse in combination with restylane for facial augmentation.

OBJECTIVES: To report the long-term results of 72 consecutive patients treated with Radiesse (BioForm Inc, Franksville, Wis) and 29 patients treated with Radiesse and Restylane (Q-Medical, Uppsala, Sweden) and to share recommendations based on our experience. METHODS: A total of 72 patients were treated with Radiesse between October 2003 and December 2004. Of these patients, 29 also received Restylane for facial augmentation. Forty-six Radiesse-treated and 15 Radiesse and Restylane-treated patients completed questionnaires detailing their experience with the procedure, postoperative sequelae, overall satisfaction, and satisfaction at each site treated. RESULTS: On a 10-point scale, the overall satisfaction with Radiesse averaged 7.6, and 30 patients (65%) would recommend this procedure to others. Of the 72 patients, 2 (3%) reported persistent nodules, and both required removal of a small amount of the material. The overall satisfaction with the Radiesse and Restylane-combined treatment averaged 8.1, and 12 patients (79%) would recommend this procedure to others. No patients reported persistent nodules. CONCLUSIONS: The use of Radiesse and Restylane in combination is an excellent option for facial enhancement. With long-term experience, complications in the lip area with Radiesse treatment are now avoided with the use of Restylane. In contrast to patients treated with Radiesse alone, the combination treatment group in this study tended to have greater immediate and overall satisfaction scores and was more likely to recommend the combination procedure to others.

Adult↗
PubMed1976

Chronic intravascular coagulation associated with chronic myelocytic leukemia. Use of heparin in connection with a surgical procedure.

A women with Philadelphia chromosome-positive chronic myelocytic leukemia lived nearly 12 years from the time of diagnosis. During most of this period she received no therapy, and marked cyclic oscillations in the white blood cell count were documented. The last two years of her illness were marked by a hemorrhagic disorder associated with hypofibrinogenemia, thrombocytopenia, increased plasma fibrinopeptide A concentration and markedly elevated serum levels of fibrin degradation products. The coagulation disorder was rapidly reversible on several occasions with heparin therapy. After treatment with heparin and platelet transfusions, the patient underwent successful resection of a large ovarian cyst with excellent hemostasis during the procedure. Postoperatively, the administration of heparin and platelets was discontinued and a large wound hematoma developed. After resumption of therapy with heparin and platelets, the remainder of her postoperative course was uneventful. The literature on the subject is reviewed and tentative guidelines are offered concerning the management of patients with intravascular coagulation who require diagnostic or therapeutic surgical procedures.

Adult↗
PubMedDate not supplied

Treatment of descending thoracic aneurysms by endovascular stent grafting.

PURPOSE: Endovascular stent-graft treatment for true aneurysms of the descending thoracic aorta is a valid and effective alternative to conventional surgery. A review of our experience with 21 consecutive patients is reported and technical considerations are discussed. METHODS: Twenty-one patients (mean age 73 years) with true aneurysms of the descending thoracic aorta (n = 14) or contained rupture (n = 7) were treated between October 1999 and July 2001. Seven patients (33%) underwent emergency endovascular procedure. Postoperatively, the patients were followed with CT scans at 1, 3, 6, and 12 months. Follow-up, which averaged 17 months, was 100% complete. THIRTY-DAY RESULTS: No conversions to open repair were necessary. Two patients died (10%), one of acute intestinal ischemia and the other because of multiorgan failure. Four patients showed endoleaks immediately after stenting. Two patients required new endovascular stentgrafts, while the remaining two were treated conservatively. Besides endoleaks, eight major complications occurred in six patients (two stroke, two paraplegia, two respiratory insufficiency, and one renal failure). MID-TERM RESULTS: Three more patients died during the follow-up period. One patient died of heart failure after a complicated postoperative course, 91 days after stenting. The second patient died because of aortic rupture, 139 days after stenting. The third patient died of heart failure, 15 months after the endovascular procedure. The remaining 16 patients are alive and have been regularly controlled by CT scans. No late migration or endoleaks have been detected. In all the survivors, the size of the aneurysm was unchanged or diminished. CONCLUSIONS: Treatment of descending thoracic aortic aneurysms by endovascular stentgraft devices has good early and mid-term results. More accurate selection of patients may further reduce mortality and morbidity.

Aged↗
PubMed2000

[Simultaneously corneal laceration repair, traumatic cataract removal and intraocular lens implantation].

OBJECTIVE: The study aimed to evaluate the outcome of patients who undrwent simultaneously corneal laceration repair, cataract extraction and posterior chamber lens implantation. METHODS: Traumatic cataract extraction and posterior chamber intraocular lens (PC IOL) implantation were performed in 36 eyes of 36 cases with corneal laceration. YAG laser was the postoperative procedure for embrane before the lens and after cataract. Penetrating keratoplasty was performed for central cicatrice of cornea. All the patients have been followed up for 3-12 months. RESULTS: The postoperative visual acuity s.c. was 0.1-0.3 in 8 cases(22.8%), 0.4-0.5 in 14 cases (40%) 0.6-0.8 in 13 cases (37.1%) on following up. There were no serious complication attributable to PC IOL implantation. CONCLUSION: As long as the range of surgical indication was known well, PC IOL implantation can get good clinical effects at the time of primary repair.

Adolescent↗
PubMed2004

[Clinical analysis of 2340 cases of pancreatic cancer].

OBJECTIVE: To investigate the factors related to curable resection of pancreatic cancer and to obtain better efficacy. METHODS: A uniform questionnaire survey on the clinical epidemiology of pancreatic cancer was conducted by the Society of Pancreatic Cancer, Chinese Anti-cancer Association from January 1, 1990 to December 31, 2000 on a total of 2340 the patients with pancreatic cancer confirmed clinically or pathologically in 14 hospitals in China. Survival analysis was conducted for selected patients with complete data. Cox regression was used to screen out single and multiple risk factors. Cumulative survival rate was calculated by life table and Gehan score test. RESULTS: Cox single factor analysis showed that the significant variables at alpha = 0.05 level included age, occupation, duration of disease, location of neoplasm, operation type, postoperative pancreatic fistula, postoperative hepatic failure, chemotherapy, TNM stage, immunotherapy, liver metastasis, and invasion of the superior mesenteric vessel. Cox multifactor analysis revealed that the significant variables at alpha = 0.05 level included age, surgical procedures, postoperative pancreatic fistula, postoperative hepatic failure, chemotherapy, and immunotherapy. These were independent factors for the prognosis of patients with pancreatic carcinoma. Among these factors, age less than 70 years, radical operation, chemotherapy and immunotherapy were all protective factors. 92.9% of the patients were aged more than 40 years, and only 7.09% were less than 40 years. The median survival time of patients after radical resection of carcinoma of the pancreatic head was 17.11 months and the 1-year survival rate was 54.36%. The 3 and 5-year survival rates were 13.47% and 8.47%. CONCLUSION: For early diagnosis, an effective way to screen population older than 40 years is really an effective way to detect patients early and promptly. And comprehensive therapy is conducive to better quality of life and longer survival time.

Adolescent↗
PubMed1994

[Longitudinal analysis of glucose metabolism in recurrent meningioma].

We repeatedly measured kinetic rate constants and glucose metabolic rate (kinetic rCMRG1) using dynamic positron emission tomography (PET) and autoradiographic rCMRG1 in a patient with recurrent meningioma. A 50-year-old woman who presented with a left visual disturbance was admitted to our hospital. MR images revealed a mass lesion occupying the left middle fossa. The patient underwent Simpson grade IV surgery. The histological diagnosis was meningothelial meningioma. One year later the tumor had grown back to almost the same size as before treatment and was removed again by Simpson grade IV procedure. Postoperatively, the patient underwent radiation therapy (54 Gy). Two years after the second operation, the tumor was found to have invaded the left orbit and was resected by Simpson grade IV procedure. After additional radiation therapy, the patient was discharged. The rate constants were analyzed preoperatively and whenever the tumor recurred according to the three compartment 18F-fluorodeoxyglucose (FDG) model. Preoperative PET indicated tumor k1 and k2 values higher than in the contralateral gray matter, suggesting high permeability due to absence of the blood-tumor barrier and an abundant blood supply. The tumor k3 value, an indicator of hexokinase activity, was as high as in the contralateral gray matter. When the tumor recurred, the tumor k1, k2 and k3 values remained consistently high, indicating high proliferative activity. In contrast, the contralateral gray matter k1, k2 and k3 values decreased to some extent, suggesting effects of surgery or radiotherapy. Tumor rCMRG1 values, both autoradiographic and kinetic, were enhanced markedly.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoradiography↗
PubMed2005

Endoscopic-assisted cranionasal resection of olfactory neuroblastoma.

BACKGROUND: Cranionasal resection was first described in 1997 for the surgical resection of olfactory neuroblastoma. The endoscopic transnasal approach is used in cranionasal resection to replace the more invasive craniofacial resection. It has the advantages of avoiding the facial wound and its associated pain, swelling, and scar. The authors have routinely practiced cranionasal resection since 1996 for resection of all anterior skull base tumors in which the resultant skull base bony defect is limited to the nasal and sinus roof. The aim of this study was to review the results of cranionasal resection for olfactory neuroblastoma. METHODS: The results of cranionasal resection for olfactory neuroblastoma in six patients from 1996 to 2003 were reviewed. RESULTS: The Kadesh stages were 3A, 2B, and 1C. None of the patients had postoperative complications. Postoperative radiotherapy was given only to the patient with Kadesh stage C disease. There were no local recurrences. Two patients died of lung metastasis. CONCLUSIONS: Cranionasal resection is a safe and adequate procedure. Postoperative radiotherapy is not necessary after clear resection of Kadesh A and B tumors.

Adult↗
PubMed2002

The case for laparoscopic common bile duct exploration.

The modern surgeon's approach to choledocholithiasis depends his or her view of cholangiography. During the early 1990 there was a swing away from cholangiography, which had previously been common practice. This was because of perceptions of difficulty with the technique, the time it took, and perhaps an implied increase in costs because of the time factor. There was no evidence on which to base this decision. This led to a marked upswing in the use of endoscopic retrograde cholangiopancreatography (ERCP). There were a large number of ERCPs with normal results performed prior to laparoscopic cholecystectomy. This paper states the case for intraoperative cholangiography and common bile duct clearance at the time of cholecystectomy. It is hoped that this technique will be adopted so patients can undergo a single procedure to remove their gallstones and common bile duct stones if they exist and to decrease the incidence of normal preoperative ERCPs and the need for a second procedure postoperatively to clear stones if they are found.

Cholangiography↗
PubMed1991

Transabdominal esophagomyotomy and partial fundoplication for treatment of achalasia.

The most common surgical treatment for achalasia is a modified anterior extramucosal esophagomyotomy. Unfortunately, a poor outcome may result secondary to recurrent dysphagia or gastroesophageal reflux. The reported incidence of reflux is 4 to 50 per cent. Our treatment for achalasia is an esophagomyotomy carried onto the cardia combined with a partial gastric fundoplication. Of 22 patients who presented with achalasia and moderate to severe symptoms of dysphagia and odynophagia, 19 had this procedure performed. Of these 19 patients, only two required a second procedure (postoperative dilatation) for recurrent symptoms. All three patients who had a full fundoplication required further surgical correction. Although fundoplication has been condemned in the past as treatment of achalasia to avoid the postoperative outcome of reflux, we have been successful with a partial fundoplication added to the standard esophagomyotomy. Given the fine line that needs to be tread to prevent recurrent signs and symptoms of achalasia or reflux when performing esophagomyotomy, our procedure offers a viable alternative to transthoracic esophagomyotomy alone.

Adult↗
PubMed2000

[Laryngo-hypopharyngo-esophagectomy in advanced hypopharyngeal carcinoma. Is radical surgery intervention still justified today?].

Minimal invasive laser surgery with preservation of the organs is well established in the treatment of hypopharynx carcinoma. In cases of advanced tumors of the hypopharynx, which can not be managed by laser surgery, the combined radio-chemo therapy becomes the treatment of choice because of the low morbidity and the comparable results. The indication for an operative procedure, which means loss of larynx and oesophagus, is seen more and more restrictively. From 1993 to 1997 101 patients with advanced neoplasm of the hypopharynx or larynx (larynxcarcinoma T4; hypopharynx carcinoma T3-T4 with N > 2b) were treated in the Department of Otolaryngology of the University of Regensburg. 5 of these patients underwent a laryngohypopharyngoesophagectomy. Only patients with a severe dysfunction of the larynx (dyspnea, dysphagia, aspiration) were selected for this procedure. Postoperative complications were: one insufficiency of anastomosis with secondary bleeding and five pleura effusions. In all cases postoperative radiation began within six weeks after the operation. All patients were nourished orally when they were discharged from hospital. The mean follow up was 21 months. During this time none of the patients died. In one case pulmonary metastasis was found after 11 months. In another case a regional recurrence was diagnosed after 11 months and was removed by operation. No local recurrence was found at that time. This operative procedure can be done only in experienced and well trained medical centers. Furthermore excellent cooperation of the operating teams and strong regard to the selection criteria is obligatory.

Esophagectomy↗
PubMed1997

The effect of peritonsillar corticosteroid infiltration in tonsillectomy.

A prospective, randomized, double-blind, placebo-control clinical study was performed to determine the effects of peritonsillar infiltration of dexamethasone on peroperative and postoperative morbidity in patients undergoing tonsillectomy with local anesthesia. A total of fifty-two patients, aged 14-34, were randomized to infiltrate dexamethasone (0.5 mg/kg, maximum dose, 12 mg) or placebo with local anesthetic at the peritonsillar region. Incidence of postoperative complications, pain medications, appetite, oral intake (type of diet) and fever were also compared between the two groups. Demographics of dexamethasone and placebo groups were similar. No statistically significant differences were noted peroperative procedures, postoperative complications, pain medication, appetite, oral intake (type of diet) between the two groups of patients.

Adolescent↗
PubMed1994

Foraminal lumbar disc herniation. Experience with 83 patients.

STUDY DESIGN: This study analyzed a series of 83 patients operated on for foraminal lumbar disc herniation. OBJECTIVES: This study sought to develop clinical and radiologic diagnoses, evaluate interlaminar and extra-articular exposures, and evaluate postoperative results. SUMMARY OF BACKGROUND DATA: Some authors have reported a specific clinical syndrome, but other reports have indicated the clinical picture is indistinguishable from usual posterolateral disc herniation. Surgical management often has been compared between the interlaminar and extra-articular approaches. METHODS: Clinical findings were reviewed. All patients were evaluated with computed tomography, but radiologic diagnosis required computed tomographic discography for 26 patients. Interlaminar exposure with partial medial facetectomy was performed in 73 patients and an extra-articular approach was necessary in 10 patients. Postoperative results were evaluated with a 2-year follow-up. RESULTS: Foraminal lumbar disc herniations have a specific clinical picture, particularly severe radicular signs. Precise preoperative radiologic evaluation is essential for successful operative procedure. Postoperative results were good in 76% of the patients. The other patients felt mild residual radicular pain, although no residual root compression was found on postoperative computed tomography. Only 21% of the patients that had a radicular deficit recovered totally. CONCLUSIONS: Foraminal lumbar disc herniation involves characteristic clinical features. Radiologic diagnosis requires high-resolution computed tomography, computed tomographic discography, or magnetic resonance imaging. Most foraminal lumbar disc herniations are reached through the interlaminar exposure extended to the upper lamina and medial facet without total facetectomy. An extra-articular approach should be reserved for extra-foraminal herniations.

Diskectomy↗