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At least 235 records · Page 13Linked to original sources
PubMed1989

Hypertension in the surgical patient: management of blood pressure and anesthesia.

Although hypertension has always been a high risk factor during anesthesia and surgery, risk can be reduced by preoperative control of blood pressure, evaluation of the patient to determine risk factors that can exacerbate blood pressure rises, and continuation of preoperative antihypertensive therapy. Patient hemodynamics must be monitored to manage blood pressure fluctuations and signs of ischemia as early as possible. Selection of anesthetic and adjuvant agents must be tailored to the patients, the agents must be administered carefully and in a timely fashion, and the anesthesiologist must be aware of the relevant variables. Increased knowledge of the pathophysiology of hypertension, antihypertensive therapy, and the development of new anesthetics and muscle relaxants with minimum hemodynamic effects has helped minimize complications related to perioperative hypertension.

Anesthesia↗
PubMed2002

[Usefulness of simulation with multi-slice CT for laparoscopic nephrectomy].

In recent years, laparoscopic surgery has attracted attention as a minimally invasive type of surgery because of the small surgical wounds and early recovery it provides. We carry out this technique on the basis of volume data that we make use of in multi-slice CT imaging technology in laparoscopic nephrectomy by the retroperitoneal approach, and we have created CT virtual laparoscopy by virtual endoscopic display as an intra-operative navigatior with an image analysis system. We provide information on detailed vascular anatomy to form intra-operative images that act as similar support images. With the provision of this volume data, we consider virtual endoscopic display the most suitable method for surgery. When we perform virtual laparoscopy, we simulate the insertion point and angle, the order of vascular structures and their locations, the number of arteries and veins, and their bifurcation points and ligation points in conjunction with the surgeon prior to operation. As the branch patterns of the renal artery are varied, perioperative confusion and surgical mishaps can be avoided through the information that is provided beforehand. Thus surgery is more accurate and proceeds more smoothly, because the surgeon has accurate anatomical information. In addition, the time required for surgery is decreased, reducing risk and the possibility of complications.

Aged↗
PubMed1997

Atherosclerotic Renovascular Disease: Prevalence, Natural History, Noninvasiveive Diagnosis and Endovascular Therapy Using Palmaz Stents.

Atherosclerotic renovascular disease (RVD) occurs with a high prevalence in older patients who have severe hypertension and other vascular disease. Natural history studies of RVD have demonstrated progression with risk for occlusion. RVD leading to ischemic nephropathy and renal failure accounts for up to 14 % of all patients over the age of 50 years who are beginning dialysis. A number of clinical variables are helpful in identifying patients with a high likelihood of RVD. In addition, screening with noninvasiveive studies including renal artery duplex exam, as well as with abdominal aortography at the time of coronary angiography, may be warranted in patients at high risk for RVD. Balloon angioplasty for ostial RVD has produced disappointing results, and surgical bypass has been associated with significant morbidity and mortality risks, especially in elderly patients with generalized atherosclerosis. The recent use of Palmaz stents as primary therapy for ostial RVD has resulted in restenosis rates as low as 8 %, with markedly reduced risks compared to surgery. Suggested guidelines for screening for RVD by performing abdominal aortography at the time of coronary angiography are outlined, along with a review of the preliminary data available regarding the use of Palmaz stents for ostial RVD.

Journal Article↗
PubMed2000

Infective endocarditis as a cause of fever in hemodialysis patients.

Vascular access infections are common in maintenance hemodialysis patients especially with dual lumen cuffed catheter. Persistent infections may lead to valvular seeding and the development of infective endocarditis. Though antibiotic therapy may often suffice, many patients may require surgical correction which carries a high risk of mortality. However appropriate preoperative therapy may considerably reduce the risk of surgery in maintenance hemodialysis patients.

Adult↗
PubMed2001

Sigmoid volvulus in children: report of two cases.

Volvulus of the sigmoid colon is rare in children. An early, accurate diagnosis can avoid unnecessary surgery and reduce the risk of complications. This condition is mainly due to a redundant sigmoid colon with a narrow mesosigmoid attachment. We describe two cases of sigmoid volvulus, which showed different clinical severities and were treated with different methods. Patient 1, a 9-year-old boy, presented with acute abdominal pain and vomiting. Patient 2, an 11-year-old boy, presented with abdominal pain, abdominal distention, and bloody mucoid stool. Plain abdominal radiographs revealed a distended colonic loop extending upward from the pelvis in patient 1 and a typical "coffee bean" sign in patient 2. Barium enema examination was used to confirm the diagnosis in both cases. The volvulus was reduced by insertion of a rectal tube in patient 1 and surgically in patient 2. Sigmoid colon volvulus should be included in the differential diagnosis of childhood abdominal pain or distention. This report suggests that nonsurgical reduction should be attempted first for uncompromised sigmoid volvulus in children, unless bowel ischemia or perforation develops.

Child↗
PubMed2001

[Prevention of cerebral ictus, of carotid origin].

The current incidence of stroke in Europe and the USA is about 200 per 100,000 population per annum. Eighty percent of strokes are ischaemic and 20% are due to hemorrhage. Approximately half the patients with ischaemic strike have carotid artery stenosis and about one third (10% all stroke victims) have had no warning symptoms such as transient ischaemi attacks. The European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) have effectively shown that carotid endarterectomy (CEA) can prevent strokes in symptomatic patients. The benefit of operation is, at present, confined to those with at least 70% stenosis; for 30-69%, the trials have not yet reported a result. In asymptomatic patients the Veterans Administration Study and the Asymptomatic Carotid Atherosclerosis Study (ACAS) have yielded promising results that surgery may reduce the risk of TIA and minor stroke. There is as yet no convincing evidence in asymptomatic patients that moderate or severe stroke (or death) can be prevented by CEA. The aim of this trial is to determine whether CEA and appropriate best medical treatment (BMT) can improve stroke free survival time when compared with BMT alone.

Carotid Artery Diseases↗
PubMed2004

Management of the patient with Barrett's esophagus: a continuing dilemma for the clinician.

The primary controversy regarding Barrett's esophagus (BE) relates to what form of therapy is "best" and, more importantly, whether any therapy results in the regression of abnormal epithelium or reduces the rate of progression to dysplasia and/or adenocarcinoma. The current standard of practice suggests that patients with BE should be treated in a similar fashion as patients with typical gastroesophageal reflux disease, that is, with antisecretory agents as needed to provide complete symptom relief. The most recent guidelines from the American College of Gastroenterology point out that there are no prospective studies that support any alternative approach to treatment (ie, neither high-dose acid suppression nor antireflux surgery has demonstrated reduced risk of dysplasia or esophageal adenocarcinoma). However, accumulating evidence suggests that simply controlling symptoms is inadequate.

Adenocarcinoma↗
PubMed2005

How are hemoglobin levels affected by androgen deprivation in non-metastatic prostate cancer patients?

PURPOSE: To examine the change of hemoglobin in relation to testosterone level in non-metastatic prostate cancer patients receiving 2-year androgen suppression. METHODS AND MATERIALS: A cohort of 72 patients, as participants of a phase II study, were treated with adjuvant radiotherapy plus 2-year androgen suppression after surgery to reduce the risk of relapse. Patients had laboratory tests including hemoglobin (Hb) and testosterone, and a quality of life questionnaire at regular intervals during the androgen suppression and post-androgen suppression period. The pattern of the change in Hb was evaluated in relation to testosterone level. The clinical significance of Hb change was assessed with a correlation analysis between Hb and the three domains of the questionnaire (global health status, physical functioning, and fatigue). RESULTS: Median age was 64.2 years. Median follow-up was 37 months. Mean Hb at the baseline was 148.4 g/L. It declined slightly with radiotherapy by 2.2 g/L. Maximal Hb decline during androgen suppression was 10.5 g/L (p < 0.0001), occurring at 24 months after the initiation of androgen suppression. In most patients, Hb decline was < 20 g/L. In the post-androgen suppression period, the recovery of Hb was slow and followed that of testosterone. The three quality of life domains did not show any significant correlation with the change in Hb. CONCLUSION: The decline and recovery of Hb was closely related to that of testosterone. Two-year androgen suppression resulted in a statistically significant decline of Hb, which had, however, no clinically apparent adverse effect on the three quality of life domains.

Aged↗
PubMed1991

Somatosensory and magnetic evoked potentials in a postoperative paraparetic patient: case report.

Somatosensory evoked potential (SSEP) testing is increasingly being used to test for spinal cord injuries and to monitor spinal surgery to reduce the risk of paraplegia. It is a sensory test, but it is assumed that any process severe enough to affect the motor tracts will also affect the sensory tracts and, therefore, be identified. Increasingly, however, isolated motor-tract involvement has been reported. A new technique, magnetic coil stimulation of the cortex, directly monitors the motor tracts. We report a case where the SSEP was normal although the magnetic motor-evoked potential was abnormal, supporting the hypothesis that direct testing of motor tracts may be advantageous.

Child↗
PubMed1982

[Management of transient ischemic cerebral attacks (author's transl)].

Practitioners should be familiar with the description of transient ischemic attacks (TIA) as 40% are followed more or less rapidly by a stroke. Analysis of the natural history of TIA shows that patients die twice as often from cardiac manifestations of atheroma than from cerebral lesions. This demonstrates the significance of diagnosis and treatment of risk factors. Patients are at increased risk of stroke during the six to twelve months following TIA. Anticoagulants and inhibitors of platelet aggregation seem to reduce this risk. Carotid surgery is indicated only for localized vascular lesions; in other cases surgery increases morbidity. Doppler examination is the best means of detecting cases which need emergency surgical treatment.

Anticoagulants↗
PubMed1993

Prilocaine: an old anesthetic agent and a new ophthalmic procedure.

We present a new local anesthetic technique for ophthalmic surgery that reduces the risks associated with retrobulbar and peribulbar anesthesia. This method uses topical proparacaine plus 1.5 mL of prilocaine (3%) with felypressin injected into the subconjunctival (sub-Tenon's) space. Of 5210 consecutive adult patients in whom the technique was used, all demonstrated adequate analgesia. Sixty-three (1.2%) of the eyes required supplemental analgesia, provided by a single injection of prilocaine (0.5 mL). Ecchymosis and subconjunctival hemorrhage developed in 63 (1.2%) of the eyes. There were no instances of ptosis.

Adult↗
PubMed1995

Paraplegia following surgical correction of scoliosis with Cotrel-Dubousset instrumentation.

Three patients with paraplegia following corrective surgery for idiopathic scoliosis, using the Cotrel-Dubousset (CD) instrumentation, were admitted to our department over a period of 22 months. They were operated on by three different surgeons and they were the first serious neurological complications in these surgeons' careers. The monitoring method was the "wake-up" test, applied at the end of the correction maneuver with the instrument. One patient presented paraplegia at the "wake-up" test and the other two were paraplegic shortly after ceasing anesthesia. Electrophysiological spinal cord monitoring during surgery may reduce the risks of complications.

Adolescent↗
PubMed1995

Aprotinin use with hypothermic circulatory arrest for aortic valve and thoracic aortic surgery: renal function and early survival.

BACKGROUND AND AIM OF STUDY: Aprotinin is widely used during high risk cardiac surgery to reduce blood loss. Concern has been expressed about the safety of aprotinin in association with hypothermic circulatory arrest for surgery of the thoracic aorta and aortic valve. METHODS: A consecutive series of 19 patients undergoing surgery of the ascending aorta and/or the aortic arch using hypothermic circulatory arrest (15 - 20 degrees C) in conjunction with the use of aprotinin were studied prospectively from January 1993 to October 1994. The indications for operation were aortic dissection (n = 15) (11 acute) or annuloaortic ectasia (n = 4); 11 were emergency procedures. Ten patients underwent aortic valve replacement as part of a composite aortic root replacement and in seven patients aortic valve resuspension was possible. RESULTS: Mean total chest tube drainage was 878 +/- 548 ml (range 300 - 2,000 ml) with a mean usage of homologous blood of 2,328 +/- 1,600 ml. All but one patient survived (mortality 5.3%). None of the survivors experienced any adverse cardiac or neurological events. Serum creatinine rose significantly from a mean of 102 +/- 17 micromol/L preoperatively, to a mean of 172 +/- 100 micromol/L postoperatively (p<0.05), however, none of the patients became anuric or required dialysis and all values returned to preoperative levels by six weeks after surgery. Median intensive care stay was two days (range 1 - 20 days) and the median postoperative hospital stay was 11 days (range 6 - 50 days). CONCLUSION: These data suggest that aprotinin in conjunction with hypothermic circulatory arrest for surgery of the thoracic aorta and aortic valve has no adverse effect on early survival. However, significant though transient postoperative renal dysfunction was commonly observed in our experience.

Adult↗
PubMed1996

[Term abdominal pregnancy with delivery of a living child. Two case reports].

The lack of antenatal care and the growing number of genital infections make ectopic pregnancy a current unrecognized pathology in areas with few physicians. Such pregnancies exceptionally reach term but delivery of a live infant is rare. We report two cases in which echographic diagnosis of abdominal pregnancy was followed by the delivery of a live child. In both cases, fetal hypotrophy led to neonatal death. Maternal outcome was however favorable with surgery to reduce the risk of hemorrhage. Safe childbearing requires improved preventive measures and better maternal sanitary conditions and education, particularly important for subjects living in areas poorly provided with health facilities.

Adult↗
PubMed2005

Preoperative cardiovascular evaluation for noncardiac surgery.

Cardiovascular complications following noncardiac surgery constitute an enormous burden of perioperative morbidity and mortality. Annually, more than one million operations are complicated by adverse cardiovascular events, such as perioperative myocardial infarction or death from cardiac causes. In order to combat this problem, cardiac evaluation prior to noncardiac surgery should ask two questions about the patient: What is the risk of cardiac complications during and after surgery? How can that risk be reduced or eliminated? Risk assessment evaluates patients' co-morbidities and exercise tolerance, as well as the type of surgery to be performed, to determine the overall risk of perioperative cardiac complications. Previous or current cardiac disease, diabetes and renal insufficiency all confer higher risks for perioperative cardiac complications. Poor exercise tolerance and high-risk surgical procedures (e.g., vascular, prolonged thoracic or abdominal operations) also predict worse perioperative outcomes. Noninvasive stress testing is widely used to help predict risk of perioperative complications, but the poor predictive power of these tests hampers their usefulness. After estimating the risk of cardiac complications, one should take measures to reduce it. Beta blockade has shown clear benefits in risk reduction. At this time, there are no data suggesting benefits of percutaneous coronary intervention or coronary artery bypass grafting in reducing noncardiac surgical risk. In addition, angioplasty with stenting and its attendant need for anticoagulation can expose patients to increased risk of perioperative bleeding. Thus, the use of coronary revascularization prior to noncardiac surgery should be reserved for those patients with an independent cardiac need for the procedure, such as unstable angina or stable angina refractory to medical therapy. In summary, patients with low clinical risk factors and good functional status, undergoing a low or intermediate risk surgery, have an excellent prognosis and may proceed to surgery without further delay. In addition, stable patients who have previously undergone coronary revascularization may also safely undergo surgery. Patients requiring urgent surgery should proceed immediately, since the consequences of delay usually outweigh the benefits of preoperative risk assessment. However, elective surgery should be indefinitely deferred for those patients with unstable coronary syndromes, since consequences of the cardiac disease usually negate the benefits of surgery. Controversy involves the intermediate or high clinical risk patient considering high-risk, but elective, surgery. Noninvasive testing offers only limited assistance in estimating risk for these patients. The best risk reduction strategy for these patients is perioperative beta blockade use. The role of coronary revascularization specifically to reduce perioperative cardiac complications remains unproven.

Cardiovascular Diseases↗
PubMed1999

Adverse cardiac outcomes after noncardiac surgery in patients with prior percutaneous transluminal coronary angioplasty.

UNLABELLED: In this retrospective cohort study, we compared adverse cardiac outcomes after noncardiac surgery among patients with prior percutaneous transluminal coronary angioplasty (PTCA), patients with nonrevascularized coronary artery disease (CAD), and normal controls. Inpatient hospital discharge abstracts from all nonfederal acute care hospitals in Washington State linked to death certificates were evaluated. Patients > or =45 yr old with prior PTCA who underwent noncardiac surgery from 1987 to 1993 were matched by age, sex, surgery type, and discharge year to 686 patients with CAD and to 2155 normal controls (no CAD). We compared risk for adverse cardiac outcomes (death, myocardial infarction, angina, congestive heart failure, malignant dysrhythmia, cardiogenic shock, coronary artery bypass graft, or PTCA) within 30 days. Patients with PTCA had twice the risk of adverse cardiac outcome as normal controls (odds ratio [OR] 1.98; P < 0.001), with a higher risk of angina (OR 7.84), congestive heart failure (OR 2.06), and myocardial infarction (OR 3.86) but a lower risk of death (OR 0.46; P < 0.001). Patients with PTCA had half the risk of adverse cardiac outcome as patients with CAD (OR 0.50; P < 0.001), including less risk of angina (OR 0.51) and congestive heart failure (OR 0.40; P < 0.001), but no difference in myocardial infarction (P = 0.304) or death (P = 0.436). No difference was found between 142 patients with recent PTCA (< or =90 days before noncardiac surgery) matched to patients with CAD (OR 0.90; P = 0.396). Patients revascularized by PTCA >90 days before noncardiac surgery seem to have a lower risk of poor outcome than nonrevascularized patients, although not as low as normal controls. For recent PTCA patients, the lack of difference compared with CAD patient outcomes requires a larger sample size for verification. Present findings do not lend support to a role for prophylactic PTCA to improve noncardiac surgery outcomes. This investigation did not control for CAD severity, medical management, or comorbidities. Study of these factors is needed before the clinical implications of PTCA for noncardiac surgical risk can be completely assessed. IMPLICATIONS: Hospital records showed patients with prior percutaneous transluminal coronary angioplasty were twice as likely as healthy patients to have an adverse cardiac outcome after noncardiac surgery, although their risk was reduced by half compared with patients with untreated coronary artery disease. Further study of the role of percutaneous transluminal coronary angioplasty in modulating noncardiac surgery risk is needed.

Aged↗
PubMed2005

Efficacy of Seprafilm for reducing reoperative risk in pediatric surgical patients undergoing abdominal surgery.

BACKGROUND: The safety and efficacy of Seprafilm (Genzyme Corporation, Cambridge, Mass) in adult surgery patients have been established. The aim of this study was to evaluate the safety and efficacy of Seprafilm in pediatric surgical patients. METHODS: One hundred twenty-two pediatric abdominal surgery patients were enrolled. Sixty-seven patients received Seprafilm application. Of these patients, 18 again received Seprafilm at abdominal closure during a second surgery, and of the 18, 4 received Seprafilm at closure after a third surgery. Of the 55 control patients who did not receive Seprafilm, 14 had a second surgery, and of these 14 patients, 4 had a third surgery. Adverse events, operation time, and blood loss were compared with assessed Seprafilm safety. Seprafilm efficacy evaluations included incidence and severity of adhesions in those patients who required relaparotomy. RESULTS: The incidence (Seprafilm, 40.9%; control, 82.4%) and severity (Seprafilm: 59.1%, grade 0; control: 17.6%, grade 0) of adhesions under the abdominal incision site were significantly reduced in the Seprafilm group (P = .007 and P = .0009, respectively). In addition, mean relaparotomy operation time was significantly shorter for Seprafilm patients (P = .004). At relaparotomy, blood loss/body weight ratio for Seprafilm patients compared with control patients showed a trend toward but did not reach significance (P = .09). CONCLUSIONS: Decreased incidence and severity of postsurgical adhesions with Seprafilm in pediatric patients may lead to reduction of the risks associated with subsequent operation.

Abdomen↗
PubMed1995

[Vascular surgery methods for elderly patients. Elective interventions with reduced risk are possible].

As in other areas, the percentage of elderly patients consulting the vascular surgeon is also on the increase. In recent years, our diagnostic possibilities have been expanded by non-invasive procedures (e. g. colour-coded duplex sonography, NMR angiography) and by improvements in intravascular imaging procedures. Early diagnosis makes it possible to perform interventions electively, which is of particular importance for minimizing risks in the geriatric patient. In the case of supra-aortic interventions (e.g. carotid reconstruction), surgical treatment of an aneurysm, and in venous occlusions, the indication for surgery in the elderly should not be applied too restrictively. For the treatment of arterial occlusions, a fundamental choice must be made between interventional (e.g. PTA) and surgical procedures. When peripheral arterial occlusive disease presents, conservative therapy should be applied for as long as is possible, since over the long term this can save many patients the need for surgery.

Age Factors↗