Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Postoperative Procedures”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

Jejunoileal bypass for the treatment of morbid obesity.

With a reported mortality rate of less than 0.5%, and an immediate morbidity of 2% to 4%, jejunoileal bypass may result in a more significant weight loss than can be achieved with gastric bypass. Jejunoileal bypass cannot be outeaten, whereas gastric bypass can. Careful attention to preoperative, intraoperative and postoperative procedures will protect most jejunoileal bypass patients from both the side effects and complications of this surgical technique, allowing the morbidly obese to achieve the maximum benefit from intestinal bypass with fewer adverse results.

Body Weight↗
PubMed2005

Cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons: results of a controlled prospective randomized study with 2-year follow-up.

PURPOSE: To determine if there is a different clinical outcome after cross-pin versus interference screw fixation in anterior cruciate ligament (ACL) reconstruction with hamstring tendons. TYPE OF STUDY: Prospective randomized clinical follow-up study. METHODS: Sixty-two patients were randomized into either TransFix cross-pin (Arthrex, Naples, FL) (TransFix group, n = 31) or metal interference screw femoral fixation (screw group, n = 31) in ACL reconstruction with hamstring tendons. The distal fixations were an AO screw with spiked washer post and metal interference screw. The evaluation methods were clinical examination, CA 4000 laxity (OSI, Hayward, CA), and Lido isokinetic muscle torque measurements (Lido MultiJoint II; Loredon, West Sacramento, CA) as well as International Knee Documentation Committee (IKDC), Tegner activity level, Lysholm knee, and Kujala patellofemoral scores. RESULTS: There were no differences between the study groups preoperatively. For the 2-year follow-up, 26 patients of the TransFix group and 30 patients of the screw group were available (90%). The evaluation methods disclosed no statistical differences between the groups at the 1- or 2-year follow-up examinations. At the 2-year follow-up, 22 (85%) of the TransFix and 22 (73%) of the screw group patients were in the IKDC A or B categories. There were significantly more additional procedures postoperatively in the TransFix group owing to the removal of the tibial fixation post hardware in 15 (48%) cases. CONCLUSIONS: There were no statistically or clinically relevant differences in the results 1 or 2 years postoperatively and both techniques seemed to improve patients' performance. LEVEL OF EVIDENCE: Level I.

Adolescent↗
PubMed1977

Diffuse spasm of the esophagus. Clinical manometric, and surgical considerations.

Extended esophagomyotomy was performed on 11 patients with diffuse spasm of the esophagus (DSE). Preoperative and postoperative clinical, manometric, and roentgenographic findings are reviewed. Preoperative manometry performed in all patients disclosed a mean deglutitive pressure of 70 mm. Hg in the diseases areas and indicated the required length of myotomy. The lower esophageal sphincter (LES) was within normal limits in most instances, with a mean amplitude of 20 mm. Hg, and its exclusion from the myotomy eliminated the need for additional antireflux procedures. Postoperative manometry in 10 patients disclosed a 70 percent reduction in deglutitive pressures in the myotomized segments, and the mean LES amplitude of 13 mm. Hg remained within the normal range (10 to 20 mm. Hg). Ten of the 11 patients were clinically improved, and postoperative reflux developed in only one patient. These results support the continued use of extended esophagomyotomy in selected patients with DSE and suggest that exclusion of the LES from the myotomy affords satisfactory antireflux protection without ancillary sphincter-enhancing maneuvers.

Adult↗
PubMed1996

Salvage of instrumental lumbar fusions complicated by surgical wound infection.

STUDY DESIGN: This study retrospectively reviewed instrumented lumbar fusions complicated by surgical wound infection and managed by a protocol including antibiotic impregnated beads. OBJECTIVE: To evaluate the potential for an acceptable clinical outcome in cases of instrumented lumbar fusion complicated by wound infection. SUMMARY OF BACKGROUND DATA: Initial studies of pedicle screw instrumentation suggested an increased infection rate versus noninstrumented fusion. The presence of a metallic implant also complicates wound management. METHODS: Eight hundred fifty-eight instrumented fusions were reviewed with 22 (2.6%) deep wound infections identified. Analysis included preoperative risk factors, surgical procedure, postoperative course, and clinical outcome. RESULTS: Nineteen patients (mean age, 55 years) were reviewed at a minimum of 1 year after surgery. Sixteen (83%) reported significant preoperative health problems. Forty-seven percent of the patients had three- and four-level fusions. Mean operative time was 342 minutes. Mean estimated blood loss was 1620 mL. Infection was diagnosed at an average of 16 days after surgery with wound drainage as the most common presenting feature. Patients underwent between two and 10 (mean, 4.7) irrigation procedures. Seven patients had other significant noninfectious complications. At follow-up evaluation, no patient had recurrence of infection. By comparison to preoperative symptoms, 15 patients were improved, three were unchanged, and one deteriorated. Fusion was apparently solid in 14 patients, probable in four patients, and nonunion occurred in one patient. CONCLUSION: Although wound infection is a significant complication, this study suggests that aggressive surgical management can result in preservation of an adequate fusion rate and maintenance of an acceptable postoperative outcome.

Adult↗
PubMed2002

Intraoperative intra-arterial urokinase therapy after failed embolectomy in acute lower limb ischemia.

BACKGROUND: Aim of this study is to evaluate the use of intraoperative intra-arterial urokinase infusion (IIUI) in overcoming residual thrombi after thromboembolectomy in acute lower limb ischemia. METHODS DESIGN: retrospective study over a 3-year period. SETTING: University affiliated hospital. PATIENTS: 21 patients with acute lower limb ischemia who underwent IIUI after embolectomy (18 transfemoral, 3 transpopliteal) had failed to achieve adequate distal perfusion. Postoperatively, all patients were maintained on full dose heparinization. MAIN OUTCOME MEASUREMENTS: complete or partial clot lysis on post-IIUI angiography; restoration of pedal pulses and a viable leg at discharge. RESULTS: Angiographically, complete and partial lysis was demonstrated in 14 and 3 patients, respectively. Two patients with prolonged ischemia required fasciotomy. One of these eventually had an amputation. Altogether, limb amputations (1 above knee, 2 below knee) were necessary in 3 patients. The angiographic appearance of lysis correlated well with the restoration of pedal pulses and/or limb viability. One patient died of myocardial infarction 3 days after the procedure. Postoperatively, there were 5 (24%) wound hematomas of which 1 required surgical exploration. Over a mean follow-up period of 8 months (range 1-16), limb salvage was sustained in the 17 patients with successful angiographic lysis. CONCLUSIONS: IIUI is an effective therapeutic adjunct to failed embolectomy in acute lower limb ischemia. Use of this procedure is recommended as part of the routine management in such cases.

Aged↗
PubMedDate not supplied

[Biliary calculi in liver cirrhosis. Clinical, epidemiologic & therapeutic aspects].

BACKGROUND: Incidence of cholelithiasis in cirrhotic patients is twice of threefold that in non cirrhotic one. Cholelithiasis is often asintomatic, however, when complications occur, emergency surgery is burden by high rates of morbidity and mortality. Purpose of the current study is to state the clinical features and to assess the outcome of elective surgery in these patients. METHODS: Sixtyseven consecutive patients with liver cirrhosis (Group A) who underwent elective surgery for biliary stones were retrospectively reviewed. Preoperative clinical features, surgical procedure, postoperative morbidity and morality were recorded and compared with those of the 3291 non cirrhotic patients (Group B) observed in the same period and submitted to elective surgery for biliary stones. RESULTS: Stone involvement of the biliary tract (A vs B:31.3% vs 20.5%), cholangitis (A vs B:23.8% vs 13.0%) and acute biliary pancreatitis (A vs B:4.4% vs 0.7%) were found to be more frequent among cirrhotic patients. In Group A postoperative morbidity and mortality in Child-Pugh A and B were found to be not statistically different from those of Group B patients. CONCLUSION: Authors conclude that definitive biliary surgery may be considered as a successful and safe indication in the treatment of cirrhotic patients in Child-Pugh A and B grade. Conservative approaches are considered as more suitable in Child-Pugh C patients, and definitive elective procedures should be considered for these patients only when an improvement of their liver function can be achieved.

Adult↗
PubMed2004

Intraoperative local anesthesia decreases postoperative parenteral opioid requirements for transperitoneal laparoscopic renal and adrenal surgery: a randomized, double-blind, placebo controlled investigation.

PURPOSE: To determine if local anesthesia decreases discomfort following laparoscopic upper retroperitoneal surgery, we performed a randomized, double-blind, placebo controlled study in which the port sites and hand assist incision were infiltrated with bupivacaine or placebo prior to surgery. MATERIALS AND METHODS: A total of 72 patients undergoing transperitoneal laparoscopic renal or adrenal surgery were randomly assigned to the treatment (0.5% bupivacaine) or placebo (0.9% normal saline) arm. Port and hand assist port sites were infiltrated at the outset of the procedure. Postoperative pain and opioid use were measured at consistent intervals. RESULTS: A total of 37 individuals were treated with placebo (standard laparoscopy [SL] in 15 and hand assisted laparoscopy [HALS] in 22) and 35 were treated with bupivacaine (SL in 16 and HALS in 19). Mean parenteral morphine equivalents use for the placebo vs bupivacaine groups were 29.6 vs 20.0 mg at 12 hours, 50.2 vs 34.5 mg at 24 hours and 57.1 vs 36.6 mg for the total hospital stay (all p <0.05). Parenteral opioid use was decreased in the bupivacaine group in the SL and HALS subgroups with a significant effect at 12 hours in the latter subgroup. On multivariate ANOVA bupivacaine use but not SL vs HALS was associated with decreased parenteral opioid use at all time points (p <0.05). CONCLUSIONS: At the outset of transperitoneal laparoscopic urological surgery in the upper retroperitoneum, port site and other incision infiltration with long acting local anesthesia decreases postoperative parenteral opioid requirements compared with placebo controls. The effect was seen with SL and HALS and it was greater than any effect of SL vs HALS.

Adrenal Glands↗
PubMed2004

Left ventricular outflow obstruction after Fontan procedure involving a patient with complete atrioventricular septal defects complicated by a small left ventricle.

We report a 1-year-old girl who developed ventricular outflow tract obstruction early after a Fontan operation, necessitating surgical relief using the Damus-Kaye-Stansel procedure. The patient had a complete atrioventricular septal defect complicated by a muscular ventricular septal defect (VSD) and a small left ventricle, a morphology that has not previously been reported in cases of systemic outflow tract obstruction after the Fontan procedure. Postoperative systemic outflow obstruction must be considered as a possible sequela following Fontan surgery in patients with an atrioventricular septal defect and a small left ventricle.

Aftercare↗
PubMedDate not supplied

Stroke prevention during carotid surgery in high risk patients (value of transcranial Doppler and local anesthesia).

In a series of 114 cases, carotid surgery was performed under local anesthesia by cervical block in order to assess cerebral status. Preoperative transcranial Doppler was used to select high risk patients for shunting. Intraoperatively brain function was checked by carotid arterial blood pressure monitoring and transcranial Doppler. No stroke occurred during the procedure. Postoperatively two deaths (1.8%) occurred, one due to intracerebral hemorrhage and one to a late myocardial infarct. The predictive value of both transcranial Doppler and stump pressure monitoring for shunting was 97% respectively. In combination, the two methods provided 100% protection. During the same period, 1406 patients underwent carotid surgery under general anesthesia. Carotid surgery stroke can be prevented either by using transcranial Doppler together with carotid stump pressure monitoring when the procedure is performed under general anesthesia or by operating under local anesthesia.

Aged↗
PubMed2000

A clinical comparison of outpatient and standard myringoplasty.

This prospective study compared the surgical outcomes of 35 patients who underwent myringoplasty--16 who were treated as outpatients and 19 who were admitted as inpatients. The outpatient technique involved a free skin graft, with the temporalis fascia placed as an underlay graft. The inpatients underwent the standard myringoplasty procedure. Postoperatively, 14 of the 16 outpatients (87.5%) and 17 of the 19 inpatients (89.5%) were completely healed within 2 weeks. The results of this study indicate that outpatient myringoplasty with a free skin graft is as safe and effective as standard myringoplasty for most patients.

Ambulatory Surgical Procedures↗
PubMed2004

Vitrectomy with or without arteriovenous adventitial sheathotomy for macular edema associated with branch retinal vein occlusion.

PURPOSE: compare the results of vitrectomy with or without arteriovenous (AV) crossing sheathotomy for macular edema associated with branch retinal vein occlusion (BRVO). DESIGN: Interventional case series. METHODS: A retrospective study of 36 eyes with BRVO-associated macular edema. Twenty eyes underwent AV sheathotomy (AS group), and 16 eyes underwent posterior vitreous detachment (PVD group). Best-corrected visual acuity (BCVA), fluorescein angiography (FA), and optical coherence tomography to determine foveal thickness were conducted preoperatively and at 12 months postoperatively. RESULTS: The mean postoperative BCVAs were significantly better in both the AS and the PVD group (P = .008 and P = .001, respectively). Foveal thickness decreased significantly 1 month after surgery in both groups (P = .002 and P = .007) and continued to decrease up to 12 months. The postoperative mean BCVA and improvement of BCVA and foveal thickness were not significantly different for the two groups at any postoperative period. Postoperative FA showed reperfusion of the occluded vein in 10 eyes in the AS group and 2 eyes in the PVD group, and formation of shunt vessels at the AV crossing site or around the macular region in all of the other eyes of both groups. CONCLUSIONS: Both AV sheathotomy and simple PVD significantly reduced macular edema associated with BRVO. However, there was no significant difference in the improvement of macular function following either procedure. Postoperative improvement of retinal circulation by either reperfusion of the occluded vein or collateral vessel formation was found. This accounted for functional and morphologic improvements.

Aged↗
PubMed2006

N-chlorotaurine--a new safe substance for postoperative ear care.

OBJECTIVES: The new endogenous substance N-chlorotaurine (NCT), which for the first time was synthesized and introduced into clinical practice by our research group, was now used for postoperative ear care following tympanoplasty. The antiseptic and drying effect of NCT was evaluated and compared to the standard postoperative procedure in our department. METHODS: Prospective randomized trial on 10 patients. Local irrigations of the external auditory canal with 1% NCT solution were performed once daily until the canal was dry. RESULTS: NCT was well tolerated. The external auditory canal showed no signs of infections and dried significantly more rapidly than the control group. In contrast to previous suppositions, epithelialization proceeded without complications and was identical in both groups. CONCLUSIONS: As NCT in our first postoperative patient study was effective in preventing infections and drying of the outer ear canal was faster without impairing epithelialization, this agent seems useful for postoperative ear care.

Adult↗
PubMed1997

Intrathecal morphine for postoperative analgesia following repair of frontal encephaloceles in children: comparison with intermittent, on-demand dosing of nalbuphine.

STUDY OBJECTIVE: To determine the efficacy of lumbar intrathecal (i.t.) morphine in a dose of 0.02 mg/kg in providing analgesia following repair of frontal encephaloceles. DESIGN: Prospective, open-label investigation of i.t. morphine with secondary comparison to a retrospective cohort. SETTING: Metropolitan hospital in the Philippines. PATIENTS: 24 ASA physical status I and II children undergoing frontal encephalocele repair. INTERVENTIONS: Following induction of general anesthesia. I.t. morphine (Group 1) was administered via single-shot technique or through a lumbar i.t. drain placed for cerebrospinal fluid drainage during the surgical procedure. Postoperative analgesia was assessed by visual analog score in patients greater than 5 years of age or a behavioral score in patients less than 5 years of age. The retrospective cohort received postoperative analgesia with intermittent doses of intravenous nalbuphine (Group 2). MEASUREMENTS AND MAIN RESULTS: Group 1 had decreased postoperative analgesic requirements, decreased intraoperative inhalational anesthetic requirements, and a longer time to the first request for postoperative analgesia than Group 2. The time to the first request for postoperative analgesia was 16.0 +/- 9.1 hours in Group 1 and 1.6 +/- 1.2 hours in Group 2 (p < 0.0001). Six of 12 patients in Group 1 required no analgesic drugs during the first 24 postoperative hours while all 12 patients in Group 2 (p = 0.02) did require analgesic drugs during this period. The patients in Group 1 who did not require supplemental analgesic drugs maintained pain scores of 2 or less throughout the first 24 postoperative hours. CONCLUSION: Lumbar IT morphine provides effective analgesia following repair of frontal encephaloceles in children and adolescents.

Analgesics, Opioid↗
PubMed1996

Resection of meningiomas with implantable microwave coagulation.

Implantable microwave coagulation was used to perform resection on 62 patients that had intracranial meningiomas. When 20-60 W microwave power was applied for 15 s, the temperature at the center of the tumor tissue was 43-63 degrees C; 30 mm from the center, the temperature was under 40 degrees C. Histological changes in the center of the tumor showed coagulative necrosis, diminished nuclei, and obliterated blood vessels. The changes at 10-20 mm from the center of the tumor showed coagulative necrosis and degeneration and, 30-50 mm from the center of the tumor, showed normal cell morphology after microwave coagulation. The thermal field in brain tumor has an effective diameter of about 40 mm. No side effects on the normal brain tissues were observed. The amount of blood loss during the operation was minimal while the meningioma was coagulated, especially when the meningioma was located at the skull base or in the parasagittal or cerebral convexity region. After microwave coagulation, the entire tumor could easily be removed. Among the 62 surgically treated cases, gross total tumor excision was 85 percent. No postoperative complications occurred after microwave coagulation, and there was no operative mortality in the series. We believe that this new technique has the advantage of simplicity, less blood loss, and smooth postoperative procedures. Hemostatic effects during the operation are satisfactory, and blood transfusion can be reduced by 50-60 percent.

Adult↗
PubMed1982

The emerging role of epidural anesthesia in arteriography and in vascular operations.

Continuous epidural anesthesia offers special advantages for patients with vascular disease. In 193 patients who had this technique employed for aortofemoral arteriography, profound pain relief was provided and the accompanying vasodilation produced superior demonstration of collateral and small distal vessels. Eleven of these patients had epidural anesthesia for major vascular reconstruction operations. This caused minimal depression of pulmonary and myocardial performance during the procedure. Postoperative epidural analgesics improved the pulmonary performance by allowing normal pain-free breathing. No epidural complications were seen. Special precautions are described for the safe use of these techniques.

Analgesia↗
PubMed1981

[Comparison of preoperative and postoperative findings after stress incontinence surgery in women (author's transl)].

The authors attempt to assess success of surgery in 44 women with stress incontinence treated with colporrhaphia ant. et post. with/without vaginal hysterectomy, by evaluating preoperative and postoperative findings. Examination comprised, after detailed anamnesis, besides general gynaecological examination and examination of urine for pathological constituents, the following methods: simultaneous urethrocystometry, cystometry, urethrocystography, electromyography of the sphincter system, as well as uroflowmetry. It was found that despite subjectively reported success of operation there was often no direct correlation to the actual, objective findings. This underlines once again that assessment of the result of surgery is possible only via application of a wide range of diagnostic procedures postoperatively with the same methods. The results obtained are discussed with reference to reports published in medical literature.

Adult↗
PubMed2003

Yersinia septic shock following an autologous transfusion in a pediatric patient.

Although the literature on infections transmitted via transfused blood focuses on viruses, Yersinia enterocolitica can also cause severe infections in patients receiving transfusions. A 13-year-old patient developed severe sepsis after an autologous blood transfusion contaminated with Y. enterocolitica. The patient was an otherwise healthy female undergoing posterior spinal fusion for congenital scoliosis. Prior to surgery, the patient donated blood for perioperative and postoperative use. A few days before the donation, she had complained of abdominal pain and was experiencing mild diarrhea. The patient received four units of packed red blood cells (PRBCs) during the surgery. Intraoperatively, the patient developed fever up to 103.6 degrees F, became hypotensive requiring epinephrine and dopamine, and developed metabolic acidosis with serum bicarbonate concentration dropping to 16 mmol/l. The surgery team believed the patient was experiencing malignant hyperthermia and attempted to cool patient during the procedure. Postoperatively, the patient was transferred to the pediatric intensive care unit and treated for severe shock of unknown etiology. The patient further developed disseminated intravascular coagulation. The patient received supportive care and was started on ampicillin/sulbactam on postoperative day (POD) one which was changed to clindamycin, ciprofloxacin and tobramycin on POD two when blood cultures grew gram-negative bacilli. On POD three, cultures were identified as Y. enterocolitica and antibiotics were changed to tobramycin and cefotaxime based on susceptibility data. Sequelae of the shock included adult respiratory distress syndrome requiring intubation and a tracheostomy and multiple intracranial hemorrhagic infarcts with subsequent seizure disorder. Due to severe lower extremity ischemia, she required a bilateral below the knee amputation. The cultures of the snippets from the bags of blood transfused to the patient also grew Y. enterocolitica. This case illustrates the importance of considering transfusion related bacterial infections in patients receiving PRBCs. All patients in shock following any type of transfusion may require aggressive antibiotic therapy, until the diagnosis and etiology are known.

Adolescent↗
PubMed2000

Management of the abdominal wall defect in the prune belly syndrome by muscle transposition: an 18-year follow-up.

Prune belly syndrome (PBS), an uncommon anomaly, consists of genito-urinary abnormalities and a partial or complete absence of abdominal wall musculature. Although the patient's genito-urinary problems are addressed, the attention currently directed toward the abdominal wall deficiency has been mostly aimed at improving the cosmetic appearance of patients and does little to replace the important functions of the musculature. These functions are the support of the viscera and their compression as well as the movement of the trunk. A case report with an 18-year follow-up is presented where thigh muscles were transposed to act as substitutes for the missing musculature. Although this presentation is based on a single case, it is intended to alert patients and physicians to a method of improving the lot of patients with PBS. In this patient, the result was very satisfactory. From being unable to move his trunk as a schoolboy before the surgical procedure, postoperatively he was able to participate in all school activities. As an adult, he is fully active and is a lead guitarist in a band. His excretory functions are normal and the scoliosis, present when first seen, has not progressed. It is suggested that consideration be given to the management of the abdominal wall deficiency in PBS by the transposition of muscle(s), because no alternative effective treatment directed to restoring absent muscle function appears to exist. Because the operative procedure is well tested and successful in adult patients who lose their abdominal wall musculature, the dissemination of this data appears to be necessary.

Abdominal Muscles↗