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At least 253 records · Page 14Linked to original sources
PubMed1979

Reanastomosis of the previously ligated fallopian tube.

Tubal sterilization procedures are being performed on young women in increasing numbers. For a variety of reasons a small but significant number of women are requesting reversal of the tubal interruption. This report presents a series of 20 consecutive patients on whom tuabl reanastomoses of previously noncoagulated, surgically ligated fallopian tubes were performed. An intraluminal tubal suture technique is described. Low magnification (X2 to X4) was used. The comparative results of the patients operated upon revealed a tubal pregnancy rate of 80%, a total pregnancy rate of 70%, a viable pregnancy rate of 55%, three abortions, and one ectopic pregnancy.

Fallopian Tubes↗
PubMed1980

Minilaparotomy under local anesthesia for outpatient sterilization: a preliminary report.

An outpatient sterilization program was started at Silas B. Hays Hospital, Fort Ord, California, and later extended to Malcolm Grow USAF Medical Center and the Walter Reed Army Medical Center. From January 1976 to June 1978, two hundred and eight outpatient minilaparotomy Pomeroy tubal ligations were performed under local anesthesia. The minilaparotomy technique, using standard operating room equipment, is described. The average operating time was 31.8 minutes and the complication rate was 2.5%.

Adult↗
PubMed1980

Microsurgical reversal of female sterilization: a reappraisal.

The role of microsurgery in reversal of sterilization has been reassessed and 118 cases reviewed. The technical variations for tubo-tubal anastomosis necessitated by the condition of the oviducts have been outlined in detail. All 118 cases were included in the analysis without requirement for a minimal postoperative trial period. Seventy-six of these (64.4%) had achieved one or more intrauterine pregnancies. There was one ectopic gestation. Forty-seven patients, reported earlier, were resurveyed. These patients had a minimal postoperative trial period of 18 months. Thirty-eight (80.8%) had achieved one or more term pregnancies or were in the latter half of a normally progressing pregnancy. The mean time interval between the reconstructive surgery and the occurrence of pregnancy was 10.2 months. The longest time interval was 40 months. An inverse relationship was noted between the total length of the reconstructed oviducts and the occurrence of pregnancy.

Adult↗
PubMed2003

Can particulate extraction from the ascending aorta reduce neurologic injury in cardiac surgery?

OBJECTIVE: This study examined whether extraction of particulate emboli using intra-aortic filtration could decrease neurologic outcomes. METHODS: Patients (N = 582) were enrolled in a prospective, controlled study and alternately assigned to the therapy arm (n = 304; intra-aortic filtration) or control arm (n = 278). Preoperative, procedural, and postoperative data were collected. Neurologic examinations included the National Institutes of Health Stroke Scale, Glasgow Coma Scale, and memory tests. Investigators administering neurologic tests were blinded to the study arm. By the use of logistic regression and propensity matching, composite neurologic outcomes (transient ischemic attack, stroke, delirium, coma, and memory deficit) were evaluated. RESULTS: Patients in the filter group experienced a lower incidence of adverse neurologic outcomes than patients in the control group (4.3% vs 11.9%) (P <.001). There were significantly less transient ischemic attacks (0% vs 1.4%), delirium (3.0% vs 6.5%), and memory deficit (1.3% vs 6.2%). There were fewer strokes in the filter group compared with the control group (0.7% vs 2.2%), although the sample size was too small for a significant finding. Both groups experienced 1 coma outcome. The use of a filter was associated with an adjusted odds ratio of 0.375, implying that a patient who does not receive a filter is 2.7 times more likely to experience an adverse neurologic event. Logistic modeling also demonstrated that there are increasing chances of poor neurologic outcome with increasing age. The model indicates that there may be an increasing protective benefit from the filter with increasing age, although the interaction was not significant. CONCLUSIONS: The extraction of particulate emboli using intra-aortic filtration resulted in decreased neurologic outcomes.

Aged↗
PubMed1985

Surgery of anorectal anomalies.

This article discusses the disparate views regarding sphincteric anatomy, both normal and abnormal, and describes preoperative procedures for and operative approaches to resolving anorectal anomalies.

Anal Canal↗
PubMed2001

Is postoperative cystography necessary after ureteral reimplantation?

OBJECTIVES: To evaluate the patients in our practice to determine whether postoperative cystography was useful in monitoring the outcome after ureteroneocystostomy. Surgical repair of vesicoureteral reflux is the treatment of choice after medical therapy failure. Radiographic evaluation by ultrasonography or voiding cystourethrography (VCUG) is commonly used postoperatively to evaluate for urinary tract obstruction or persistent reflux. However, imaging modalities are not without cost, both in monetary terms and in terms of radiation exposure and trauma to the child. METHODS: We reviewed the records of all patients who underwent ureteroneocystostomy without ureteral tapering at our institution between January 1, 1996 and December 31, 1999 for primary vesicoureteral reflux. These records were evaluated with respect to the type of surgical procedure, preoperative and postoperative clinical course, and radiographic studies performed. RESULTS: We performed reimplantation on 267 renal units in 153 patients. The surgical technique was the Cohen cross-trigonal in 120 renal units (45%), Glenn-Anderson ureteral advancement in 92 (35%), and modified Leadbetter-Politano ureteral advancement in 55 (20%). All patients underwent imaging with ultrasonography within 6 weeks of surgery. The follow-up ranged from 4 to 42 months (average 14.2). Between 3 and 8 months postoperatively, 61 patients underwent imaging with VCUG. We identified persistent reflux in six renal units. Four of six had marked improvement in their reflux. All the patients with persistent reflux were asymptomatic, including 2 patients who were no longer receiving antibiotics. Four patients developed febrile urinary tract infections postoperatively. Three of the four underwent imaging with VCUG after treatment; all three had no evidence of reflux. CONCLUSIONS: In our population, the addition of VCUG to the postoperative evaluation did not allow us to identify those patients at risk of febrile urinary tract infections. Patients in whom persistent reflux was identified were all asymptomatic. We continue to monitor patients with ultrasonography, but believe that VCUG often provides little benefit to these children.

Adolescent↗
PubMed1991

Pathologic review of consecutive radical prostatectomy specimens. Nerve sparing versus nonnerve sparing.

Retrospective pathologic analysis was conducted of specimens from 88 radical retropubic prostatectomy operations performed between 1982 and 1987 inclusive. The median age of patients was sixty years (range, 46 to 73 years). Of the 88 radical prostatectomies performed, 51 were nerve-sparing (40 bilateral) and 37 were nonnerve-sparing (11 unilateral) procedures. Preoperative clinical staging was similar in both groups. Thirty-five of 37 patients (95%) in nonnerve-staging group and 51 of 51 patients (100%) in nerve-sparing group had clinical Stage B2 disease or less. Pathologic staging in both groups was also similar. In 26 of 37 patients (70%) in nonnerve-sparing group and in 35 of 51 patients (69%) in nerve-sparing group, disease remained localized to the prostate. Both groups were analyzed retrospectively to determine whether or not the incidences of microinvasion of capsule and of extraprostatic disease differed. Review of the apical and lateral margins of the specimens revealed no statistically significant difference in either the degree of microinvasion of capsule or the incidence of extraprostatic disease between the groups.

Adenocarcinoma↗
PubMed2003

Effect of laser in situ keratomileusis on optic nerve head topography and retinal nerve fiber layer thickness.

PURPOSE: To determine whether laser in situ keratomileusis (LASIK) produces significant changes in optic nerve head (ONH) topography and retinal nerve fiber layer (RNFL) thickness as measured by the Heidelberg Retina Tomograph (HRT) and to evaluate the potential neuroprotective effect of topical betaxolol on these changes. SETTING: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. METHODS: In this prospective randomized double-masked comparative case series, 34 patients having LASIK for myopia were randomly assigned to receive topical betaxolol 0.5% solution or placebo twice a day for 2 days before the procedure and 7 days after the procedure. Preoperative and postoperative (1 week and 1 and 3 months) images were made with the HRT. Four HRT parameters (rim area, rim volume, mean RNFL thickness, and cup shape measure) were analyzed in a masked fashion. The Student paired t test was used for statistical analysis. RESULTS: No significant changes from baseline occurred in any HRT parameter in either patient group or when the patients were evaluated as a single group. CONCLUSIONS: Laser in situ keratomileusis did not adversely affect ONH morphology or RNFL thickness as measured by HRT. Since no neural damage was detected, the potential neuroprotective effect of betaxolol could not be evaluated.

Adrenergic beta-Antagonists↗
PubMed1998

Cataract surgery in patients with dry eyes.

PURPOSE: To evaluate the potential causes of postoperative complications and the visual outcome after surgery for age-related cataract in dry eyes. SETTING: Tertiary-care multidisciplinary referral medical institution. METHODS: The records of 15 patients (21 eyes) with age-related cataract, a Schirmer value of 5.0 mm or less in 5 minutes, and a tear-film breakup time of 5 seconds or less having complications after cataract surgery were reviewed. Patients were assigned to 1 of 2 groups: dry eye with probable secondary Sjögren's syndrome (Group 1); dry eye without connective tissue disorders (Group 2). The surgical procedure, preoperative and postoperative medications, postoperative complications, and final visual outcome were analyzed. RESULTS: Ten eyes (8 patients) in Group 1 and 11 (7 patients) in Group 2 had cataract surgery. In Group 1, postoperative endophthalmitis developed in 3 eyes and peripheral keratolysis in 4; 5 eyes attained a visual acuity between 6/60 and 6/18 2 years after surgery. In Group 2, filamentary keratitis developed in 6 eyes and peripheral keratolysis in 2 eyes; 6 eyes achieved a visual acuity of 6/12 or better 2 year after surgery. A significant decrease in visual acuity occurred between 3 months and 2 years postoperatively in both Group 1 (P = .010) and Group 2 (P = .0005). CONCLUSION: Cataract surgery in dry eyes had fewer complications and better visual outcome in patients who did not have connective tissue disease than in those who did.

Adult↗
PubMed2001

Urgent surgical revascularization of unstable angina. Influence of double mammary arteries.

OBJECTIVE: Aim of this study was to evaluate retrospectively: (1) the outcome in patients with unstable angina (UA) refractory to the medical therapy undergoing urgent-emergent CABG; (2) the influence of both IMAs employment. PATIENTS AND METHODS: Between January 1995 and July 2000, 576 (28.5%) consecutive patients with UA underwent CABG procedure. 182 (31.6%, Group I) patients, presenting unstable hemodynamic or angina pectoris refractory to the maximal medical therapy, underwent urgent/emergent CABG. 397 (68.4%, Group II) patients, after the maximal medical therapy did not present angina's episodes or ECG alterations and underwent elective CABG procedure. Preoperative data were similar in the two groups. Both IMAs were used in 68 (37.4%) patients of I and 152 (38%) of II (P>0.05) to left side revascularization. RESULTS: CAD extension was greater in Group I: 45 (24.7%) patients presented ischemia in >1 area vs 53 (13.5%) in II (P<0.001). Incidence of anteroseptal ischemia resulted significantly higher in I (P=0.017); left main coronary artery stenosis was present in 68 (37%) patients in I vs 108 (27%) in II (P=0.01). LV function resulted significantly depressed in I, demonstrated by a significantly lower LVEF (P<0.001), higher NYHA class (P<0.001) and preoperative incidence of IABP (P<0.001). Intraoperative data analysis did not reveal any difference between groups. Hospital mortality was 13 (7%) and 21 (5.3%) patients in I and II respectively (P=ns). Multivariate analysis of all preoperative and intraoperative variables revealed the age >65 years (P=0.01), congestive heart failure (P<0.001), LVEF<35% (P=0.03), >1 ischemic area (P=0.02) as strong predictors for poor overall survival, and LIMA (P=0.006) and both IMAs (P=0.001) as strong predictors for good overall survival. Actuarial survival at 1, 3 and 5 years resulted to be 98.5, 96.5 and 90% in I and 99, 96 and 92% in II (P=ns). CONCLUSION: CABG has been associated with acceptable outcome in patients with UA which should be applied soonest possible in patients refractory to medical treatment. Total coronary revascularization and employment of both IMAs for left myocardial side are associated with low operative risk and incidence of complications, permit to have acceptable short and long-term outcome in this pool of patients.

Aged↗
PubMed2003

Beating heart coronary artery bypass: operative strategy and technique.

With beating heart techniques firmly established, coronary surgeons now have a variety of approaches from which to choose the best operation for each individual patient based upon their own personal and institutional experience. Selection of the best operative approach and combination of available techniques for each patient is a dynamic process and forms the basis of our operative strategy. We consider four basic alternative operative approaches in each patient based on specific physiologic and anatomic criteria. Success begins with a committed team and close collaboration between surgeon and anesthesiologist. Effective communication is essential to maintaining clinical stability and avoiding disaster. During beating heart surgery, global ischemia is eliminated and regional ischemia is managed by an individualized grafting strategy designed to minimize the area of regional myocardium that is ischemic during each anastomosis. Maneuvers are described that are designed to minimize compression, ischemia, and length of time that the heart is displaced and usually result in satisfactory exposure and hemodynamics. A proven successful operative strategy is outlined including 1) initial patient evaluation and preoperative procedure selection; 2) operative choreography; 3) incision and initial exposure; 4) an individualized revascularization strategy; and 5) target vessel exposure, stabilization, vascular control, and visualization. Most cardiac surgeons already possess the skills required to successfully adopt beating heart surgery. Knowing when to patiently wait, when to persist, and when to intervene is more important to the successful application of these techniques than any skill.

Anastomosis, Surgical↗
PubMedDate not supplied

Arterial complications of pancreatitis: diagnostic and therapeutic aspects in 104 cases.

PURPOSE: A retrospective study of 104 cases of arterial lesions related to pancreatitis was undertaken to examine the diagnostic and therapeutic benefits of arteriography compared with ultrasonography (US) and computed tomography (CT). PATIENTS AND METHODS: Data were acquired from responses to a questionnaire. Eighty-seven patients were men, 17 were women (age range, 21-80 years; mean, 48 years). These lesions were usually revealed by hemorrhage (70 cases), pain (69 cases), or both (46 cases). RESULTS: Arteriography was immediately positive in 90 of 93 patients in whom it was performed, but US and CT may also permit incidental discovery of silent lesions (17 cases). These lesions are often single (90%) and related to an arterial rupture in a pseudocyst (60%) or a pseudoaneurysm (48%). They involved the splenic (42%), the gastroduodenal (22%), and the small pancreatic arteries (25%). Of 32 cases in which embolization was performed, immediate success was achieved in all cases but bleeding recurred in 12 cases (37%). Treatment in 25 patients was a definitive success (78%), and five patients died of hemorrhage (16%). CONCLUSION: Arteriography remains essential for diagnosis of arterial lesions, and embolization may be indicated as a stabilizing preoperative procedure and also for immediately stopping hemorrhage.

Abdominal Pain↗
PubMed2002

Role of fine needle aspiration cytology in diagnosis of pleomorphic adenomas.

This retrospective study was carried out to review the cases diagnosed as pleomorphic adenoma in major or minor salivary glands and determine the difficulties encountered on typing this tumour on fine needle aspiration cytology (FNAC). Over a 19-year period (1982-2000) 488 pleomorphic adenomas were diagnosed on FNAC from different sites (parotid - 372 cases, submandibular - 95 cases; oral cavity - 21 cases). Histology was available in 232 cases. Twenty-nine cases where a histological diagnosis of pleomorphic adenoma was made but the cytological diagnosis was variable were also reviewed. In 216 of the 232 cases a good cytohistological correlation was available. On review only 4 of the 16 cases initially diagnosed as pleomorphic adenoma on FNAC where the histology revealed a different tumour were categorized as pleomorphic adenoma, while 3 each were classified as adenoid cystic carcinoma and benign tumour ?type, and 2 each were diagnosed to be muco-epidermoid carcinoma, monomorphic adenoma and acinic cell carcinoma. On review of the FNAC smears from 29 cases where a histological diagnosis of pleomorphic adenoma was available while the cytological diagnosis was variable, only 11 (38%) were categorized as pleomorphic adenoma. In the majority of the remaining cases the cytological diagnosis did not alter markedly, 7 of 10 cases where the tumour could not be typed on cytology initially could not be typed even on review. In conclusion, FNAC is an ideal, fairly accurate preoperative procedure for the diagnosis of pleomorphic adenomas. Certain diagnostic problems occur in differentiating pleomorphic adenomas from adenoid cystic carcinoma, monomorphic adenoma and mucoepidermoid carcinoma. Carcinoma ex-pleomorphic adenoma is difficult to identify on FNAC and in our series all 4 such cases on histology were considered benign on cytology.

Adenoma, Pleomorphic↗
PubMed2004

Prevention and management of complications of airway surgery in children.

Preventing and managing complications of airway surgery in children requires proactive attention to both surgical and anaesthetic aspects of the planned procedure. Preoperative evaluation should include a thorough physical examination and, especially in children with multiple congenital anomalies, flexible fibreoptic nasopharyngolaryngoscopy, direct laryngoscopy and rigid or flexible bronchoscopy. The goal is to identify dynamic abnormalities such as laryngomalacia or vocal cord paralysis, tracheal or bronchial lesions, gastro-oesophageal reflux disease (GORD), aspiration, laryngotracheal stenosis, totally obstructing tracheostomy-associated granulation tissue and Noonan syndrome preoperatively, and then to plan surgical management to achieve the best possible outcome for each patient.

Child↗
PubMedDate not supplied

Application of 3D computer-assisted techniques to sinonasal pathology--case report: war wounds of paranasal sinuses caused by metallic foreign bodies.

Foreign bodies in paranasal sinuses are found quite infrequently. They are usually detected after various types of head trauma and most commonly occur as a consequence of improper handling of firearms or explosives. In countries at war, eg, during the war in Croatia, adults and children were almost equally exposed to these injuries. The diagnosis should be based on results from precise computer tomography (CT) scanning in axial and coronal sections, and, using these data, tissues of different densities at these anatomical locations can be differentiated. The possibility of exact preoperative, noninvasive visualization of the spatial relationships of anatomic and pathologic structures with 3-dimensional (3D) computer-assisted diagnosis and intraoperative navigational techniques allows the surgeon to achieve a considerable advantage in the preoperative examination of the patient and to reduce the risk of intraoperative complications, all by the use of virtual surgery (VS) or virtual diagnosis. The expected contribution of the mentioned computer-assisted surgical technique manifests itself in defining the most appropriate mode of CT scanning of the head to design the 3D operating field model, and the possibility of active and dynamic 3D visualization of the desired anatomical regions is realized. 3D reconstruction of anatomic units becomes a routine preoperative procedure, providing a highly useful and informative visualization of the regions of interest, and, thus, advancing the definition of geometric information on anatomical contours of the 3D model by the transfer of so-called image pixel to contour pixel.

Child↗
PubMed2002

Role of plasma thrombopoietin level in thrombocytopenia of postoperative biliary atresia patients.

BACKGROUND/PURPOSE: To evaluate if thrombocytopenia may be related to plasma thrombopoietin level (P-TPO) in postoperative biliary atresia (BA). METHODS: Forty-three postoperative BA patients aged 1 to 20 years were included. P-TPO was measured by enzyme immunoassay. P-TPO was compared with platelet counts (Plt), Child's classification, presence of splenomegaly, and liver function tests. RESULTS: P-TPO significantly correlated with Plt, child's classification, serum albumin, and cholinesterase level, respectively. In 4 patients undergoing portal decompression procedure, preoperative and postoperative Plt and P-TPO were 87.5 +/- 69.1 x 10(3) and 50.3 +/- 28.0, 118.8 +/- 62.3 x 10(3)/mm3, and 53.0 +/- 55.0 pg/mL, respectively, without significant difference. In 6 patients undergoing liver transplantation (LTx), Plt and P-TPO after LTx was 157.5 +/- 83.5 x 10(3) and 143.5 +/- 75.2, respectively, which were significantly higher than those before LTx (55.0 +/- 15.6 x 10(3)/mm3 and 53.2 +/- 32.9 pg/mL). CONCLUSION: Thrombocytopenia in postoperative BA may be caused by decreased plasma TPO level in accordance with the severity of liver dysfunction rather than hypersplenism.

Adolescent↗
PubMed2004

[Extranasopharyngeal angiofibroma of the nasal cavity and paranasal sinuses].

BACKGROUND: Angiofibromas commonly arise in the nasopharynx in young male patients. Diagnosis is widely based on radiographic imaging to avoid ill-advised biopsy which may result in brisk bleeding. This study was undertaken to evaluate the incidence, clinical features and complications that may occur during the process of diagnosis and surgical therapy of angiofibromas outside the nasopharynx. METHODS AND PATIENTS: Case report of a 13-year-old female patient and review of the literature. RESULTS: Our patient received multi-agent chemotherapy elsewhere due to a misdiagnosed angiofibroma. Computed Tomography (CT) revealed a maxillary tumor which was repeatedly biopsied. Hypervascularity was excluded by arteriography and the lesion removed after lateral rhinotomy. The data of 42 patients were analyzed including our own case. 32 patients were male, 10 female. The majority became symptomatic aged 19 years or younger (71.4 %). The maxilla was most commonly affected (38 %), less frequently the ethmoid, nasal cavity or septum, beside others. In 38 patients, symptoms developed within 12 months or less (average: 8.5 months). Epistaxis, nasal obstruction and facial swelling were reported for most patients. Brisk bleeding occurred in 10 patients during tumor removal and resulted from biopsies in 11 of 20 patients. Angiography detected hypervascularity in 3 of 4 patients. There was no case with lethal outcome. CONCLUSION: Extranasopharyngeal angiofibromas of the nasal cavity or paranasal sinuses should be included in the differential diagnosis of nasal tumors. Compared to nasopharyngeal angiofibromas, more female patients are involved, symptoms develop more quickly but hypervascularity is less common. Signs of questionable hypervascularity in Computed Tomography and Magnetic Resonance Imaging (MRI) should indicate arteriography prior to surgical procedures. Preoperative embolization of hypervascular lesions during arteriography will reduce the risk of brisk bleeding during biopsy or surgical tumor removal.

Adolescent↗