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At least 325 records · Page 18Linked to original sources
PubMed1991

Triple arthrodesis.

Triple arthrodesis is a useful operation for the relief of chronic pain and repair of instability and deformity in the rearfoot. Due to the nature of the procedure, preoperative surgical planning is of extreme importance to minimize the incidence of long-term problems associated with rearfoot fusion. Complete intraoperative reduction of the deformity and stable rigid fixation is necessary to avoid complications associated with arthrodesis failure and any long-term problems in neighboring joints, particularly in the ankle joint and joints of the mid- and forefoot. Even with good reduction and fixation, there is still the possibility of nonunion or painful pseudoarthrosis. Gait alterations that may lead to residual pain and degenerative joint disease can also be seen. While these problems can occur, they might not be as symptomatic as the patients' preoperative complaints. The surgeon, however, needs to be aware that these conditions exist and may need to be addressed in the long-term care of the patient.

Ankle Joint↗
PubMed1991

[No reason to set an age limit on tympanic membrane closure in children].

The results of 819 tympanic membrane reconstructions performed by the author between 1974 and 1987 were reviewed. The mean follow up period was 5.6 years (range 2 to 10 years). An attempt was made to answer the question whether it is justified to set an age limit for performance of eardrum reconstructions in children. Of the 819 reconstructions 304 were done between the age of 4 and 16. The review shows that if a strict preoperative procedure is followed, there is no significant difference in closure rate between children (91%) and adults (90%). The grafting material did not influence the closure rate.

Adolescent↗
PubMed1990

Recent developments in imaging diagnosis in fractures of the acetabulum: the role of CAT and tridimensional reconstruction.

The authors report their experience in a radiographic study of the treatment of 22 cases of fractures of the acetabulum. All the patients were studied using both traditional radiography and CAT, and the results were then compared. In 17 cases (77%) the CAT images were integrated with a tridimensional reconstruction (3D). The diagnostic aid provided by CAT was of crucial importance in planning treatment and selecting the most suitable surgical approach. Furthermore, 3D reconstruction may provide a valuable link between traditional radiography and CAT in evaluating complex fractures. The authors conclude that a comprehensive radio-diagnostic study should be a routine preoperative procedure in complex fractures of the acetabulum, and in all cases where traditional radiography yields doubtful results.

Acetabulum↗
PubMed1989

[Prosthodontic considerations in implant therapy].

Numerous factors affect the success or failure of the various intra-osseous implants. In particular, such considerations as the implant materials, properly selected or not, preceded by careful patient screening and thorough analysis of soft and hard tissues, implant insertion conditions, oral hygiene and the overlying prostheses determine the success of the implant therapy. Among these, the final overlying prostheses serve two major purposes of restoring lost masticatory function and esthetic improvement. In addition, due to the intimate relationship with the health and remodeling of the surrounding tissues, the prostheses must be designed with the utmost care. Analyzing this kind of osteointegrated system from the histologic standpoint of the implant/bone relationship, one can roughly classify this system into three types. One is a fibro-osseous integration yielded by enveloping with fibro connective tissue. The other is osseointegration by directly contacting with bone. Lastly, the osteoankylosis form whereby fusion of the implant and bone takes place. Irrespective of the different types and a basic physical principle applied, the function of the final prostheses should be to transmit occlusal force widely to the supporting cortical and basal bones (i.e., jaw bones) via the implant device without creating any undesirable concentrated, rotational or lateral force. Therefore, the final prostheses are not designed independently or after the implant operation. Instead, the prostheses design comes first, followed by careful analysis of the opposing occlusion, proximal dentition and other intraoral structures. Based on the determined existing intraoral environment, the particular type of implant and its form is selected to fit the individual case. Preoperative procedure requires articulator mounted study casts to evaluate the opposing occlusion and implant positioning from which the mesiodistal and buccolingual positioning is determined. Subsequently, the final prosthesis design is prewaxed and the required number of implants and their interspan distances are determined from the wax-up. Next, the Surgical Guide Plate device is employed to help determine radiographically the implant positioning and the anatomical jaw morphology. As mentioned earlier, the purpose of the final prosthesis is to restore the lost masticatory function and esthetic improvement along with presservation of the remaining teeth and harmony with the intraoral soft and hard tissues. Implants serve a critical supportive role of helping the success of the final prosthetic treatment. Intraosseous implants can be used as independent support system or can be combined with remaining natural dentition to support the overlying prosthesis.(ABSTRACT TRUNCATED AT 400 WORDS)

Dental Implants↗
PubMed1989

Antibiotic prophylaxis for dental patients with prosthetic joints.

Because of the threat of hematogenous spread of infection arising from invasive dental procedures, preoperative antibiotic prophylaxis should be considered for patients who are endoprostheses recipients. No universally accepted protocol exists to guide practitioners in determining indications or treatment methods for such patients. To ascertain their recommendations, 264 Indiana orthopaedic surgeons were surveyed and 121, 46%, responded. A high percentage of respondents always or usually recommend preoperative antibiotic prophylaxis for oral surgery, extraction and in the case of acute dental infection for hip arthroplasty patients. A slightly lesser percentage of respondents would premedicate for dental restorations for patients with lesser joint arthroplasties. Eighty-four percent of the respondents chose oral cephalosporin as the preferred antibiotic, but the recommended dosage and duration varied. In the absence of universally accepted protocol, it is recommended that dentists contact their patient's surgeon to determine what the most appropriate measures are for that particular person.

Anti-Bacterial Agents↗
PubMed1989

[Isolation perfusion chemotherapy using cisplatin in malignant tumors of the extremities].

Since 1960 isolation perfusion chemotherapy has been performed as a preoperative procedure combined with surgery in 226 patients with malignant tumor of the extremities in our department. In this report we presented the result of isolation perfusion chemotherapy using cisplatin (CDDP) for 27 patients since 1983. The histologic classification of the malignant tumor was osteosarcoma in 17 patients, malignant fibrous histiocytoma (MFH) of bone in 8, and other tumor in 2. The extremity was perfused with CDDP (100 micrograms/ml) for 60 minutes. Of 27 patients, 11 were treated with hyperthermic isolation perfusion. The two-year survival rate of the 15 patients with osteosarcoma was 80%, and that of the 7 patients with MFH of bone 71%. The tumor was microscopically analyzed, and the ratio of necrotic to viable tumor cells was calculated. The degree of tumor necrosis was classified as excellent (greater than or equal to 95%), good (80-94%), fair (50-79%), and poor (less than 50%). Of 16 patients, 7 were excellent, 5 good, 3 fair and 1 poor. We concluded that isolation perfusion chemotherapy using CDDP is an effective procedure combined with surgery for malignant tumor of the extremities.

Adolescent↗
PubMed1989

[Endoscopic treatment of cholangitis via an external nasobiliary drain].

The acute suppurative cholangitis is an acute emergency condition requiring quick decompression of the obstructed bile pathways. The authors present their experience in the treatment of 51 patients by endoscopic sphincterotomy with or without mechanical lithotripsy and extraction of the stones and a nasobiliary drainage for 5 up to 15 days. Technically the manipulation was 100% successful and its therapeutic efficacy was 94.2% including II patients to whom it was performed as a preoperative procedure. In 6 patients (11.8%) a transitory amylase elevation was registered and one patient (2%) developed acute pancreatitis. The treatment was unsuccessful in 6% of the patients--these were patients with severe liver impairment (biliary cirrhosis) and long term cholangitis. The authors recommend the biliary drainage as an emergency and temporary treatment of the acute suppurative cholangitis.

Acute Disease↗
PubMed1988

[Recently experienced ten cases of insulinoma--preoperative diagnosis of localization and intraoperative simultaneous monitoring of glucose and insulin].

We have experienced 10 cases of insulinoma during the last 10 years from 1977 to 1986. All cases had strong hypoglycemic symptoms such as disturbance of consciousness, and insulinoma still tended to be misdiagnosed as epilepsy. The diagnosis of insulinoma was easily available from serum IRI (immunoreactive insulin)/plasma glucose ratio in all of the ten cases. As preoperative procedures for the diagnosis of localization, arteriography, computed tomography and portal blood sampling were positive in 6 of 8, 4 of 6 and 2 of 2 patients, respectively. At operation, all insulinomas could be identified by digital palpation. We performed simple excision of the tumor in 6 patients and distal pancreatectomy in 4 patients. The tumors were solitary and benign in all patients, ranging in size from 1.0 cm to 4.5 cm. Three cases were presented as case reports. In these cases, portal blood sampling and/or intraoperative monitoring of plasma glucose and serum IRI were performed. Portal blood sampling was effective even for a case which was negative in image diagnostic procedures. Furthermore, simultaneous monitoring of plasma glucose and serum IRI by quick radioimmunoassay seemed to be a good guide to the completeness of resection of insulin producing tumors.

Adenoma, Islet Cell↗
PubMed1987

Infiltration of the mesosalpinx for pain relief after laparoscopic tubal sterilization with Yoon rings.

Approximately 200 women of American Society of Anesthesiologists class I and II physical status electing outpatient laparoscopic tubal sterilization with Yoon rings were involved in a double-blind study to evaluate postoperative pain relief after intraoperative suprapubic infiltration of the fallopian mesosalpinx. The postoperative pain levels were lower after bilateral infiltration of 0.5% bupivacaine beneath the site of ring application. Postoperative, suprapubic infiltration provided safe, prolonged and effective pain relief, allowed prompt ambulation and early discharge, and reduced the need for narcotic analgesics and postoperative analgesia.

Adnexa Uteri↗
PubMed1977

[Porto-systemic anastomosis in the treatment of portal hypertension due to intrahepatic block. Advanced surgical technics].

A physiopathological interpretation is offered of the possibilities given by recent selective or portally regulated reduction of pressure in achieving a balance between reduction of pressure and diversion. Classic demonstrations, in fact, prove effective in the prevention of haemorrhage due to rupture of oesophageal varices. On the other hand, by over-diversion of the portal flow from the liver, they may cause a further deterioration in liver performance and more imposing the greater the flow of portal blood through the liver preoperatively. Procedures aimed at de-tension of the portal system, particularly the gastro-oesophageal segment, and at ensuring an intrahepatic venous flow sufficient to obviate steal syndrome damage, are described. Some of these procedures are still at the experimental stage. The techniques involved are explained, along with the underlying principles achieved by or prospected for each of them.

Drainage↗
PubMed1988

Vasectomy.

In summary, a vasectomy is a safe, simple, and effective method of male contraception without any known long-term health hazards. Because of its simplicity, it is performed in more than 500,000 patients per year, mainly in a physician's office, making it a very cost-effective contraceptive method. With the introduction of the microscope into the operating suite of the urologist, this procedure that was once considered permanent is amenable to reversal at a later date.

Antibody Formation↗
PubMed1988

[Treatment of unreduced anterior shoulder dislocation].

We evaluated the results of treatment in six patients with unreduced chronic anterior dislocations of the shoulder. In three patients the dislocations had not been recognized by the initial treating physician. In the remaining three patients the dislocations initially had been diagnosed but reduction had failed and the dislocations had remained unreduced. In one of the six shoulders the dislocation was left unreduced. The dislocation existed for 3.5 years and there was absence of disabling functional impairment, pain or neurovascular disturbance. In five of six shoulders the function was severely impaired. One of five shoulders with an anterior dislocation of three weeks duration could be reduced by closed manipulation. Four shoulders underwent open reduction. In all patients the humeral head could be preserved. Associated osseous lesions of the glenoid or the humeral head (Hill-Sachs lesions, fractures) were treated by rotation osteotomies according to Weber and the Eden-Lange-Hybinette procedure. Preoperatively all shoulders were graded as poor. Postoperatively the results in one was graded as excellent, in three as good and in one (algodystrophy of the left arm) as fair.

Adolescent↗
PubMed1988

[Treatment of acquired stenosis of the external auditory canal].

Often difficult surgical problems are encountered during treatment of acquired stenosis of external auditory canal. Theses stenoses can be of tumoral, inflammatory or traumatic origin and are the cause of infectious complications related to epidermal retention. Even with the assistance of modern imaging procedures, preoperative investigation is not simple, precise details of lesions being obtained in greater detail during surgical exploration. Four stages are involved in surgical treatment: excision of lesion, reaming of bony canal and enlargement of auditory meatus, providing cover and maintaining graft in place. The CO2 laser can be useful for excision of lesion or possible postoperative recurrence, and adjacent pedicle flaps are best for covering site. Postoperative inflammatory episodes can be treated by infiltration of local corticoids. Whatever the result of these different techniques, long-term surveillance of these patients is essential.

Constriction, Pathologic↗
PubMedDate not supplied

Disseminated intravascular coagulation caused by abdominal aortic aneurysm.

A 71-year-old male with disseminated intravascular coagulation (DIC) caused by abdominal aortic aneurysm was successfully treated surgically. He had aortic regurgitation, an old myocardial infarction, and nephrotic syndrome. The infrarenal part of the inferior vena cava, which was on the left side of the aneurysm, was temporarily transected during the surgical procedure. Preoperative heparin therapy was insufficient, but infusion of blood components during the operation and minimal dissection of the aneurysm were effective in controlling intraoperative hemorrhage. Hypofibrinogenemia and thrombocytopenia were normalized immediately after operation, and hemorrhagic diathesis was completely cured. In this case, the definitive treatment of DIC caused by an abdominal aortic aneurysm war removal of the lesion and the infusion of coagulation factors during the operation was effective in minimizing blood loss.

Aged↗
PubMed1987

[Factors determining the success of the surgical treatment of chronic postinfarct heart aneurysm].

Evaluation of instrumental findings in relation to clinical course of the early postoperative period in 105 patients operated on for chronic postinfarction aneurysm of the heart demonstrated that regional left-ventricular contractility, particularly that of unscarred myocardial tissue, is the principal determinant of surgical success, followed by the severity of attendant coronary sclerosis and, consequently, the adequacy of the chosen surgical procedure. Preoperative congestive heart failure, indicative of disrupted left-ventricular myocardial compensatory potential, is an aggravating factor.

Animals↗
PubMed1987

[Current aspects of surgery of benign struma].

Preoperative procedures, surgical techniques, and postoperative management are discussed in this paper, against the background of latest developments and with reference to 443 struma patients who received surgical treatment in 1984 and 1985. The technique of surgical removal has been modified by the author, as compared to what it used to be back to 1964. Ligature of the inferior thyroid artery has been abandoned. The postoperative rate of unilateral nerve palsy recurrence has been reduced from 4.47 to 2.20 per cent, whereas other complications remained unchanged, such as postoperative bleeding and thyreotoxicosis. Other topical aspects resulted from modification of the regime of prophylaxis to prevent recurrence. The substitution therapy applied by late 1985 had been based on daily thyroxine doses as low as 50 micrograms, with the postoperative hypothyreosis rate reaching a level of more than 50 per cent, as early as three months after surgery. The hypothyreosis rate was lowered to something below ten per cent, after the daily T4-therapy had been increased to 75 micrograms, on January 1st, 1986. General life-long and individually adjusted prophylaxis against recurrence is ensured by regular postoperative clinical and TSH follow-up with adequately adapted thyroxine medication.

Adenoma↗
PubMed1987

Diagnostic and operative arthroscopy of the ankle. An experimental approach.

To determine safe and effective placements of the arthroscope, 14 freshly amputated ankle joint specimens were used for experimental diagnostic and operative procedures. Preoperatively, chondral and osteochondral lesions, articular defects, and loose bodies were created within the ankle joint. The following arthroscopic portals were investigated: anteromedial, anterocentral, anterolateral, posteromedial, and posterolateral. Overlapping of vision fields was noted with the three anterior portals. Optimum visualization of a lesion was obtained when the arthroscope was placed on the same side as the lesion. Lesions on the posterior aspect of the talar dome and within the posterior talar pouch required the posterior placement of the arthroscope for optimum visualization. The use of the anterocentral approach, with a 2.7-mm arthroscope yields good visualization of the anterior aspect of the joint, and very often, of the posterior compartment. Anatomic guidelines for the avoidance of neurovascular structures and the exact placement of the arthroscope in both anterior and posterior portals are presented and were specifically defined in two additional fresh ankle specimens.

Ankle Joint↗