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At least 343 records · Page 19Linked to original sources
PubMed2004

Extensor mechanism complications in total knee arthroplasty.

Recent improvements in total knee arthroplasty (TKA) surgical technique, instrumentation, and prosthetic design have decreased the incidence of extensor mechanism complications following TKA. The majority of these complications continue to be secondary to errors in surgical technique. Extensor mechanism complications following TKA include soft-tissue impingement, instability, patellar fractures, patellar component failures, and extensor mechanism rupture. Both nonsurgical and surgical treatment may be used in the management of these complications. However, the majority of these complications are avoidable with attention to proper surgical technique and selection of appropriate patellar components in TKA.

Arthroplasty, Replacement, Knee↗
PubMed2003

How many cases need to be reviewed to compare performance in surgical pathology?

Recent studies have shown increased interest in measuring error rates in surgical pathology. We sought to determine how many surgical pathology cases need to be reviewed to show a significant difference from published error rates for review of routine or biopsy cases. Results of 4 series with this type of diagnostic material involving a total of 11,683 cases were reviewed to determine the range of published false-negative, false-positive, typing error, threshold error, and clinically significant error rates. Error rates ranged from 0.00% to 2.36%; clinically significant error rates ranged from 0.34% to 1.19%. Assuming a power of 0.80 and a 1-sided alpha of 0.05, the number of cases needed to be reviewed to show that a laboratory with either twice or one half the published error rate was significantly different from the range of published error rates varied from 3.30 to 50, 158. For clinically significant errors, the number of cases varied from 665 to 5,886. Because the published error rates are low, a relatively large number of cases need to be reviewed and a relatively great difference in error rate needs to exist to show a significant difference in performance in surgical pathology.

Diagnostic Errors↗
PubMed1979

[Surgical treatment of retinoschisis (author's transl)].

We have made a review of 20 retinoschisis without retinal detachment operated on 12 patients. There is no case of hereditary retinoschisis, the affection may occur at any age, and there is no preferential refractive error. Main surgical indications were macular involvement or impending involvement, and associated retinal tears. A good anatomical result has been obtained in 90% of our cases (18 out of 20) with 2/3 complete reattachments and 1/3 almost complete reattachments (with minimal and well sealed residual schisis). Association of cryocoagulation and indentation is more effective than cryocoagulation alone. On the functional point of view we have had 15% of improved visual acuities and 30% of worsened ones, thus surgical intervention implies macular risks that one must try to prevent by using procedures as atraumatic as possible.

Adolescent↗
PubMed2003

[Surgical correction of presbyopia].

There are a lot of surgical procedures to correct refractive errors, but the surgical correction of presbyopia is still a problem. In this paper the authors present surgical procedures, which can be used to correct presbyopia. There are three groups of surgery: the corneal, scleral and intrabulbar procedures.

Cornea↗
PubMedDate not supplied

In vitro study of Human Dermal Fibroblasts seeded on two kinds of surgical meshes: monofilamented Polypropylene and multifilamented Polyestere.

Many different synthetic biomaterials have been recently proposed in the majority of the techniques for hernioplasty and pelvic floor surgery. Required qualities of an implantable prosthetic material have been well established in the past and today the biomaterials better performing to this purpose are the monofilamented Polypropylene (Marlex) and the multifilamented Polyestere (Mersilene). But, in spite of a wide surgical use of these two kinds of meshes, many failures of these implantations are reported leading to removal of the prosthetic implanted material. If some of these failures are due to errors in surgical technique, others seem to be due to inadequacy of the selected material, too much soft or too much stiff, or too much or too little incorporated into the host tissue. This experiment investigated the different behaviour of in vitro cultured Human Dermal Fibroblasts, seeded on specimens of both meshes and then observed by Light (LM) and Scanning Electron Microscopy (SEM). Around the multifilamented threads of Polyestere mesh, fibroblasts could grow very well, filling the holes and making a continous cell layer completely envelopping the mesh. At the same culture time, around the Polypropylene mesh only big groups of fibroblasts were evident at the thread interlacing points. Therefore, it could be concluded that both meshes stimulate good fibroblast attachment and proliferation but in a very different way and amount; it will be up to the surgeon to select the appropriate mesh according to the specific surgical purpose.

Biocompatible Materials↗
PubMed1996

A comparison of quality control methods applied to carotid endarterectomy.

OBJECTIVES: To compare the ability of continuous wave Doppler (CWD), B-mode ultrasound (BMU), angioscopy and transcranial Doppler (TCD) to detect technical error during carotid endarterectomy (CEA). DESIGN: A prospective, comparative study in 100 consecutive patients. SETTING: Leicester Royal Infirmary, Leicester, U.K. MATERIALS: Intraoperative TCD monitoring was performed using a SciMed PcDop 842 2 MHz TCD. An Olympus 2.8mm flexible angioscope was used to inspect the arterial lumen prior to restoration of bloodflow. After restoration of flow 10Mhz BMU images and 8Mhz CWD velocity spectra of carotid artery blood flow were obtained. CHIEF OUTCOME MEASURES: The detection of intimal flaps, thrombus, stenoses or other errors of surgical technique likely to result in perioperative morbidity. MAIN RESULTS: CWD and BMU images were technically inadequate in 9% and 24% of cases respectively and neither technique altered clinical management. Angioscopy demonstrated significant technical errors in 12 cases (four intimal flaps, thrombus in eight). TCD detected shunt malfunction in 13% of patients, emboli during dissection in 23% and early postoperative carotid artery thrombosis in three patients. CONCLUSIONS: A combination of TCD monitoring and completion angioscopy provided the maximum yield in terms of diagnosing technical error and establishing the cause of perioperative morbidity.

Angioscopy↗
PubMedDate not supplied

[Varicose vein recurrence after surgery of the sapheno-femoral junction: color Doppler ultrasonography study].

The aim of this study was to evaluate the accuracy and sensitivity of colour Doppler ultrasonography for the diagnosis of postoperative recurrent varicose veins in patients submitted to surgical ligation of the saphenofemoral junction with a view to classifying the recurrences according to the causes. We studied 401 lower limbs in the orthostatic position with colour Doppler ultrasonography in 318 patients (64 M and 254 F) presenting postoperative varicose vein recurrence during the follow-up (12-60 months). We evaluated the type of reflux at the inguinal level under the Valsalva manoeuvre and divided them into 5 types. We observed an incomplete crossectomy (type 1) in 23.2% of the cases; an incontinent saphenofemoral junction, intact and in an anatomical site in 12.5% (type 2); a major tributary (double saphena) originating from the common femoral vein near to the crossectomy site in 10.2% (type 3); neovascularization in 9.7% (type 4) and the presence of a number of major tributaries from the veins of the perineal and pudendal region or from the abdominal parietal veins in 44.4% (type 5). In all cases it was possible to note and classify the type of recurrence. Colour Doppler ultrasonography is an accurate, reliable tool for the diagnosis and classification of postoperative varicose vein recurrences in patients submitted to surgical obliteration of the saphenofemoral junction. It is decisive in the preoperative evaluation and follow-up of patients. In our experience, more than one half of the cases of recurrence were not due to an error of surgical technique.

Adult↗
PubMed2004

Medication errors involving continuously infused medications in a surgical intensive care unit.

OBJECTIVE: To document the incidence of medication errors related to medications administered by continuous infusion. DESIGN: Observational study. SETTING: Sixteen-bed surgical intensive care unit. MEASUREMENTS AND MAIN RESULTS: All continuous infusions in the surgical intensive care unit were evaluated at least once daily for correct flow-sheet charting, concentration, infusion rate, and dose administered, as well as patients' heights and weights (actual, ideal, and "dry"). Collected information was examined to determine the error rate, types of errors occurring, and weight used for dose calculation. Variations inpatient weight measures were compared. Seventy-one patients with 202 total infusions were observed. Errors involving continuously infused medications in our surgical intensive care unit occurred at a rate of 105.9 per 1,000 patient days. For nonweight-based infusions, 94% of doses were delivered correctly. Slightly >10% of the doses administered for weight-based infusions (dose based on dry body weight) were incorrect. Significant differences were found between the weight measurements recorded, but this did not translate into statistically significant differences in the apparent calculated doses delivered. CONCLUSIONS: Medications delivered by continuous infusion, particularly those that are weight based, can contribute to medication errors in the intensive care unit. A large proportion (87.6%) of doses for weight-based infusions was calculated based on estimated or unreliable admission weights. There were no severe consequences resulting from the errors observed in this 1 month investigation; however, depending on the pharmacokinetic characteristics of the drug being administered, there is a potential to deliver artificially low or high doses resulting in subtherapeutic or adverse effects.

Female↗
PubMed1989

Antibiotic prophylaxis in surgery.

Scientific studies conducted during the last 10 years have resulted in a great improvement of our approach to the appropriate use of prophylactic antibiotics in the surgical patient. Errors of the past including faulty timing of the initial dosage as well as prolonged duration of prophylaxis have largely been remedied. Present studies are designed to define the patients within the various subsets of diseases or surgical procedures who are at greatest risk of infection. It is these patients who can be expected to benefit most from the efficacious use of prophylactic antibiotics as well as other preventative measures.

Anti-Bacterial Agents↗
PubMed2005

Identification of mislabeled specimen by molecular methods: case report and review.

Specimen misidentification is a common cause of errors in surgical pathology. We report a case where bone-marrow biopsies from patients of different genders were mislabeled and molecular methods were applied to resolve the identity. A short tandem repeat (STR)-polymerase chain reaction-based assay, commonly used in paternity testing, was employed in an attempt to assign the correct identity to the specimens. However, the specimens had been processed by decalcification and the DNA yield was poor. One of the markers in the assay is the non-STR amelogenin locus that distinguishes the X and Y chromosomes. This amelogenin marker results in a product of low molecular weight, enabling unequivocal resolution of identity despite a poor DNA yield. The prevalence of errors in pathology due to specimen misidentifications is reviewed.

Bone Marrow Cells↗
PubMed1991

Adverse surgical outcomes among patients with cognitive impairments.

To determine the factors that contributed to adverse outcomes, the records of 59 cognitively impaired patients with nonfatal complications (n = 23) or death (n = 36) on a general surgery teaching service over a 30-month period were examined retrospectively. Specific complications are reported. Patient, disease, and management factors related to mortality and morbidity are identified. Patients with cognitive impairments had a higher mortality rate (9.6 vs 6.3%) and approximately the same rate of nonfatal complications (6.1 vs 7.6%) when compared with general surgery patients as a whole. Patient characteristics including age over 70, dementia, nursing home residence, contractures, inability to communicate, need for total care, and gross malnutrition were associated with fatal outcomes. Vascular, colonic, esophageal, gastric, or duodenal conditions, emergency admission, urgent operation, and admission APACHE II scores greater than or equal to 15 were disease-related factors associated with mortality. Management risk factors were prehospital or inpatient diagnostic delays and technical or judgmental errors of surgical management. Twenty-four of 36 deaths were directly related either to a diagnostic delay (11), an operative technical error (11), or a judgmental error of postoperative airway management (2). Eighty-five per cent of diagnostic delays (11/13) and 37 per cent (11/30) of technical errors resulted in mortality. Suggestions for improving the care of these patients are discussed.

Adult↗
PubMed2004

Medical errors: impact on clinical laboratories and other critical areas.

The Institute of Medicine (IOM) report (1999) stated that the prevalence of medical errors is high in today's health care system. Some specialties in health care are more risky than others. A varying blunder/error rate of 0.1-9.3% in clinical diagnostic laboratories has been reported in the literature. Many of these errors occur in the preanalytical and postanalytical phases of testing. It has been suggested that the errors occurring in clinical diagnostic laboratories are smaller in number than those occurring elsewhere in a hospital setting. However, given the quantum of laboratory tests used in health care, even this small rate may reflect a large number of errors. The surgical specialties, emergency rooms, and intensive care units have been previously identified as areas of risk for patient safety. Though the nature of work in these specialties and their interdependence on clinical diagnostic laboratories presents abundant opportunities for error-generating behavior, many of these errors may be preventable. Appropriate attention to system factors involved in these errors and designing intelligent system approaches may help control and eliminate many of these errors in health care.

Clinical Laboratory Information Systems↗
PubMed2005

An insurer's perspective on error and loss in pathology.

OBJECTIVES: To identify errors in surgical pathology practice that lead to malpractice claims, and to define the frequency and severity of pathology malpractice claims and discuss the implications. DESIGN: Three hundred seventy-eight pathology malpractice claims reported to The Doctors Company of Napa, Calif, between 1998 and 2003, were reviewed. Nuisance claims and autopsy claims were excluded; the 335 remaining claims were analyzed. RESULTS: Pathology claim frequency is low. Pathology claim severity is high, especially for claims involving a misdiagnosis of melanoma or a false-negative Papanicolaou test. Fifty-seven percent of claims involved the following 5 categories: breast specimens, melanoma, Papanicolaou smears, gynecologic specimens, and operational error. Sixty-three percent of claims involved failure to diagnose cancer, resulting in delay in diagnosis or inappropriate treatment. CONCLUSION: A false-negative diagnosis of melanoma is the single most common reason for filing a malpractice claim against a pathologist. Nearly one third of misdiagnoses involve melanoma misdiagnosed as Spitz nevus, "dysplastic" nevus, spindle cell squamous carcinoma, atypical fibroxanthoma, and dermatofibroma.

Diagnostic Errors↗