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At least 379 records · Page 21Linked to original sources
PubMed1995

Utility of 99mTc-sestamibi scintigraphy as a first-line imaging procedure in the preoperative evaluation of hyperparathyroidism.

OBJECTIVE: The use of preoperative imaging in patients with hyperparathyroidism remains controversial. Many of the available techniques are insufficiently sensitive and specific to justify their routine use. We have evaluated the sensitivity and specificity of 99mTc-sestamibi scintigraphy in the management of patients with different forms of hyperparathyroidism. DESIGN: Preoperative imaging evaluation was carried out by scintigraphic detection of pathological parathyroid glands using 99mTc-sestamibi as a radiotracer; confirmation of scan findings was obtained surgically. PATIENTS: A group of 25 patients with primary (n = 21) or secondary (n = 4) hyperparathyroidism were studied. All were considered for surgical treatment. MEASUREMENTS: In all cases parathyroid imaging was carried out by 99mTc-sestamibi scintigraphy together with at least one other imaging technique which included CT-scan, ultrasonography, MRI or 201TI/99mTc subtraction scintigraphy. Blood tests included measurements of total calcium and PTH. RESULTS: 99mTc-sestamibi scintigraphy correctly localized 20 out of 21 adenomas, giving a sensitivity of 95.2%, markedly higher than that obtained with the other imaging techniques (ultrasonography 75%, 201TI/99mTc subtraction scintigraphy 57.1%, CT-scan 41.7% and MRI 33%). Of a total of 17 glands identified surgically as hyperplastic and confirmed by pathological examination, 99mTc-sestamibi scintigraphy showed a positive image in 10, corresponding always to the larger abnormal glands (sensitivity 58.8%, higher than that observed with the other techniques). No false positive images were obtained with 99mTc-sestamibi. All the ectopic adenomas (n = 3) were identified preoperatively, which contributed significantly to the surgical approach. CONCLUSION: In patients with hyperparathyroidism, 99mTc-sestamibi scintigraphy may be used as the single imaging technique as it shows a very high sensitivity and specificity in the preoperative localization of pathological parathyroid glands; the benefit of localizing parathyroid tissue prior to surgery in cases of ectopic adenomas clearly indicates that when an imaging procedure is required, this technique may be of great help in the management of hyperparathyroidism.

Adolescent↗
PubMedDate not supplied

The Green-Watermann procedure: geometric analysis and preoperative radiographic template technique.

The Green-Watermann procedure is indicated as surgical treatment of hallux limitus. The procedure requires five first metatarsal osteotomies, all of which interact to achieve the final surgical outcome. It is the unique interaction of each osteotomy that creates first metatarsal shortening, capital fragment plantar transposition, capital fragment lateral transposition, and proximal articular set angle (P.A.S.A.) correction. The geometry of the Green-Watermann procedure is reviewed. A preoperative radiographic templating technique is provided.

Foot Deformities, Acquired↗
PubMed1984

Thyroid surgery.

In a 5-year period we treated 233 patients referred to us with a thyroid swelling. Among them, 39 patients (17%) had a malignant tumor. Seventy-eight percent of the patients were women. The preoperative examination procedure is discussed. Preoperatively, recurrent nerve palsy was found in 2.6% of patients with benign tumors and in 28% of patients with malignant tumors. The histologic features of the benign and the malignant tumors are described. The operative procedure in the benign group consisted of enucleation, resection, or lobectomy. In the patients with malignant tumors a radical operation was performed, consisting of lobectomy (unilateral or bilateral) when possible, eventually combined with radical neck dissection. The operative complications are discussed.

Adolescent↗
PubMed1988

Cancellation of preoperative breast localization procedures: analysis of 53 cases.

Among 603 patients scheduled for a breast biopsy at the authors' institution in 1987, the biopsy was canceled on the day of the procedure in 53 (8.8%). All had been referred from other facilities. An analysis of the original mammograms and the additional imaging procedures performed is presented. The reasons for termination of the planned biopsies include (a) no mass present (n = 22), (b) aspiration of a mass (n = 13), (c) skin calcifications (n = 9), (d) random calcifications (n = 4), (e) skin artifacts (n = 3), and (f) other (n = 2). Practicing radiologists should adapt rigid criteria for biopsy recommendation and propose radiographic follow-up for low-suspicion abnormalities detected.

Biopsy, Needle↗
PubMed1998

A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation.

PURPOSE: We studied the efficacy of preoperative noninvasive assessment of the upper extremity to identify arteries and veins suitable for hemodialysis access to increase our use of autogenous fistulas (AF). METHODS: From Sep. 1, 1994, to Apr. 1, 1997, 172 patients who required chronic hemodialysis underwent segmental upper extremity Doppler pressures and duplex ultrasound with mapping of arteries and veins. The following criteria were necessary for satisfactory arterial inflow: absence of a pressure gradient between arms, patent palmar arch, and arterial lumen diameter 2.0 mm or more. The criteria necessary for satisfactory venous outflow were venous luminal diameter greater than or equal to 2.5 mm for AF and greater than or equal to 4.0 mm for synthetic bridging grafts (BG) and continuity with distal superficial veins in the arm. Intraoperative and duplex ultrasound measurements were compared. Contemporary experience was compared with the 2-year period (1992 to 1994) before implementation of the protocol. RESULTS: During the period from Sep. 1, 1994, to Apr. 1, 1997, 108 patients (63%) had AF, 52 (30%) had prosthetic BG, and 12 (7%) had permanent catheters (PC) placed. Early failure was seen in 8.3% of AFs. Primary cumulative patency rates were 83% for AF and 74% for BG at 1 year (p < 0.05), with a mean clinical follow-up of 15.2 months. No postoperative infections were observed with AF, whereas six infections (12%) were observed with BG and two (17%) with PC insertion. During the period from June 1, 1992, to Aug. 31, 1994, 183 procedures were performed with a distribution of 14% AF, 62% BG, and 24% PC. In this earlier period the AF early failure rate was 36%, and the patency rates were 48%, 63%, and 48% for AF, BG, and PC, respectively (mean follow-up, 13.8 months). CONCLUSION: A protocol of noninvasive assessment increased use of AFs. The cumulative patency rate of AFs was improved, and early failure rates were reduced when compared with the preceding institutional experience. Routine noninvasive assessment is recommended to document adequacy of arterial inflow and delineate venous outflow to maximize opportunities for AF.

Arm↗
PubMed1989

Statistical procedure for the preoperative prediction of the result of cochlear implantation.

Predicting the result of a cochlear implant preoperatively continues to be the best way to prevent an unfavourable outcome. Data from 28 cases (subdivided into two groups by their results) formed the basis for discriminant analysis using different parameters. Allocation to the two groups was found to be satisfactory. Since a jack-knifed design was used, allocation was done on the basis of data material from cases not included in this programme's analysis. Data correlation was described by an equation from which the result can be predicted with adequate accuracy using language competence, duration of deafness on the operated side, speech discrimination and threshold of acoustical sensations on promontory electrostimulation. The equation is applicable to all patients, irrespective of whether their deafness is prelingual or postlingual. Since the patient material was enlarged by 19 additional cases, we were able to confirm that the formula enables a prognosis of sufficient quality.

Adolescent↗
PubMed1992

[The pathogenetic and clinical grounds for the advantages of nondrug procedures in the preoperative preparation of patients with diffuse toxic goiter].

An analysis of 615 patients operated upon for diffuse toxic goiter is presented. In 148 of them (24%) preoperative preparation was made with the help of nonmedicamental methods (extracorporal hemosorption, hyperbaric oxygenation (HBO), plasmapheresis). The state of euthyroidism was controlled according to their clinical symptoms and was verified by radioimmunological studies of triiodothyronine (T3), thyroxin (T4), thyrotropine (TTG). Indicators of corticosteroid hormones, thyrostimulating antibodies, antigenic HLA structure and antioxidative activity of different media of blood were also determined. The estimation of the data obtained as compared with results of morphological examinations allowed a conclusion that the above nonmedicamental methods in patients with diffuse toxic goiter are pathogenetically substantiated. Clinical expedience of their use is obvious. No lethal outcomes or complications resulted from using hemosorption and HBO. Single complications took place resulting immediately from catheterization of large venous vessels. Long-term results from 3 to 9 years have shown that recurrences of the disease in patients given nonmedicamental preoperative preparation were met much more rarely as compared with patients who obtained routine preparation (1.4% and 5.4 correspondingly).

Combined Modality Therapy↗
PubMed1979

Effective use of blood in elective surgical procedures.

The preoperative requests for crossmatching of blood in elective surgical procedures were studied at the Flinders Medical Centre, South Australia. The study revealed that surgeons order crossmatched blood on the basis of habit. This led to considerable time-expiry of blood, and to unnecessary use of laboratory personnel's time and reagents. The statistical information collected during the study was used to educate the surgeons to change their blood-ordering practice. In procedures where excessive blood loss is unlikely to occur, as a stand-by, a "group-and-screen" procedure was substituted for crossmatching. A firm recommendation for maximum blood order in elective surgical procedures was also made. It is estimated that this approach would save approximately $80,000 per year per 350-bed general hospital in Australia.

Australia↗
PubMed1988

[Procedures and results of limb salvage surgery of musculoskeletal sarcoma].

During the 8-year period beginning 1979, 116 cases of musculoskeletal sarcoma were treated by limb salvage operation. Of these, the local recurrence rate was 9% and the postoperative metastatic rate was 28%. The limb salvage rate was about 80%. Limb salvage procedures were generally performed using curative surgical procedures without preoperative adjunctive therapy. However, reduction of the surgical margin to achieve local cure was made possible by combined therapy with preoperative adjunctive chemotherapy or radiotherapy. The wide procedures combined with preoperative adjunctive therapy achieved a local curability rate equal to curative procedures. Marginal procedures following preoperative radiotherapy were also undertaken in those cases in which the tumor was located in an area for which curative or wide procedures were not feasible. Also, similar procedures were performed for patients of advanced age, patients with lung metastasis, patients who refused ablative surgery, and for extirpation of lymph node metastases. Accordingly, we were able to determine which procedures best ensure local curability. Also, the most significant prognostic factor was found to be local recurrence caused by inadequate surgical margin. This was especially true in the treatment of high malignant sarcoma. Moreover, from analysis of recurrent cases, the suggested factors contributing to local recurrence were: the invasive character of the tumor, lymph node metastasis, skip metastasis, tumor dissemination due to pathological fracture, previously performed inadequate surgery, venous invasion, and multicentrical occurrence of certain tumors.

Adult↗
PubMed2003

Will the spectrum of lesions prompting a "B3" breast core biopsy increase the benign biopsy rate?

AIM: To audit the benign surgical biopsies in women screened, assessed, and referred by the Leeds/Wakefield Breast Screening Unit for the year 1999-2000 with a view to determining any association with a preoperative B3 core biopsy categorisation. METHODS: The results of all preoperative diagnostic procedures in all patients who underwent surgical excision for a lesion proving benign in the year 1999-2000 were reviewed. Cases were categorised according to whether the preoperative fine needle aspirate cytology (FNAC) or core biopsy had been equivocal or of uncertain malignant potential (C3/B3), inadequate or unrepresentative (C1/B1), or benign (C2/B2). In those cases with a C3/B3 FNAC or core biopsy result, reasons for the uncertainty were determined by examination of the report and, where necessary, slides. In cases with C1/B1 or C2/B2 investigations and in those without a preoperative procedure, the reasons for surgical referral were determined from the screening records. Case records of all patients with a B3 core biopsy categorisation who subsequently proved to have malignancy were also reviewed. RESULTS: Thirty six women had benign surgical biopsies in the 1999-2000 screening year. In 13 of the 36 patients, referral for diagnostic biopsy rested on radiological and/or pathological suspicion of radial scar. The core biopsy category was B3 in all but one, which was in the B1 category. In a further 10 patients, referral was based primarily on a pathological B3 categorisation. The reasons for this were as follows: papillary lesion (two), fibroepithelial lesion (two), atypical intraductal epithelial proliferation (two), stromal mucin (two), atypical lobular hyperplasia (one), and an unusual vascular lesion (one). Two cases with a C3 on FNAC also derived from papillary lesions. In the remaining nine patients, the radiological features were sufficiently suspicious to prompt referral in the presence of either inadequate/unrepresentative (C1/B1) or benign (B2) preoperative pathological findings. Two women had no preoperative needle biopsy. CONCLUSIONS: In 22 of 36 benign biopsies, the initial core biopsy categorisation was B3. According to the current system of core biopsy categorisation, a diversity of lesions must be designated as of "uncertain malignant potential" (B3) because the technique provides insufficient tissue for full histological assessment. The use of this category may increase the number of benign biopsies if all such cases are referred for surgery. An increase in the benign biopsy rate may be averted if larger amounts of tissue can be obtained using newer vacuum assisted techniques such as the Mammotome.

Biopsy↗
PubMed1994

[Preoperative hand disinfection].

At Telemark Central Hospital we decided to change the procedure for preoperative disinfection of the hands in order to improve antimicrobial efficacy and to minimize skin problems for the personnel. Previously, preoperative disinfection of hands was performed by scrubbing the hand with a detergent containing chlorohexidine (Hibiscrub) which often caused dryness, fissures and dermatitis. In the recent years it has been amply shown that alcoholic solutions have a very good and immediate antibacterial effect on the skin flora, while chlorohexidine has a prolonged effect. In this paper we describe our new procedures for preoperative disinfection of hands and the necessary planning and preparation we undertook to obtain acceptance for these procedures among the personnel.

Alcohols↗
PubMed2002

Validation of a clinical prediction rule to reduce preoperative type and screen procedures.

BACKGROUND: We have developed a prediction rule for the occurrence of perioperative red blood cell transfusion to help to reduce the number of unnecessary preoperative type and screen procedures. We evaluated the robustness of this prediction rule in patients from another hospital. METHODS: The rule was retrospectively applied to 1282 consecutive patients ('validation set') who underwent similar surgical procedures to the patients in the derivation study. The outcome was similarly defined as any allogeneic transfusion on the day of surgery or during the first postoperative day. The predictive value of the rule was assessed using a Receiver Operating Characteristic curve (ROC) and compared with the results of the derivation study. Subsequently, the number of correctly predicted transfusions was compared. RESULTS: The patient characteristics did not differ between the two sets, except for the incidence of transfusion (derivation study: 18%; present study: 8%). In the validation set, the ROC area of the prediction rule was 0.78 (95% confidence intervals [CI]: 0.73-0.82), which was within the CI of the ROC area found in the derivation study (0.75; 95% CI: 0.72-0.79). In total, 35% of the type and screen procedures could be omitted (derivation study: 50%), with 13% missed transfused patients (derivation study: 20%). CONCLUSIONS: After comparing the results of this validation study with that of the derivation study, the prediction rule was robust and may work in other clinics as well.

Adolescent↗
PubMedDate not supplied

Intraoperative palpation for clinically suspicious axillary sentinel lymph nodes reduces the false-negative rate of sentinel lymph node biopsy in breast cancer.

Axillary sentinel lymph node biopsy (SLNB) is widely used to identify the first lymph node draining breast tumors. When the sentinel lymph node is free of metastasis, axillary dissection is avoided because the rest of the nodes are expected to be negative as well. A false-negative rate of 5% is considered acceptable. In the case of a false-negative SLNB, adjuvant local and systemic treatments might be suboptimal. We assessed the effect of intraoperative axillary palpation for clinically suspicious lymph nodes that are not otherwise detected by radioactive tracer or blue dye on the false-negative rate of SLNB in breast cancer patients. Our prospective database of patients having surgery for primary invasive breast cancer and who had a SLNB from 2000 to 2004 was reviewed. Only patients with clinically negative nodes preoperatively were included. The procedure included preoperative injection of radiotracer, with dye injection as backup, and intraoperative palpation of the axilla for suspicious lymph nodes that were not radioactive or blue. Of the 290 patients, 89 (30.7%) had sentinel node involvement by tumor. Seven patients had clinically suspicious nodes identified solely by palpation and not by tracer, in addition to sentinel lymph nodes detected by tracer. In five of the seven patients, the nodes harbored metastasis. In four of these five patients (4.5% of the 89 patients with axillary involvement), the palpable nodes were the only ones involved. A generous axillary incision and systematic palpation of the axilla reduces the false-negative rate and should be a part of the SLNB procedure.

Breast Neoplasms↗
PubMed2000

[Insulinomas in multiple endocrine neoplasia type 1. Report of a series of 44 cases by the multiple endocrine neoplasia study group].

STUDY AIM: The aim of this retrospective study conducted by the "Groupe d'étude des néoplasies endocriniennes multiples type 1" (GENEM) was to report a series of insulinomas associated with multiple endocrine neoplasias type 1 (NEM 1) and to determine the most appropriate strategy for the topographical exploration and surgical management. PATIENTS AND METHODS: From 1960 to 1996, 44 patients were included, 16 men and 28 women (mean age: 36.4 +/- 13.9 years). This study concerned morphological investigations, tumoral features, modalities and results of the treatment. RESULTS: Insulinomas were associated with other functional islet tumors in 15 patients: ZE syndrome (n = 8), glucagonoma (n = 6), vipoma (n = 1). Malignant lesions were present in 6 patients: isolated insulinomas (n = 2), insulinomas associated with ZE syndrome (n = 2) and vipoma (n = 1). The sensitivity of the preoperative imaging procedures was less than 70%. Fourty-one patients were operated on: subtotal pancreatectomy (n = 26 including cephalic enucleations in 8), enucleations (n = 8), total pancreatectomy (n = 3), pancreaticoduodenectomy with caudal enucleations (n = 1), and for 3 patients, no details were available. There was no postoperative mortality. Hyperinsulinism disappeared in 27 patients (including 2 after reoperation) with a mean follow-up of 9 years. Among 6 patients with malignant lesions, 3 were alive with a 3, 4 and 10 year-follow-up. CONCLUSION: Subtotal pancreatectomy with splenic conservation and enucleation of cephalic lesions is suggested as the procedure of choice in this group of patients. This procedure allows simplification of preoperative imaging investigations because lesions of the pancreatic head have only to be detected. Preoperative endoscopic ultrasonography and intraoperative ultrasonography are the best investigations.

Adult↗
PubMed1987

Preoperative computerized tomographic imaging in hyperparathyroidism.

The surgery of hyperparathyroidism can be technically very difficult, even for an experienced surgeon. Until the present decade, preoperative localization procedures were of little help because of poor resolution of imaging modalities, significant morbidity, and the cost of invasive procedures. The efficacy of preoperative high-resolution CT scanning was evaluated in ten patients with primary hyperparathyroidism who had not previously been operated on. Contrast and noncontrast scans were performed on each patient, under the supervision of an experienced radiologist. Surgical findings were the standard against which all CT scans were judged. Each patient was diagnosed as having a single adenoma. Preoperative scans localized eight of ten adenomas for an overall sensitivity of 80 percent. In one patient, the adenoma was incorrectly localized for a specificity of 89 percent. The smallest adenoma correctly localized measured 4 x 4 mm in its axial dimensions. In addition to shortening operative time, accurate preoperative localization permitted use of unilateral dissection technique. Recent literature has repeatedly proved unilateral dissection superior to bilateral dissection by production of identical cure rates and a 2- to 12-fold decrease in postoperative hypocalcemia. We suggest that CT scanning be considered in the routine preoperative workup of patients who have primary hyperparathyroid disease.

Adenoma↗