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At least 397 records · Page 22Linked to original sources
PubMed1990

[Vitrectomy in proliferative diabetic retinopathy. Preoperative factors for surgical procedure and postoperative results].

In this study we evaluated the impact of preoperative factors on the choice of intraocular tamponades (balanced salt solution and gas or silicone oil) and postsurgical visual function in cases of vitrectomy for proliferative diabetic retinopathy. We studied 150 consecutive vitrectomies for proliferative diabetic retinopathy, which were carried out from October 1987 to February 1989. The extent of central or peripheral traction and retinal detachment were found to have a major influence on the choice of intraocular tamponades. Different types of diabetes, renal failure, and the time interval since the last vitreous hemorrhage showed no influence on the choice of intraocular tamponades. Visual acuity was improved after vitrectomy in the group with silicone oil tamponade, as well as in the control group with BSS or gas tamponade. Patients receiving silicone oil had more advanced stages of proliferative diabetic retinopathy and therefore more complicated postsurgical courses. Silicone oil is more likely to be avoided in cases without retinal detachment, where the risk of further vitreous hemorrhage is felt to be low and in cases with complete panretinal photocoagulation. The present study supports the therapeutic value of complete panretinal photocoagulation for proliferative diabetic retinopathy--even in cases where the proliferative retinopathy progresses and a vitrectomy is needed. It is demonstrated that many patients requiring vitrectomy did not receive sufficient photocoagulation earlier.

Adult↗
PubMed1985

A computer-based method of filing photographs and procedures.

Careful preoperative and postoperative photographs are an essential part of facial plastic surgery for medical and legal documentation, publication, patient education, and lectures. Computers play an increasing role in many aspects of the medical practice. A method of filing photographs and procedures and a related data base system allows rapid access by multiple factors, including name, procedure, age, surgeon, assistants, anesthetic, complications, dates of all photographs, multiple procedure subheadings, and so on. Additional variables can be added as a date base for analysis of operation results and postoperative recall of patients. This system is based on a personal computer (IBM-PC Computer) and readily available software. The system allow simple entry and retrieval of photographs on any of the multiple variables. We found it to be a superb adjunct to photography in facial plastic and reconstructive surgery.

Computers↗
PubMed1979

Hodgkin's disease: evaluation of staging procedures for abdominal involvement.

Results of preoperative assessment procedures and subsequent staging laparotomy are evaluated in 32 consecutive patients who presented with extra-abdominal Hodgkin's disease which was not already known to be in an advanced stage. Disease was found in the abdominal cavity of 10 of the 27 patients who presented with disease above the diaphragm, and of two of the five patients in whom disease presented in the inguinal nodes. In patients who initially presented with disease above the diaphragm, the spleen was involved in all 10 cases where abdominal disease was detected. Lymphography was not found to be reliable as a diagnostic aid in doubtful cases. Neither liver nor spleen scans were found to be helpful in assessment of these patients.

Abdominal Neoplasms↗
PubMed1988

Evaluation of a proposed standard reporting system for preoperative angiograms in infrainguinal bypass procedures: angiographic correlates of measured runoff resistance.

Preoperative angiography is widely used to estimate runoff before peripheral vascular bypass surgery. The Ad Hoc Committee on Reporting Standards for the Society for Vascular Surgery and the International Society for Cardiovascular Surgery recently proposed an angiographic scoring system that grades the quality of vessels distal to the proposed bypass site and calculates an overall runoff score after adjusting each vessel score by an arbitrary weighting factor. We compared this score with intraoperatively measured runoff resistance in 67 patients undergoing infrainguinal bypass. Correlation between overall runoff score and measured resistance varied with the distal bypass site and was reasonably predictive for femoropopliteal above-knee bypasses (r = 0.67, p = 0.004, N = 17) and femoroposterior tibial bypasses (r = 0.73, p = 0.03, N = 9), but not for femoropopliteal below-knee (r = 0.05, p = 0.76, N = 34) or femoroperoneal (r = 0.57, p = 0.18, N = 7) bypasses. When multiple linear regression was used to calculate the weighting factors (rather than using arbitrarily assigned factors), the correlation between overall angiogram score and measured resistance improved substantially for femoropopliteal above-knee (r = 0.85, p = 0.00006), femoropopliteal below-knee (r = 0.50, p = 0.03) and femoroperoneal (r = 0.83, p = 0.02) bypasses. Correlation for the entire group of 67 patients improved from r = 0.30 (p = 0.02) to r = 0.64 (p = 0.0001). We conclude that the committee's scoring system correlates with measured runoff resistance but can be improved by the use of multiple linear regression to calculate weighting factors for each vessel in the outflow tract.

Anastomosis, Surgical↗
PubMed2006

One-stage combined surgery with or without preoperative traction for developmental dislocation of the hip in older children.

PURPOSE: To compare one-stage combined surgery with and without preoperative traction, in older children with developmental dislocation of the hip (DDH). METHODS: Records of 9 children who underwent combined surgery for DDH with preoperative traction in 12 hips (group 1) and 12 undergoing the same procedure without preoperative traction in 16 hips (group 2) were retrospectively reviewed. The surgery consisted of open reduction, Salter's innominate osteotomy and femoral shortening with derotation varus osteotomy. The mean age of the patients at the time of operation was 5.8 years. The mean follow-up period was 5.9 years. RESULTS: At final follow-up, clinical outcome in group 1 was worse than that in group 2, though radiographic assessment demonstrated no significant difference between the groups. CONCLUSION: One-stage combined surgery without preoperative traction is effective in the treatment of DDH in older children, and has a lower complication rate, but radiographically the groups did not differ.

Bone Diseases, Developmental↗
PubMed1989

[Comparison of the results of preoperative studies with imaging procedures with the surgical status of ovarian cancer].

Optimal cytoreductive surgery of ovarian cancer is based on the preoperative diagnosis and assessment of tumour spread. Of 147 patients who underwent staging laparotomy at the Department of Gynaecology of the University of Tübingen, intraoperative staging was compared retrospectively with the results of sonography, computed tomography, double-contrast enema and urography. Ultrasound and computed tomography were comparable concerning accuracy of the diagnosis in 86 and 79% of the cases, respectively. Combined application of both methods resulted in an accuracy of 90%. Involvement of colon was diagnosed by double-contrast enema in only 41% of the cases in which enterotomy had to be performed. Involvement of bladder and ureter was observed in 80% of the cases by intravenous urography. According to our results abdominal ultrasound and urography should be performed in patients with palpable pelvic masses. The application of computed tomography as an additional method is indicated in patients with tumour classified as benign by sonographic examination. Double-contrast enema is of limited value in the diagnosis of colon involvement.

Adolescent↗
PubMed1993

[Evaluation of the localizing procedures of primary aldosteronism].

The validity of preoperative localizing procedures was studied in 36 patients with primary aldosteronism due to adrenal adenoma, all of whom were confirmed surgically. Adrenalectomy resulted in normalization of blood pressure and serum potassium. Furthermore, we reviewed the correlation between mass size and some clinical parameters as well as the accuracy of localization procedures. Adopted localization procedures included imaging techniques such as abdominal ultrasonography, computed tomography (CT), adrenal scintiscan, magnetic resonance imaging (MRI) and adrenal venography, and as a functional diagnostic procedure, adrenal venous sampling. Among imaging procedures, CT was the most effective to detect adrenal mass with as high accuracy as 88%, adrenal venography following with 83%. The correct localization was obtained in 60% by adrenal scintiscan and only 39% by ultrasonography. Although MRI was performed only in 2 cases, the smallest adenoma could be detected only by MRI, suggesting that MRI might be useful to detect microadenoma by increased signal intensity. Although adrenal scintiscan had been considered to be useful because of its functional diagnostic characteristics, the correct localization was as low accuracy as 60%, which was not improved by the administration of dexamethasone. To assess the accuracy of lateralization for adrenal venous sampling, we calculated the ratio of aldosterone concentration in adrenal vein to inferior vena cava. When the ratio was more than 10 or less than 1, the correct localization was made.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1995

Esophageal carcinoma metastatic to the brain: clinical value and cost-effectiveness of routine enhanced head CT before esophagectomy.

PURPOSE: To assess the value of screening enhanced head CT before esophagectomy for carcinoma, identify increased risk factor(s) for brain metastases, and determine metastasis incidence. METHODS: Thoracic surgery files of patients undergoing esophagectomies for squamous carcinomas, adenocarcinomas, and undifferentiated carcinomas between January 1984 and March 1993 were reviewed regarding sex, size (length) of neoplasm, and brain metastases. Surgical pathology and tumor registry files also were reviewed. Records of patients with brain metastases were reviewed in detail. RESULTS: Three hundred thirty-four esophagectomies were performed for 230 adenocarcinomas (202 male, 28 female) and 104 squamous carcinomas (61 male, 43 female). In 9 males and 1 female with adenocarcinomas and 1 male and 1 female with squamous carcinomas, brain metastases developed. Surgical pathology files identified 293 additional esophageal carcinomas, including 2 males with adenocarcinomas metastatic to brain. Tumor registry files identified I additional male with brain metastasis from an undifferentiated esophageal neoplasm. No statistically significant preoperative characteristic of esophageal carcinomas with proneness to brain metastases was found, except large size of primary neoplasm. Preoperative screening head CT done on approximately 240 patients who underwent esophagectomies showed no metastases. CONCLUSIONS: Brain metastases from carcinomas of the esophagus are relatively uncommon (3.6% in the esophagectomy cohort). They tend to occur in patients with large primary neoplasm, probably especially adenocarcinomas involving the esophagogastric junction, and with findings of local invasion and lymph node metastases by CT and/or microscopically. It may be reasonable to obtain head CT as a last preoperative staging procedure in such patients. Routine preoperative head CT for staging is not cost effective.

Aged↗
PubMed2003

[Review of 26 patients operated on for primary hyperparathyroidism].

The traditional surgical approach for primary hyperparathyroidism (PHP) is routine bilateral neck exploration. At Saiseikai Utsunomiya Hospital, however, unilateral exploration, and the direct resection of one gland is performed if single gland enlargement is suspected, based on the findings of several preoperative localization procedures. Here, we reviewed 26 patients who underwent single gland operations for PHP at our institution between 1993 and 2001. The 26 patients (21 women and 5 men) ranged in age from 20 to 79 years (mean, 54.8 years). None of the patients had multiple endocrine neoplasia (MEN), familial hypercalcemia, or malignant tumors. At least three preoperative localization procedures, such as ultrasonography, computed tomography, thallium technetium scanning, 99mTc sestamibi scintigraphy, or magnetic resonance imaging, were performed in each patient. A parathyroidectomy was then performed under general anesthesia. Contralateral exploration was not routinely performed. In addition, an intraoperative biopsy of the other glands was not performed. The following data were retrospectively collected in all patients: serum calcium, and the HS-PTH at one month and 6 months after the parathyroidectomy. All patients were normocalcemic, and the serum HS-PTH concentration significantly decreased in all patients after this operation. Patients were divided into two groups (adenoma group, n = 16; hyperplasia group, n = 6) and the data was analyzed according to the histological and pathological diagnosis. In both pathological groups, all patients were normocalcemic and the serum HS-PTH concentration was significantly lower after surgery. The serum HS-PTH concentration showed no significant difference between the adenoma group and the hyperplasia group at 6 months after surgery. No complications, including recurrent laryngeal nerve palsy or permanent hypocalcemia, were observed after surgery. In conclusion, if a single gland disease is suspected based on the findings of multiple preoperative localization procedures, resection of the enlarged gland alone appears to provide good results for the treatment of either adenoma or hyperplasia resulting in PHP. In addition, this procedure also reduces the occurrence of postoperative hypocalcemia, because the normal glands are not injured by the biopsy procedures.

Adenoma↗
PubMed1976

Relevant diagnostic procedures in renovascular hypertension.

The validity of invasive preoperative diagnostic procedures in patients with unilateral renovascular hypertension was assessed. A significant lowering of blood pressure following reconstructive surgery can be predicted if following stimulation with Dihydralazine the renal-venous renin ratio of the involved to the noninvolved kidney is at least 2.0. Furthermore, it is of importance to determine the renal perfusion rate in the contralateral non-stenotic kidney which should be within normal limits. If these two criteria are met then in the majority of cases surgical intervention in unilateral hypertension is meaningful.

Adult↗
PubMed1990

Vasectomy technique.

When performing a vasectomy, a gentle atraumatic technique reduces complications. The aim is to avoid cutting anything but the vas to reduce complications and to make microsurgical reversal possible. In this article common problems are discussed and possible solutions suggested. (An article 'Vasectomy in review' by the same author appears in the June issue.)

Anesthesia, Local↗
PubMed2001

[Survey on the preoperative evaluation in Catalonian surgical centers. II. What is the attitude and opinion of the professionals involved?].

OBJECTIVE: Previous studies have provided evidence of the existence of differences in preoperative assessment practices and have questioned the usefulness of generalized testing for all patients. The objective of this study was to determine the attitudes and opinions of anesthesiologists and surgeons about their application of preoperative assessment procedures and their knowledge of the scientific principles underlying their practice. SUBJECTS AND METHODS: A questionnaire was mailed to 227 specialists in anesthesiology and postoperative intensive care, general and gastrointestinal surgery, orthopedic surgery and traumatology of all hospitals in Catalonia (Spain) with active operating theaters. RESULTS: The overall response rate was 61% of the surveyed population, with 86% of the Catalan hospitals represented. The medical literature supports the routine performance of a chest x-ray and an ECG in the opinion of 17 and 26% of the respondents, respectively. Those two procedures are always ordered by 43 and 37%, respectively, even if they believe that the medical literature does not support generalized application. Legal protection was given as the reason for routine ordering of preoperative tests in asymptomatic patients, and 89% believed that a protocol for selective preoperative assessment procedures would improve efficiency. CONCLUSIONS: This study reveals a discrepancy between the opinions of professionals involved in preoperative assessment and their real practice in Catalan hospitals, probably influenced by perceived need for legal protection.

Anesthesiology↗