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At least 433 records · Page 24Linked to original sources
PubMed2001

Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection.

A series of 253 consecutive patients with proved primary hyperparathyroidism due to parathyroid tumours was reviewed. There were 68 (26.9%) men and 185 (73.1%) women, with a median age of 57 years (range 13-82 years). All patients, prior to successful parathyroidectomy, underwent one or more preoperative localization procedures such as: neck ultrasonography (US) in 191 (75.5%), (201)Tl/(99m)Tc-pertechnetate subtraction scintigraphy (TPS) in 144 (56.9%), CT scan in 92 (36.4%), (99m)Tc-sestamibi/(99m)Tc-pertechnetate subtraction scintigraphy (MPS) in 90 (35.6%), selective venous sampling (SVS) with parathyroid hormone (PTH) assay in 30 (11.9%), and magnetic resonance imaging (MRI) in 6 (2.4%) patients. The results were compared with operative and histological findings that showed 235 (92.9%) solitary parathyroid adenomas, 13 (5.1%) carcinomas and 5 (2.0%) double adenomas. Sensitivity and positive predictive value were 82.9% and 93.8% for US, 83.6% and 91.8% for TPS, 81.3% and 98.7% for CT scan, 85.1% and 96.1% for MPS, 65.4% and 80.9% for SVS, and 80.0% and 80.0% for MRI respectively. No different results (P=NS) were found using US, TPS, MPS or CT scan, whereas SVS and MRI sensitivity was lower (P<0.05). The combination of MPS and US was 94.0% sensitive (P<0.05) but when TPS, CT scan or MRI were also used overall sensitivity did not improve significantly (P=NS). In conclusion, MPS should be used as the starting preoperative localization procedure, while US and MPS together represent the most reliable noninvasive localization tool. If MPS and US are negative or not in agreement, further studies are not cost-effective and the patient should undergo bilateral neck exploration.

Adolescent↗
PubMed1995

[The experiences of a hospital radiology department with outside referrals for the preoperative marking of suspicious breast lesions].

PURPOSE: To outline the experience of a referral radiology department with preoperative localisation procedures on the basic of mammograms obtained by other facilities. MATERIAL AND METHODS: 342 consecutive female patients aged 56.5 +/- 11.9 years underwent preoperative breast localisation procedures prior to surgery. Of these patients 241 had their mammograms obtained in various private practices and 101 in the radiology department. Retrospectively all mammograms were classified by lesions morphology, lesion size and presence or absence of calcifications. RESULTS: The overall benign-to-malignant ratio (B/M-ratio) was 1.7:1. In the referred patient group the B/M-ratio was 1.9:1, compared to a B/M-ratio of 1.3:1 obtained by the radiology department. Referred patients presented significantly (p < 0.001) more often with calcifications that patients from the radiology department. CONCLUSION: Possible factors for the higher B/M-ratio in referred patients are prompt referral to surgical biopsy, misinterpretation of mammograms, failure in the written report, lack of a second opinion and lack of feedback and communication between surgeon, pathologist and radiologist.

Aged↗
PubMed1997

Intraoperative hemodilution is more cost-effective than preoperative autologous donation for patients undergoing procedures associated with a low risk for transfusion.

STUDY OBJECTIVE: To determine the utilization and cost of autologous blood that was donated preoperatively, and to compare it to the cost of employing intraoperative hemodilution to provide autologous blood for patients undergoing surgical procedures with a low risk for the need for transfusion. DESIGN: Retrospective chart review. SETTING: University medical center. PATIENTS: All ASA physical status I and II patients who underwent nononcologic gynecologic procedures and preoperatively donated autologous blood between July 1993 and June 1994. MEASUREMENTS AND MAIN RESULTS: The utilization and overall cost of predonated autologous blood was determined. The cost for employing intraoperative hemodilution and potential cost saving was then calculated. Of the 234 units of preoperatively donated autologous blood, 38 units were returned to patients who had an estimated blood loss of at least 500 ml, 32 units returned to patients who had an estimated blood loss less than 500 ml, and 164 units were wasted. No patient received allogeneic blood. The estimated total cost for all preoperatively donated autologous blood was $23,274.62. Employing hemodilution for those same patients would have cost $5,574.74, and resulted in a potential 75.6% savings. CONCLUSIONS: Inappropriate selection of patients for preoperative blood donation is costly. For those patients scheduled to undergo surgical procedures associated with a low probability for the need for blood transfusion, but who desire that autologous blood be available, hemodilution provides fresh whole blood, free from the possibility of processing or clerical errors, while decreasing blood bank utilization and affording substantial cost savings.

Adult↗
PubMed1976

Jejunoileal bypass procedures in morbid obesity: preoperative psychological findings.

Seventy patients who averaged 155% overweight and requested jejunoileal bypass surgery as a treatment intervention for morbid obesity were studied preoperatively for prominent psychological characteristics. By use of standard personality tests and a structured psychiatric interview, it was found that 89% were judged to be psychologically favorable risks for the operation. Most frequently the diagnostic opinion was of a mild personality disorder.

Adult↗
PubMed1988

Procedures and experiences with preoperative skin preparation in Sweden.

The current situation with preoperative skin preparation in Sweden is described. Patients are given two preoperative washes with chlorhexidine scrub, and are sent to theatre on a clean bed, so no extra linen is required. Wound infection rates are acceptably low, and use of chlorhexidine has also assisted in reduction of infection associated with central venous catheters. Use of chlorhexidine scrub is recommended to help healing of infected wounds.

Baths↗
PubMed1998

Minimally invasive antireflux surgery.

BACKGROUND: Previous reports of minimally invasive antireflux surgery for gastroesophageal reflux disease (GERD) have been small, short-term series utilizing only a laparoscopic approach. We conducted a retrospective review and report our 66-month experience with more than 1,000 laparoscopic and thoracoscopic antireflux procedures. METHODS: Between September 1991 and October 1997, 968 adults underwent 1,003 minimally invasive antireflux procedures on a tailored basis, based on their preoperative evaluation. Procedures performed were laparoscopic Nissen (626), Toupet (348), paraesophageal (33), and thoracoscopic Belsey (22). A total of 23% (233) of patients underwent an ancillary procedure (esophageal myotomy 85, vagotomy 67, pyloromyotomy 13, and cholecystectomy 66). RESULTS: Follow-up averaged 33 months (range 1 to 66), operative mortality was 0.1%. Complications occurred in 2.7% with a 1% long-term dysphagia rate. Demonstrated recurrence rate was 3.8% to date, with an associated 3.4% reporting symptoms of GERD. CONCLUSION: Minimally invasive antireflux procedures provide sustained relief of GERD symptoms with low morbidity and rapid recovery.

Adult↗
PubMedDate not supplied

[Diagnostic value of imaging procedures in nephroblastoma before preoperative chemotherapy: initial results].

According to the international SIOP 9 study preoperative chemotherapy for patients between 6 months and 16 years old is a major component of the therapeutic management of Wilms' tumour. Prior to treatment, the diagnosis is established by diagnostic imaging alone, without biopsy. This study was therefore undertaken to verify the accuracy of diagnostic imaging in the German GPO study group. Between July 1988 and November 1990, 156 patients with known histology were registered in the study centre. Of these patients, 67% (105/156) received preoperative chemotherapy. The diagnosis was initially established by US, TVP and CT, and in some cases MRT without prior biopsy. Of these preoperatively treated patients, 92.4% (97/105) had Wilms' tumour or one of its variants. Five patients had a different malignant tumour. Three cases, i.e. 2.8% of the preoperatively treated patients or 1.9% of all registered patients with known histology, had benign tumours of the kidney. Morphologically, the Wilms' tumour was revealed by a characteristic inhomogeneity in sonography and the CT scan. The inhomogeneity in the CT scan increased following injection of contrast medium. Intratumoral bleeding and cystic areas were observed frequently in the native scan. Calcifications were seen in 5% of the cases. The predictive value of pretherapeutic diagnostic imaging was good enough to justify instituting chemotherapy without diagnostic biopsy. It is still difficult in diagnostic imaging to differentiate the very rare benign cystic nephroma from malignant nephroblastoma. Intravenous pyelography proved to be the best method for distinguishing extrarenal from renal tumours.

Child↗
PubMed1994

The entorhinal cortex and a delayed non-matching-to-place task in mice: emphasis on preoperative training and presentation procedure.

This study examined the effects of ibotenate lesions of the entorhinal cortex (EC) on performance of a spatial recognition memory task, the delayed non-matching-to-place task (DNMTP), varying in level of difficulty according to the number of interpolated arm visits between sample-place presentation and subsequent recognition in mice. Results of experiment 1, designed to test the rate of acquisition of the task, showed that experimental animals were impaired in the basic non-matching task. However, with further training they were able to learn the task. Impairments were also observed when the amount of interpolating information inserted was gradually increased, and then all problem difficulties were pseudorandomly tested. There was no measurable recovery of function over time when the animals were retested on the task approximately 1 month later. Experiment 2 showed that the animals that received extensive training on the task prior to lesions of the EC were only transiently impaired in the DNMTP task. These data suggest that the EC plays an important role in acquisition rather than retention of the spatial recognition memory task.

Animals↗
PubMed1989

Treatment of uterine leiomyomata: past, present and future.

Hysterectomy for uterine leiomyomata can now be considered a safe procedure, but preoperative LHRH analogue administration greatly facilitates the surgical procedure, allowing myomectomy, when otherwise a hysterectomy may have been necessary. In selected cases, especially near the end of the reproductive period, LHRH analogues may become a valid alternative to hysterectomy.

Female↗
PubMed2002

Experience with predeposition of autologous blood in elective orthopaedic and plastic surgery: the role of oral iron medication.

The risk of transmission of transfusion-associated infections, mainly AIDS, led to the increased use of autologous transfusion by four methods: predeposition of autologous blood, haemodilution, intraoperative and postoperative blood salvage. We started a program of autologous predeposition at blood transfusion centre of Saint Andrews General Hospital of Patras in co-operation with orthopaedic and plastic surgery in 1992. To date, 617 autologous units have been collected from 257 patients undergoing various operations. Our protocol was as follows: the minimum Hb value before each donation was 12 g/dl, body weight over 50 kg, age 18-70 years and 8-10 day intervals between donations. The exclusion criteria were anaemia, evidence of blood loss, renal disease, chronic and acute inflammatory or malignant disorders, pregnancy and lactation. We chose 40 patients with haemoglobin values of 13-15 g/dl and ferritin levels > 50 ng/ml, who gave three autologous units. They were separated in two groups of twenty patients. Those in group 1 received 300 mg of elemental iron in three daily oral doses, while the others in group 2 received no iron medication. We studied haematologic variables, reticulocytes and ferritin levels in both groups before each autologous donation. We also studied the possible complications and their incidence in patients over 60 years old. According to our results, haematologic variables such as Hb, mean corpuscular Hb (MCH), mean corpuscular volume (MCV) and reticulocytes were not influenced by oral iron therapy. We observed a slight increase in MCV in both study groups which means the production of larger red blood cells. We also noticed a higher decrease of ferritin in patients with no iron therapy, but without a fall of ferritin levels under the normal values. We conclude that oral iron therapy in non-iron deficient patients undergoing a moderate program of three autologous units is not necessary. In addition, autologous blood donation is also feasible in patients over 60 years old without severe complications.

Adolescent↗
PubMed2004

[Cleft lip and palate surgery in India].

10 cleft lip and palate temporary facilities were set up 1994-2003 in a Christian Hospital in Central India. 725 patients were operated upon. An analysis of the operations in regard to lip closure, closure of the soft and the hard palate, secondary cleft operations and cleft-related surgery is given. Differing therapy concepts in developed countries are discussed and compared to experiences of other third world volunteer medical groups.

Adolescent↗
PubMed2006

[Refractive surgery: a solution for elimination of glasses?].

Refractive surgery corresponds to all surgical methods designed for correction of refractive errors called ametropia (myopia, hyperopia, astigmatism and presbyopia). This area in ophthalmology, recently opened, is in continuous progress concerning techniques of treatment and also of diagnosis. These innovations allowed spectacular performances making possible the corrections of all refractive defaults. Two main categories can be distinguished depending on the corneal or intraocular location of the surgery. The first group includes incisions, excimer photoablation, laser thermokeratoplasty and intrastromal segments. The second group represents implantation of intraocular lens in front of natural lens (phakic IOL) or taking the place of the lens after its removal (pseudophakic IOLs).

Algorithms↗
PubMed1990

[Procedures and results with preoperative individual AO reconstruction plates].

As a rule continuous bony defects of the mandible after tumour resection are temporarily bridged with the AO reconstruction plate. To precontour the plate, CT-scans of the mandible at a scale of 1:1 6 mm above and parallel to the inferior margin are needed. Corresponding layers further cranial show the anatomy of the chin. Using a lateral cephalograph, the mandibular angle and the length of the plate in the ascending ramus are measured. Using the CT-scans, the lateral cephalograph, a prebent template and a corresponding model of the mandible, the plate is bent into shape. Of the nineteen preshaped reconstruction plates implanted, eleven did not need any intraoperative adjustment. The other eight plates needed only slight modifications of contour. Preoperative bending of the reconstruction plate reduces the time taken for the operation, protects the material and the plate is precisely shaped.

Bone Plates↗
PubMed1983

Midtrimester abortion: techniques and complications.

Midtrimester abortion may be accomplished by a variety of techniques, alone or in combination. Comprehensive care of patients who require or request pregnancy termination in the second trimester must include careful assessment of medical and psychological conditions. Special attention needs to be paid to gestational age, and for many cases ultrasonography should be part of the evaluation. With the variety of techniques and combinations available, physicians can now individualize patient care to minimize morbidity and mortality while improving patient comfort and well being.

Abortion, Induced↗
PubMed1993

The implant-supported single-tooth restoration. Preoperative evaluation and clinical procedure.

The implant-supported restoration is a relatively new and promising treatment modality. The CeraOne system offers a complete set of easy-to-use prosthetic components plus the all-ceramic and ceramometal restorative alternatives. No clinical signs of loosening have been reported since the adjunct of a torque controller that provides a tightening force of 32 Ncm to the abutment gold fixation screw. Even with these developments, however, a meticulous presurgical evaluation of the periodontium and careful fixture placement are still imperative for a successful esthetic and functional result.

Crowns↗
PubMed1997

[Craniosynostosis and faciocraniosynostosis].

The authors present a review of the aetiopathogenesis and treatment, based on a series of 1321 craniostenoses operated by the Enfants Malades team. After briefly reviewing the embryology of craniofacial growth, the authors describe the morphological classification of craniostenoses and their morphological and functional consequences. The main neurosurgical problems related to craniofacial surgery are described. The surgical techniques currently used by the unit are described for each type of craniostenosis, according to age: H or flap transposition craniectomies for scaphocephaly, unilateral advancement of a bilateral head-band for plagiocephaly, anterior transposition for oxycephaly, and fronto-orbital adbancement for brachycephaly. The results are presented with a follow-up of several years. The principles of one-stage or two-stage surgical treatment for the main types of faciocraniostenosis are recalled: initial fronto-orbital advancement then secondary treatment of maxillary recession. The prospects of one-stage combined treatment with early maxillary distraction are proposed. Surgical indications are described. The complications, morbidity and mortality are indicated for the series. It must be remembered that craniostenosis surgery is a form of plastic surgery with neurosurgical complications. To obtain optimal results with the lowest risk, craniofacial must be performed by multidisciplinary teams in specialized centres.

Child↗
PubMed2001

Preoperative determinants of an esophageal lengthening procedure in laparoscopic antireflux surgery.

BACKGROUND: In a minority of patients undergoing antireflux surgery, an esophageal lengthening procedure is required to reduce the gastroesophageal junction (GEJ) below the esophageal hiatus. We evaluated risk factors associated with an irreducible GEJ to identify clinical features that were predictive of the need for a Collis gastroplasty in patients undergoing laparoscopic antireflux surgery. METHODS: Patients who required a Collis gastroplasty during a laparoscopic antireflux procedure (defined as the inability to reduce the GEJ > 2.5 cm below the esophageal hiatus despite extensive mobilization of the mediastinal esophagus) were compared to a random sample of patients who did not have a Collis gastroplasty. Predictors of the need for an esophageal lengthening procedure were identified using logistic regression modeling. Risks were expressed as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Twenty patients who had a Collis gastroplasty were compared to 133 patients who had adequate esophageal length. The presence of a stricture (OR 3.0; 95% CI 1.0, 9.7), paraesophageal hernia (OR 3.5; 95% CI 1.3, 9.6), Barrett's esophagus (OR 3.7, 95% CI 1.3, 10.7), and re-do antireflux surgery (OR 6.4; 95% CI 2.0, 20.7) were associated with the need for gastroplasty. Patients with none of these factors were extremely unlikely to require a gastroplasty (OR 0.08; 95% CI 0.02, 0.34). CONCLUSION: Patients undergoing laparoscopic antireflux surgery who are at high risk of needing an esophageal lengthening procedure can be easily identified preoperatively using simple clinical characteristics.

Age Factors↗
PubMed1993

Elective surgery in children with sickle cell disease without preoperative blood transfusion.

It is generally recommended that patients with sickle cell disease receive red blood cell (RBC) transfusions before undergoing general anesthesia and surgery. Since RBC transfusions are costly, inconvenient, and may cause serious complications, it might be useful to identify groups of patients for whom they are not absolutely necessary. We report our experience with 54 pediatric patients undergoing 66 elective surgical procedures without preoperative transfusion preparation. All patients were felt to be clinically and hematologically stable in the immediate preoperative period. For the majority of procedures (57/66, 86%) no transfusions were administered at any time during the perioperative course. There were no intraoperative complications or postoperative deaths. Overall, some type of postoperative complication was encountered after 17 procedures (26%). Complications were usually minor and were more likely to occur after procedures involving thoracotomy or laparotomy (10/20, 50%) and tonsillectomy/adenoidectomy (T&A) (5/9, 56%) than other procedures (2/37, 5%; P < .001). Pulmonary complications were especially more prevalent in the group undergoing thoracotomy, laparatomy, or T&A (9/29 v 0/37 for all other procedures, P < .001). We conclude that preoperative transfusions might be avoided in children with sickle cell disease who undergo most minor surgical procedures on an elective basis. Patients undergoing thoracotomy, laparotomy, or T&A are at a relatively higher risk of developing postoperative complications and would comprise ideal groups for evaluation of preoperative transfusion regimens in prospective carefully controlled, randomized studies.

Adolescent↗