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At least 469 records · Page 26Linked to original sources
PubMed2000

Primary suture vs. T-tube after common bile duct exploration (our 25 years of experience).

PURPOSE: The aim of our retrospective study is to return confidence in primary suture (PS) procedure after common bile duct exploration (CBDE). The first CBDE was performed in 1884 using PS. T-tube drainage was introduced 10 years later, and PS procedure has been abandoned today. MATERIAL AND METHODS: In the course of the last 25 years (1974-1999 period) 4971 cholecystectomy have been performed with 682 (13.5%) CBDEs. There have been 201 (30%) T-tubes, 238 (34%) PS, 219 (32%) biliodigestive anastomosis (BDA) and only 24 (3%) papillotomies (PT) performed. Intraoperative choledochoscopy has been performed as a routine intraoperative method, too. RESULTS: In 439 patients, operated either using PS or T tube procedure were as follows: retained stones 6:16 (2.5%:8%), billiary complications 4:14 (1.6%:7%) and mortality 1:6 (0.3%:3%), respectively. PS is a significantly less expensive procedure, spending less medicaments, i.v. fluids, X-ray and laboratory tests, with a shorter postoperative hospital stay. CONCLUSION: PS is unjustly abandoned operative procedure. The advantages of the method are lower complications rate as well as lower costs. Present progress in surgery, less operative aggression, must be considered, especially during laparoscopic cholecystectomy.

Adult↗
PubMed1992

Partial portacaval shunt: renaissance of an old concept.

BACKGROUND: Partial diversion of the portal system aims to reduce portal pressure sufficiently to prevent variceal hemorrhage but still maintain adequate hepatic portal flow. METHODS: Partial portacaval shunts were performed in 25 patients with cirrhosis with portal hypertension and esophageal varices, either as a primary procedure (n = 16) or for failure of endoscopic sclerotherapy (n = 9), with ringed polytetrafluoroethylene prostheses (8, 10, or 12 mm). RESULTS: All patients have now been followed up for at least 1 year. The operative mortality rate (2 months) was 4%. In 24 patients who survived beyond the initial perioperative period, there was no recurrence of variceal bleeding. Cumulative shunt patency (up to 4 years) is 96%. Acute encephalopathy was detected in two patients (8%), but no patients had signs of chronic encephalopathy. Intraoperative pressure measurements revealed a significant correlation between decreasing diameter of the graft and the percentage reduction of the portacaval pressure gradient. Selective angiography, performed 1 year after surgery, revealed that hepatopetal flow was maintained in 70% of patients with a 10 mm shunt. CONCLUSIONS: It is possible to achieve a partial portacaval shunt, related to the diameter of the prosthesis, that preserves hepatopetal flow in the majority of patients and is associated with a very low incidence of shunt thrombosis. This effectively prevents recurrent variceal bleeding and significant postoperative encephalopathy. The performance of subsequent orthotopic liver transplantation is not compromised. The technique is recommended, either as a primary procedure or when sclerotherapy has failed, in patients with good liver function who are unlikely to require early liver transplantation (grade A and some grade B cirrhosis).

Adolescent↗
PubMed2004

Sentinel lymph node biopsy in patients with Stage I/II melanoma: Clinical experience and literature review.

BACKGROUND: The sentinel lymph node (sN) represents one of the most powerful predictors of the outcome of patients with Stages I and II cutaneous melanoma, and may be relevant for the therapeutic planning of early-stage melanoma patients. Since adopting the technique of lymphatic mapping with vital blue dye (Patent Blue-V) in July 1993, we have periodically up-dated the methodology and revised our results in order to define the contribution of radio-guided surgery (RGS) to the detection of the sN as well as the role of intraoperative frozen section examination of the sN. MATERIALS AND METHODS: Between July 1993 and December 1997, 180 patients with clinically node-negative primary cutaneous melanoma (Stages I-II) underwent sN biopsy followed by "selective lymph node dissection" (SLND) whenever sN metastasis was detected. Presently, complete data are available in 165 patients who were divided into two consecutive subsets of 39 and 126 patients, based on the technique for the identification of the sN: Patent Blue-V only or Patent Blue-V associated to RGS. Moreover, in this second subset of patients intraoperative frozen section findings were compared with definitive pathologic examination. RESULTS: As regards the first subset of 39 patients (17 males and 22 females; mean age 51.3 years), the sN was identified in 35 patients (89.7%); 8 patients (22.8%) were found to have metastatic melanoma cells in their sN, and they all underwent SLND of the affected basin. As regards the second set of 126 patients (54 males and 72 females; mean age 53.5 years), the sN was detected in every case by means of the combined technique (Patent Blue-V and RGS): in 4 of 126 patients (3.2%), the sN was detected by means of RGS only whereas in no patient was the sN detected by Patent Blue-V only. Frozen section examination was performed in 123 of 126 patients who had sN detection by Patent Blue-V and RGS, and the intraoperative examination had a sensitivity of 66.6% (22 of 33), specificity of 100% (90 of 90), negative predictive value of 89.1% (90 of 101), and accuracy of 91% (112 of 123). The benefit of frozen section examination in avoiding a two-stage procedure was 17.9% (22 of 123 patients). In patients with thicker lesions (pT(3)-pT(4)), the sensitivity and the benefit of intraoperative examination were 76% (19 of 25) and 32% (19 of 59 patients), respectively. CONCLUSIONS: Sentinel node lymphadenectomy can be better accomplished when both procedures (lymphatic mapping with Patent Blue-V and RGS) are used because the two methods look quite complementary. In fact, the use of the radiocolloid mapping allows to detect a hot spot in the regional basin prior to making the skin incision in order to perform a minimal invasive access, and it may also more accurately differentiate the true sN from a secondary echelon node (non-sN). The use of frozen section examination should be restricted to patients with pT(3)-pT(4) primary melanoma, due to the higher sensitivity and benefit in terms of avoiding a two-stage operative procedure.

Adolescent↗
PubMed1991

Transoesophageal echocardiogram may fail to diagnose perioperative myocardial infarction.

We report a case in which a 55-yr-old man undergoing aortocoronary bypass was monitored with electrocardiogram and transoesophageal echocardiogram. Intraoperative electrocardiogram and simultaneous ECG recordings using the Holter monitor showed an ST elevation of greater than 2 mm and new Q wave formation in leads AVF and V5 during skin closure. However, the transoesophageal echocardiogram showed no wall motion abnormalities. No significant haemodynamic abnormalities were observed during the period of intraoperative ECG changes. He was treated with nitroglycerin infusion. Confirmation of a perioperative myocardial infarct was documented by postoperative 12-lead ECG and CPK-MB. A post-operative transthoracic echocardiogram showed a hypokinetic left ventricle with an anteroapical infarct. Thus transoesophageal echocardiography failed to detect an apical wall motion abnormality when the probe was placed at the midpapillary level. This limitation can be overcome by periodically obtaining apical views or by using probes with more than one imaging plane.

Aorta↗
PubMed1985

Lesser curve disconnection using a stapling device: highly selective vagotomy made quicker and easier.

A stapling device has been used to disconnect the lesser curve of the stomach during highly selective vagotomy in a consecutive series of ten patients. This modification renders the operation technically easier and quicker to perform. Postoperative recovery was uneventful in all patients, and in the subsequent follow-up period of 7-15 months, no problems relating to the technique were encountered.

Duodenal Ulcer↗
PubMedDate not supplied

[The indices of organ blood flow and external respiratory functions during cholecystectomy].

Surgical intervention for acute cholecystitis (whether planned or urgent) is always accompanied by considerable disorders of ventilation and blood flow in the vitals. In patients aged below 60 ventilation is nearly halved and blood flow in the brain, liver and lungs is 2-3 times as low while patients aged above 60 show 4-5-fold fall of lung perfusion and 1.5-fold decrease of liver blood flow. Planned operations result in 1.6-1.9-fold decrease of liver blood flow and 2.4-fold reduction of lung circulation registered by the 7th day of observation. These functions appear to be affected considerably less after urgent cholecystectomy and were established to rehabilitate during the first week of post-operative period.

Acute Disease↗
PubMed2001

[Comparative evaluation of the efficacy of pre- and intraoperative reserving of autoblood in surgical treatment of ischemic heart disease and while using a Cell Saver].

A prospective investigation included 142 patients who had undergone operations of coronary bypass under conditions of extracorporeal circulation for ischemic heart disease. Two methods of taking blood were used: one day before operation and at the beginning of operation. The transfusion of autoblood was performed after cessation of the extracorporeal circulation. Cell saver was used during operations on all the patients. The preoperative reserving of autoblood promoted the greater degree of hemodilution (both during extracorporeal circulation and at the early postoperative period). The intraoperative reserving of autoblood led to saving higher indices of content of hemoglobin, number of erythrocytes and hematokrit index at the early postoperative period. However, when using the cell saver, the method of reserving blood (7-8 ml/kg of body mass) was of no substantial influence on the frequency of using the allogenic blood.

Blood Loss, Surgical↗
PubMed2005

Ten-year experience with pediatric laparoscopic appendectomy--are we getting better?

BACKGROUND/PURPOSE: The purpose of this study was to compare our initial (1994-1997) and recent (2001-2003) experiences in laparoscopic appendectomy (LA). METHODS: A 2-year (2001-2003) retrospective chart review of cases of appendicitis was performed and compared with data obtained from 1994 to 1997 cases. Operating and anesthetic times as well as postoperative outcomes were analyzed. Cases of conversion to open appendectomy were included in the analysis. RESULTS: Two hundred and thirty-three LA cases from 2001 to 2003 were compared with 119 cases from 1994 to 1997. Operating time decreased significantly from 58 to 47 minutes in acute appendicitis (AA) and from 80 to 58 minutes in perforated appendicitis (PA). Anesthetic time decreased significantly in both AA (82 to 71 minutes) and PA (106 to 84 minutes). There were significant decreases in the conversion rate in PA (23.4% to 3.5%), although no change was seen in AA. In PA, the incidence of postoperative abscess decreased from 36.2% to 16.5%. There was no significant decrease in length of stay, amount of analgesia used, time to resume regular diet, or incidence of wound infections and bowel obstructions. CONCLUSIONS: Ten years of experience in LA has resulted in decreases in anesthetic and operating times for AA and PA as well as decreases in the incidence of abscesses and conversion rates.

Abscess↗
PubMed1992

Iloprost reduces peripheral resistance during femoro-distal reconstruction.

A randomised placebo-controlled trial was conducted to investigate the effect of iloprost, a stable prostacyclin mimetic, on peripheral resistance during femoro-distal bypass. Patients undergoing femoro-distal long saphenous vein bypass for critical ischaemia received 3000 ng of iloprost or placebo infused into the graft via an unligated side branch over 2 min. Graft blood flow and peripheral resistance were measured for 20 min, using an operative Doppler flowmeter (OpDop 130, SciMed, U.K.) and a pressure transducer to record graft pressure. Postoperatively, graft blood flow was assessed by daily duplex ultrasound for 7 days. Iloprost produced an immediate drop in peripheral resistance in all cases (n = 18) by a mean (range) of 40% (4-80%) compared with controls (n = 15) in whom there was a 5.3% (-8 to +36%) increase in resistance (p less than 0.01, Wilcoxon test). Decreased peripheral resistance in iloprost-treated patients persisted to 20 min. The largest decreases in peripheral resistance occurred in patients with the highest initial resistances (r = 0.56, p less than 0.02). Graft flow during the same period increased by 52% (-7 to 294%) compared with controls in whom there was a 6% (-17 to 26%) increase in flow, (p less than 0.01). Flow remained elevated by 53% over baseline values at 1 week post-infusion in the iloprost-treated group but this did not achieve statistical significance compared to controls in whom flow also increased by 13%. Iloprost produces an immediate decrease in peripheral resistance associated with a prolonged increase in graft blood flow. This may reduce graft failure in the early postoperative period.

Aged↗
PubMed1997

Peri-operative thoracic epidural analgesia for thoracotomy.

In a prospective study, experiences with peri-operative thoracic epidural analgesia (TEA) for thoracic surgery were documented. Two hundred and seven patients scheduled for elective thoracotomy were investigated. All patients received thoracic epidural catheters 2 h pre-operatively. The catheters were inserted between T4-5 and T8-9 intervertebral spaces. Epidural medication with bupivacaine and fentanyl was started preoperatively, maintained throughout surgery and was continued post-operatively via patient controlled analgesia (PCA) devices. Patients were anaesthetized with propofol and tracheal intubation was performed following neuromuscular blockade with vecuronium. Ninety-five percent of the patients were extubated immediately after surgery. 70.5% of all the patients had excellent post-operative analgesia (VAS pain scoring 0-2) on the day of surgery, 78% the day after surgery and 91% on the second day after surgery. Additionally early post-operative mobilization could be started in 63% of all patients. No neurological sequelae caused by thoracic epidural catheterization was seen in the early post-operative period.

Adult↗
PubMedDate not supplied

[The diagnostic value of blood rheology studies in cardiac surgical interventions].

The diagnostic value of routine studies of blood rheology in cardiosurgical patients was investigated. Blood rheology, hemostatic system, and acid-base balance were analyzed in 75 cardiosurgical patients during the early postoperative period. In 41 of these the postoperative period was uneventful and 34 patients developed complications. The blood fluidity conditions and estimation of the risk of thrombotic and hemorrhagic complications were assessed using the "Aggregate Status of the Blood" software. The data indicate a high diagnostic and prognostic significance of plasma viscosity, relative blood viscosity, erythrocyte aggregation and deformability indices in evaluation of the status of cardiosurgical patients in early periods after surgery. Application of hemorheological studies as routine methods for examination of patients improved the quality of treatment. Hence, rheological studies of the blood and plasma should become an obligatory component in the diagnosis of the hemostatic status in the early postoperative period after aortocoronary bypass surgery.

Arteries↗
PubMed2006

[Effect of huperzine A on cerebral cholinesterase and acetylcholine in elderly patients during recovery from general anesthesia].

OBJECTIVE: To observe the effect of huperzine A on cerebral cholinergic system in elderly patients during recovery from general anesthesia. METHODS: Thirty elderly patients undergoing elective surgery under general anesthesia were randomized in a double-blind manner into group I (n=15) to receive huperzine A (0.3 mg/2 ml) and group II (n=15) with normal saline (2 ml) given intravenously. Huperzine A or normal saline was administered 30 min before completion of the operation, and acetylcholine (Ach) concentration in the cerebral spinal fluid (CSF) of the patients was determined using high-performance liquid chromatography with electrochemical detector (HPLC-ECD) and the activity of cholinesterase inhibitors (ChE) evaluated with automatic biochemistry analyzer before general anesthesia induction (T1) and 5 h after operation completion (T2). RESULTS: In both the groups, Ach concentration in the CSF were lower at T2 than that at T1 (P<0.01), and at T2, CSF Ach concentration was significantly higher in group I than in group II (P<0.01); in group I, the activity of CSF ChE at T2 was lower than that at T1 (P<0.01), and also lower than at T2 in group II (P<0.01). CONCLUSION: Huperzine A can inhibit cholinesterase to increase Ach, which has a positive effect on cerebral cholinergic system in elderly patients during recovery from general anesthesia.

Acetylcholine↗
PubMedDate not supplied

[Hypoglycemia-inducing islet cell tumors. Measurement of blood glucose and insulin levels during operation. Results in seven cases (author's transl)].

The identification of hypoglycemic langerhans tumours by the surgeon, being sometimes difficult, per-operative quantity determinations of the glycemia and insulinemia levels help to ensure that all the insulino-secretory tissue has been removed. The technical protocol described includes an excess of glucids. In the 5 cases of adenomas, between 30 and 60 minutes after exeresis, a distinct increase in glycemia was noted (on average 1,25 g/l) in comparison to the initial level; this increase was not however significant in the 2 observations of adenomatous hyperplasia. Following the removal of the lesion, the fall in insulinemia is also more noticeable in adenomas (reaching 75,8 per cent of the initial level) than in adenomatous hyperplasia. Nonetheless, the fall in the latter is still considerable (42,4 per cent). This examination would be the best test, excvept that the results are known only after the operation. The 7 patients operated on recovered after 2 enucleo-excisions, and 5 isthmo-corporal-caudal splenopancreatectomies, the average post-operative period reaching 4 years.

Adenoma, Islet Cell↗
PubMed1989

[Perioperative treatment of patients with chronic TMJ diseases].

The concept of perioperative diagnosis and treatment of patients with chronic TMJ disease has been confirmed by a follow-up examination of ten female patients after surgical treatment. Eight of the ten patients were pain-free after observation periods of 3 to 20 months. Following an initial bite-guard splint therapy, instrumental functional analysis, MR tomography and arthrographic visualization of dynamic movement profiles are indispensable. The results have also shown that, depending on the intraoperative finding, a postoperative splint therapy should be performed for six months.

Adult↗