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At least 487 records · Page 27Linked to original sources
PubMedDate not supplied

Risk-adjusted monitoring of binary surgical outcomes.

A graphical procedure suitable for prospectively monitoring surgical performance is proposed. The approach is based on accumulating evidence from the outcomes of all previous surgical patients in a series using a new type of cumulative sum chart. Cumulative sum procedures are designed to "signal" if sufficient evidence has accumulated that the surgical failure rate has changed substantially. In this way, the chart rapidly detects deterioration (or improvement) in surgical performance while not overreacting to the expected fluctuations due to chance. Through the use of a likelihood-based scoring method, the cumulative sum procedure is adapted so that it adjusts for the surgical risk of each patient estimated preoperatively. The procedure is therefore applicable in situations where it is desirable to adjust for a mix of patients. Signals of the chart lead to investigations of the cause and to the timely introduction of remedial measures designed to avoid unnecessary future failures.

Cardiac Surgical Procedures↗
PubMed1993

Perioperative management of the thoracotomy patient.

The perioperative management of the thoracotomy patient must be both specific and flexible. The assessment of preoperative information yields information as to operability and resectability. Once anesthesia is administered for operative procedures, however, techniques and methods must be changed to accommodate additional information obtained during the surgical procedure. The preoperative and intraoperative management is focused on improving pulmonary function during the postoperative period and improving outcome. Significant advances in pain management techniques have evolved within the last 10 to 15 years. Relieving the intense pain associated with a thoracotomy incision not only improves patient well-being, but improves breathing patterns and pulmonary function, resulting in a more comfortable and ambulatory patient. Epidural analgesia, intrathecal analgesia, intrapleural installation of local anesthetics, and PCA are but a few of the techniques that enhance the therapeutic armamentarium and improve the postoperative course. Inasmuch as surgical extirpation of lung cancers remains the best hope of survival for many patients, a detailed and aggressive management plan is necessary to achieve the desired result.

Anesthesia, General↗
PubMed1995

Successful removal of large pineal region meningiomas: two case reports.

BACKGROUND: Pineal region meningiomas are extremely rare tumors and comprise about 8% of tumors of this region. Two cases of large pineal region meningiomas in young males are presented. METHODS: Computed tomography (CT) scan and cerebral angiography were used to evaluate the patients preoperatively. Both patients were operated on through an occipital transtentorial approach either as a single- or two-stage procedure. RESULTS: Preoperative work-up revealed that both tumors received their main blood supply from the posterior lateral choroidal arteries and were therefore originating from the velum interpositum cerebri (superior tela choroidea). Complete tumor removal was effected in the first patient using a right occipital transtentorial approach. In the second patient, after partial removal using the same approach, complete resection was achieved at a second stage via the left occipital transtentorial approach 3 months later. CONCLUSION: Cerebral angiography, which must include vertebral angiography, is important in the preoperative surgical planning of these tumors. The occipital transtentorial approach provides good access. However, a two-stage procedure using right and left sides may be necessary for large meningiomas receiving a bilateral blood supply from both posterior lateral choroidal arteries. Diagnosis, the surgical approach, and methods of tumor excision are discussed.

Adult↗
PubMed1977

Pseudocholinesterase deficiency: an additional preoperative consideration in outpatient diagnostic procedures.

Because pseudocholinesterase deficiency is an unusual anesthetic complication which requires specialized equipment and postanesthetic management and nursing care for successful treatment, it takes on added significance when it occurs in the ambulatory surgical patient. It emphasizes the fact that while operative procedures performed in the ambulatory surgical setting may be of comparatively minor magnitude, this does not in any way render them minor anesthetic procedures.

Adult↗
PubMed1996

Endoscopic ultrasonography for the preoperative localization of insulinomas.

Preoperative radiological localization of insulinomas often fails because of the small size of the tumors. We studied retrospectively the value of different procedures in preoperative localization of insulinomas in 18 patients. Radiological assessment included transabdominal ultrasonography, computed tomography, angiography, magnetic resonance imaging, transhepatic venous sampling, and endoscopic ultrasonography (EUS) for the last 11 patients. During surgery, the association of palpation and intraoperative ultrasonography localized 16 solitary tumors and two multiple tumors (mean size, 1.8 +/- 1.1 cm). There insulinomas were found to be malignant. Conventional preoperative methods correctly localized the tumor in seven of 18 cases (38%), whereas the sensitivity of EUS was 10 of 11 cases (90%). Surgical procedures involved eight enucleations, nine distal pancreatectomies, and one total pancreatectomy. Because of its high sensitivity and safety, EUS was found to be the best method for preoperative localization of insulinomas, and we recommend that EUS replace conventional methods for the majority of cases.

Endosonography↗
PubMedDate not supplied

A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography.

A prospective study was conducted from March 1999 to April 2000 that included 73 patients who underwent elective laparoscopic cholecystectomy for uncomplicated gallstone disease. The study was conducted at one surgical unit in the Department of Surgery and Department of Radio-diagnosis and one surgical unit in the Department of Surgery, Maulana Azad Medical College and the associated Lok Nayak Hospital, which is the largest referral hospital in northern India and is located in the capital of India. A preoperative ultrasound was performed just prior to surgery, and 4 ultrasonographic parameters were analyzed. namely gallbladder wall thickness, contracted gallbladder, impaction of gallstones at the neck of the gallbladder, and common bile duct stones. The surgical findings were objectively graded as difficult or easy laparoscopic cholecystectomy according to 5 operative parameters, namely total time taken for the surgery, time taken to dissect gallbladder bed, spillage of stones, tear of gallbladder during dissection, and conversion to the open procedure. Of the 73 cases, 17 (23.3%) were conversions to the open procedure. Of the 21 (28.76%) cases predicted to be difficult, 17 (23.3%) were technically difficult, of which 13 (17.8%) were converted to the open procedure. Of the 52 (71.23%) cases predicted to be easy on ultrasonography, only 7 (9.38%) were found to be difficult on surgery, of which only 4 (5.48%) had to be converted to the open procedure. Based on our results, we conclude that preoperative ultrasonography is of great value in selecting patients preoperatively for laparoscopic cholecystectomy and minimizing complications and conversion to the open procedure.

Adult↗
PubMedDate not supplied

[Preoperative transhepatic biliary drainage in the jaundiced patient: our experience].

The authors assessed the efficacy of PTBD in a group of 72 patients with obstructive jaundice due to lithiasis or malignant obstruction, that underwent preoperatively PTBD procedure. They analysed the early and late complications and its effectiveness in decreasing the bilirubin levels. The results, in agreement with the most recent reports, suggest the uselessness of the preoperative PTBD in the treatment of the patients with a jaundice due to a biliary lithiasis. Concerning the patients with a neoplastic jaundice, this procedure seems to be more effective in the patients with a biliary obstruction due to pancreatic head or distal choledochus carcinoma: in the patients with a far advanced cancer, the PTBD procedure could be the first step to the insertion of biliary endoprosthesis; on the other hand, in the patients that may undergo a curative treatment, PTBD could be useful preoperatively both to reach an adequate water-electrolyte [correction of hydroelectrolithic] balance and nutritional status both to complete the diagnostic procedure.

Aged↗
PubMed2005

Benefits and limitations of image guidance in the surgical treatment of intracranial dural arteriovenous fistulas.

BACKGROUND: Despite major advances in endovascular embolization techniques, microsurgical resection remains a reliable and effective treatment modality for dural arteriovenous fistulas (DAVF). However, intraoperative detection of these lesions and identification of feeding arteries and draining veins can be challenging. In a series of 6 patients who were not candidates for definitive treatment by endovascular embolization we evaluated the benefits and limitations of computer-assisted image guidance for surgical ablation of DAVF. METHODS: Of the 6 patients, 5 presented with haemorrhage and one with seizures. Diagnosis of DAVF was made by conventional angiography and dynamic contrast enhanced MR angiography (CE-MRA). All patients were surgically treated with the assistance of a 3D high resolution T1-weighted MR data set and time-of-flight MR angiography (MRA) obtained for neuronavigation. Registration was based on cranial fiducials and image-guided surgery was performed with the navigation system. FINDINGS: Four of the 6 patients suffered from DAVF draining into the superior sagittal sinus, one fistula drained into paracavernous veins adjacent to the superior petrosal sinus and one patient had a pial fistula draining in the straight sinus. DAVF diagnosed with conventional angiography could be located on CE-MRA and MRA prior to surgery. MRI and MRA images were combined on the neuronavigation workstation and DAVF were located intraoperatively by using a tracking device. In 4 out of 6 cases neuronavigation was used for direct intraoperative identification of DAVF. Brain shift prevented direct tracking of pathological vessels in the other 2 cases, where navigation could only be used to assist craniotomy. Microsurgical dissection and coagulation of the fistulas led to complete cure in all patients as confirmed by angiography. CONCLUSIONS: Neuronavigation may be used as an additional tool for microsurgical treatment of DAVF. However, in this small series of 6 cases, surgical procedures have not been substantially altered by the use of the neuronavigation system. Image guidance has been beneficial for the location of small, superficially located DAVF, whereas a navigated approach to deep-seated lesions was less accurate due to the familiar problem of brain shift and brain retraction during surgery.

Adult↗
PubMed1990

[Surgical treatment of cholelithiasis and its complications. Comparison of 2 treatment periods].

We have realized a retrospective analysis of all cholecystectomies performed during two five-year periods (period I: 1970 to 1974, period II: 1984 to 1988) for stone disease. We were especially interested in the development concerning the type of intervention, the diagnostic procedures, the morbidity and mortality. Our analysis showed in the second period the substitution of the preoperative diagnostic procedure away from the cholangiography up to the ultrasound, a significant decrease of interventions, a marked decrease of surgically performed papillotomies and a reduction of mortality.

Ampulla of Vater↗
PubMed1989

[Diagnosis of hemorrhage of Meckel's diverticulum using technetium scintigraphy].

A 5-year-old boy is described with bleeding from Meckel's diverticulum diagnosed preoperatively by technetium scintigraphy. Despite limited indications to radioisotope methods in children they are valuable diagnostic procedures in preoperative diagnosis of the presence of ectopic tissue in Meckel's diverticulum.

Child, Preschool↗
PubMed2006

Impact of preoperative treatment strategies on the early perioperative outcome in neonates with hypoplastic left heart syndrome.

OBJECTIVE: This study was undertaken to determine the impact of specific intensive care procedures on preoperative hemodynamics, incidence of preoperative organ dysfunction, and in-hospital mortality among neonates with hypoplastic left heart syndrome with pulmonary overcirculation and to assess the influence of the change in preoperative management on early postoperative outcome. METHODS: In this retrospective evaluation of 72 neonates with classic hypoplastic left heart syndrome and severe pulmonary overcirculation with different preoperative management strategies from 1992 to 1995 and from 1996 to 2000, univariate and multivariate analyses of risk factors were performed with stepwise logistic regression. RESULTS: Among patients with ventilatory and inotropic support from admission until surgery, degree of metabolic acidosis (lowest recorded and prerepair pH values) was significantly higher than among patients who received systemic vasodilators without ventilation before surgery. Preoperative organ dysfunction occurred in 19 of 72 patients (26%), predominantly before 1996; the most significant was hepatic failure in 13 (68%). Lowest recorded and prerepair pH values did not predict the development of organ dysfunction, whereas inotropic medication, lack of afterload reduction, and especially ventilatory support correlated significantly with organ injury. In-hospital mortality decreased from 65% (13/20) to 13% (6/46) from the first to the second period. According to multivariate analysis, ventilatory support and organ dysfunction were significantly related to in-hospital mortality. CONCLUSION: In neonates with hypoplastic left heart syndrome, systemic afterload reduction can avoid preoperative artificial respiration, identified as a significant risk factor for the development of preoperative dysfunction of end organs and in-hospital mortality.

Cardiac Surgical Procedures↗
PubMed1989

[New aspects of preoperative imaging diagnosis in aggressive fibromatosis].

Aggressive fibromatosis is a surgical problem due to its tendency to recur following excision. The imaging methods available are presented and their diagnostic value discussed. A combination of different investigative procedures allows preoperative assessment of tumor type and extent and accurate planning of surgical procedure.

Angiography↗
PubMed1979

Usefulness of preoperative screening tests in perioperative respiratory therapy.

The incidence of postoperative pulmonary morbidity was studied in 910 surgical patients who had received preoperative screening by routine history-physical examinations, chest x-ray, and spirometry. Retrospective data were correlated with results of the preoperative screening procedures to calculate accuracy and efficiency of each test and test-combination. Use of the data to predict total cost of therapy, and cost per patient benefited, is described for a protocol of perioperative respiratory therapy when it is administered to all patients with positive screening tests. The optimum screening procedure is identified by comparison. It was shown that when an optimum screening procedure is used, with therapy administered only to patients with positive screening tests, about 80% of at-risk patients can be identified preoperatively and the cose of therapy can be reduced by up to 50%, or, in a selected population, by up to 75%. A screening procedure using all three of the tests studied, in combination, was shown to provide maximum economy of therapy with minimum loss of efficiency. The routine history-physical examination alone, for identification of at-risk patients, was shown to be inaccurate and inefficient. Spirometry was shown to be equally as useful as chest x-ray in improving the accuracy and efficiency of screening procedures.

California↗
PubMed1988

Preoperative skin preparation and surgical outcome.

The use of antiseptics in surgery from Lister to the present day is described. A review of current procedures for preoperative preparation for surgery is given; and some data showing that the effect of chlorhexidine on skin flora is persistent is recorded.

Anti-Infective Agents, Local↗
PubMed1998

TRAM flap perforator ligation and the delay phenomenon: development of an endoscopic/laparoscopic delay procedure.

Despite its versatility in breast reconstruction, the TRAM flap is at times subject to ischemic compromise, especially in certain high risk populations. A preoperative delay procedure can decrease the likelihood of TRAM flap failure or fat necrosis, but the required extent of this delay procedure is not clearly defined. In an attempt to augment flap vascularity while reducing surgical dissection and morbidity, six distinct delay procedures and a nondelayed control were compared in a rat TRAM flap model (n = 8 for all groups). An important feature that was incorporated into several groups was the ligation of the contralateral rectus perforators through minimal skin incisions (endoscopic analogy, groups 4 to 7). The most effective delay procedure was the combination of contralateral rectus perforator ligation and ipsilateral dominant pedicle ligation (group 7), which was achieved with two minimal skin incisions and no significant flap undermining. This procedure reduced the flap necrosis from 63.2 +/- 5.8 percent (control) to 13.5 +/- 3.3 percent (p < 0.001). After completion of the animal studies, clinical application of a "minimally invasive" TRAM flap delay procedure was then undertaken in eight high risk patients with only modest ischemic compromise. Although the clinical experience is too early to draw definite conclusions, we feel that "endoscopic delay" has potential as a modality that will increase flap vascularity but minimize the morbidity of the preliminary procedure.

Animals↗