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At least 55 records · Page 3Linked to original sources
PubMed2000

Conservative surgical treatment of diffuse peritonitis.

BACKGROUND: Peritonitis is, even today, a significant source of death and complications. The objective of this study was to determine the morbidity and mortality rates, the incidence of reoperations, and the need for additional treatment strategies (on demand) in patients with diffuse peritonitis. METHODS: Prospective analysis including all patients (n = 258) with diffuse peritonitis admitted to our surgical service between November 1993 and April 1998 who underwent a uniform surgical treatment concept of peritonitis including early intervention, source control, and extensive intraoperative lavage. RESULTS: The 258 patients with diffuse peritonitis averaged a mean Mannheim Peritonitis Index of 27.1 points (range, 11-43 points). Source control at the initial operation was possible in 230 of the patients (89%), of those, 21 patients (9%) needed reintervention. In 28 patients (11%), source control was not possible at the initial operation. Twenty of these patients (71%) had to undergo additional treatment strategies (on demand) such as continuous lavage and/or laparostomy. Overall 228 of the 258 patients (88%) needed just 1 initial surgical intervention. The overall morbidity rate was 41%; the rate of reoperation was 12%, and the hospital mortality rate was 14%. CONCLUSIONS: A conservative surgical treatment concept supplemented with "extensive" intraoperative lavage reduces the reoperation rate compared with other treatment standards of peritonitis and achieves a low mortality rate in patients with diffuse peritonitis.

Adolescent↗
PubMed2004

[Supratentorial cavernoma and epileptic seizures. Are there predictors for postoperative seizure control?].

For cavernous haemangiomas, it is the aim of surgical treatment to control epilepsy and eliminate potential sources of intracerebral haematomas. In the following investigation, it was attempted to find indicators for seizure freedom after surgery. Success of therapy was assessed according to three patterns of classification. Thirty patients underwent tailored resection based on findings from preoperative investigations and intraoperative electrocorticography. Follow-up averaged 4 years. Lesionectomy, extended lesionectomy, and modified lobe resection were carried out in 13, 11, and six patients, respectively. For all procedures, including microsurgical lesionectomy, the firm gliotic layer unequivocally differed in colour and consistency from normal brain and was removed. Further tissue resection was carried out only if the electrocortical course suggested persistent spike activity around the resection cavity or if presurgical MRI evaluation (e.g. hippocampal atrophy) or electrophysiology also pointed to pathology distant from the lesion. Of the patients, 53.3% became completely seizure-free (Engel I), and one additional patient had only occasional isolated auras. Dramatic reductions in seizure frequency and severity were exhibited by 26.7%. Outcome in respect to seizure control was not associated with resection procedure, comparing pure lesionectomy with lesionectomy plus cortectomy. In the group of patients with epilepsy surgery, those with hippocampectomy had significantly better outcome than those without. Important prognostic factors were early operation after seizure manifestation (91.7% operated upon within 2 years of seizure onset became seizure-free). Another prognostic factor was unifocal seizure onset (bilateral or multifocal seizure onset was found in care of the ten patients with unfavourable outcome). None of the four patients harbouring multiple cavernomas became seizure-free after resection of one lesion, which was believed to be mostly attributable to the epileptic focus that was removed.

Adult↗
PubMedDate not supplied

The management and prevention of tetanus.

Tetanus is a rare disease in the United States, but it has a high mortality rate and is preventable through immunization. Using a computerized literature search, we reviewed English language articles on tetanus in the United States. We found that despite the availability of an effective vaccine, tetanus still causes considerable morbidity. The elderly are at great risk of tetanus, because they have never been immunized or their immunity has waned. Emergency physicians can reduce the likelihood of tetanus by ensuring appropriate wound care, including tetanus immunization and use of tetanus immune globulin, as appropriate. Treatment consists of neutralization of circulating toxin, surgical excision to eliminate the source of toxin, control of muscle spasms, and prevention of respiratory and metabolic complications. A case-finding approach for all persons who receive care in emergency departments will reduce the size of the susceptible population.

Adult↗
PubMedDate not supplied

[A fatal case of lower gastrointestinal hemorrhage: report of case and review of the literature].

Gastrointestinal hemorrhage continues to be a major medical problem. Even with improvements in both diagnostic and therapeutic, a significant number of patients still require surgical intervention for control of hemorrhage. When the source of persistent lower gastrointestinal hemorrhage is unknown, subtotal colectomy is a conceptually rational management choice. The authors present a case of massive lower gastrointestinal hemorrhage with unusual fatal outcome. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Angiography↗
PubMedDate not supplied

Selective arterial embolization for control of lower gastrointestinal bleeding: recommendations for a clinical management pathway.

PURPOSE: Angiography remains as the modality of choice in the diagnosis of lower gastrointestinal bleeding. Traditionally, angiography is used for localization of a bleeding source for surgical resection. Advances in transcatheter techniques have allowed for hemorrhage control through embolization of bleeding points, without the need for emergent laparotomy. METHODS: A series of 10 consecutive patients who underwent angiographic embolization for lower gastrointestinal hemorrhage was retrospectively reviewed. Success and complication rates, as well as post-embolization follow-up methods, were recorded. RESULTS: Over a 3-year period, 10 angiographic embolizations were performed for lower gastrointestinal hemorrhage. Average age of the patients was 75 years. Source of hemorrhage included diverticular disease in 4 patients, cancer in 2, polyps in 2, angiodysplasia in 1, and anastomotic bleeding in 1. Six patients required no further therapy. Four patients went on to have surgery: Three secondary to recurrent hemorrhage, 1 due to sepsis from ischemic bowel necrosis. There were no deaths. Four patients had an abdominal and pelvic computed tomography (CT) scan within 48 hours of embolization. Four patients had a colonoscopy within 48 hours of the procedure. CONCLUSIONS: Angiography remains an important diagnostic tool in the management of lower gastrointestinal bleeding. In addition, it is a safe and effective treatment option, especially in patients with high surgical risk. Hemorrhage control obtained in the angiography suite may allow for patient stabilization and resuscitation with staging and bowel preparation for surgery. Patients need to be carefully monitored for evidence of bowel ischemia through the use of colonoscopy or computed tomography.

Aged↗
PubMed2002

[Importance of source control in secondary peritonitis].

AIMS: In this study we discussed retrospectively secondary peritonitis patients, surgical treatment modalities and their effectiveness in our clinic. MATERIALS & METHODOLOGY: 91 patients were operated due to diffuse peritonitis between December 1998 through July 2001 in our clinic were analysed by age, sex, etiology of peritonitis, treatment modalities, morbidity and mortality. RESULTS: 32 patients were female (35.2%) and 59 patients were male (64.8%). The median age was 40.4. The most common etiologic factor for secondary peritonitis is peptic ulcus perforation (38.4%). 23 cases (25.2%) had the diagnosis only by physical examination and laboratory assessment. The other cases diagnosed with roentgenographic evaluation. In the first operation, the aim was the source control and eradication. In 3 cases, planned re-laparotomy "staged abdominal repair" (STAR) were performed. Conservative treatment modality was performed for 8 cases. The median hospital stay for the patients were 7.4 day. Morbidity was encountered in 13 (13.6%) and mortality was encountered in 2 (2.1%). CONCLUSION: Source control must be the primary aim of the first operation for secondary peritonitis patients. If there is an uncertainty for source control, STAR procedure should be the choice of the treatment modality for decrease morbidity and mortality.

Adolescent↗
PubMed2004

Upper gastrointestinal hemorrhage due to duodenal stromal tumor.

BACKGROUND: Gastrointestinal stromal tumor represents a rare neoplasm that originates in the muscular wall of the hollow viscera. AIM: To report gastrointestinal stromal tumor as a source of upper gastrointestinal bleeding, which required urgent surgical control. PATIENT/METHOD: A man with 61 years old was admitted to the emergency service sustaining hematemesis and melena. Endoscopy showed active bleeding from a tumor in the second portion of the duodenum, which was controlled by heater probe cauterization. Surgery was performed through a median laparotomy. A local resection of a 4 cm tumor in the second portion of the duodenum was carried out, together with a primary end-to-end anastomosis and a duodenal diverticulization. No complications happened during the post-operative period. Morphologic examination showed gastrointestinal stromal tumor with no atypical mitosis and a preserved capsule. CONCLUSION: Albeit not being common, gastrointestinal stromal tumors can represent a source of substantial gastrointestinal hemorrhage.

Duodenal Neoplasms↗
PubMed1995

Controlled mold geometry for surgical deficit treatment planning.

The relatively precise placement of brachytherapy sources afforded by stereotactic frames for brain implants is not generally achievable for other sites, which lack the fixed geometry of the cranium and its contents. An exception is a source-containing rigid mold that delivers brachytherapy when inserted securely in a surgical defect. A technique has been developed in which an acrylic mold of the region to be treated is suspended in a demountable aluminum box, which is then filled to a suitable level with dental stone to form a casting that supports the mold and that can be removed intact. First, the box is aligned on a mill table and a ball mill is used to drill three parallel holes in the acrylic mold, with precisely known locations and depths and as widely separated as possible. The spherical air cavities that result from plugging these holes with ball-milled acrylic rods become reference markers in subsequent computed tomography (CT) scans. After optimum CT-coordinate locations have been planned for 125I seeds in catheters, they are transformed to mill coordinates using a matrix developed from the known marker coordinates in the two systems. Catheter holes are then drilled with the mold in the reassembled casting and box. The method has been used to treat both recurrent maxillary cancer and recurrent orbital rhabdomyosarcoma.

Biophysical Phenomena↗
PubMed2004

Control of microbial contamination during surgical harvest of pig renal xenografts.

The pig has been identified as the most likely source of xenograft material for clinical use and studies are ongoing to overcome the immunological hurdles of pig-to-human transplantation. Attention is now being focussed on identifying and reducing the potential microbiological hazards associated with this technique. Studies have primarily addressed issues surrounding the production and health monitoring of xenograft source pigs and none have so far specifically evaluated the possible risks of microbial contamination during xenograft harvest. In this report, we evaluate the possible routes for contamination of a pig kidney xenograft during organ harvest and describe approaches to the control of these hazards, including the novel use of a custom designed airtight surgical canopy. A standard procedure for microbiological monitoring during xenograft harvest was devised and evaluated. This allowed the rapid identification and anti-microbial sensitivity testing of any isolated organisms. This would enable an early and appropriate pre-emptive treatment of infection because of transmission of pig micro-organisms.

Animals↗
PubMed2006

Initial resuscitation of hemorrhagic shock.

The primary treatment of hemorrhagic shock is control of the source of bleeding as soon as possible and fluid replacement. In controlled hemorrhagic shock (CHS) where the source of bleeding has been occluded fluid replacement is aimed toward normalization of hemodynamic parameters. In uncontrolled hemorrhagic shock (UCHS) in which bleeding has temporarily stopped because of hypotension, vasoconstriction, and clot formation, fluid treatment is aimed at restoration of radial pulse, or restoration of sensorium or obtaining a blood pressure of 80 mmHg by aliquots of 250 ml of lactated Ringer's solution (hypotensive resuscitation). When evacuation time is shorter than one hour (usually urban trauma) immediate evacuation to a surgical facility is indicated after airway and breathing (A, B) have been secured ("scoop and run"). Precious time is not wasted by introducing an intravenous line. When expected evacuation time exceeds one hour an intravenous line is introduced and fluid treatment started before evacuation.Crystalloid solutions and blood transfusion are the mainstays of pre-hospital and in-hospital treatment of hemorrhagic shock. In the pre-hospital setting four types of fluid are presently recommended: crystalloid solutions, colloid solutions, hypertonic saline and oxygen-carrying blood substitutes. In unstable or unresponsive hemorrhagic shock surgical treatment is mandatory as soon as possible to control the source of bleeding.

Journal Article↗
PubMed1984

Surgical wound environment.

People are the major source of bacterial contamination in the hospital environment, and to control environmental bacteria, the shedding potential of people must be controlled. In a conventional operating room, the more complete the surgical attire worn by everyone in the room, the better the control; i.e., body exhaust equipment for the anesthesiologist and the scrub nurse is essential. The laminar airflow filter system and ultraviolet light are effective environmental controls for preventing wound contamination.

Clothing↗
PubMed2006

Permanent prostate brachytherapy: a century of technical evolution.

PURPOSE: To summarise the practical aspects of the development of techniques of interstitial permanent prostate brachytherapy (PPB) implantation. Prostate brachytherapy dates back to Pasteau's publication in 1913 describing the insertion of a radium capsule into the prostatic urethra to treat carcinoma of the prostate. Various implantation methods were employed but with unsatisfactory results until the development of the transrectal ultrasound in the 1980s. The subsequent two-stage Seattle technique allowed for a planned homogenous distribution of radioactive sources throughout the gland resulting in biochemical control comparable to surgical and external beam radiotherapy series. With the advent of advanced computer software and improved imaging, the technique has developed accordingly to a single stage procedure with on-table dosimetric assessment. The principles of targeting dose to the prostate while avoiding surrounding organs at risk remain as relevant today as nearly a century ago. There is an array of techniques to consider for the novice PPB provider. Whether the evolution of PPB techniques will translate into improved biochemical control is yet to be seen.

Brachytherapy↗
PubMed1992

Antimicrobial therapy of intra-abdominal sepsis.

Intra-abdominal sepsis remains a highly morbid and lethal event despite the availability of potent antimicrobial agents and improvements in surgical management and intensive care. Appropriate management consists of source control, antimicrobial agents directed against both facultative gram-negative and anaerobic organisms, and physiologic and metabolic support. A variety of single and dual agent regimens are appropriate for initial therapy, as long as both aerobes and anaerobes are effectively targeted. Culture, Gram stain, and sensitivity testing may provide valuable information, especially when resistant organisms are encountered. Further studies to determine the relative efficacy of various agents need to be carefully designed both to avoid the pitfalls of previous studies and to provide useful and comparable data.

Abdomen↗
PubMed1998

Magnetic resonance angiographic source images for depicting topography and surgical planning for middle cerebral artery aneurysms: technique application.

PURPOSE: To evaluate the usefulness of magnetic resonance (MR) angiographic source images for determining the feasibility of M1 segment control via the distal approach in pterional craniotomy for middle cerebral artery (MCA) aneurysms. METHODS: MR angiographic source and conventional angiographic source images were obtained in 40 patients with MCA aneurysms. Each aneurysm was treated surgically using a pterional craniotomy. We initially approached the aneurysm distally. When this was judged inappropriate, the approach was altered to proximally. We compared the topography based on these angiograms to that confirmed during surgery. RESULTS: MR angiographic source images visualized the aneurysm, the M1 and M2 segments of the MCA, the insula, and the frontal and temporal opercula in all 40 patients. In 22 (55%) of them, the distal portion of the M1 segment was recognized from the posterolateral perspective between the aneurysmal neck and the insular surface. These aneurysms were successfully clipped via the distal approach after definite proximal control of the MCA was obtained. CONCLUSIONS: It was concluded that MR angiographic source images have a distinguishing feature in defining cerebral tissue-vascular relationships and that they are useful in the surgical planning for MCA aneurysms.

Feasibility Studies↗
PubMed1995

[Can we rely on Norwegian surgery data? A quality control at central and local hospitals of the procedure codes used in the survey on organization of gastrointestinal cancer surgery].

The nation-wide register of hospital discharges in Norway includes ICD-9 and national procedure codes. Hospitals were asked to check five surgical procedures listed in the register against the primary data sources. 649 discharges were controlled. The response rate was 68%. The results indicate that the quality of the data in the register varies for the different procedures. For procedures with high volume (resection of rectum), the error in the register is 3%. This is the same as reported from other Nordic countries. The proportion of errors in the register was high in hospitals with only one registered procedure code. The quality of data can to some extent be checked on the basis of DRG coding (DRG group 468/477). Quality control of register data is required when the number in DRG 468/477 is high in the nation-wide register or when the number of specific procedures in hospitals is low.

Databases, Factual↗
PubMed2006

Antifungal prophylaxis with azoles in high-risk, surgical intensive care unit patients: a meta-analysis of randomized, placebo-controlled trials.

OBJECTIVE: The use of antifungal prophylaxis remains controversial in most populations including surgical intensive care unit patients. A meta-analysis of randomized controlled trials was performed to evaluate the safety and effectiveness of azoles as antifungal prophylaxis in high-risk patients receiving treatment in the surgical intensive care unit. DATA SOURCE: Data were obtained from PubMed, Current Contents, Cochrane central register of controlled trials, and references from relevant articles. STUDY SELECTION: Randomized controlled trials using azoles as antifungal prophylaxis vs. placebo were included in the study. DATA EXTRACTION: Two independent reviewers extracted data concerning the development of fungal infections (superficial or invasive), adverse effects, and mortality. SYNTHESIS: Six randomized controlled trials were included in the main analysis. Publication bias and statistically significant heterogeneity were not observed among the analyzed studies. Patients receiving antifungal prophylaxis developed fewer episodes of candidemia (odds ratio [OR] = 0.28, 95% confidence interval [CI] 0.09-0.86), nonbloodstream invasive fungal infections (OR = 0.26, 95% CI 0.12-0.53), and noninvasive (superficial) fungal infections (OR = 0.22, 95% CI 0.11-0.43), respectively. No reduction in mortality was observed among patients who received azole prophylaxis (OR = 0.74, 95% CI 0.52-1.05). There was no significant difference in reported adverse effects (OR = 1.28, 95% CI 0.82-1.98). CONCLUSIONS: Despite its limitations, our meta-analysis suggests that the prophylactic use of azoles in high-risk surgical intensive care unit patients is associated with a reduction of fungal infections but not in all-cause mortality. However, although not noted in the analyzed randomized controlled trials, there is concern about the use of azoles due to possible shift toward non-albicans species and development of resistance to azoles.

Antifungal Agents↗
PubMed2006

Systematic reviews and meta-analysis for the surgeon scientist.

BACKGROUND: Understanding of data-reporting methods is imperative for correct interpretation of the medical literature as well as for proper performance of future clinical research. Recent developments in biostatistics have greatly changed the types of statistical analyses used and the minimum quality standards that must be maintained. METHOD: Different types of review are described, including systematic review with and without meta-analysis. Minimum reporting standards, sources of bias, both quantitative and qualitative, and references are discussed. RESULTS AND CONCLUSION: Meta-analysis has become a clearly defined technique, with reporting standards for both randomized controlled trials and observational studies. It is assuming a wider role in the surgical literature. Although many sources of bias exist, there are clear reporting standards and readers should be aware of these when studying the literature.

General Surgery↗
PubMed2006

Treatment of gastro-jejunal leakage and fistulization after gastric bypass with coated self-expanding stents.

Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gastric bypass (RYGBP) surgery. Most authors agree that operative treatment is the mainstay of therapy in patients with signs of sepsis. However, intestinal contents causing localized infection may impede healing of sutured leaks in some patients, and fistulas develop. Because the anastomosis cannot be disconnected or exteriorized for anatomical reasons, other forms of treatment have to be applied. The following case-reports describe a technique with implantation of coated self-expanding stents. Leakage of the gastro-jejunostomy occurred in one patient 3 days after RYGBP and resulted in formation of a fistula. A fistula developed in a second patient 63 days after RYGBP. Coated self-extending stents were implanted endoscopically in both patients on postoperative days 19 and 67. Enteral nutrition could be started 6 days later. Stents were removed 2 months after implantation without problems. Weight loss and quality of life 7 and 21 months after stent removal have been excellent in both patients. Implantation of coated self-expanding stents was an effective and minimally invasive option for gastro-jejunal anastomotic fistulas after RYGBP where surgical repair was not possible. In these cases, application of stents allows septic source control without any other intervention.

Adult↗