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At least 541 records · Page 30Linked to original sources
PubMedDate not supplied

Exploratory celiotomy in 200 nontraumatized dogs and cats.

Two hundred dogs and cats undergoing exploratory celiotomy for reasons other than trauma were grouped by disease classification and by body system affected. There were 61 animals in which infection or inflammation predominated, 63 animals with neoplasia, and 76 animals with noninflammatory and non-neoplastic conditions. Body systems affected were digestive, lymphatic, urinary, reproductive, other, and undetermined. Seventy-three percent of the animals survived the hospitalization period; survival rates for animals with infection or inflammation, neoplasia, and other disorders were 69%, 60%, and 86%, respectively. Within the same groups, the exploratory celiotomy provided strictly diagnostic information in 72%, 79%, and 24% of the animals, and surgical treatment was provided to 28%, 21%, and 58% of the animals, respectively. Intraoperative cytologic and histologic diagnoses were consistent in 78% of the animals; the consistency rates for animals with infection or inflammation, neoplasia, and other disorders were 81%, 88%, and 59%, respectively. Complications after surgery were observed in 30% of the animals, with 60% of the complications disease related. Complications were observed in six animals with reproductive disorders (67%), six animals with urinary disease (46%), 35 animals with digestive disease (29%), and three animals with lymphatic disease (13%).

Abdomen↗
PubMed1989

Neuroleptanesthesia versus thoracic epidural anesthesia for abdominal aortic surgery.

The hemodynamic consequences of abdominal aortic surgery with infrarenal cross-clamping were studied in 21 patients randomized in two groups. In Group I (11 patients), neuroleptanesthesia was utilized, while Group II (10 patients) received thoracic epidural anesthesia at the T8-9 level. Hemodynamic measurements were performed using Swan-Ganz catheters during the surgical procedures in all patients, with special attention to the periods of clamping and unclamping of the abdominal aorta. The thoracic epidural anesthesia group was characterized by greater hemodynamic stability during surgery, while patients in the neuroleptanesthesia group had significant lability of blood pressure, heart rate, and cardiac index. Nevertheless, in the two groups of patients, it is suggested that cardiac function was unfitted to the tissue oxygen demand after unclamping of the aortic prosthesis because the saturation in oxygen of the mixed venous blood and an increase in arteriovenous difference in oxygen were documented. These results point out that, whatever the anesthesia technique, the critical period in abdominal surgery could be aortic unclamping.

Anesthesia, Epidural↗
PubMed1987

Intrathecal morphine in aortic aneurysm surgery.

The purpose of this study was to compare the peri-operative conditions produced by intrathecal morphine with those that result from conventional analgesia in aortic aneurysm surgery. Low-dose intrathecal morphine provides a level of analgesia during operation indistinguishable from that of moderate doses of parenteral opiate, but is no more effective in attenuating autonomic responses to the procedure. Analgesia is prolonged into the postoperative period, does not cause clinically evident respiratory depression and can be enhanced by small doses of intravenous opiate. The principal advantage of intrathecal morphine is the avoidance of irregular and inadequate pain relief in the early, and most painful, part of the postoperative period. Low-dose intrathecal morphine appears safe, effective and feasible in aortic aneurysm surgery and provides an alternative to traditional management with parenteral opiates.

Adult↗
PubMed1991

[Consecutive observation of the plasma MDA, XO and UA levels and erythrocyte SOD in 10 cases of cardiopulmonary bypass].

The plasma malonaldehyde (MDA), xanthine oxidase (XO) and uric acid (UA) levels and erythrocyte superoxide dismutase (SOD) were measured in 10 cases during cardiopulmonary bypass (CPB) operation. These examinations were taken at pre-aortic clamping, 15 min after aortic clamping, 30, 60, 120 and 180 min after reperfusion respectively. The results showed that MDA, XO and UA rise but SOD decreases after reperfusion. We believe that a lot of oxygen free radicals (OFR) release during peri-operative period and the XO may be an important pathway of OFR release.

Cardiopulmonary Bypass↗
PubMed1997

Pancreatic insulinomas. A 15-year experience.

OBJECTIVE: To describe our experience in the management of patients with pancreatic insulinomas, emphasizing the need for preoperative localization and the outcome of surgical treatment. DESIGN: A case series. SETTING: A university hospital in Hong Kong. PATIENTS: From 1981 to 1995, 27 patients with pancreatic insulinomas were surgically treated; the mean follow-up was 25.4 months. MAIN OUTCOME MEASURES: Postoperative morbidity and euglycemia during the follow-up period. RESULTS: The accuracy of tumor localization by ultrasonography, computed tomography, and angiography was 33%, 44%, and 52%, respectively. Venous sampling for an insulin assay regionalized 90% of the tumors. In 24 patients with solitary tumors, most lesions detected or missed by preoperative localization could be either seen (n = 14) or palpated (n = 22). Intraoperative ultrasonography (n = 17) has been routinely performed since 1987; nonpalpable tumors were imaged in 2 of 15 patients with solitary tumors. Eight solitary occult tumors were detected by palpation alone or a combination of palpation and intraoperative ultrasonography. Operative mortality occurred in 1 (3.7%) of the 27 patients, while major morbidity developed in 9 (33%) of the patients. Euglycemia was achieved in 25 patients. Surgery cured all patients with benign insulinomas, whereas the cure rate for patients with malignant neoplasms was only 33%. The type of surgical treatment or correct preoperative localization did not affect the outcome of surgery. CONCLUSIONS: Pancreatic insulinomas can be readily localized intraoperatively despite failed preoperative localization studies. Surgical treatment cured benign adenomas but was associated with notable morbidity.

Adolescent↗
PubMed1994

Monitor surveillance and vigilance of anesthesia residents.

BACKGROUND: Anesthesia residents take longer to detect changes in electronically monitored data during the induction phase of anesthesia during the maintenance phase. This study was performed to investigate the reasons for this delay and to validate a method of measuring vigilance. METHODS: The activity of ten residents was studied during 73 surgical procedures. Data were collected during three 15-min periods from each case: induction, starting with application of the electrocardiograph; maintenance, an arbitrary period between induction and emergence; and emergence, ending with detachment of the electrocardiograph. Vigilance was measured as the time taken to detect a change, from normal to abnormal, of an artificial parameter displayed on the physiologic monitor (response time). An observer simultaneously recorded each time that the resident looked toward the monitors. RESULTS: Vigilance to the monitor display was less during induction and emergence than during maintenance (P < 0.005). Residents spent less total time watching monitors during induction than during maintenance (P < 0.005), and the duration of each monitor observation was shorter (P < 0.0005). Anesthesia residents usually looked at the monitors several times before detecting the abnormal value. The measure of anesthesia vigilance correlated with independent measures of monitor watching time and frequency. CONCLUSIONS: The results suggest that during induction of anesthesia, which is a period of high anesthesiologist workload, residents glance toward monitors to gather data rather than scan displays. The results help to validate the method for measuring anesthesia vigilance.

Anesthesia↗
PubMed1990

Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery.

Pulmonary oxygen transfer, defined by PaO2/FIO2, and radiologic presence of atelectasis were measured pre-, intra-, and postoperatively to postoperative day 9 in elective cardiac aortocoronary bypass surgical patients, who were randomly allocated either to receive 18 h PEEP while on the ventilator followed by 12 h of nasal continuous positive airway pressure (nasal CPAP) or to be control subjects. The two groups were comparable in age, sex, forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 over forced vital capacity (FVC), time on pump, units of blood transfused, New York Heart Association grading, and cardiac performance indices. The PaO2/FIO2 was significantly (p less than .05) better from half an hour after extubation until 24 h postextubation in the nasal CPAP group, but was decreased for the remainder of the study in both groups. Incidence of atelectasis/consolidation was not different in both groups during the study period. We conclude that nasal CPAP is well tolerated as a treatment of hypoxemia in the immediate postoperative period of aortocoronary bypass patients. CPAP does not change the course of postoperative atelectasis.

Aged↗
PubMed1988

Complement activation during cardiopulmonary bypass in children.

Complement activation was evaluated prospectively in serial serum and plasma samples from 30 children, who underwent cardiopulmonary bypass operations. Each patient showed a decrease in total hemolytic C levels and increase in C3 activation product (C3a desArg and C3bi/c) levels. In 11 of the 30 patients surgery was associated with a complication: death (2), respiratory failure (RF, 9), septicaemia (4), postpericardiotomy syndrome (PPS, 1) and pancreatitis (1). Patients suffering from RF were younger, underwent longer perfusions and had somewhat more extensive changes in the C system, although no direct correlation between high C3a desArg levels and RF existed. Instead, the increase in C3a desArg was in linear correlation with the perfusion time. Most complications during the latter postoperative period were associated with distinct episodes of lower grade C activation.

Cardiopulmonary Bypass↗
PubMed1993

Convective warming therapy does not increase the risk of wound contamination in the operating room.

Although convective warming therapy is effective in preventing hypothermia in anesthetized patients, little is known concerning the potential risks of its use. Hence, this balanced cross-over study was designed to determine if the use of convective warming therapy increased the risk of wound contamination. For 4 h, eight healthy male volunteers (aged 20-25 yr) lay supine on an operating room table with their lower bodies and legs covered with a warming cover and sterile surgical drape. The convective warming therapy was administered for 2 h. The other 2 h served as the control. In each session, culture plates were placed directly on the subject's abdomen through an opening in the drape. Tympanic membrane and leg skin temperatures were significantly higher with active warming. No significant differences in the number of bacterial colonies were observed between the two study periods. It was concluded that convective warming therapy, when appropriately applied, does not increase the risk for airborne bacterial wound contamination in the operating room.

Adult↗
PubMed1991

[Delayed evolution of post-traumatic contralateral extracerebral hematoma after evacuation of initial hematoma].

105 patients over a 5-year period underwent emergency evacuation of traumatic intracranial hematomas. Seven (6.7%) developed delayed contralateral extracerebral hematomas (5 epidural and 2 subdural hematomas). These hematomas were insignificant or not present on initial computed tomography (CT) scan, but repeat CT scan after craniotomy showed sizable hemorrhage. In one patient, neurological deterioration heralded the delayed onset. In one case, intraoperative ultrasound imaging disclosed an epidural hematoma. Ultrasound examination is recommended in cases with a skull fracture contralateral to the initial hemorrhage.

Adolescent↗
PubMed1994

Incidence of carcinoma in multinodular goitre in Saudi Arabia.

Over a period of 3 years, 614 patients were admitted to the General Surgery Department at the Riyadh Central Hospital with thyroid enlargements. Based on the clinical examination and non-invasive investigations, the thyroid swellings were classified into solitary nodule (45%), multinodular (44%) and diffuse goitre (11%). Subsequent classification of the goitres on the basis of intraoperative findings and histopathological examination revealed increase in the number of multinodular goitres to 70% while the solitary nodule and diffuse goitres dropped to 24% and 6%, respectively. Malignant changes were seen in 10% of the multinodular goitres after pathological examination. 75% of the carcinomas seen in multinodular goitres were of the papillary type. In almost none of the cases, it was possible to discover the malignancy preoperatively. The study recommends surgical intervention in all nodules goitres irrespective of being solitary or multinodular.

Biopsy, Needle↗
PubMedDate not supplied

[Role of calcium blockers in protecting the myocardium in cardiac surgery].

Calcium plays an essential role in ischemic events observed during cardiac surgery. Many experiments have studied the effects of calcium channel blockers on intracellular calcium overload during the periods of cardiac ischemia and reperfusion. Calcium channel blockers are no longer used before and during cardiac surgery because hypothermia inhibits their pharmacological action. However, during the post-operative period, calcium channel blockers are the drugs of choice to control coronary spasm, and arterial hypertension which is secondary to peripheral vasoconstriction.

Animals↗
PubMed1989

[Monitoring of somatosensory evoked potentials during surgery for scoliosis in young adults: apropos of 33 cases].

The risk of serious neurologic complications in spinal surgery for scoliosis is not insignificant. The recording of cortical somatosensory evoked potentials (CSEP) is an electrophysiological method of monitoring during surgery. Measurement of CSEPs was carried out before, during and after surgery in a preliminary series of 33 patients. These recordings were made: after induction of anesthesia and exposure of the spine; after instrumentation but without correction; after maximum traction; and at termination of surgery. The aim of this work was to establish alarm criteria. Statistical analysis showed a significant increase in latencies after instrumentation without correction, and after maximum traction. The alarm criteria were determined as an increase of more than 5 msec in the first positive deflection associated with an unusual drop in amplitude (over 75%). If these anomalies persist, the "wake-up test" must be used. In practice, this monitoring has often aided in reducing the period of surgery by using the "wake-up test" in a few selected cases.

Adolescent↗
PubMed1990

Perioperative prophylactic chemotherapy of Echinococcus granulosus: determination of minimum effective length of albendazole therapy in in vitro protoscolex culture.

Protoscoleces of Echinococcus granulosus were cultured in vitro in 500, 250 or 100 micrograms/l albendazole sulphoxide for 1,3,7,10,14d and then 'rescued' (R) into drug-free medium for the remainder of the culture period. Successful minimum lengths of therapy were much longer than for praziquantel, and only at 500 micrograms/l was the 10dR treatment as effective as continuous therapy for 28d. Treatment with 100 micrograms/l both in continuous culture and in the 'R' experiments was ineffective over a 35d period. The results are compared with those from similar experiments using praziquantel.

Albendazole↗
PubMed1993

[Effects of clonidine vs trinitroglycerin on myocardial oxygen balance and on pulmonary gas exchange after myocardial revascularization].

The authors examined the effects of clonidine, a preferential alpha-adrenergic agonist, upon myocardial oxygen balance and pulmonary function during the perioperative period in patients undergoing CABG surgery. Anesthesia was provided by fentanyl infusion reaching the final dose of 100 micrograms.kg.min-1 in 10 minutes before skin incision. Ten patients received clonidine 0.125 mg intravenously after induction of anesthesia; a group of 10 patients was managed identically except for nitroglycerin infusion during the pre-CPB period, in order to keep the aortic pressure in the normal range. Intergroup differences in hemodynamics, respiratory data, rewarming time, post-operative ST-tract pattern and enzyme values were evaluated. Results are suggestive (in the clonidine group) for ameliorating myocardial oxygen balance by reducing oxygen consumption indexes (systolic aortic pressure, cardiac index, rate pressure product) and increasing coronary blood flow [coronary perfusion pressure (p < 0.01)] at the end of the surgery and intensive care. Global oxygen consumption reduction, recorded in the clonidine group patients, the oxygen available being unchanged, ameliorated the total oxygen balance mainly after sternotomy (p < 0.05) and at the end of bypass (p < 0.05). Cardiac index was greater during the awakening and rewarming period in intensive care and the ventilatory/perfusion ratio was improved, allowing a minor minute ventilation required in clonidine group patients, specially during admission to intensive care.

Clonidine↗
PubMed1989

Mechanisms of hypertension during and after orthotopic liver transplantation in children.

The aim of this study was to assess the hormonal alterations that may mediate the systemic hypertension that develops in patients during the perioperative period of orthotopic liver transplantation. We studied nine pediatric patients without previous hypertension or renal disease during six time points, starting before transplantation and ending at 48 hours after surgery. Hypertension developed in all patients in association with central venous pressures less than 10 mm Hg. Free water clearance was negative in all nine patients. Vasopressin levels increased intraoperatively but fell as hypertension developed. Atrial natriuretic factor levels increased as systemic blood pressure rose. A high level of plasma renin activity was observed in four patients with renal insufficiency. In six patients, postoperative 24-hour urinary norepinephrine excretion was within the normal age-adjusted range. These findings suggest that the combination of cyclosporine, corticosteroids, and, in some patients, an elevated plasma renin activity prevents the kidney from responding to the acute volume and salt overload with an appropriate diuresis and natriuresis, thus leading to systemic hypertension. The treatment of hypertension after liver transplantation may include salt restriction, diuretics, and, in those patients with a low creatinine excretion index, angiotensin coverting enzyme inhibitors.

Adolescent↗