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At least 595 records · Page 33Linked to original sources
PubMed1998

[Nine consecutive patients with gallstone ileus. Personal experience].

INTRODUCTION: Gallstone ileus is a mechanical obstruction of the gastrointestinal tract caused by the impaction of one or more gallstones within the bowel lumen. The insidious clinical presentation and the lack of specific signs of biliary disease are responsible for the delayed preoperative diagnosis which leads to an overall mortality rate of 15%. MATERIAL AND METHODS: A series of 9 consecutive patients (7 women and 2 men, age ranging from 17 to 83 years), with surgically proved gallstone ileus, was retrospectively reviewed: the authors report the radiologic procedures performed preoperatively and the diagnostic findings. Plain abdominal radiographs were performed in 4 of 9 patients, abdominal US in 4 and CT in 7 patients. All radiologic examinations were retrospectively reviewed by all authors independently, to recognize the different signs of gallstone ileus. RESULTS: The signs of Rigler's triad (small bowel obstruction, ectopic gallstones and air in the biliary tree) were observed on plain abdominal films in two cases, and ectopic gallstones and pneumobilia in two cases. The ectopic gallstones and the small bowel obstruction were demonstrated on abdominal US images in three cases. Rigler's triad was identified on abdominal CT images in 4 cases, while two findings (small bowel obstruction and ectopic gallstones) were observed in three cases. CONCLUSIONS: When the bowel is obstructed by a radiopaque calcified stone, plain radiographs and US of the abdomen are usually enough to diagnose gallstone ileus and no further studies are required.

Adolescent↗
PubMedDate not supplied

[Aggressive angiomyxoma of the pelvis and perineum: a case report and review of the literature].

Aggressive angiomyxoma is a rare mesenchymal tumour arising from soft tissue of the pelvis and perineum. Other features of this tumour are non-specific clinical signs, local invasion, a high local recurrence rate, and recurrence long after initial excision. We provide a case report with a review of the literature. A 57-year-old woman with a large bulky mass in the perineum was admitted to our institution. She had previously undergone iterative surgery for excision of pelvic and perineal masses. The preoperative diagnostic procedure is described as well as the therapeutic surgical approach (a double simultaneous laparotomic and perineal approach was opted for). The surgical procedure was difficult, time-consuming and dangerous owing to an extensive area of hard retroperitoneal sclerosis involving the low urinary viscera, the vaginal stump and the mesorectum. Radical excision of the mass favoured the re-establishment of the normal pelvic anatomy, resolution of the preoperative symptoms and complete recovery of working capability. Surgical excision is the gold standard in the treatment of aggressive angiomyxoma. This benign neoplasm may sometimes present a malignant course owing to involvement of pelvic viscera. It is also associated with a high late recurrence rate due to local aggressiveness, and longterm follow-up is therefore necessary.

Female↗
PubMed1997

[Diagnostic and therapeutic strategy of insulinomas. Apropos of a personal experience of 21 cases].

Insulinomas account for about 90% of all pancreatic endocrine tumors and their surgical resection leads to cure in 90% of patients. Although current laboratory tests have simplified the clinical diagnosis of insulinomas, despite recourse to an array of most preoperative diagnostic procedures in 10-15% of patients the exact location of the tumor remains undefined. Tumor localization is difficult because: 80% of insulinomas measure less than 2 cm, about 10-12% of insulinomas are multicentric and 4-6% escape detection because are multiple endocrine neoplasms (MEN). If preoperative imaging fails to detect the site of the lesion, the surgeon could be obliged to perform a "blinded resection" with high risks of failure. The Authors refer their experience in a series of 21 patients operated on for insulinoma over the past 8 years (1987-1995). Arteriography with calcium stimulation (ASVS) and scintigraphy with 111-Indium-labeled octreotide performed in the later 16 and 13 cases respectively, achieved a correct tumor localization (confirmed by surgery) in 100% and 84.7% of patients. Intraoperative ultrasonography, performed in 18 cases, allowed not only to localize the tumor but also to study the tumor's neighbouring anatomic structures (Wirsung duct. splenic artery and vein), thus providing the anatomical and surgical information necessary to plan the right surgical strategy (tumor enucleation or pancreatic resection). Tumor enucleation was performed in 15 patients, distal pancreatic resections in 5 cases and multiple liver biopsies in 1 case: this patient had liver micrometastases from a malignant insulinoma without a palpable tumor. Operative mortality was nil. Postoperative complications occurred only in 5 of the 15 enucleations (1 pseudocyst successfully treated with a ultrasound-guided drainage and 4 pancreatic fistula resolved by medical therapy).

Adolescent↗
PubMedDate not supplied

[The Borggreve rotation-plasty. A surgical method in therapy of malignant bone tumors and functional results].

From 1980 to 1992, 39 Borggreve-rotation-plasties were performed in patients with malignant bone tumors at the Orthopaedic Clinic of the University of Hamburg. The rotation-plasty was first published in 1930 by Borggreve. Salzer (Wien) described the method in 1981 for the operative treatment of osteosarcomas about the knee. The rotation-plasty is feasible for tumors of the distal femur, even when other limb-saving procedures are impossible, e.g. due to skip metastases, insufficient soft tissue coverage or involvement of the knee joint. The procedure was done on 26 female and 13 male patients, the age ranging between 7 and 45 years with a mean age of 17 years. The histological diagnosis was osteosarcoma in 36 cases, MFH, Ewing's sarcoma and Giant cell tumor in one case, respectively. The operative technique was slightly modified, compared to the method described originally by Salzer. The range of error of the different preoperative imaging procedures was evaluated and compared with the tumor extent in the resected specimen. MRI was found to be most precise. We saw no local recurrencies. Three patients had early thromboses, two of those had to be amputated, slow preoperative compression of the popliteal vein being the main cause in both. One patient developed a lymphatic fistula ten years postoperatively, which was eliminated in a second operation. All patients are followed routinely in the oncologic outpatient service. The functional results were rates "excellent" or "good" for all patients in six of seven categories, according to the Enneking evaluation system.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Corneoscleral rim cultures: lack of utility and implications for clinical decision-making and infection prevention in the care of patients undergoing corneal transplantation.

PURPOSE: To assess the utility of donor corneoscleral rim cultures. METHODS: A retrospective review of the culture results of 774 corneoscleral rims that remained after trephination of corneas for transplantation into patients at our academic medical center between January 1992 and November 1997. RESULTS: Forty-one (5.3%) corneoscleral rim cultures yielded microorganisms, mostly coagulase-negative staphylococci. Two patients developed endophthalmitis (one with Staphylococcus aureus and one with Pseudomonas aeruginosa) within 3 months after transplantation; each had a negative corneoscleral rim culture and neither patient's infection was temporally related to the transplant procedure. CONCLUSIONS: Preoperative donor corneoscleral rim cultures are unreliable predictors of endophthalmitis complicating corneal transplantation and, therefore, are not useful in the clinical management of patients having corneal transplants. Moreover, the discrepancy between the results of corneoscleral rim cultures and subsequent endophthalmitis renders them invalid as a quality assurance procedure. Instead, for patients with suspected endophthalmitis after corneal transplantation, we recommend that corneal surgeons select antimicrobial therapy based on current guidelines and the results of directed sampling. Furthermore, eye banks should prospectively track recipients who develop clinical endophthalmitis, immediately notify the corneal surgeon who transplanted the matched cornea of that used for the index case, and, in selected situations, attempt to identify a possible source of contamination.

Bacteria↗
PubMed1975

Therapeutic percutaneous embolization for extra-axial vascular lesions of the head, neck, and spine.

Therapeutic percutaneous embolization of extra-axial vascular tumors and arteriovenous malformations was performed 41 times in 27 patients. Twenty-one patients (78%) had a clinically favorable result. In 11 of these patients, the procedure was preoperative and caused a dramatic reduction of surgical blood loss. In the remaining 10 patients with a favorable result, therapeutic embolization alone resulted in a significant clinical amelioration documented by a detailed follow-up varying from 2 to 5 years. In patients with uncontrollable epistaxis, the procedure was life-saving. The guidelines and instrumentation for a safe and effective technique are presented, based on the authors' experience with more than 100 cases of vascular lesions of the brain and spinal cord. A low-viscosity silicone polymer was developed by the authors and used clinically as an intravascular adhesive for the embolization of vascular tumors.

Adult↗
PubMed2006

Magnetoencephalography in neurosurgery.

OBJECTIVE: To present applications of magnetoencephalography (MEG) in studies of neurosurgical patients. METHODS: MEG maps magnetic fields generated by electric currents in the brain, and allows the localization of brain areas producing evoked sensory responses and spontaneous electromagnetic activity. The identified sources can be integrated with other imaging modalities, e.g., with magnetic resonance imaging scans of individual patients with brain tumors or intractable epilepsy, or with other types of brain imaging data. RESULTS: MEG measurements using modern whole-scalp instruments assist in tailoring individual therapies for neurosurgical patients by producing maps of functionally irretrievable cortical areas and by identifying cortical sources of interictal and ictal epileptiform activity. The excellent time resolution of MEG enables tracking of complex spaciotemporal source patterns, helping, for example, with the separation of the epileptic pacemaker from propagated activity. The combination of noninvasive mapping of subcortical pathways by magnetic resonance imaging diffusion tensor imaging with MEG source localization will, in the near future, provide even more accurate navigational tools for preoperative planning. Other possible future applications of MEG include the noninvasive estimation of language lateralization and the follow-up of brain plasticity elicited by central or peripheral neural lesions or during the treatment of chronic pain. CONCLUSION: MEG is a mature technique suitable for producing preoperative "road maps" of eloquent cortical areas and for localizing epileptiform activity.

Brain Diseases↗
PubMed1978

[Surgical therapy of axial hiatal hernias and reflux disease. 1. Results of an inquiry among Swiss surgeons in 1977].

Of the 153 heads of surgical departments in Switzerland, 152 joined in an inquiry into diagnostic procedures, surgical indications, and types of procedure in the treatment of axial hiatal hernia and reflux disease. Fundoplication is by far the most frequent procedure. Of the modifications performed in complicated reflux disease, 34% are controversial. Surgery for hiatal hernia and reflux disease is performed 3 times less frequently in the German part of Switzerland than in the other parts. German-speaking surgeons ascribe to themselves a greater willingness to perform preoperative diagnostic procedures--endoscopy, radiological and non-radiological tests of esophageal function--than the surgeons of the other parts of Switzerland. However, the German-speaking surgeons are more reluctant than the other surgeons to perform surgery in patients with esophagitis. The German-speaking surgeons are even more reluctant to perform surgery on the basis of subjective symptoms. Axial hiatal hernia is considered a relative indication for surgery by half of Swiss surgeons. Only a few surgeons consider this condition an absolute indication for surgery.

Cardia↗
PubMed2002

Efficacy of cholangiography under helical computed tomography for laparoscopic cholecystectomy.

PURPOSE: Although laparoscopic cholecystectomy (LC) is known to be safe, the optimal imaging technique for examining the common bile duct and cystic duct prior to laparoscopic intervention remains controversial. The objective of this study was to evaluate the efficacy of cholangiography under helical computed tomography (helical CT cholangiography) for LC. METHODS: We studied 53 consecutive patients who underwent LC carried out by the same surgeon. The data of 23 of these patients who had undergone LC before the introduction of helical CT were used as the reference standard. Among the 53 patients, 28 were prospectively randomized for preoperative biliary tract evaluation with versus without helical CT cholangiography, into a CT/+ group (n = 13) and a CT/- group (n = 15), respectively. Two patients were excluded from the study preoperatively. RESULTS: There were no significant differences in age or laboratory findings, including liver function tests or the serum amylase level before or after surgery, between the two groups. In the CT/- group, endoscopic retrograde cholangiography-related pancreatitis developed in one patient, and one patient required conversion to open surgery. In contrast, in the CT/+ group, there were no preoperative complications and no patient required conversion to open surgery. The mean operative time was significantly shorter in the CT/+ group than in the CT/- group (P = 0.0137). CONCLUSION: These findings provide evidence to support the advantages of helical CT cholangiography in relation to operative time, conversion, and procedure-related preoperative complications.

Adult↗
PubMed1990

Crossed cerebellar diaschisis in intracarotid sodium amytal procedures: a SPECT study.

Eight patients with drug-resistant complex-partial seizures were subjected to left- and right-sided intracarotid sodium amytal (ISA) procedures during preoperative investigations for surgical treatment. Regional changes of cerebral and cerebellar blood flow during barbiturization were measured by [99mTc]-HMPAO-SPECT. Crossed cerebellar diaschisis (CCD) was observed in 13 out of 16 tests (81%) as well as ipsilateral cerebral hypoperfusion (87%). Thus CCD occurred more frequently in ISA procedures than in previously studied patients with cerebral infarctions and tumors. Since intracarotid injections of sodium amytal lead to hypoperfusion mainly in those areas of the brain that are supplied by the middle cerebral artery, functional suppression of these regions is supposed to be one of the main preconditions of CCD. Our findings suggest that CCD as demonstrated by the SPECT-technique is a common phenomenon in ISA procedures.

Adolescent↗
PubMedDate not supplied

Vitrectomy for stage 1 macular holes identified by optical coherence tomography.

BACKGROUND AND OBJECTIVE: To describe a series of patients with decreased vision secondary to stage 1 macular hole confirmed by optical coherence tomography (OCT) that failed to spontaneously resolve with observation. To determine whether current surgical techniques can prevent progression to a full-thickness macular hole and lead to improved visual acuity. PATIENTS AND METHODS: Retrospective, comparative case series presenting patient demographics, duration of symptoms, timing of surgery, preoperative and postoperative vision, and clinical outcome based on examination and OCT. RESULTS: Five eyes of five patients with stage 1 macular holes identified on OCT required surgical repair. All eyes showed anatomic closure and lack of progression to a full-thickness hole confirmed by OCT after one procedure. Mean preoperative visual acuity was 20/102 (range, 20/50 to 20/200) and mean postoperative visual acuity was 20/52 (range, 20/25 to 20/200). Average improvement for all five eyes was 3 Snellen lines, with four of the five (80%) improving 5 lines each. CONCLUSION: In symptomatic eyes with stage 1 macular holes that fail to spontaneously resolve with observation, vitrectomy with intraocular gas tamponade may prevent progression to a full-thickness hole and lead to improved visual acuity.

Aged↗
PubMed1990

[The value of preoperative diagnosis for surgical treatment of liver tumor. Results of a consecutive study series from the surgical viewpoint].

Value of preoperative diagnostic procedures in the surgical treatment of liver tumors. Results of a consecutive examination series from surgical view. Between September 1985 and December 1988 93 patients with tumors of the liver were operated at the University Hospital of Mainz. Most of them had metastases of colorectal cancer. The accuracy of preoperative diagnostic proceedings was very high using abdominal ultrasonography and computed tomography. The sensitivity of both methods for detecting a tumor amounts 88 and 95%. In spite of this high accuracy the intraoperative findings were different in 29% of the treated patients. An unfavourable intraoperative situation did not exclude a radical resection of the tumor. Therefore we think that the indication to operation is correct if there is any doubt about the expansion of the tumor.

Adenoma, Bile Duct↗
PubMed1995

Gonadotropin-releasing hormone agonist therapy reduces postoperative adhesion formation and reformation after adhesiolysis in rat models for adhesion formation and endometriosis.

OBJECTIVES: To evaluate the effectiveness of GnRH agonist (GnRH-a) therapy on adhesion formation and reformation in established rat models for surgically induced adhesion formation and endometriosis. DESIGN: Before surgery, female Sprague-Dawley rats were injected with GnRH-a or control diluent. Six days later, rats were assigned to one of four surgical groups: [1] endometriosis, [2] endometriosis sham, [3] adhesion model, or [4] adhesion sham. Three weeks after surgery, a second-look laparotomy was performed, adhesions were scored (0 = no adhesions to 3 = severe adhesions) and mechanically disrupted, and rats received a second GnRH-a or diluent injection either analogous to their initial injection or in a crossover design. Three weeks after the second injection, rats were killed and adhesion reformation was scored. Data were evaluated using nonparameteric tests including Mann-Whitney, Kruskal-Wallis, and Friedman's tests comparing GnRH-a treatments with diluent controls. RESULTS: Preoperative GnRH-a therapy reduced adhesion scores in rats with surgically induced endometriosis (mean +/- SEM; GnRH-a 1.1 +/- 0.2 versus diluent 2.2 +/- 0.2) and adhesions (GnRH-a 0.3 +/- 0.1 versus diluent 0.6 +/- 0.1). Pretreatment GnRH-a therapy did not affect adhesion scores in the endometriosis sham procedure. Combined preoperative and postoperative GnRHa therapy (GnRH-a-GnRH-a) but not postoperative GnRH-a therapy alone (diluent-GnRH-a) reduced adhesion reformation after adhesiolysis in the endometriosis model (GnRH-a-GnRH-a 1.1 +/- 0.3, diluent-GnRH-a 1.6 +/- 0.7), the endometriosis sham (GnRH-a-GnRH-a 0.7 +/- 0.2, diluent-GnRHa 1.8 +/- 0.1), and the adhesion model (GnRH-a-GnRH-a 0.3 +/- 0.2, diluent-GnRHa 1.0 +/- 0.5). No adhesions were observed in the adhesion sham group. CONCLUSIONS: Gonadotropin-releasing hormone agonist therapy was successful in reducing adhesion formation and reformation. These studies suggest that GnRH-a therapy for adhesion prevention in women should be explored.

Animals↗
PubMed2005

Association of genetic polymorphisms with risk of renal injury after coronary bypass graft surgery.

BACKGROUND: Post-cardiac surgery renal dysfunction is a common, serious, multifactorial disorder, with interpatient variability predicted poorly by preoperative clinical, procedural, and biological markers. Therefore, we tested the hypothesis that selected gene variants are associated with acute renal injury, reflected by a serum creatinine level increase after cardiac surgery. METHODS: One thousand six hundred seventy-one patients undergoing aortocoronary surgery were studied. Clinical covariates were recorded. DNA was isolated from preoperative blood; mass spectrometry was used for genotype analysis. A model was developed relating clinical and genetic factors to postoperative acute renal injury. RESULTS: A race effect was found; therefore, Caucasians and African Americans were analyzed separately. Overall, clinical factors alone account poorly for postoperative renal injury, although more so in African Americans than Caucasians. When 12 candidate polymorphisms were assessed, 2 alleles (interleukin 6 -572C and angiotensinogen 842C) showed a strong association with renal injury in Caucasians (P < 0.0001; >50% decrease in renal filtration when they present together). Using less stringent criteria for significance (0.01 > P > 0.001), 4 additional polymorphisms are identified (apolipoproteinE 448C [4], angiotensin receptor1 1166C, and endothelial nitric oxide synthase [eNOS] 894T in Caucasians; eNOS 894T and angiotensin-converting enzyme deletion and insertion in African Americans). Adding genetic to clinical factors resulted in the best model, with overall ability to explain renal injury increasing approximately 4-fold in Caucasians and doubling in African Americans (P < 0.0005). CONCLUSION: In this study, we identify genetic polymorphisms that collectively provide 2- to 4-fold improvement over preoperative clinical factors alone in explaining post-cardiac surgery renal dysfunction. From a mechanistic perspective, most identified genetic variants are associated with increased renal inflammatory and/or vasoconstrictor responses.

Acute Kidney Injury↗
PubMed1994

[Ultrasound imaging of soft tissue tumors of the extremities and para-articular soft tissue changes].

Valid preoperative imaging procedures are important in the diagnosis of soft-tissue tumours of the extremities due to their potential malignancy. The value of ultrasound regarding these tumours is still under controversial discussion. Hence, it was the aim of this retrospective study to examine the value of ultrasound in respect of these particular problems. Therefore, in 20 cases ultrasonography was compared with intraoperative findings and other imaging techniques. Finally ultrasonography is merely an "adjuvant" diagnostic procedure, because it does not precisely outline the anatomical topography is incomplete and differentiation from neural and vascular structures is not possible in all cases. In contrast, ultrasonographic description of the size of tumours demonstrates a good correlation when compared with intraoperative findings. In addition, ultrasound examination can help to improve preoperative diagnosis in cases when imaging with MRI and CT is disturbed due to already implanted metallic endoprosthetic components.

Adult↗
PubMed2005

Erectile dysfunction following nerve-sparing radical retropubic prostatectomy and its treatment with sildenafil.

BACKGROUND: We retrospectively evaluated the erectile function after nerve-sparing radical retropubic prostatectomy (RRP) and the efficacy of sildenafil for erectile dysfunction (ED) following RRP according to the preoperative erectile function. METHODS: We evaluated 48 Japanese patients who underwent nerve-sparing RRP at the Sapporo Medical University School of Medicine, Sapporo, Japan, between January 1996 and December 2001. Erectile function following nerve-sparing RRP was assessed by a simple mailed questionnaire that was constructed for the study. RESULTS: Of the 48 patients, 36 had normal erectile function preoperatively, but for 12, function was not sufficient to penetrate. The overall estimated recovery rates of any degree of erection were 50.6% at 36 months and 94.3% at 60 months. However, that of erection sufficient to penetrate was only 17.7% at 36 months and was only seen in bilateral nerve-sparing patients. Sildenafil was effective in 9 of 13 ED patients (69.2%) in both nerve-sparing groups. When patients were divided according to preoperative erectile function, no difference was found in the efficacy rate between patients with normal function and those with ED. CONCLUSIONS: Even bilateral nerve-sparing RRP can not always guarantee a sufficient erection. However, sildenafil is effective for ED following nerve-sparing RRP regardless of the nerve-sparing procedure or preoperative erectile function. Thus, preoperative function alone, although depending on its severity, may not necessarily be a reason for exclusion from receiving nerve-sparing RRP if patients want to have the operation.

Aged↗
PubMed1998

Microvascular anastomosis in oral and maxillofacial surgery: a comparative study of recipient artery between Japanese and German patients.

The causes of unsuccessful microsurgery include pre-existing histopathological changes in the recipient vascular wall. Medical history, preoperative therapy, and life background such as aging may have complex effects on the morbid state of recipient vessels. Focusing on these points, specimens of recipient vessels were obtained at the microsurgery of the oral and maxillofacial regions, and the condition of the arterial wall was analyzed pathologically. This study was performed in both Japan and Germany simultaneously, and the results are compared between the two countries. A higher percentage and a more advanced abnormality of the artery seem to exist in the German patients than in the Japanese patients. This difference could be due to the severe preoperative multimodal chemo- and radio-therapy more often applied in Germany and the higher incidences of systemic diseases such as hypertension and diabetes as well as of smoking in German population. The success rate of the surgery is, however, the same in both countries. It could be concluded that the viability of the flaps was not affected directly by preoperative damage to the recipient artery.

Adult↗