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At least 613 records · Page 34Linked to original sources
PubMed1994

Influence of surgery on serum concentrations of hyaluronan.

OBJECTIVE: To investigate the changes in serum hyaluronan concentrations in response to surgery. DESIGN: A prospective case series evaluating serum hyaluronan concentrations before, during, and after surgery. SETTING: Operating room and recovery room of a university hospital. PATIENTS: Twelve consecutive patients undergoing vascular surgery because of arterial insufficiency of the lower extremities. MEASUREMENTS AND MAIN RESULTS: Serum hyaluronan concentrations were measured before and after induction of anesthesia and before, during, and after surgery. Routine chemical analyses of blood samples were made before and after surgery. Blood loss and fluid volumes infused were registered. Mean serum hyaluronan concentrations increased from baseline 25 +/- 10 (SD) to 36 +/- 15 micrograms/L (p < .05) during surgery, and increased further at 1 hr after the end of surgery to 52 +/- 38 micrograms/L (p < .001 compared with baseline), but had decreased nearly to baseline levels at 2 hrs postoperatively. A positive correlation was seen between peak hyaluronan concentrations and baseline serum hyaluronan levels (r2 = .73; p < .001), but no strong relationship was seen between serum hyaluronan concentrations and other parameters studied. CONCLUSIONS: Surgery is accompanied by a small increase in serum hyaluronan concentrations in humans. The major increase is seen in the postoperative period, and is probably due to increased influx of interstitial hyaluronan when the returning muscular tone activates lymph flow.

Aged↗
PubMed1990

Autologous transfusion.

Autologous transfusion is but one component of the comprehensive blood conservation program. It is often appropriate to employ more than one method of autologous transfusion. In addition, use of pharmacological measures to decrease blood loss, meticulous attention to surgical hemostasis, acceptance of lower hemoglobin levels during the perioperative period, and seeking the advice of transfusion medicine experts in assessing the need for administration of blood components are also important. Finally, the risks of homologous blood transfusion should not overshadow the life-saving benefits of transfusion.

Blood Transfusion, Autologous↗
PubMed1989

Systemic effects of tissue plasminogen activator-associated fibrinolysis and its relation to thrombin generation in orthotopic liver transplantation.

Orthotopic liver transplantation is frequently associated with hyperfibrinolysis, the origin and clinical relevance of which is largely unknown. In 20 orthotopic liver transplantations, we studied the occurrence and systemic effects of hyperfibrinolysis. Severe fibrinolysis was defined to be present when the euglobulin-clot lysis time and the whole-blood-clot lysis time, as measured by thrombelastography, were shorter than 60 and 90 min, respectively, at some time during the operation. Based on these criteria, 7 patients had minimal fibrinolysis (group I), and 13 patients had severe fibrinolysis (group II). In group II a gradual increase of tissue-type plasminogen activator (t-PA) activity was seen during the anhepatic stage, followed by an "explosive" increase immediately after graft reperfusion (P = 0.0004, compared with group I), and a reduction of plasminogen activator inhibitor (PAI) activity. Plasma degradation products of fibrinogen and fibrin increased parallel to t-PA activity, and levels were significantly higher at 45 min after graft reperfusion in group II compared with group I (P less than 0.04). Thrombin-antithrombin III complexes showed an identical steady increase in both groups, indicating that increased t-PA activity was not related to thrombin formation. A combination of increased endothelial release and reduced hepatic clearance may have caused the increased t-PA activity. The t-PA-associated destruction of fibrinogen and fibrin after graft reperfusion is consistent with the clinical signs of severe oozing often seen in this period. These observations may have important clinical implications for the treatment of bleeding in patients undergoing orthotopic liver transplantation.

Adult↗
PubMed1999

Intraocular pressure fluctuations during strabismus operations and the postoperative period.

PURPOSE: To evaluate the intraocular pressure (IOP) variations which occur during and after strabismus surgery. METHOD: We measured the IOP in 34 eyes of 20 pediatric patients undergoing primary strabismus surgery under general anesthesia. Measurements were performed by the Tono-Pen (Mentor O&Q Inc. Norwell, MA) prior to surgery, immediately after suturing of the conjunctive, and 1 week and 4 weeks after surgery. All patients received the same local antibiotics and steroid solutions postoperatively. RESULTS: IOP decreased from baseline to the end of surgery by a mean of 8.26 +/- 1.8 mmHg and increased from baseline to 4 weeks after surgery by a mean of 3.6 +/- 1.8 mmHg. Thirty-eight percent of the eyes had an IOP of 21 mmHg or more during the postoperative period. CONCLUSION: IOP variations are prevalent during and after strabismus surgery. Careful postoperative measurements are recommended in order to identify individuals who may be prone to iatrogenically increased IOP.

Adolescent↗
PubMed1991

[Treatment of uterine bleeding due to adherent placenta by intrauterine suturing].

We have tried to suture the wound surface in order to check uterine bleeding due to adherent placenta and placenta accreta at the time of cesarean section to preserve the reproductive function of the uterine. Of the 15 patients 13 had active bleeding from the sinusoid at the site of placental attachment: 2 were placenta accreta with bleeding after removal of local site of implantation. No bleeding occurred after the suturing for a follow-up period of 1 to 3 years. The postpartum course was uneventful. This operation is a simple and useful method to check uterine bleeding in cases of adherent placenta and placenta accreta. The procedure indications and important points to be noticed was discussed.

Adult↗
PubMed1993

Laparoscopic versus open cholecystectomy: a matched study.

To determine the efficacy of laparoscopic cholecystectomy (LC) in the treatment of gallstone disease, all patients who underwent elective surgery for cholelithiasis during three consecutive periods (1989, 1990 and 1991) were studied. There were 121 patients in each period. All patients in the first period underwent open cholecystectomy (OC), whereas 70 (58%) patients underwent laparoscopic procedures in the second period (OC-LC). LC was the treatment of choice in the third period. Multiple factors, including sex, age, clinical and biochemical presentation of the disease and modified Apache II score were comparable among the three groups. The authors found significant differences in length of hospitalization (6.4 +/- 4.2 days in the OC group, 3.6 +/- 2.4 days in the OC-LC group and 2.4 +/- 1.7 days in the LC group, p < 0.01 when compared with the OC group) and return to work after surgery (5.8 +/- 2.8 weeks, 2.8 +/- 1.2 weeks and 1.3 +/- 1.8 weeks respectively, p < 0.01 when compared with the OC group). There was no significant difference in postoperative complications among the groups, but complications in the OC patients were more severe. Although operative time increased significantly after the introduction of LC, it returned to the range of OC after 36 procedures. Nine patients (5%) with LC required conversion to OC. Benefits of LC include a shorter hospital stay and a shorter recovery period. There were no deaths, very low morbidity, a substantial decrease in overall cost and a high degree of patient satisfaction with LC.

Adult↗
PubMed1992

Plasma concentrations of flumazenil during liver transplantation.

Six patients were given flumazenil (1 mg) during the anhepatic period of liver transplantation. We found higher mean plasma flumazenil concentrations during the anhepatic period than occurred in patients with hepatic cirrhosis. It was only possible to measure plasma flumazenil concentrations in four patients after revascularisation of the donor liver. Of these, elimination half-lives could be calculated in only three patients (normal in one and prolonged in two). In these two patients the elimination half-lives were prolonged to the same extent as in patients with fulminant hepatic failure. The changes during the anhepatic period occur because the liver contributes to the central volume of distribution. After revascularisation of the donor organ the prolonged half-lives indicate that transplanted livers may not recover normal metabolic functions immediately.

Blood Loss, Surgical↗
PubMed1992

[The correlation between urine urea nitrogen and total urine nitrogen output in perioperative patients].

Daily urine urea nitrogen (UUN) and total urine nitrogen output (TUNO) concentrations were measured in 19 patients undergoing G-I surgery during the perioperative period of 114 days. The results showed that there was a strong correlation between UUN and TUNO in statistic regression analysis. A formula is worked out TUNO = UUN + 0.7 which is of great value in estimating the nitrogen balance of TPN patients.

Adult↗
PubMed1979

Effect of epidural analgesia on metabolic profiles during and after surgery.

Blood concentrations of glucose, lactate, alanine, free fatty acids, glycerol and 3-hydroxybutyrate were measured during 24 h in 12 females undergoing elective hysterectomy under either general anaesthesia or epidural analgesia extending from T4 to S5. The results showed that the peroperative and immediate postoperative metabolic profiles in the group receiving general anaesthesia reflected substrate mobilization (increased glucose, lactate, 3-hydroxybutyrate), and that epidural analgesia blocked these changes, probably mediated through an inhibited adrenaline response to surgery. Peroperative values of free fatty acids and glycerol were significantly lowered by epidural analgesia, indicating inhibition of lipolysis. Alanine decreased similarly in both groups. In the later postoperative period metabolic profiles were similar in two groups, indicating that the influence of fasting may override the effect of the relatively minor trauma.

Adult↗
PubMed2001

Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy.

OBJECTIVE: To assess the utility of triage guidelines for patients with cholelithiasis and suspected choledocholithiasis, incorporating selective use of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC). SUMMARY BACKGROUND DATA: ERCP is the most frequently used modality for the diagnosis and resolution of choledocholithiasis before LC. MRC has recently emerged as an accurate, noninvasive modality for the detection of choledocholithiasis. However, useful strategies for implementing this diagnostic modality for patient evaluation before LC have not been investigated. METHODS: During a 16-month period, the authors prospectively evaluated all patients before LC using triage guidelines incorporating patient information obtained from clinical evaluation, serum chemistry analysis, and abdominal ultrasonography. Patients were then assigned to one of four groups based on the level of suspicion for choledocholithiasis (group I, extremely high; group 2, high; group 3, moderate; group 4, low). Group 1 patients underwent ERCP and clearance of common bile duct stones; group 2 patients underwent MRC; group 3 patients underwent LC with intraoperative cholangiography; and group 4 patients underwent LC without intraoperative cholangiography. RESULTS: Choledocholithiasis was detected in 43 of 440 patients (9.8%). The occurrence of choledocholithiasis among patients in the four groups were 92.6% (25/27), 32.4% (12/37), 3.8% (2/52), and 0.9% (3/324) for groups 1, 2, 3, and 4, respectively (P <.001). MRC was used for 8.4% (37/440) of patients. Patient triage resulted in the identification of common bile duct stones during preoperative ERCP in 92.3% (36/39) of the patients. Unsuspected common bile duct stones occurred in six patients (1.4%). CONCLUSIONS: The probability of choledocholithiasis can be accurately assessed based on information obtained during the initial noninvasive evaluation. Stratification of risks for choledocholithiasis facilitates patient management with the most appropriate diagnostic studies and interventions, thereby improving patient care and resource utilization.

Algorithms↗
PubMed2000

[Treatment of hydatid cysts' residual cavities (experimental and clinical study)].

Experimental series of 60 cotton rats and 150 white mice infected with echinococcus showed that 80-100% glycerin and 3% peroxide solution were effective scolicidal solutions for inactivation of the parasite. 344 patients have been operated on for hydatid disease with inactivation of the parasite by means of these scolicidal solutions. Glycerin during the surgical management of the hydatid cysts is effective and harmless in uncomplicated hydatid liver disease and any hydatid pulmonary cysts. Glycerin is contraindicated in complicated hydatid liver disease because of immunity disturbance. In complicated hydatid liver disease management of the hydatid cysts by 3% peroxide is effective and harmless. It is necessary to correct the hydatid liver disease patients' immunity in the preoperative and postoperative periods. Tactivin and antiechinococcus drug SK-1 are effective immunomodulators in hydatid liver disease.

Adjuvants, Immunologic↗
PubMed1990

Myocardial dysfunction during percutaneous transluminal coronary angioplasty.

Balloon inflation during percutaneous transluminal coronary angioplasty (PTCA) transiently occludes the coronary artery, causing temporary ischemia. In patients without collaterals, regional hypokinesis of the ventricular myocardium at risk occurs within the first 20 seconds and persists throughout balloon inflation. Early PTCA procedures were performed with brief balloon inflations, but the desire to improve procedural results has led many operators to extend balloon inflation times to 45 seconds or longer. Although the ischemic indicators of pain and electrocardiographic changes are commonly noted with these longer inflations, actual hemodynamic consequences are often obscured by physiological compensation. The PTCA-induced ischemic period is often too short to measure changes in cardiac output by conventional methods, but it is increasingly evident that profound regional myocardial dysfunction, in fact, occurs. Continuous two-dimensional echocardiography with quantitative assessment of regional wall motion and ejection fraction is particularly effective in detecting the location, extent, and temporal change of ischemic regional contractile dysfunction. Echocardiographic recordings during baseline, ischemia, and post-balloon-deflation periods permit examination of PTCA-caused alterations in ejection fraction and ventricular volumes and allow the use of testing techniques aimed at mitigation of ischemia.

Adult↗
PubMed1989

[A study on the triglyceride clearance in the perioperative period].

Native Chinese have been used to low fat diet for long history. To evaluate the tolerance of 50% fat caloric source in Chinese patients will be valuable in medical science and clinical practice. Triglyceride (TRG) clearance was studied in research ward in the period of 1986-1987. The results showed that POD + 7 TRG clearance was better than AOD-3. No functional disorders of the liver, heart, and kidney were found after 11 days of total parenteral nutrition support with mixed energy.

Adult↗
PubMed1985

Indoprofen--a new non-opioid analgesic. A comparison with pethidine.

Indoprofen (400 mg), a non-opioid, non-steroidal anti-inflammatory drug, was compared on a random, double-blind basis with pethidine (1,5 mg/kg) after elective caesarean section (40 patients) and after orthopaedic surgery (40 patients). The drugs were given intravenously during anaesthesia and provided adequate analgesia for a period of up to 2 hours postoperatively. No significant differences between the two drugs were noted in terms of efficacy and side-effects.

Adolescent↗
PubMed1984

[Microvascular decompression of the trigeminal nerve - a causal therapy of trigeminal neuralgia?].

Preliminary experiences with the microvascular decompression of the trigeminal nerve within the cerebello-pontine angle ("Jannetta's operation") in ten patients are reported. All nine patients with typical tic douloureux were found to have a cross-compression of the nerve by the superior cerebellar artery. This vessel was separated from the nerve and held in place by a piece of Gelfoam. All nine patients were painfree immediately following surgery. Their sensation within the trigeminal area was unchanged compared to the preoperative state. The remaining patient suffered of atypical facial pain and did not reveal a cross-compression of the trigeminal nerve neither by an artery nor by a vein. Microvascular decompression seems to be a causal therapy in trigeminal neuralgia and is a non-destructive operation. Although our period of postoperative observation is short (up to five months), the results are very promising and correspond to the experiences reported by other authors. Advantages and disadvantages compared to the radiofrequency lesion (electro- and thermocoagulation) of the trigeminal nerve are discussed.

Humans↗
PubMed1989

Pharmacokinetics of sufentanil in patients undergoing abdominal aortic surgery.

The authors determined the pharmacokinetics of sufentanil, 12.5 micrograms.kg-1 iv in patients undergoing elective abdominal aortic surgery. The mean age (+/- SD) of the ten patients was 68.4 +/- 7.9 yr; their mean weight was 74.4 +/- 19.1 kg. Six patients underwent aortobifemoral grafting and four had abdominal aortic aneurysm repair. Serum sufentanil concentrations were determined in samples drawn at increasing intervals over a 24-h period. A three-compartment pharmacokinetic model was fit to the concentration versus time data. Total drug clearance was 15.0 +/- 3.2 ml.min-1.kg-1. The volume of distribution at steady-state (Vdss) was 8.7 +/- 4.5 l.kg-1. The elimination half-time were positively correlated with patient age. There were no significant correlations between the pharmacokinetic variables and the duration of aortic cross-clamping, the duration of surgery, or the rate or total volume of iv fluids given intraoperatively. In general surgical patients, the mean elimination half-time of sufentanil has been reported to be 2.7 h. When sufentanil is used in large doses as the primary anesthetic agent for patients undergoing abdominal aortic surgery, the long elimination half-time observed implies that recovery will take much longer than would have been anticipated from previously published pharmacokinetic data.

Aged↗
PubMed1990

Enoximone treatment of impaired myocardial function during cardiac surgery: combined effects with epinephrine.

Enoximone belongs to a new class of noncatecholamine-positive inotropes, which selectively inhibit phosphodiesterase type III and increase cyclic AMP (cAMP). This study was performed in 30 coronary artery surgery patients with impaired myocardial function (ejection fraction [EF] less than 50%). The study's two purposes were to investigate the hemodynamic effects of enoximone, 0.5 mg/kg, administered following induction of anesthesia (phase I), and to assess whether enoximone can potentiate the actions of sympathomimetic agents during weaning from cardiopulmonary bypass (CPB) (phase II). Starting with already reduced hemodynamics, induction of anesthesia led to a further deterioration of blood pressure and cardiac output (CO). Administration of enoximone produced a significant increase in cardiac index (CI) (+47%), whereas pulmonary capillary wedge pressure (PCWP) (-37%), pulmonary artery pressure (PAP) (-17%), and systemic vascular resistance (SVR) (-17%) were significantly reduced. Heart rate (HR) was not increased, and no dysrhythmias occurred during the investigation. The hemodynamic effects were maintained for 30 minutes until the start of the operation. In phase II, where weaning from CPB was not possible without pharmacological support, either enoximone (0.5 mg/kg) + epinephrine (0.1 micrograms/kg/min) or only epinephrine (same dosage) was randomly selected. Weaning was successful in both groups, but the combined therapy produced a larger increase in cl and a more pronounced decrease of the elevated filling pressure (PCWP). PAP was not changed in the combined therapy group, but increased in the patients receiving epinephrine alone. It is concluded that enoximone has beneficial hemodynamic effects in the perioperative period, and that potentiation of the effects of epinephrine in severe heart failure may be one of the drug's most useful features.

Aged↗
PubMed1983

Intra-operative saline irrigation of the peritoneal cavity in experimental post-traumatic peritonitis.

A trial of intra-operative saline irrigation of the peritoneal cavity for the prevention of peritonitis was conducted in an animal model. Following abdominal missile injury with intestinal perforation, 43 anaesthetized pigs were operated on an randomly assigned to three treatment groups. In two of the groups intraperitoneal irrigation with 3 litres of saline solution was performed during the operation, using a jet technique in one group. A control group of pigs received no irrigation. The effect of irrigation was evaluated with quantitative bacteriologic studies of peritoneal exudate and peritoneal biopsy specimens. Continuous anaesthesia and assisted ventilation were used and the post-trauma observation period was 3 days. The average bacterial density in the peritoneal exudate decreased by more than 99% in all treatment groups during the operation, but increased to more than the pre-irrigation level during the observation period. Irrigation did not result in significantly greater elimination of the bacterial population. The mortality was not lower in irrigated animals than in the controls. Intra-operative saline irrigation thus did not prevent peritonitis in this experimental model.

Animals↗