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At least 649 records · Page 36Linked to original sources
PubMed2006

[Retroperitoneal laparoscopic enucleation of the renal hamartoma].

OBJECTIVE: To investigate the operative technique and the clinical value of retroperitoneal laparoscopic enucleation of the renal hamartoma. METHODS: Twenty-five patients of renal hamartoma received retroperitoneal laparoscopic enucleation. The patients were placed in lateral decubitus position. All laparoscopic surgical procedures were performed retroperitoneally using 3 port-sites. The tumor was exposed and resected along the edge, and the tumor clipped out with a lithotomy forceps. The renal hamartoma was confirmed through a pathological diagnosis during the operation. The resection surface was sutured with fibrin and absorbable hemostatic gauze. RESULTS: The operations were finished successfully in all patients. The diameter of tumors ranged from 1.8 cm x 2.0 cm to 4.5 cm x 4.9 cm. The operative time was 50 - 90 (mean=70) min. The blood loss was 30 - 80 (mean=55) mL. The hospital stay was 7 - 9 (mean=8) days. CONCLUSION: Retroperitoneal laparoscopic enucleation of the renal hamartoma is safe and effective, whose advantages include minimal invasive, less blood loss, short hospital stay, and rapid convalescence.

Adult↗
PubMed1978

[Neurosurgical treatment of trigeminal neuralgia].

Sweet's method for thermocoagulation of the Gasserian ganglion is a real advance in the operative treatment of trigeminal neuralgia. The advantages of this method are obvious: minimum operation risk, minimum complication rate, short postoperative convalescence, shorter confinement to hospital and finally the possibility of repeating the operation without risk in the event of a relapse.

Electrocoagulation↗
PubMed1994

Treatment of bleeding peptic ulcer by bilateral truncal vagotomy via a transpleural thoracoscopic approach and laparoscopic pyloromyotomy.

Six cases of recurrent bleeding duodenal ulcer were treated by bilateral truncal vagotomy via a right transpleural thoracoscopic approach and laparoscopic pyloromyotomy at Tainan Municipal Hospital. The vagus nerves were completely transected, which was proved by pathology. Basal acid output and insulin-stimulated maximum acid output were reduced by 68%-77% and 87%-92%, respectively, after vagotomy. On the other hand, there was no delay in gastric emptying on the basis of either patients' complaints or an upper gastrointestinal series of x-rays. Transpleural thoracoscopic bilateral truncal vagotomy and laparoscopic pyloromyotomy are safe, effective and offer more complete transection of the vagus nerves in treatment of complicated peptic ulcer. In addition, this new technique provides shorter hospitalization and an earlier convalescence.

Adult↗
PubMed1994

[Aorto-bifemoral bypass through retroperitoneal "mini"-incision (preliminary report)].

The large vertical midline or transverse transperitoneal approaches used to the conventional aortoiliac reconstruction are accompanied with a relatively high postoperative morbidity and mortality rate (2% to 5%) even in patients who are good risks undergoing aortic surgery. The purpose of this study was develop a new technique for aorto-bifemoral bypass operation to minimize the operative stress on these patients. The recommended left paramedian retroperitoneal approach using 5-6 cm skin-incision and a special retractor with three dimensional vision and using modified surgical instruments directly with eye control, offers the possibility to decrease the operative stress significantly and the sufficient control of the serious bleeding might occur. If it is necessary this exposure can be immediately converted to a conventional approach by simply enlargement of the incision. In our first case the functional results were very good and consequently hospitalization time and the convalescence period were short. This minimal access approach appears to diminish the catabolic response and is hopefully associated with accelerated recovery and virtual abolition of large wound-related complications. It could become the procedure of choice for selected patients with obstructive or aneurysmal aorto-iliac disease.

Anastomosis, Surgical↗
PubMed1993

Laparoscopic nephrectomy: current status.

In this manuscript we describe our initial experience with 22 patients who underwent laparoscopic nephrectomy at our institution. Of the 22 patients, 16 patients had benign disease, and 6 patients had malignant disease. Of the 6 patients with malignancy, 3 patients underwent laparoscopic nephroureterectomy for transitional cell cancer of the upper urinary tract. In 21 patients, a transabdominal approach was utilized, whereas 1 patient underwent laparoscopic nephrectomy using an entirely retroperitoneal approach. Laparoscopic nephrectomy showed lengthy operative times, but resulted in reduced postoperative discomfort, shortened hospital stay, and rapid convalescence. As laparoscopic nephrectomy has been performed with reproducible success by various other groups worldwide, further refinements in surgical technique, paired with advances in laparoscopic instruments designed for stapling and suturing, will most likely result in an increasing application of the principles of laparoscopy to diseases of the kidney, renal pelvis and ureter.

Humans↗
PubMed1996

[Extrauterine pregnancy: diagnosis and treatment].

The incidence of ectopic pregnancy in Denmark has doubled since the beginning of the 1980's. A total of 2400 cases per year are identified corresponding to an ectopic localization in one of 40 pregnancies. An early diagnosis of ectopic pregnancy depends on the use of vaginal ultrasound examination and serial determination of the concentration of serum-HCG. By this information the diagnosis of an ectopic pregnancy can usually be established without the use of laparoscopy. In approximately 20% of the women the ectopic pregnancy regresses without treatment. Laparoscopic salpingotomy compared to treatment by laparotomy reduces the hospital stay and the convalescence period. The fertility is preserved in 60-80% of the women, if the contralateral salpinx has not previously been damaged. The possibility of making the diagnosis of ectopic pregnancy without laparoscopy has resulted in an increased interest in medical treatment. Repeated administration of methotrexate leads to regression of the ectopic pregnancy in approximately 95% of the treated women, however, 20% have temporary unpleasant side-effects. After treatment with a single dose of methotrexate, the side effects are avoided. The effectiveness, however, seems severely reduced. There is a need for a continued development of non-invasive methods for the treatment of ectopic pregnancy.

Denmark↗
PubMed1997

Orientational research into dismissed managers in health care.

The importance of the competence of managers is illustrated by findings of provisional research conducted on the failure of managers in health care (15 case studies of dismissed managers in hospitals, nursing homes, and convalescent homes). The first guarded conclusion that may be drawn from the preliminary study is that, as a rule, the dismissal is based on the attitude and competence of the manager ("software") and not on business expertise or technical skill ("hardware"). It could be said that the manager in health care is judged more on the process than the results.

Attitude of Health Personnel↗
PubMed1998

Complications after treatment of proximal femoral fractures.

BACKGROUND AND AIMS: The number of fractures of the proximal femur is increasing faster than the number of elderly people. The aim of the study was to record all complications after operative treatment of proximal femoral fractures in order to reduce the incidence of these complications in the future. MATERIAL AND METHODS: The files of 334 patients with proximal femoral fractures were retrospectively analyzed. The number of all general and operative complications were recorded. RESULTS AND CONCLUSIONS: The primary mortality was 8 percent. The most common general complication was a thromboembolic one. Local complications were recorded in 66 cases. Thirty-eight percent of femoral neck fractures treated by internal fixation were complicated. Increased attention should be focused on the sufficient antithrombosis prophylaxis, which should be continued at least during the whole convalescence period at the hospital. It remains to be clarified, if improved technical skill may improve the results of femoral neck osteosynthesis, which in this group of patients appeared far from satisfactory. The development of post-operative care and selection of right patients to an appropriate rehabilitation program is perhaps the most important factor today, in order to reduce complications in general.

Adult↗
PubMed1998

[Laparoscopic adrenalectomy. A general review of a current technic].

The anatomical situation of the adrenal gland explains the diversity of the surgical incisions used for adrenalectomy. Laparoscopic adrenalectomy was first performed in 1992. It allows eradication of small adrenal lesions, which are often incidental findings. There are two routes of laparoscopic access to the adrenal gland: transperitoneal and retroperitoneal. Laparoscopy allows excellent operative exposure, reduction of postoperative pain and hospital stay and rapid convalescence. Retroperitoneoscopy, by allowing direct access to the retroperitoneum, is more rapid than the transperitoneal route.

Adrenal Gland Diseases↗
PubMed1998

[Minimal invasive surgical treatment of coronary multi-vessel disease].

To reduce surgical trauma and median sternotomy related complications in cardiac surgery, a new minimally invasive surgical technique has been developed for the treatment of coronary artery multivessel disease using a small left lateral chest incision in the 3rd intercostal space. This technique enables direct LIMA harvesting and performance of bypass surgery upon all coronary vessels with cardiopulmonary bypass and cardioplegic arrest. So far, 123 patients have been treated with this procedure and survived with fewer complications, and we believe that routine application of this procedure will lead to reduced morbidity in patients receiving coronary artery bypass surgery, short hospital stay and early convalescence, combined with good cosmetic results.

Aged↗
PubMed2000

Diagnostic laparoscopy for the acute abdomen and trauma.

BACKGROUND: We set out to investigate the potential benefits of routine diagnostic laparoscopy (DL) in cases of acute abdomen. METHODS: A prospective study of 120 DL in acute abdominal cases was performed in comparison with 310 similar acute abdominal cases treated without DL. The diagnostic accuracy, hospital stay, therapeutic delay, and convalescence time were then evaluated. RESULTS: DL established the indications for intervention in 96% of cases, yielded a diagnosis in 90%, and changed the treatment in 14%. The sensitivity achieved was 99.3%, specificity was 83.3%, and accuracy was 88.6%. There were two false positives, one false negative, and three results insufficient to make a diagnosis. Morbidity was one (0.8%), and mortality was one (0.8%). Seventy-nine patients (66%) were managed by laparoscopy and 24 by open interventions. The hospital stay in DL groups was shorter (median, 5 days vs 6 days in controls, p<0.0003), as was the effective treatment time (median, 5 days vs 6 days, p<0.0012). The convalescence time was also shorter in DL groups (median, 14 days vs 14 days, p<0.04). Therapeutic delay occurred in 16% of the control group cases, doubling the morbidity rate, increasing mortality by 50%, and prolonging hospital stay (median, 9 days vs 6 days, p>0.3 (NS). CONCLUSIONS: DL in the acute abdomen is a safe and accurate procedure that enables laparoscopic interventions and helps avoid nontherapeutic surgery. DL and appropriate treatment reduces hospital stay, therapeutic delay, and convalescence time.

Abdomen, Acute↗
PubMed2003

Development and validation of an instrument to predict probability of home discharge from a geriatric convalescence unit in Spain.

OBJECTIVES: To develop and validate an instrument to predict probability of home discharge upon hospital admission. DESIGN: Prospective cohort study. SETTING: Geriatric convalescence unit (GCU) in Spain. PARTICIPANTS: Seven hundred eighty-one patients aged 65 and older consecutively admitted to a GCU over a 4-year period. The total sample was randomized and divided into two subgroups; the first (n = 575) was used to construct the predictive instrument (development subgroup) and the second (n = 206) for the validation process (validation subgroup). MEASUREMENTS: All patients were evaluated within the first 72 hours after admission. Age, sex, functional status before admission, diagnostic categories, functional status on admission, comorbidity, cognitive function, and social support were assessed. RESULTS: Logistic regression analysis identified three patient characteristics as independent predictors of home discharge in the development subgroup: higher scores on functional status at admission (Barthel index), normal Mini-Mental State Examination scores, and lower scores on Social Familial Evaluation Scale. A scoring system ranging from 0 to 5 was constructed using these variables to predict probability of home discharge (PHD). Different PHD scores (0-1, 2, 3, 4, and 5) identified patients with different probabilities of returning home on discharge in the validation subgroup (36.5%, 53.6%, 60.8%, 83.3%, and 100%, respectively). PHD scores of 4 and 5 demonstrated substantially higher posttest than pretest probability, with moderate and high clinical effect value. Scores of 0 or 1 demonstrated substantially lower posttest than pretest probability. CONCLUSION: A PHD instrument may be useful in identifying patients most likely to be discharged to home from the GCU. Patients with low probability of home discharge may also be identified early.

Aged↗
PubMed1998

[Laparoscopically assisted surgery in Crohn disease].

UNLABELLED: From Jan. 1993 to Apr. 1997 intestinal resections in Crohn's disease have been performed in 275 patients. 89 patients have been operated on laparoscopic assisted. The following parameters were analyzed: previous laparotomies, extent of resection, steroid medication, conversionrate, complications, operative time and postoperative stay. Endpoints were: conversionrate, complications, reconvalescence and overall satisfaction with the laparoscopic technique. RESULTS: The duration of the disease ranged from 1 to 16 years (x = 6). 47 patients were under steroid medication at the time of surgery. 30 patients had undergone previous laparotomies. In 10 patients the operation had to be converted into open surgery. The following procedures have been performed: ileocaecal resections (45), anastomotic resections (14), small bowel resections (4), hemicolectomies (12), colectomies (9), loopileostomies (4), adhesiolysis (1). Minor complications occurred in 6.7% of patients, major complications in 5.6%. Operative time ranged from 70 to 420 minutes (x = 173.7). The postoperative hospital stay was 13.3 days in the average. CONCLUSION: The morbidity of 12.3% is not higher than in open surgery. When complications do not occur the patients benefit from early convalescence, better cosmetics and shorter hospital stay.

Adolescent↗
PubMed2005

The impact of severe respiratory syncytial virus on the child, caregiver, and family during hospitalization and recovery.

OBJECTIVE: To quantify the magnitude of child, caregiver, and family distress associated with hospitalization for severe respiratory syncytial virus (RSV) and the posthospitalization recovery period. DESIGN: A prospective study of 46 RSV-hospitalized infants and children < or =30 months of age with a history of prematurity (gestational age of < or =35 weeks) and 45 age-matched control subjects was performed. RSV group data were gathered during hospitalization and on days 4, 14, 21, and 60 after discharge; control group data were collected at the end of the RSV season and 60 days thereafter. MAIN OUTCOME MEASURES: RSV severity; caregiver's rating of the child's health (100-point rating) and functional status (Functional Status IIR); caregiver health, stress (7-point rating), and anxiety (Spielberger State Anxiety Inventory); and family health and functioning (Family Adaptability and Cohesion Evaluation Scale II) were recorded. RESULTS: The mean age of the sample was 10.2 months; 51% of the subjects were male. The average duration of hospital stay for the RSV group was 5.8 +/- 8 days. Most patients received supplemental oxygen (76%) and were monitored for apnea (60%). The mean age of the caregivers (93% mothers) was 29 years. During hospitalization, the RSV-infected patients' health and functional status were significantly poorer than those of control subjects. Caregivers of RSV-infected children reported more stress, greater anxiety, poorer health, and poorer family health and functioning. As long as 60 days after discharge, caregivers of RSV-infected children reported the children's health as significantly poorer and were personally more anxious, compared with control subjects. CONCLUSIONS: RSV-related hospitalization creates significant distress for infants and children, caregivers, and families, with some effects extending as long as 60 days after discharge.

Adult↗