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At least 757 records · Page 42Linked to original sources
PubMed1998

Can postoperative abdominal wound dehiscence be predicted?

The purpose of this study was to identify risk factors in wound dehiscence and to determine which factors might be predictable. Forty patients with abdominal wound dehiscence were compared with 40 control patients standardized by sex and age. Hypoproteinemia, nausea/vomiting, fever, wound infection, abdominal distension, type of suture material, 2 or more abdominal drains, and the surgeon's experience were factors significantly associated with wound dehiscence. Emergency surgery, jaundice, ostomy, total parenteral nutrition, ascites, pulmonary morbidity, co-existence of disease, anemia, leucocytosis, and type of incision were nonsignificant variables. The number of patients with wound dehiscence increased with an increase in the number of risk factors, reaching 100% for patients with 8 risk factors. The risk factors of wound dehiscence can be predicted early and their number can be decreased before and after surgery by an experienced surgeon, leading to a lowered incidence of wound failure.

Abdomen↗
PubMed1998

Late-onset bleb leaks after glaucoma filtering surgery.

OBJECTIVE: To determine the incidence of focal, late-onset, conjunctival bleb leaks after glaucoma filtering surgery. DESIGN: Prospective, cross-sectional analysis. SETTING: Tertiary care outpatient referral center. PATIENTS: Consecutive patients who underwent glaucoma filtering surgery prior to June 1996 presenting for evaluation from September 2,1996, through November 15,1996. Five hundred twenty-five eyes of 525 consecutive patients were enrolled in the study. INTERVENTION: Bleb height (elevated or flat), area (diffuse or localized), and wall thickness (thin, thick, or encapsulated) were classified. Each bleb was tested for focal leakage using a moistened fluorescein strip, cobalt blue illumination, and slit-lamp biomicroscopy. Diffuse transconjunctival aqueous flow did not qualify as a focal leak. MAIN OUTCOME MEASURE: Seidel-positive aqueous leakage. RESULTS: Bleb leakage occurred in 14 eyes following trabeculectomy (mitomycin C treatment, 10 eyes; 5-fluorouracil treatment, 3 eyes; no antifibrosis agent, 1 eye) and in 1 eye following combined cataract and glaucoma surgery with adjunctive mitomycin C therapy. Bleb leakage occurred more frequently in eyes that received mitomycin C (10 [3.7%] of 273 eyes) than 5-fluorouracil (3 [1.4%] of 213 eyes) or no antifibrosis agent (1 [2.6%] of 39 eyes), using Kaplan-Meier estimates (P=.008, log-rank test). Conjunctival blebs were significantly thinner after trabeculectomy with mitomycin C than with 5-fluorouracil (P=.001). Bleb wall thickness was greater following combined cataract and glaucoma surgery than following trabeculectomy alone (P=.008). Age (P=.84), sex (P=.68), race (P=.77), duration of mitomycin C exposure (P=.62), number of antiglaucoma medications (P=.16), and total 5-fluorouracil dose (P=.85) were not associated with late-onset leaks. CONCLUSIONS: The risk of late-onset focal bleb leakage increases following trabeculectomy with mitomycin C therapy. Late leakage after combined cataract and glaucoma surgery is infrequent.

Adolescent↗
PubMed2006

Demonstration of aqueous streaming through a laser iridotomy window against the corneal endothelium.

OBJECTIVE: To determine the pathogenesis of the bullous keratopathy that is frequently observed in patients after argon laser iridotomy (ALI) by comparing the changes in aqueous flow after ALI with those that follow peripheral iridectomy in rabbit eyes. METHODS: Silicone particles were injected into the anterior chamber of rabbit eyes as tracers to monitor aqueous flow. Particle tracking velocimetry with image analysis was used to determine the direction and speed of aqueous flow in 5 pigmented rabbits that underwent ALI and 5 that underwent peripheral iridectomy. RESULTS: In the ALI group, silicone particles were found to stream through the iridotomy window against the corneal endothelium immediately after the pupil was constricted by a light stimulus. The mean +/- SD speed of the particles was 2.97 +/- 1.51 mm/s. In contrast, the mean +/- SD flow rate through the iridectomy window in the peripheral iridectomy group was significantly slower at 0.36 +/- 0.30 mm/s (P = .01). CONCLUSION: Constriction of the pupil elicited marked aqueous streaming through the ALI window against the corneal endothelium. Clinical Relevance The mechanical stress to the corneal endothelium by the abnormal aqueous stream may be partially responsible for the corneal decompensation that follows ALI.

Animals↗
PubMed1996

Personal computer-based 3-dimensional ultrasound biomicroscopy of the anterior segment.

OBJECTIVE: To develop a practical, inexpensive system for 3-dimensional ultrasound biomicroscopic imaging of the anterior segment with a commercially available high-frequency ultrasound imager and a personal computer. METHODS: Sequential, high-frequency, ultrasound biomicroscopic images of the anterior segment were obtained with a motorized scanning control arm designed in our imaging laboratory. Images were acquired by a personal computer-based video capture device. Ultrasound slice data were then reconstructed as 3-dimensional volumetric images by a personal computer and commercially available software. RESULTS: Four 3-dimensional visualization formats were developed to enhance the clinical utility of high-frequency ultrasound. Rotational animation sequences were created that detailed the extent and anatomy of a filtering bleb, intraocular lens subluxation, focal angle closure from an iridociliary cyst, intraocular foreign bodies, and an iris tumor. CONCLUSIONS: Three-dimensional, high-frequency ultrasound of the anterior segment enhances our ability to visualize spatial relationships between adjacent anatomic structures. The low cost and ease of use of this system make widespread clinical application practical.

Adult↗
PubMed1990

Translumbar amputation.

Six patients underwent translumbar amputation (TLA), a life-saving procedure, after standard modalities of therapy failed to control the progression of the disease. The primary diagnoses were as follows: pelvic arterial-venous (A-V) malformation, 1; sacral chordoma, 3; giant cell tumor of the sacrum, 1; and paraplegia with squamous cell cancer arising in intractable decubitus, 1. There were no operative deaths. The following postoperative complications developed in five patients: urinary fistulae, 2; small bowel obstruction, 1; intraabdominal bleeding, 1; hypertension, 2; small bowel fistula, 1; and dehiscence of skin closure, 1. Two patients died with distant metastases (24 months) and distant metastases with local recurrence (6 months). The remaining four patients were alive and well 72, 56, 48, and 18 months after the surgical procedure. All of these patients have reached the rehabilitation goals.

Adolescent↗
PubMed1993

Surgical polypectomy of duodenal adenomas in familial adenomatous polyposis: experience of two European centres.

Between 1978 and 1988, 12 patients with familial adenomatous polyposis (FAP) and severe duodenal polyposis underwent duodenotomy and duodenal polypectomy. The patients were from two separate institutions; all were women, with a mean age of 45.6 (range 25-62) years at the time of duodenotomy. Recurrent duodenal polyposis was detected at endoscopy in all 12 patients, at a mean of 13.3 (range 5-36) months after duodenotomy. All patients had moderate to severe duodenal polyposis at the time of the last endoscopic examination. Local excision of duodenal adenomas is an unsatisfactory treatment option in those with FAP. The ideal management of patients with FAP who have severe duodenal polyposis remains uncertain.

Adenoma↗
PubMed2004

Posterior laparostomy through the bed of the 12th rib to drain retroperitoneal infection after endoscopic sphincterotomy.

BACKGROUND: Duodenal perforation occurs in 0.4-1 per cent of endoscopic procedures. The best therapeutic approach for periampullary injury is controversial; initially the treatment is generally conservative, but sometimes large retroperitoneal infections develop that require surgery. METHODS: Six patients with an extensive retroperitoneal collection and unstable sepsis as a consequence of periampullary duodenal perforation sustained during endoscopic retrograde cholangiopancreatography were treated by right posterior laparostomy through the bed of the 12th rib. RESULTS: The sepsis was managed effectively by an open posterior approach, resulting in spontaneous closure of the duodenal leak after a mean(s.d.) of 14.5(5.2) days. No hospital death or major complication was recorded. Late incisional hernia developed in one patient. CONCLUSION: The technique of posterior laparostomy through the bed of the 12th rib provided adequate debridement and drainage of upper and lower parts of the retroperitoneal space involved by infection following periampullary duodenal perforation. Good control of retroperitoneal sepsis and duodenal secretions resulted in spontaneous closure of the duodenal leak, avoiding the need for more complex intra-abdominal procedures.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

Thorascopic staging of stomal recurrence.

BACKGROUND: Squamous cell carcinoma of the low cervical area may be secondary to stomal recurrence following laryngectomy, low cervical esophageal disease, or peritracheal metastasis. Most often patients with disease in this area have already received both surgery and radiotherapy. Prior to Sisson's description of the trans-sternal radical neck dissection or mediastinal dissection the management and prognosis was uniformly poor. Since then, a number of authors have reported their experience with mediastinal dissection. Survival remains poor but palliation has been acceptable. Unfortunately, resectability of the disease cannot often be determined prior to the actual surgical procedure. A number of patients are explored only to have the procedure terminated. Thoracoscopy is a procedure that involves insertion of two or three trocars into the right thoracic cavity with collapse of the right lung. A form of endoscopic surgery, it permits visualization and dissection of the important structures of the mediastinum. Tracheal, esophageal, and great vessel invasion by tumor can be evaluated. METHODS: Prospectively, all patients initially seen with stomal recurrence from 1991 to 1994 were evaluated. CT scans, MRIs as well as thoracoscopy were performed when indicated. RESULTS: One patient required conversion to a minithoracotomy involving a 7-cm chest incision. The patient was found to have unresectable disease with tumor involving the great vessels of the mediastinum. A second patient was found to have unresectable disease with tumor encasing the subclavian artery. The third patient was found to have no mediastinum involvement. The patient with no mediastinum involvement underwent a stomal resection with mediastinal dissection. Reconstruction with a pectoralis major myogenous flap was performed. The patient has remained disease free to date. The remaining two patients were judged to have unresectable disease and were offered palliative treatment. Both of these patients died of the disease within 6 months. CONCLUSIONS: Thoracoscopy provides important information in judging the surgical resectability of patients with stomal recurrence. This procedure has not been previously described in the otolaryngologic literature. We provide some suggestions for its use in the evaluation of the mediastinal extent of disease.

Aged↗
PubMed2006

Hybrid ileostomy.

Explore the source record for details and available documents.

Anastomosis, Surgical↗
PubMed1994

Laser sclerostomy ab interno using continuous wave and pulsed lasers in a rabbit model.

PURPOSE: This experimental study was designed to find an optimal combination of parameters for a gonioscopic ab interno approach to laser sclerostomy. METHODS: Laser sclerostomy ab interno was performed delivering the laser energy via a slit lamp and a gonioscopic contact lens to the iridocorneal angle. The laser energy is required to be well transmitted by the cornea and at the same time to be maximally absorbed by the sclera at the iridocorneal angle. For local enhancement of absorption the sclera was stained with the biocompatible dyes Fluorescein (absorption maximum at 480 nm) and Methylene blue (absorption maximum at 668 nm) applied by iontophoresis. A continuous-wave (cw)-Argon laser and a cw-dye laser produced relatively long pulses (200 ms) at wavelengths matching with these respective maxima. Additionally a pulsed dye laser emitting shorter pulses (2 microseconds) was successively adapted to the wavelengths of the two maxima. In some cases a Q-switched Nd: YAG laser had to be used for perforation of Descemet's membrane. A total of 44 rabbit eyes was treated to compare the results for these four different laser/dye combinations. RESULTS: While no successfull perforation of the sclera could be achieved using the cw-dye laser with scleral staining by Methylene blue, the intraoperative success rate ranged between 59% and 75% for the other three laser/dye combinations. Histological examinations of the eyes on the first postoperative day showed smaller thermal necrosis zones, but more often fibrin reactions when using the shorter pulse length. Although we often found iris adherences to the internal fistula ostium, no major complications were observed. CONCLUSION: Further improvement of intraoperative success rates is needed, before clinical application of the approach can be considered.

Animals↗
PubMed1993

Internal ablative sinostomy using a fiber delivered Q-switched CTE: YAG laser (2.69 microns).

Current trends of laser technology towards low-thermal photoablative pulsed mid-infrared lasers open new, more adequate approaches to experimental surgical procedures which have already been evaluated in the past. Transcorneal laser ablation of the trabecular meshwork (internal sinostomy) in human autopsy eyes was performed with a Q-switched CTE:YAG laser (wavelength: 2.69 microns, pulse width: 1 microsecond). Beam delivery was achieved with conventional optical quartz fibers (Low-hydroxy-fused-silica: 0.3 ppm, 50 cm length, 200 microns diameter). Light- and scanning-electron-microscopy were used for histological examination and micromorphological analysis. By applying two laser pulses (6 J/cm2) to the functional trabecular meshwork, a round sinostomy with a diameter corresponding to the diameter of the fiber-tip was achieved. It was possible to set several internal sinostomies into the chamber angle opposite to the entering paracentesis of the laser fiber-tip. Collateral thermal tissue alteration reached up to 50 microns, and since fiber-tip contact was maintained during laser application, thermal tissue alteration was also found around the opposite wall of Schlemm's canal. At higher energy fluences mechanical (disruptive vaporization) effects were significantly enhanced. It can be concluded, that low-thermal pulsed mid-infrared lasers are adequate instruments to perform transcorneal trabecular ablation (abinterno sinostomy). The laser used in this study (CTE:YAG) bears the advantage that its radiation can easily be delivered in conventional optical quartz fibers.

Fiber Optic Technology↗
PubMed1992

Stoma anxieties: a comparison of the attitudes of Asian migrants and the indigenous population in the United Kingdom towards abdominal surgery and the role of intestinal stomas.

We have studied stoma care nurses' experience with Asian patients having a stoma. The general public's attitudes to abdominal surgery in general were assessed in a survey of employees in Leicester. Many stoma care nurses are aware of the needs of Asian patients, especially with regards to ethnic dress, but only half of the ostomists who wanted to see a stoma care nurse or fellow ostomist were able to do so (chi 2 = 4.5, p less than 0.03). All ostomists considered counselling on education, employment and marriage inadequate. There is a high level of anxiety about stomas and these anxieties are surprisingly similar for all ethnic groups.

Abdomen↗
PubMed1993

Feasibility of stoma continence, using electrically stimulated rectus abdominis muscle in pigs.

To develop surgical techniques to obtain stoma continence with a muscular sphincter, the anatomy (especially innervation and vascularization patterns) of the human abdominal wall muscles was studied in three cadaver dissections. It was found that transposed rectus abdominis muscle might be positioned as a new sphincter (sphincteroplasty). Next, the feasibility was assessed in six pigs, and the rectus muscle was positioned as a sphincter around a Thiry Vella loop. The use of three different surgical procedures has been assessed: 1) a muscular ring of the proximal rectus was constructed and partly denervated the muscle; 2) the distal end of the Thiry Vella loop was pulled through the middle of the rectus muscle, thereby also introducing partial muscle denervation; and 3) a sling was constructed using the distal muscle part. In four of these six pigs, identical procedures were performed also at the left side. These new sphincters were electrically stimulated (with implanted stimulation devices) to study the feasibility of prolonged sphincter contraction independent of will. Stimulation with a frequency of 25 Hz was used at the right and 2 Hz was used at the left sphincters. It was found that electrical stimulation with a frequency of 25 Hz as well as 2 Hz increased the percentage of Type I (relatively fatigue-resistant) muscle fibers significantly from 42 to 65 percent (n = 6) in the right and from 50 to 67 percent (n = 4) in the left rectus muscle into innervated muscle areas of the sphincters. This increase is considered essential for sustained sphincter function. Stoma continence was not achieved because constructing muscular rings (as a sphincter) caused partial atrophy. Construction of a sling using the distal part of the rectus did not cause substantial atrophy, but continence was not achieved because the dorsal side of the Thiry Vella loop was not completely covered with muscle fibers.

Abdominal Muscles↗